La interacció a l’aula de 4t d'ESO Narració de l'experiència

se. They were just happy that the team believed in them and could offer support because previously, nobody had appeared to care. Maybe I am just focussing on role because of my knowledge about role overlap and role ambiguity as a recognised barrier to inter-professional working? Am I transposing my assumptions?

Over time, the interviews revealed how the nurse was seen as being a supportive team member and participants often described ‘the team’ rather than individual team members, which suggested that roles were not seen as important as the team function itself. After exploring the data and subsequent interviews for other examples, the findings appeared to suggest that Elaine’s observation of the nurse was uncommon. The early concept of role ambiguity played a significant role in the early analysis because it reinforced the purpose of analytic memos as a tool to aid sensitivity and highlighted the value of looking for the negative case. Acknowledging researcher experience and its impact on the analytic process also reflected the significance of the canons described by Corbin & Strauss (2008) and ensured the transparency of the analytic process. Working with the data through analytic memos and developing sensitivity is explored in more detail next.

111 5.5. Working with Data to Develop the Categories.

Working with the data through moving in and out of the interview transcripts and the analytic memos, revealed lower and higher-level concepts, which were later developed into categories. In total four categories emerged which generated meaning about the participants world and their experience of person-centred care. The four categories related to ‘the sceptical professional’, ‘validation’, ‘becoming a person’ and ‘regaining control’ and reflected the participant’s experience of health care from the moment they developed chronic back pain. In moving from a descriptive to an analytical position, the higher-level concepts were further analysed to theoretically saturate meaning about the participants’ experience of person-centred care. This process revealed how they were empowered to ‘regain control’ which had later helped to repair their self-esteem. Regaining control of pain underscored the participants’ journey through health care and reflected the loss of control they felt as a result of the chronicity of their condition. The next part of this chapter explores the analytic process that was used to identify categories, such as insight into open codes, memos and reflections that were used to create meaning about the participant’s experience of person-centred care.

5.5.1. Sensitising

Re-reading the transcripts, re-visiting memos and elaborating the memos helped develop a broad understanding of the participant’s world, which was sharpened through an emerging sensitivity to the data. An important component of analysis and subsequent category development was the way in which the analytic process enabled sensitivity to develop. Being sensitive to the participant’s world was a significant part of the analytic process that emerged at the start of the study and deepened as the analysis thickened. The significance of this wasn’t realised at first and memo 3 illustrates an initial confusion with the participants need to be believed and how this began to inform the analysis. The memo provides insight into how knowledge acquired from previous interviews with participants was used to capture and explore meaning with subsequent interviews. This example of constant comparative analysis illustrates how this approach generated meaning early on in the study through sensitivity.

112

Memo 3

Nina liked the accessibility of the team. Being believed gave her the confidence to just call on one of the team if she needed. She said that on the way to the PMP room, she would pass all the offices of the team – which made them more accessible as a team and provided reassurance for others they were there for.

Helen viewed the team based on their ‘hands on’ input into her needs. Helen’s experience of health care professionals before being referred to the pain team was quite negative. No-one had believed her pain. Similar to Nina, Helen needed to be believed. Helen mentioned that it was reassuring seeing all the team’s offices on one corridor – she said that you could see the offices so you knew if they were in or not. Does this mean that she felt they were accessible? Helen liked the fact that more than one person was listening to her concerns; and for Helen, being believed was important. Her ability to talk about her pain appeared to be significant – for example, whilst someone from the DSS came to speak to them, she did not see them as part of the team – but she did think that the doctor was part of the team – even though he had only been a couple of times because he talked about how they could manage their pain. So being believed was important for her.

So why is being believed significant? Does this mean that that the participant’s pain was invisible? Helen & Nina waited a long time to be accepted. Maybe the pain team enabled the invisible to become visible? Did they make the person become visible?? I need to explore exactly what I mean by visibility.

The need to be believed was emphasised by the participants early on in the study, which suggested that this was significant and may have influenced their experience of person- centred care. Further probing about ‘being believed’ encouraged the participants to talk about their relationships with the team and the impact that this had on their perceptions of health care. The participants’ previous experience of scepticism exhibited by health professionals appeared to have generated mistrust and these findings suggest that the treatment which participants received before being referred to the pain teams was significant because it influenced their later perceptions of person-centred care. Liz’s description of her experiences was typical of other participant’s descriptions of care prior to being referred to the pain teams:

“So often you find that when you have a chronic pain problem – most professionals don’t have time for you and you find that they see it as an excuse either to get out of working cause a lot of us in the group that did not actually work or as an excuse for medication”

(Liz).

