When reflecting on the practical approach to action research, Lewin (1946) outlines how there exists a spiral of steps. Within each step, there is a series of circles which involve planning; action and fact finding surround the result of such action. In relating Lewin’s (1946) examination process to the research, a meeting initially took place with each family to establish the current history. Within this examination, areas of need and services required for the family and the individual who had sustained a TBI were identified. Needs were recorded and prioritised. Please refer to Appendix Two – Family
(A) and Individual (B) Identification of Needs. This record led onto the development of
an “overall plan”. Please refer to Appendix One –Designated Specialist Key Working
Model. The flow chart outlined areas to be addressed, noting who, and what services
were involved, with expected dates of execution. Subsequent to the development of the “overall development plan” a priority list was identified, and the decision to implement the first step of action was agreed between the researcher acting as the key worker and the family.
Once the desired objective was decided, the next step as cited by Lewin was to:
“Compose a circle of planning, executing, and reconnaissance or fact finding for the purpose of the evaluation of the results of the second step”. Re: Lewin (1946) pp: 206
This process began to form the circle of action, as it formed the rational bases for planning the third progression step. At this stage, the desired first action was put in place which involved either or both the family and the key worker exploring the services that could facilitate the desired need, for instance for the key worker to make a referral for a service/profession. Professionals who became involved at this stage were invited to become part of the research team.
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The researcher acknowledged how through utilising Lewin’s approach it presented the team with a sequential form, which could be open to literal interpretations. To accommodate such interpretations, the process of self-reflection was utilised to enable the team to identify and produce a practice that was appropriate for the service users.
Theory into practice
The researcher would now like to present the practicalities of the research by outlining how the theory was put into practice. This will be achieved through presenting the development of the research itself. Initially, research ethics approval was sought and granted from the University of Birmingham in April 2010.
Invitation Process – July to October 2010
In support of good logistics and to create a good first impression, an invitation letter (See
Appendix Three, Four, Five and Six: Invitation Letters and Information leaflet to GP and Family) outlining the aim of the research, detailing the researcher’s academic and
professional experience, and the University Ethical Approval for the proposed research was distributed to local GPs within a five mile radius of where the researcher resided in urban Dublin. The researcher made the decision to source the case study families through local GPs to support a single point of referral from within the community. To promote a greater understanding, ethical and consent forms were also included with the invite letter reiterating the aim of the research. To increase the response rate, the letter, suggested by Turocy (2002), was personalised with each GP’s name, acknowledging their value towards the success of the pilot. The letter outlined reasons, as emphasised by Dillman (2000) to why respondents were chosen to become involved in the research. The purpose of the letter was to obtain GPs who could nominate at least two families attending their clinic with experience of a loved one with a TBI. Information on the research along with ethical considerations and consent forms were also enclosed for families to review and sign. Please refer to Appendix Three - Six (Invitation
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Sampling approach
The first batch of invitations was issued to four GPs on the 1st of July 2010. Follow-up calls to the GP’s surgeries took place outlining the research and answering any questions they may have. Out of the first batch of invite letters, one GP accepted placement on the research and nominated two families who were willing to participate in the research.
The second batch of invitation letters were distributed to five more GP’s, outlining the research on the 13th of July 2010. The process of calling and following up on the letters proceeded. Within this batch, one GP commented on how he may have a family who could avail of the research. However, this later fell through as the family changed their minds and felt it was the wrong time to become involved in research. No forms were signed at this time. No families were obtained within this batch as the GPs advised that they were either too busy, had no families that would fit the criteria of the research or some GPs would not engage with the researcher, either through not accepting calls or responding to the invite letter.
On the 28th of July 2010, a third set of invite letters went out to three GPs with the same details. Follow up occurred through similar means as before. At this stage, two GPs expressed an interested in the research. One GP advised of the possibility of two families that may be interested. Later on it transpired that only one was to take up the invite to participate in the research. Another GP nominated one family who was willing to participate in the research. Therefore at this stage in August 2010, the researcher had four families that had decided to become involved in the research and three GPs.
In order to seek the final two families required for my research, a fourth set of invite letters were sent to nine GPs in the middle of August ‘2010 along with another invite letter sent to one GP in October 2010. Out of these two batches of invites, one GP nominated two families who were willing to become involved in the research. Therefore, by October 2010 the researcher had six families that had agreed to participate in the research and four GPs.
Further information on the process of the invitation process of the GPs and families to participate in the research can be seen in the Appendix Seven – Spreadsheet recording
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General Practitioners Invitations. This Appendix outlines the procedure flow within a spreadsheet, noting when the letters were issued, the follow-up calls and what was advised.
Meeting Families (September & November 2010)
Once the GPs had nominated the six families, the researcher sought consent from the families to participate in the research. Discussions took place with the relevant GPs and it was agreed for the GP to make the initial contact with families and obtain consent to hand over the contact details. Once these were obtained and transferred over to the researcher, initial contact was made with five primary carers at the beginning of September 2010 and one at the beginning of November 2010. The first phone call involved introducing and reconfirming details of the researcher and the aim of the research. A meeting was arranged with each family at a time and place of their convenience within Dublin. These meetings took place in different locations depending on the location and needs of the families. Some of the meetings took place in the family home while others took place in the hospital as the family member was currently an in-patient.
