La guarda de hecho

Validity in qualitative research requires that interpretations of results are consistent with the data. The integrity and credibility of the researcher and the research is built up through the researcher’s perceived actions in checking, questioning and theorizing the claims as well as not supressing negative findings. In this study, CR as a strategy requires that in observing behaviours, any deviations from expected or sanctioned beliefs and actions are noted to enable recognition, understanding and confirmation of the causal powers underlying them (Ackroyd 2009). So in some ways continual negative case analysis underpins the analysis process, thus ensuring interpretation of the results maintains consistency with the data.Consistent and extensive discussion with my supervisory team throughout the analysis process contributed to ensuring the validity of interpretation of the data.

Hesse and Leavy (2006) provide a reliability checklist for qualitative studies derived from Gay and Airasian (2003). With a particular focus on interviewing, the checklist includes the importance of providing full description of the sampling methods, the participants, interview methods and transcription documentation. The structured process of coding and refinement within the thematic analysis of the interviews and the content analysis of the NHHRC documents are outlined later in this chapter within the relevant methods sections. The emergence of themes following this

process is clearly explained to ensure rigour. Hesse and Leavy (2006) also stress the importance of fully describing the researcher’s relationship with the group and setting. This aspect of reliability will require further explication of my positioning as researcher within the research process.

Positioning myself in the research

My positioning as the researcher for this study incorporated my professional history as a rural nurse living in a rural town. As a product of the social world in which this research is based, I bring my own subjective meanings to the field. Entering a familiar care setting to undertake research required continual acute awareness of the influence of my own experiences in collection and analysis of the data including how my reality may alter the responses elicited from participants. Within this study, my role as researcher is subject to the same scrutiny and critical analysis as the research itself (Liamputtong and Ezzy 1999). As a rural nurse, and having been employed in many of the PHC roles available to nurses in small rural towns, to some extent I share a common culture with both the nurses interviewed and many of the

organisations providing submissions to the NHHRC. Acknowledging this position and providing the reader with the measures taken to address issues arising within the complexity of this research relationship is essential. These are issues having potential impact on the validity and trustworthiness of the findings of this study. Outlining how I have addressed the issue of ‘insider research’ plays a critical role in ensuring integrity and credibility of the study’s findings (Liamputtong and Ezzy 1999; Mullings 1999; Corbin Dwyer and Buckle 2009).

The issue of ‘insider research’, that of sharing the characteristic, role or experience under study with the research participants, has generated much discussion in the literature (Corbin Dwyer and Buckle 2009). Primarily these discussions are situated within the epistemological positioning of each research study and subsequently promote the advantages or disadvantages of either the insider or outsider position. Issues about which characteristics are shared and ‘what’ the researcher is in or outside of are often either not detailed or left unanswered (McGrath 2006). Moving beyond these binary positions, the complexity of the relationship between the researcher and the research study (including the participants) can be perceived as a

dynamic process which some authors suggest is more accurately conceived as a ‘space between’ allowing for the researcher positionality of both insider and outsider rather than accepting a dichotomous perspective (Mullings 1999; McGrath 2006; Allen, Chapman et al. 2007; Corbin Dwyer and Buckle 2009).

Whether occupying a position of insider or outsider or a ‘space between’, Corbin Dwyer and Buckle (2009) posit that ‘the core ingredient is not insider or outsider status but an ability to be open, authentic, honest, deeply interested in the experience of one’s research participants, and committed to accurately and adequately

representing their experience’ (:59).

One critique of my positioning as a nurse within this study in regards to research credibility is that the researcher’s familiarity with the characteristics under study may result in taking some knowledge in common for granted. With this in mind,

supervision of the project by a non-nursing member was secured and from the outset of the study I maintained a detailed reflective journal about the research process, noting thoughts, feelings and decisions made throughout the entire project.

Reflective journaling, whilst still based within my subjective reality, reinforced the imperative of awareness of my biases.

Critical theorists, in addressing the issue of researcher relationship with

people/groups being studied, argue that representation of the participants position, particularly those of groups perceived to be marginalised, demands both the

researchers engagement and active avoidance of distancing (Kincheloe and McLaren 2000). Being recognised as a member of the group one is studying provides an understanding of commonality which supports a level of trust and openness within the research relationship. Engaging in this process created a need for some

reciprocity of disclosure of some pertinent personal details which enhanced rapport and was evident in comments such as ‘you would know having done community nursing’ or ‘you know what it’s like’. It is this commonality of understanding within which the researcher must remain mindful to take these points further rather than assume an understanding and this was undertaken.

Maintaining participant’s anonymity was a critical factor for this study. Health services in small rural communities in Australia have distinct individuating

characteristics and, coupled with the low number of health professionals working in them and the significantly low number of male nurses, it was possible both for the nurses participating in this study as well as their health services to be readily identified. There was only one male participant in the interview component of this study. To ensure this participant’s anonymity, gender was not ascribed to the individual nurse’s quotes. Assurance of confidentiality was paramount to many, although not all, of the nurses. Most of the nurses asked for assurance of de-

identification of the data and anonymity for their responses, and some asked for this to include which State they practiced in.

Transcription of the interviews and review of my journal entries highlighted how the understanding of commonality between me as researcher and the participants

supported the potential to promote an ease of conversation whilst also necessitating vigilance regarding confidentiality and anonymity. My ethical obligation as a researcher, to avoid potential harm, demanded recognition of information provided by the participants which had the potential to adversely affect either the nurse’s employment position or the organisation/s within which they worked. The often frank and open manner in which participants engaged in discussion necessitated data de-identification which included the removal of any distinguishing features including idiosyncratic speech patterns or naming of health services to ensure anonymity and did not adversely limit the study.

Within this discussion of my positioning within the research process, and mindful of my position as a product of the social world in which this study is based, I have entered the project with a priori understandings of the research interests including power, identity and agency. While I have addressed efforts taken to acknowledge potential bias, critique of the adoption of a critical realist approach as implying determinism requires further discussion.

A CR ontology acknowledges the existence of a predetermined nature of what some objects can and cannot do (Sayer 2000). The domain of the real includes many potential causal mechanisms including the categories such as nature, social, human,

physical and chemical. Theorists argue that some aspects of these essences can be predetermined while others are socially constructed (Bhaskar 1975; Collier 1994; Archer 2000). The influence of causal mechanisms is not in a linear or predictable fashion because they can act concurrently, simultaneously and within and across different domains. Therefore, rather than being able to predict outcomes of the influence of causal powers, CR provides a way of uncovering what might need to exist in order to explain something which is experienced or observed to happen. This allows for providing explanatory frameworks for deep causal mechanisms

(Cruickshank 2003; O'Mahoney 2011). Determinism is also reduced through clearly explicating the particular context within which this study is situated as well as acknowledging the agency of nurses which incorporates their reflexive potential to inform their practice. The acknowledgement that the explanatory frameworks emerge as part of an ongoing process in developing understanding of PHC nurse identity and nurses’ agency as PHC providers assisted in minimising determinism within this study.

Although the previous chapters have outlined power dynamics as a central concern within this study, the study’s aim and design was not to observe power dynamics directly. Employing a critical paradigm provides a focus for the way in which the power dynamics of the underlying causal mechanisms can generate a given set of meanings (ideologies) about nurses’ social reality (Hesse-Biber and Leavy 2006). As such, this realist study developed an explanatory framework for nurse’s agency within PHC nurse identity to validate the empirical findings.