ContrAto dE EmISIon

Conceptualisation refers to both the clarification and analysis of the key concepts in a study and the way in which the research is integrated into the existing body of knowledge or existing theory and research (Mouton, 1996:109,110). Conceptualisation involves embedding or incorporating one’s research into the body of knowledge that is pertinent to the research problem being addressed.

The concepts identified in Phase One and Two were conceptualised within the six elements of the Practice Theory (Dickoff, James & Wiedenbach, 1968:435). The researcher did a thorough literature search of previous theoretical and empirical work in this field and related the research study to existing literature (Mouton, 1996:119). The previous studies and literature were explored to establish commonalities and compare their findings with those of this study. New insights derived from this phase as well as aspects in the literature that did not appear in the research were discussed (Woods & Cantazaro, 1988:135). The existing scientific knowledge was used to generate valid scientific statements of relevance regarding collaboration within psychiatric clinical nursing education and to formulate a conceptual framework. Conceptualisation provided for the recontextualisation of the results in the light of previous research done and provided a context for the current research findings (Morse, in Morse, 1994:34). Guidelines to operationalise the model for collaboration were formulated based on concluding statements that were derived from the process of conceptualisation of the findings of Phases One, and Two.

A brief outline of the six elements will follow below:

In what context is the activity performed? - The context was psychiatric clinical nursing education that is influenced by legal and professional legislations. Psychiatric clinical nursing education is a complex dynamic and real-life environment where collaboration should be facilitated.

Agent - Who or what performs the activity? - The agents were institutions of higher education and psychiatric health care services.

Recipient – Who or what is the recipient of the activity? - The recipient was a student nurse in a training programme leading to registration as a nurse (general, psychiatry and community) and midwife at a specific nursing college/university (South African Nursing Council Regulation, 425 of 1985, as amended).

What is the end product of the activity – purpose or terminus? - To develop a model for collaboration between institutions of higher education and psychiatric health care services to facilitate psychiatric clinical nursing education, resulting in the outcome of a student nurse capable of critical thinking, rational decision making and problem solving.

What is the guiding process/procedure? - The collaboration process in this study comprised four phases and their related procedures: Phase One: conducting a situation analysis, Phase Two: developing a collaboration strategy, Phase Three: implementing the collaboration process; and Phase Four: an evaluation of collaboration.

What is the energy source for the activity – Dynamic? – The dynamic to facilitate the collaboration process was identified as interactive facilitation; an effective communication process and collaborative dialogue.

Conceptualisation of every element of practice theory took place through an extensive literature review and the use of the following reasoning strategies - analysis, deductive and inductive reasoning, synthesis, inferences and derivation (Chinn & Kramer, 1995:63-67; Mouton, 1996: 71, 80, 168; Walker & Avant, 1995:28-32). The relational statements emanating from the conceptualisation of each of the elements of the practice theory were used to form the basis for the development of the model as well as guidelines for the operationalisation of the model of collaboration between institutions of higher education and psychiatric health care services to promote psychiatric clinical nursing education (Chinn & Kramer, 1995:96).

2.4.4 Phase Four: Model description, evaluation and guidelines

Phase Four is concerned with the model description, evaluation and guidelines for its operationalisation. The results of Phase One, and Phase Two, the conceptualisation and relational statements formed the basis of the model description. The description of its structure and process was done according to Chinn and Kramer’s guidelines (1995:26-30; 117) as follows: its purpose; definition of concepts; relationship statements; the assumptions and structure of the model; and the process of the model.

2.4.4.1 Model description

The results of conceptualisation made the description of the model possible. The following questions were used to facilitate the description of the model (Chinn & Kramer, 1995:117-119; Chinn & Kramer, 1999:84-98).

• What is the purpose of this model? - The purpose of the model was to facilitate collaboration between institutions of higher education and psychiatric health care

services to promote psychiatric clinical nursing education, the outcome of which is a student nurse capable of critical thinking, rational decision making and problem solving.

• How are concepts defined? - Concepts were identified through the process of concept analysis and from perceptions of participants. These were then defined and clarified through the conceptualisation process using the six elements of practice theory as described by Dickoff, James and Wiedenbach (1968:435).

• What is the nature of the relationships? - Relationships statements provided links among and between concepts within a model. As concepts were identified, ideas about relationships between them began to form. The ways in which the relationships emerged provided clues to the model purpose and the assumptions on which the model was based.

