Las labores de la dignidad y la resistencia

The thesis consists of ten chapters, which are summarised below:

Chapter one (This chapter) provides an outline of the field of research, context for and justification for the research question, as well as introducing myself as the researcher.

Chapter two is a focussed literature review, following the grounded theory principles of reviewing sensitising literature to the topic rather than the more traditional exhaustive literature review. A broader review of relevant literature is then incorporated in the five findings (results and discussion) chapters.

Chapter three presents an outline of Grounded Theory; its origins and guiding

principles, and the variations in grounded theory over time. In this chapter I introduce constructivist grounded theory and provide a rationale and justification for its use in my research.

19 Chapter four provides an outline of how constructivist grounded theory was used in the conduct of this research, providing an explanation of the sampling approach, use of interviews for data collection and the application of coding. In this chapter I outline the theoretical perspectives that I applied in the analysis of the data, and outline the analytical categories that emerged.

Chapters five through to nine are individual findings chapters which outline findings from the data and explore these findings in relation to the literature. I then articulate how each of the five broad findings categories informs a theory on the preparedness of paramedics to work with learners in the clinical practice setting. Specifically:

• Chapter five discusses the findings related to the knowledge and understanding paramedics have of their role when working with students and explores the meaning of language and action in association with the role.

• Chapter six outlines the processes by which paramedics are selected to work with learners.

• Chapter seven describes the findings associated with how paramedics are prepared for working with learners (e.g. by the profession, through professional learning or previous education) or seek to prepare themselves.

• Chapter eight discusses the experiences paramedics describe that impact on their performance when working with learners.

• Each of these initial four findings chapters contributes to the final findings chapter, Chapter 9, which reports on what, in the eyes of the paramedic, is needed to enhance practice when working with learners.

Chapter ten builds on the core categories identified in chapters five through to nine to articulate a theory of paramedic preceptorship.

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Chapter Two – The literature

2.1 Introduction

This literature review chapter presents a focussed review of the literature relating to my research question, in accordance with the approach to the use of literature in

constructivist grounded theory. The chapter begins with discussion of the role of the literature review in Grounded Theory, providing an explanation for the literature review approach I have taken during this study. The chapter then presents a review of the literature relevant to the field of inquiry, focussed on research in the field of paramedicine. The review explores the literature in relation to the clinical learning environment, its role and importance in paramedic education, experiences of learners undertaking learning experiences in the clinical environment, and literature regarding the experiences of the paramedics working with learners. This chapter will conclude with an analysis of the gaps in the literature relevant to this research study.

The conduct of the literature review involved a search of the databases, Embase®, Medline ® and Scopus® using two grouped sets of key words. The same sets of search terms were then used in Google Scholar™ to identify relevant grey literature or articles not indexed in the databases searched. Paramedic, Ambulance and EMT were grouped and combined with education, educator, preceptor, mentor, instructor and supervisor. These search terms were applied to the databases stated for publications from 1980 onwards. Results were reviewed for inclusion by title initially and abstract where title alone did not adequately inform the article focus. To be included in this review the article needed to have been published in a peer reviewed journal, focussed on the paramedic profession and addressed the education of paramedics in the clinical on-the-

21 job-setting. Articles excluded were those not published in peer reviewer journals or which focussed on classroom based education rather than the field clinical education setting. In order to maintain sensitivity to the paramedicine literature, beyond the initial review, the field of study was monitored during this study for additions to the literature, which were included in the review. A final update of the search terms was then undertaken at the conclusion of the study to ensure a comprehensive review was achieved. The final search following removal of duplicates and articles or other documents not considered in scope resulted in 60 articles reviewed.

2.1.1 The role of the literature review

The role of the literature in a grounded theory study is complex, with differing views on when the review should be conducted and to what extent, which will be discussed in greater detail in Chapter 3, Section 3.3. The following is a review of literature in the substantive area of inquiry only, being the clinical education environment within paramedicine, and without reference to the wider views in other health professions literature. Charmaz (2014) acknowledges there is benefit to a review of the literature either at the outset of the study or later, where if left until later it should be conducted after the analysis and associated categories in the data have been constructed.

Urquhart (2001) highlights that the grounded theory approach to the literature is not to avoid the literature, but more to prevent the inductive grounded theory methodology becoming a deductive process due to the influence of pre-conceived ideas garnered in the review.

The concept of a preliminary review of the literature is supported by Giles, King, and de Lacey (2013) who highlight its role in increasing the theoretical sensitivity (discussed in Chapter 3, Section 3.3.2) of the researcher, however at the same time they recognise the advocacy of Charmaz in then conducting a further review during data analysis.

22 Therefore my approach in this study was to be familiar with the literature relating to the research question in paramedicine, but given the volume of literature in other

professions on this topic, I refrained from reviewing that material until after my own data collection and analysis. Literature form other fields was then reviewed for supporting evidence for emerging categories within the data, allowing for a more focussed approach to the evidence. This allowed me to avoid imposing knowledge gained form other health professions that have undergone the same transition from vocational to tertiary settings, yet still incorporate the lessons learned into the discussion and synthesis of the findings within my data.

2.2 The clinical learning environment in paramedicine.