Estudio experimental

Introduction

Contemporary Action Research (AR) has continued to grow as an intellectual and social movement in education, healthcare and beyond. The AR methodology in this section of the chapter will first identify the pertinent research aims. Then AR epistemology and contemporary definitions will be identified. Selection of the AR methodology to be employed will be considered and justified. The use of Participant Action Research (PAR) will be discussed and the analysis and validation issues will be explored. Methodological issues associated with the researcher as a facilitator will examine reflexivity, and insider verses outsider researcher considerations. Finally, the potential ethical issues associated with AR and the suggested combative remedies will be explored as the AR section is concluded.

Action Research Aims

People with established renal failure face a multitude of decision-making situations, in what is essentially a life-threatening disease state. The concern based on empirical experience, is that treatment decisions are made for, rather than with, many patients. This is further compounded by the lack of consistency in the approach to individualised patient education and this is borne out in the literature review chapter. Action Research potentially provides an appropriate methodology in the pre-dialysis education context to

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establish how to improve pre-dialysis education by exploring the following the research question:

What should a learning theory and health policy informed pre-dialysis education intervention comprise?

It is this research question that will guide considerations in the identification of the most appropriate methodological approach to employ.

Action Research Definition /Epistemology

The participatory nature of action research provides the opportunity for individuals to identify issues within their own communities and facilitate change. Common features at the core of all action research approaches are concerned with action to develop practices, within a social setting. This is central to pre-dialysis education that is presented by multidisciplinary HCPs to a diverse range of pre-dialysis patients. The result is an interventionist, enquiry-based approach to achieving change, which is reflective and collective in nature (Vezzosi 2006). Action research has been defined as

“A   form   of   self-reflective enquiry undertaken by participants in social situations in order to improve the rationality and justice of their practice, their understanding of their practices and the situations in which these

practices  are  carried  out”.  (Kemmis  &  Carr  1986,  p  46)         As a research methodology, action research is commonly referenced to Kurt

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stage process of (i) deconstruction, (ii) change and (iii) locking of a permanent structure, which was further defined and challenged by Gustavsen (1992) and Eldin & Levin (1991). They argue that contemporary action research emphasises on-going dialogue and sustained change. McNiff & Whitehead (2006) contend that Lewin continues to be influential, as researchers use the original stages of the process as cyclical steps of; observe-reflect-act-evaluate-modify, to organise and report their work. One therefore acknowledges that Lewin provided the fundamental cornerstone upon which these principles could be established.

Modern Foundations

The modern foundation of human inquiry and cooperative inquiry was arguably established by the New Paradigm Research Group, in London 1977 (Greenwood 2007). Greenwood & Levin (2007) defines his vision of Action Research as:

“Human  enquiry  or  cooperative  inquiry  shows  how  Action  Research  can  

support knowledge creation by bringing explicit, tacit and emotional knowledge together to improve organizations and the welfare of

individuals”  (Greenwood  &  Levin  2007,  p  27)

Stringer (2007) concurs with this perspective and defines Action Research as fundamentally grounded in the qualitative research paradigm. More specifically, it is located within the methodological and epistemological developments associated with Critical Theoretic research. McNiff &

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Whitehead (2006) highlight three components of critical theory research; (i) in order to change a given situation it must be understood; (ii) people construct social situations, hence they can be deconstructed and reconstructed by people; (iii) situations need to be defined in terms of what brought them into existence, with specific consideration of the power differentials in relationships.

It has been argued that action research goes beyond the critical theory stance, of understanding a situation in order to change it, by aiming for understanding about how it can be changed (McNiff & Whitehead 2006). The involvement of renal service providers and renal service users aimed to understand the situations from diverse perspectives, so that current practice

could   be   challenged   and   new   approaches   developed.   Focus   was   on   ‘how’  

pre-dialysis   educational   components   work,   rather   than   just   ’what’   was  

happening, leading to a better understanding of stakeholders’   perceptions,  

interpretations and responses to investigated issues (Stringer 2007).

The way in which practice can be changed became a central element of the research process. Reason & Bradbury (2008) suggest that questioning how a situation can be improved is a common starting point for action research. In essence, a localised study has investigate localised issues. Essentially, the action researchers were part of the reality they were studying. At its most effective, action research is argued to be phenomenological, interpretive and hermeneutic; stakeholders gained clarity and understanding of an issue, and utilised this to construct effective solutions (Stringer 2007).

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A living theory approach to action research identified the relationship of factors to one another, and the researcher was accountable not only for their own learning but their influence upon the learning of others (McNiff & Whtiehead 2006). Stringer (2007) argues that the principles of democratic dialogue and communicative action, defined respectively by Gustavsen (2008) and Habermas (1984), are consonant with this concept. More recently

whilst  writing  about  “Truth  and  Justification,”  Habermas  (2003)  defines  critical  

participatory action researchers as aspiring to consider all view points and take account of them impartially and equally.

Constituents of the basic action research steps were; a review of current practice, identification of an aspect to be investigated, imagining a way forward, trying it out, and taking stock of what happened (McNiff 2002). Based on these findings the process continues in a cyclical form by; modifying what is done in the light of what has been found, and continued working in this new way (try another option if the new way of working is not right), monitoring what was done, review and evaluate any modified action, and so on (McNiff 2002).

Adaptation  of  Lewin’s  original  graphical  representation  of  the  action  research  

cycle, reflects how the process worked as issues were addressed by a collaborative group, and is shown in Figure 4.0.4

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Figure 4.0.0 Action Research, Principles and Practice. (McNiff 2002)

This simplified process model has however been criticised for its representation as a series of steps, rather than a dynamic process that encourages creativity (Hopkins 1993). McTaggert (1996) asserts that the key is a commitment to core principles and ideals. This series of commitments for conducting social enquiry, have been explored and found not to be cognisant with a step-by-step approach (Townsend 2009). Mindful of this view and the oversimplification of the graphical representation, the need to be aware of the true multi-dimensional cyclical nature of action research was recognised. Additionally, the use of a cyclical process emphasises the on- going reflection and evaluation of the situation under change and avoided development of a blame culture, if change was unsuccessful. This is an important consideration when involving HCPs in research to change practice. The threat of retribution for unsuccessful change needed to be removed from the process if individuals are to engage honestly and openly with the research process. By taking the simplistic basis of a cyclical approach, with

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the aspiration of participation and change, action research provided an appropriate foundation upon which to explore pre-dialysis education provision safely.