• On what assumptions does the model build? – The researcher made assumptions regarding the collaboration between institutions of higher education and psychiatric health care services to promote psychiatric health care services.

• What is the structure of the model? - The structure of the model gave an overall form to the conceptual relationships within it. The researcher considered the form and structure within which all concepts fitted in a coherent, unified network. Consideration was given to the relationship statements within the structure of the model.

• What is the process/procedure of this model?- In a practice discipline, the processes/procedures for model development are creating conceptual meaning, structuring and contextualising the model, refining and verifying concepts and theoretic relationships, and deliberately applying and verifying the model. From the results of Phases One and Two, the process for collaboration emerged to demonstrate how collaboration can be facilitated to promote psychiatric clinical nursing education.

Therefore in creating conceptual meaning, and in structuring and contextualising the model, refining and verifying concepts and theoretic relationships, and deliberately

applying and verifying the concepts of the model, Walker and Avant (1995:137) suggest that the concepts should be defined several times at different intervals in order to reach a satisfactory outcome. The definition of concepts should adhere to the rules proposed by Copi and Cohen (1994:192-196) namely:

• A definition should state the essential attributes; • A definition should not be circular;

• A definition should not be too broad or too narrow;

• A definition should not be expressed in an ambiguous or figurative language; • A definition should not be negative when it can be affirmative.

The attributes of the major concepts were identified, analysed and synthesised to form its definition. After the model was fully described using the above criteria, a critical evaluation took place in accordance with Chinn and Kramer’s guidelines of model evaluation (1999:99 -110). A panel of experts in theory development and qualitative research were used to evaluate and refine the model.

2.4.4.2 Evaluation and refinement of the model

As abovementioned, the evaluation of the model was made according to Chinn and Kramer’s guidelines (1999:99-110). The five questions for critical reflection and evaluation of the model are as follows:

How clear is the model? - In addressing this question, the researcher considered the semantic clarity, semantic consistency, structural clarity, and structural consistency.

How simple is this model? - The question addressed the number of structural components and relationships within the model. Complexity implied many model relationships between and among numerous concepts. On the other hand, model simplicity meant that the number of elements within each descriptive category, particularly concepts and their interrelationships, were kept minimal.

How general is this model? - The generality of a model referred to its breadth of scope and purpose; a general theory can be applied to a broad array of situations. Therefore the scope of concepts within a model provided clues to its generality.

How accessible is this model? - Accessibility addressed the extent to which the concepts within the model were grounded in empirically identifiable phenomena and how attainable the projected outcomes of the model were. Concepts can move toward increased empiric accessibility through testing relationships, deliberately applying the model, and clarifying conceptual meaning.

How important is this model? - This question addressed the extent to which the model has the potential to influence collaboration between institutions of higher education and psychiatric health care services to promote psychiatric clinical nursing education (Chinn & Kramer, 1995:125-137).

2.4.4.3 Description of guidelines for operationalisation of the model

Guidelines for operationalisation of the model were derived through reasoning strategies such as: analysis, deductive and inductive reasoning, synthesis, inference and derivation. Relational statements derived from the conceptualisation phase formed the basis for the description of guidelines.

2.5 SUMMARY

This chapter gave a detailed account of how the study was conducted in order to achieve the study objectives. The research design of the study is qualitative, exploratory, descriptive and contextual for theory generation. An in-depth description of the research method according to the four phases has been provided. Phase One was concerned with doing a concept analysis (theoretical and empirical perspective). The second phase was concerned with an exploration and description of the perceptions of nurse educators, nurse managers and clinical facilitators with regard to how collaboration between the institutions of higher education and psychiatric health care services could be facilitated to promote psychiatric clinical education. Phase Three constituted the classification of the identified major concepts within the practice theory as described by Dickoff, James and Wiedenbach (1968:435) through conceptualisation process. Phase Four constituted the model description and evaluation and guidelines for operationalisation of the model. Finally measures to ensure trustworthiness were described.

Chapter Three, will deal with the theoretical exploration and description of the meaning of collaboration within psychiatric clinical nursing education, also using Rodgers and Knafl’s evolutionary method of concept analysis (1993:77-90).