Liz was concerned because the health professionals very rarely had time for her and she felt disbelieved. Liz was upset by the way in which some health care professionals had treated her with suspicion. The condition and context of the participants’ experience was a powerful tool in negotiating meaning, which helped to generate understanding

113 about their experiences. Through listening and writing reflection and memos, a common concern emerged which exposed the way in which health care professionals had treated the participants and had undermined their confidence in health care. Although it was not an intention to include the participant experience before they were referred to the pain centres; listening to their experiences about being doubted indicated the impact this had on their trust of healthcare professionals. Re-reading the transcripts and further analysis of the properties and dimensions of the concept of ‘visibility’ highlighted the impact this had on their ability to cope with their pain. More significantly, the doubting professional became a category, and when further analysed, was later labelled/coded as ‘the sceptical professional’. Becoming sensitive to ‘visibility’ helped develop the sceptical professional as an early concept, which became increasingly significant as the analysis thickened. The development of categories is discussed in greater detail next.

5.6. The Emergence of Category 1: The Sceptical Professional.

The participants’ previous experiences of health care were similar and highlighted the plethora of professionals they had accessed before being referred to the pain team. Some participants had sought private treatments and nearly all had accessed alternative modes of treatment such as acupuncture. Each of the participants disclosed comparable concerns predicated on the way in which they had to ‘fight for a diagnosis’ from the health professionals. The participants thought that health care professionals would believe and understand their pain; conversely, the negative and systemic attitudes of some health care professionals towards people with chronic back pain were highlighted. Although the early descriptions of the sceptical professional originated from the interviews with Liz and Shona, the category actually evolved through later interviews with other participants. However, Liz and Shona’s experiences initially illustrated how they were disempowered and unable to receive further treatment, which highlighted the significance that being disbelieved had on their management of pain.

Before the advent of their chronic back pain, Liz and Shona described themselves as being active and confident individuals who had never experienced chronic illness, depression or pain. Their descriptions of care received by the GP in particular were

114 revealing, For example, they were both told that the doctor could not ‘see anything wrong with them’. They explained that they were referred to the pain teams after being told by GP’s that ‘they had tried everything’ which they interpreted as the GP giving up. This explained why other participants saw the pain teams as a ‘last chance saloon’ and a place where the ‘unfixable’ went. The GP was one example of how the sceptical professional had influenced the participant’s perceptions of health care. Table 10 presents an example of how the analytic memos were used to explore the category further.

Table 10 Exploring the Sceptic Professional:

The perceived damage that the sceptical professional caused had meant that the participant’s expectations of health care were not met. During the interviews, participants alluded to feelings of being demoralised and blamed this on the way in which they felt disbelieved. Significantly, the description of health care suggested that they had been undermined rather than supported. Shona’s and Liz’s descriptions of their

Memo Extracts Excerpts from Interviews

7. The GP told Shona that he could not see anything wrong during a physical examination.

8.9 the terms ‘don’t have time’ for you and ‘seeing it as an excuse’ (lines 157 – 158 page 5) suggest that previously, professionals hadn’t believed Sandra’s pain – so again belief here is seen as important – perhaps one of the best attributes a team offer is the collective validation and belief of the persons pain – demonstrable through observed understanding. This is echoed by other participants who have commented on similar concerns about being disbelieved and poorly understood.

9.2 seeing the same faces is important- not reaching a ‘dead end’ (Pg 7 line 209). This seemed to signal that consistency in the team and familiarity with the team members supported the participants and the extent to which they felt understood and believed. Other participants in the groups were helpful because they had been through ‘the same pain’ and therefore could appreciate the lack of understanding experienced by so many, Mutual support from other participants was

needed and helped generate an atmosphere of support.

Shona “so I went to another doctor and she had my leg up on the couch going this way that way and the other way and said that she could not see anything wrong – so take some paracetamol. Well it got so bad that the following week I went to see a different doctor because I still could not see my doctor and he did the same thing – and I said that ‘you’re doing the same thing as the other doctor and I can’t walk I’ve got this terrible pain and I can’t walk’ well I can’t see anything wrong and he told me to take pain killers” (Shona)

115 visits to the GP were similar to many of the health care experiences described by other participants. Shona’s example detailed in table 10 generated some understanding of the way in which disbelief expressed by a professional was interpreted. This insight into Shona’s world enhanced the analysis and provided a powerful image of the ‘care’ she had received. The following memos, made after the interviews with Nina, Sue, Liz and Shona, illustrate how becoming sensitive enhanced understanding about the significance of their journey prior to referral to the pain teams.