The Flow of the Interview Process
The flow of the interview adopted the layout outlined by Lofland and Lofland (1995), whereby the interview began with a general introduction about the researcher, the aim of the research, followed by acknowledging the value of the recipient’s participation. The focus of the introduction was to create a comfortable open environment, whilst building on the rapport between the interviewer and interviewee. Questions were asked to establish pre and post TBI historical background and current needs of the primary carer, utilising different interviewing techniques. One such technique adopted was “active listening” used to confirm with the interviewee that close attention was being paid to what they were saying. Another technique, in support of the researcher’s exploration of the family responses, was the use of prompts and probes as suggested by Robson (2002). Once the questions were addressed, the interview moved to the closure stage, whereby the interviewee was thanked for their participation. At this stage the next step of the research was outlined. Consideration was given to the
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possibility of the need for a “cooling off” period or the possibility of the interviewee continuing to talk after the cessation of the interview. This was required for four out of the six family initial meetings. The aims of the initial interview were to meet and greet and create a supportive collaborative alliance between the researcher and the family. Followed, with obtaining data on the current situation and needs of the family. Finally, the needs outlined were prioritised and an action plan developed. Subsequently the action plan was commenced and the first desired action initiated.
Interviews
At the initial design stage of the interview, different data recording methods were considered, for example, audio-recording to taking notes. Initially, a dictaphone was considered, noting how such a method could free up the interviewer to concentrate, listen and respond to the interviewee. However, consideration was given to concerns raised by Knowler (2007) on how interviewees may feel uncomfortable and unwilling to reveal their true thoughts and opinions should the interview be taped? The next method explored was note taking. Consideration was given to how the interviewee may become inhibited by the interviewer’s act of note taking during the process and become disheartened to whether they are being listened to. Furthermore, the researcher also considered concerns expressed by Hancock (2002) surrounding the possibility of researcher bias occurring during the transcribing process, possibly down to a lack of experience and time on both parties. After discussing these options with the families and later on with the other participants, it was decided to use note taking as all participants expressed how they would feel uncomfortable being taped. Furthermore, to address Hancock (2002) concerns surrounding researcher bias, notes were recapped and confirmed with the interviewee and were immediately typed up following cessation of the interview. (Refer to Appendix Eight – File Note from Mary (Case Study 4)).
Alternative forms of interviews, for example the semi-structured to the unstructured interview were explored to ascertain their suitability for the research. Within the unstructured
interview, the researcher uses at most aide memoireas a checklist of prompts surrounding
certain topics that he/she wishes to discuss. The question format may present as a singular question, where the interviewer asks the question and allows the interviewee to respond
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freely. Alternatively, within the semi-structured interview the interviewer has a set of questions or an idea of a specific topic that they may wish to explore. Within the research, questions were asked to establish pre and post TBI historical and current background information for instance: nature of TBI, Date of Birth, and what was the family situation pre and post TBI. Please refer to Appendix Two Identification of Needs (A & B). Ultimately, the decision was made to utilise the semi-structured interview due to, as emphasised by Hogskola (2005) and Barker, Pistrang and Elliott (2002), the collection method supports the researcher in gaining access to phenomenological data surrounding the respondent’s perceptions of themselves and the world in which they live. However, consideration was given to thoughts raised by Barker et al (2002) surrounding concerns of potential validity issues, whereby respondents may deceive themselves or others. To address such concerns, the researcher used this as an explorative tool, to address any contradictions that may arise between the data collection tools used.
Team members
Once the initial meeting with each of the six family primary carers took place and the needs identified, the process of inviting and working in collaboration with different professionals and members of the community began. Each family’s identified needs formed an individual action plan which required the service of various different multi-disciplinary teams of professionals to take part in the research. For the families who were still within the acute hospitalisation stage, the multi-disciplinary team consisted of in-house social workers, doctors and nurses. However, once discharged, other professionals, for instance members of the local PCC, for example PHNs, Community OTs, to Physiotherapists and staff from community organisations became involved to support and facilitate the action plan.
When exploring the collaborative workings with the multi-disciplinary team, the researcher initially made contact with the desired professional and introduced the aim of the research. Details of the individual case study needs were outlined and the necessary service provision required. Discussions took place, mainly over the phone towards how the professional could facilitate this action. All conversations with team members, for instance professionals and
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primary carers were recorded with the researcher recapping the details to ensure clarity and agreement of the notes taken with the individual involved. Please refer for an example to
Appendix Nine - File Note from Public Health Nurse. These records were then filed within
the family’s folder under the relative section, for example: Professionals. At all times, as the team grew and the action developed, each team member was verbally updated.
Recording Methods
Each of the six case study family’s had an individual folder, whereby records of notes of all conversations, meetings or case conferences were collated into three different sections: Family, Professionals and GPs. In promoting ease of retrieval, contact names and details were presented at the beginning of each folder.
Another form of recorded data utilised was the “flow chart”. This allowed the family to visualise the flow of the agreed actions in relation to each other. This too was reviewed regularly and adjusted accordingly. Please refer to Appendix One- Designated Specialist Key
Working Model.
Finally, the researcher supported the feedback process to the GPs, by issuing a report on each family in question in November 2010. This was to provide GPs who were under time restraints in their involvement of the research, with feedback on the needs identified by the primary carer, the services sought and needs still to be addressed.
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