CHAPTER 3

DESCRIPTION OF THE RESULTS OF CONCEPT ANALYSIS: COLLABORATION BETWEEN INSTITUTIONS OF HIGHER EDUCATION AND PSYCHIATRIC HEALTH CARE SERVICES TO PROMOTE PSYCHIATRIC CLINICAL NURSING EDUCATION

3.1. INTRODUCTION

Chapter three seeks to describe the results of the meaning description of the concept collaboration between institutions of higher education and psychiatric health care services to promote psychiatric clinical nursing education. The concept analysis was conducted from the theoretical perspective of Rogers and Knafl (1993:77-90) and the empirical perspective, from the perceptions of participants (nurse educators, nurse managers and clinical facilitators) with regard to their understanding of what is collaboration between institutions of higher education and psychiatric health care services to promote psychiatric clinical nursing education. Firstly, an overview of the method of concept analysis will be described, followed by the description of the identified categories and the related connotations of collaboration as indicated in Table 3.3. Theoretical validity and theoretical definition will be described.

3.2 METHOD OF CONCEPT ANALYSIS

The theoretical method of concept analysis to describe the meaning of collaboration between institutions of higher education and psychiatric health care services to promote psychiatric clinical nursing education was done in accordance with Rodgers and Knafl’s evolutionary method of concept analysis (Rodgers & Knafl, 1993:77-90), and consists of eight steps as indicated below.

(a) Identification of the concept of interest;

(b) Identification and selection of an appropriate setting and sample for data collection; (b) Collection of data regarding the attributes of the concept, along with surrogate

terms, references, antecedents and consequences;

(d) Identification of concepts related to the concept of interest;

(e) Analysis of data regarding the above characteristics of the concept; (f) Conducting interdisciplinary or temporal comparisons, or both, if desired; (g) Identification of a model case of the concept, if appropriate;

For the purpose of this study, of the eight steps listed by Rodgers and Knafl’s evolutionary method of concept analysis (1993:77-90), only six steps will be used. The sixth and the eighth step will not be used in this study. A brief overview of the method is described according to the selected steps.

3.2.1 Identification of the concept of interest

Collaboration is an important concept for nursing. However, collaboration is viewed as a complex phenomenon whose definition has remained vague or highly variable. This lack of clarity has resulted in the term collaboration being used in a variety of inappropriate ways in both the research and practice settings (Henneman, Lee & Cohen, 1995:103). There is therefore a need to conduct a concept analysis to clarify the meaning of concepts for the purpose of research and deriving a theoretical definition (Mackintosh, 1998:553). For this study, the meaning description of collaboration was essential in order to arrive at a theoretical definition that will direct data collection and the description of a model to facilitate collaboration between institutions of higher education and psychiatric health care services to promote psychiatric clinical nursing education, and to describe guidelines for operationalisation of the model.

3.2.2 Identification and selection of an appropriate setting and sample for data collection

In the evolutionary approach, setting refers to the time period examined and types of literature included for analysis. The appropriate setting and context of this study refers to the facilitation of clinical nursing education in a psychiatric clinical setting, as demanded by contemporary legislation and professional statutory bodies. The study sample was drawn from relevant primary and secondary literature that dealt with collaboration. The sample included relevant national and international literature on the concept collaboration within psychiatric clinical nursing education.

3.2.3 Collection of data regarding the attributes of the concept, along with surrogate terms, references, antecedents and consequences

The researcher reviewed the literature through a library search to identify as many uses of collaboration as possible, in order to arrive at data relevant to defining attributes,

along with surrogate terms, references, antecedents and consequences of collaboration within psychiatric clinical nursing education (Rodgers & Knafl, 1993:83). The researcher reviewed subject dictionaries, encyclopaedia, the Internet, CD-Rom, conference papers, research reports, regulations, journal articles and books. Both primary and secondary sources were consulted in order to describe the meaning of the concept collaboration within psychiatric clinical nursing education. A systematic review of citations, titles and available abstracts indicated a considerable overlap. After converging similar citations, 50 meanings and uses of collaboration, drawn from 250 references, were retained for the final sample. The review of literature supported or verified the ultimate choice of the defining attributes; the surrogate terms, the references, antecedents and consequences of collaboration.

3.2.3.1 Identification of defining attributes

The attributes of the concept constitute a real definition, as opposed to a nominal or dictionary definition that merely substitutes one synonymous expression for another (Rodgers & Knafl, 1993:82-83). This step involved the identification of as many uses of the concept that could be found in order to arrive at defining attributes (See Annexure 12; Table 3.3).

