Objetivos de la Investigación

The ward was selected as the research environment by the Director of Nursing; it was the major surgical ward in the hospital, and though it did not have a direct comparator within the Trust, could have been typical of any surgical ward, in any District General Hospital in the UK (Dr Foster 2012).

The task of early ethnographers (largely anthropologists) was to make the strange familiar; to examine strange and exotic cultures so their customs and

rituals could be understood by the Western world (Macdonald 2007 p. 60). As ethnography became a tool to be used to examine aspects of our own cultures, this focus changed to making the familiar strange (Wolcott 1999 p. 244). This phrase was first used by Novalis, a French philosopher and poet (1772-1801) who is asserted to have said:

“To romanticize the world is to make us aware of the magic, mystery

and wonder of the world; it is to educate the senses to see the ordinary

as extraordinary, the familiar as strange, the mundane as sacred, the

finite as infinite.” (Beiser 1988 p. 294)

This idea is also found in the works of other Romantic poets, Wordsworth and Coleridge, with the reference becoming changed to ‘making the familiar strange and the strange familiar’ (Eliot 1932), although the providence for this change seems to be lost in time.

Art, semiotics, sociology, anthropology and later ethnography took up the phrase as their own, each using it to ensure familiar objects in our familiar world are examined by attempting to remove the elements of our knowledge and experience which add context. This strategy of ‘making the familiar strange’, however needs to be combined with an awareness that while we may try to look beyond to see an object, we can never escape framing new experiences with our knowledge gained by past experiences (Wiseman 2011 p. 8). Because of this it is important to make the position of the researcher within the field visible.

4.7.2.1 Positioning within the field in this study

There is always a danger familiarity with the area under examination will lead to assumptions being made, meaning appropriate clarifying questions are not asked (Bonner & Tolhurst 2002). However as I had not worked as a ward nurse since finishing nursing training twenty years earlier, there was felt to be enough distance to be a ‘stranger’ within a surgical ward, with enough experience to have sufficient familiarity to enable appropriate data collection.

When I started this ethnographic study I had been working as a Senior Clinical Nurse Specialist in Pain Management in a District General Hospital for almost two years. Previous to that position I had worked for over six years as senior nurse in a research team conducting pain management related clinical trials for the pharmaceutical industry. Following the literature and ethical committee review to inform and legitimise the project, data collection began. I was a senior nurse, with little ward nursing experience, and my significant research experience was almost wholly quantitative in approach. To try to become part of a surgical ward, working initially in a health care assistant role, observing nurses practice in a field I was an expert practitioner in, while using an unfamiliar methodology, felt very uncomfortable.

Newcastle Ward was in a hospital where I knew no one, and no one knew me, aside from the Pain Management CNS’s who I had met previously professionally. As would anyone in a new environment I sought to be amiable, to become friends with my new colleagues. There was however a continual tension between, my position as a senior nurse with expert pain

management skills, the unfamiliar observer role required for ethnography, and my natural inclination to make friends and help people. I was in a situation where the normal social integrations had to be carefully negotiated; not too friendly otherwise I could lose perspective or contaminate the field, however not too formal and aloof to prevent losing data by being not immersed enough in the field. This negotiated social situation ensured constant monitoring of appropriateness of my conversations and behaviour. I saw situations where pain management was, in my opinion, poorly and inadequately performed, which left me frustrated and anxious. I found it difficult on occasion to judge how much staff should have known about pain management, and may sometimes have been unrealistic about their level of pain management knowledge and skills. I found there was again a

considerable tension between gathering data of what was occurring and wanting to change pain management practice by education or direction. These tensions formed an extensive part of the supervision sessions as it became evident I was judging the ward staff by my own standards of pain management care, rather than understanding the wards staffs’ perception of giving pain management care. As the observation period progressed I was assisted, through reflexivity and supervision to largely move to the latter position.

4.7.3 Sample

Angrosino (2007 p. 48) suggests the question of how many people to sample in an ethnographic study is a complex one, arguing it depends very much on the characteristics of the group under study, legitimate limitations on the

researchers resources (time, access), and on the objectives of the study. Many of the nurse researchers using ethnography in clinical settings used a group of nurses either selected from the pool of nurses (Dihle et al. 2006), or

self selected by agreement to participate (Brown & McCormack 2006).

4.7.3.1 Sample in this study

Sampling for this study was one of convenience; all staff on the ward were invited to participate. Over the course of the study there were 44 ward staff available to be participants: 30 Registered Nurses (RN), and 14 Health Care Assistants (HCA). One RN was on maternity leave for most of the study, she gave consent but was not observed or interviewed, while five RNs left the ward during the study, and were again neither observed nor interviewed. All twenty-four available RNs consented and were included as participants in the study. Five of these twenty-four RNs were not observed; two were part time and did not work with me, one was on permanent night duty, and the other two RNs were very new to the ward when the interviews were occurring (the observations had finished). One of the RNs who had

consented did not have an interview as she was on extended annual leave at the time the large majority of the interviews were occurring. All RNs

available at the time, consented to be interviewed (n=23).

Two HCAs left before being observed or interviewed, and another two left the ward after some observations had been done, but were not available to be interviewed. Nine out of the available twelve HCAs gave consent to the study (75%), of these six were observed (50%), and five interviewed (42%),

with one neither observed nor interviewed. Three HCAs who did not consent were on permanent night duty.