3.2.3.2 Identification of surrogate terms

Surrogate concepts refer to the philosophical position that a concept may be expressed in different ways (Rodgers & Knafl, 1993:83). Literature revealed that surrogate concepts, such as joint venture, and strategic alliance are often used as substitutes. They share some, but not all of collaboration’s attributes. These concepts were readily identified during data collection.

3.2.3.3 Identification of empirical referents

The reference indicates the actual situation to which the concept collaboration is applied (Rodgers & Knafl, 1993:83). Empirical referents are clearly linked to the theoretical base of the concept, and constitute the identification of antecedents, empirical references and consequences of the collaboration process (Rodgers & Knafl, 1993:90). The researcher explored various collaboration processes in literature and derived a collaboration process which comprises of four phases as follows: Phase One

- Laying the foundation; Phase Two - Structuring the collaboration strategy; Phase Three - Implementation of a collaboration strategy; Phase Four – Evaluation of collaboration. The process of collaboration will be described under the discussion of results.

3.2.3.4 Identification of antecedents

Antecedents were used to identify the underlying assumptions of the concept collaboration within psychiatric clinical nursing education. The antecedents of collaboration in the context of psychiatric clinical nursing education would be the aspects that would generally precede the process of collaboration (Rodgers & Knafl, 1993:83). For this study, the antecedents needed for successful collaboration were identified to consist of participants’ characteristics such as: (i) Self-awareness, self- regulation and self-evaluation; (ii) Trust and respect; (iii) Good interpersonal and communication skills; (iv) Empathy, open-mindedness and flexibility; (v) Perseverance and tolerance; (vi) Critical thinking, creativity and innovation; (vii) Self-confidence, assertiveness and courage and (viii) Motivation, willingness and commitment. Organisational determinants such as: (i) Screening and identification of potential collaborators; (ii) Knowledge and skills of the collaboration process, (iii) Existence of a meaningful relationship; (iv) Compatibility of organisational culture, mission, vision and values; and (v) Administrative support and commitment to collaboration. These antecedents will be described under the discussion of results.

3.2.3.5 Identification of consequences

The consequence of collaboration between institutions of higher education and psychiatric clinical nursing education has been identified as empowerment of the student nurse (Rodgers & Knafl, 1993:83). The consequence/outcome of collaboration will be described under the discussion of the results of a theoretical and empirical concept analysis of collaboration.

3.2.4 Identification of concepts related to the concept of interest

Collaboration has been associated and is being used interchangeably with terms such as partnership, cooperation, interdependence, teamwork, coordination and networking,

even though these concepts are used within specific contexts and carry a different meaning altogether (Torres & Margolis, 2000:3; Rodgers & Knafl, 1983:83).

3.2.5 Analysis of data regarding the above characteristics of the concept

Data analysis in the evolutionary approach of concept analysis is carried out according to the standard procedure of content analysis (Rodgers & Knafl, 1993:84). The content analysis of the literature was done using reasoning strategies such as analysis, synthesis, inductive and deductive reasoning strategies, retroduction, inferences and derivation (Chinn & Kramer, 1995:63-67; Walker & Avant, 1995:28-29). Analysis was used inductively by taking the data apart, whilst deductive analysis was employed to fit data into the thinking framework provided for the concept analysis in a meaningful way. Inference was used in the exploration of literature to clarify the meaning of collaboration, and inference was also made from the empirical data collected. Retroduction was used during the exploration of participants’ perceptions with regard to the meaning description of the concept collaboration. Derivation was achieved through an analogy between an intensive literature review on collaboration and empirical meaning description of collaboration, and identifying the likeness of the phenomena from these different sources. Synthesis was used to identify the relationship between concepts and categories that emerged from the data collected from both the theoretical and empirical meaning description of collaboration. The pulling together of these different sources produced the final categories of the defining attributes as reflected in Table 3.3.

As the researcher was reading through the definition and uses of collaboration, common words were underlined and clustered. The researcher reduced the descriptive attributes into three columns. The aim was to indicate a cluster of attributes that is most frequently associated with collaboration within the context of psychiatric clinical nursing education. The process of deductive analysis continued in order to further reduce the data until three columns were arrived at. Column one, consisted of 50 defining attributes of collaboration that appeared repeatedly. The defining attributes from Column One were further synthesised and reflected in Column Two. A final reduction of the attributes was made in order to derive specific categories that explicitly defined