6 ANÁLISIS E INTERPRETACION DE LOS DATOS
6.5 DENOMINACIONES DE ORIGEN
6.5.4 Rivalidad entre denominaciones
As discussed in Chapter 3, I have treated both the survey and narrative data as
interpretive representations of inherently socially constructed, value‐laden and
contextually specific human experiences (Kincheloe 2001, p. 681). This is in keeping
with the view that methods such as survey, which are usually associated with
positivist or post‐positivist methodology, can contribute to a broader interpretive
project (Westerman & Yanchar 2011, p. 141; Denzin & Lincoln 2005, p. 5). Using
interpretive approaches to achieve meaningful proximity to experience (Denzin &
Lincoln, 2005; Leech & Onwuegbuzie 2007), however, means abandoning (the
illusion of) certainty (Clandinin & Rosiek 2007, p. 46). Certainty is, in a sense,
precluded at multiple levels and points of interpretation. It is thus important to
ensure that interpretive gaps are bridged not through prescriptive steps or
positivistic analysis of discrete sections, but through iterative immersion in the texts,
and by establishing trustworthiness regarding both the design of the study and the
interpretation of data.
As noted at the beginning of this chapter (see Figure 4.1.), the construction of data in
this research arose from a sequence – from the survey of nurses to interviews with
nurses and then interviews with consumers. The sequence allowed the interview
phases to draw upon nurses’ prior clinical experience, as is noted to be valuable
(Miller and Crabtree 2005). The sequence also enabled me to refine my interview
skills before engaging with the consumer participants. Sequentially, data was
analysed and integrated from commencement of the data collection phase. Within
the sequence, interview data was also effectively embedded in the survey data (and
the other existing knowledge sources) providing a context for the interview data and
the broader project. Further, a convergence of data enabled the comparing and
contrasting of all three data sets as part of the analysis (mindful of the potential for
survey and interview data concerned with a specific aspect of the topic to actually be
looking at somewhat different phenomena). Convergence resulted in a rich mix of
consensual, complementary and sometimes conflicting data.
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To guide data analysis within the broader sequence, I drew upon what may be
described as blended and adapted forms of critical discourse (Blommaert & Bulcaen
2000), constant comparative (Glaser 1965) and classical content analysis (Leech &
Onwuegbuzie 2007). Thus, I firstly read the interview texts and considered how they
represented the contexts at hand. This involved ‘listening’ to the narrator’s voice
concerning how they narrated and also what they narrated, remaining open to what
participants were trying to convey and, while doing so, relating the data to the
research questions and also reflecting on my own interpretations.
As in Leech & Onwuegbuzie’s (2007) description of a modified constant comparison
method, in reading the interview transcripts I proposed some ‘codes’ that would
later be maintained, modified, added to, or removed according to what emerged
during the subsequent readings. Using NVivo software, codes were initially identified
deductively (identified first and then looked for in the data), inductively (emerging as
the data was considered), and also abductively (iteratively) as they emerged from
the data. In addition, independent coding of some of the data by my PhD supervisors
promoted discussion and a process of consensus‐reaching that saw my initial codes
changed very minimally. In coding the data I was very careful to compare each piece
of data attributed to a specific code with the existing pieces to ensure that they
‘fitted’ together (represented the same or similar aspect). When data could not be
fitted into an existing code a new code was generated. When initial codes or single
codes were not added to they were subsumed into other codes if possible or ignored
if they were an anomaly that was not of possible interest – while still appreciating
that ‘outliers’ (Onwuegbuzie & Leech 2007b) can have valuable information to
contribute. After all of the data was coded the codes were grouped by similarity into
themes.
Classical content analysis is similar to constant comparison analysis except that
instead of creating themes by grouping the codes together one counts the number
of times each code features (Leech & Onwuegbuzie 2007). Thus what emerges is a
frequency of codes. This process was employed by me and my supervisors
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that saw similar terms, phrases or descriptions grouped under the same code. While
this treatment of survey data may have overtones of positivistic quantification of
interpretive data (Espeland et al. 2008), it was valuable in capturing a collective
voice. I thus consider it essentially an interpretive analysis strategy to manage a large
set of data.
Because this study prioritises narrative accounts, and because the survey represents
nursing views only and features a non‐random and moderately sized sample, a
greater ‘weighting’ has been given to the interview data than to the survey data.
Some of the numerical survey data could have been treated as ‘objective’ findings
within a post‐positivist paradigm. However, the design, responses, and
interpretation of the survey involved interpretive steps. The scaled and open‐ended
questions, in particular, are clearly based on subjective interpretations. Thus, as
noted, in an attempt to utilise the data within a larger interpretive project that
adheres to my methodological principles, I consciously avoided inferential statistical
analysis of the survey data. I take these to reinforce a positivistic knowing that, as
discussed, is of limited value in the present context. Instead I have contained the
analysis of survey data to basic ‘descriptive statistics’ (Fisher & Marshall 2009). In
this way the problematic reductionism and misleading truth‐making discussed in the
previous chapter in relation to positivistic approaches was minimised, while
something of the broad details and views of nurses was still represented.
4.5.2. Trustworthiness
Trustworthiness is considered the most widely used global standard for evaluating
interpretive studies (Padgett 2009). A trustworthy study is one that is carried out
ethically, and one in which the findings represent as closely as possible the
experiences of the participants. Transparency which provides a faithful account of
‘what happened’ (Padgett 2009, p. 101‐102) is central to the establishment of
trustworthiness. Towards achieving these imperatives I have outlined my
interpretive steps to ‘faithfully give an account of what happened’ (Padgett 2009, p.
101‐102) and to make ‘the subjectivity of the process transparent’ (Sandelowski et
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research questions to a review of literature, and the outlining of methodological
foundations and specific methods involved in entering the research field and
constructing and analysing data.
4.5.3. Summary
It seems reasonable to assert that, in the present context especially, a negotiated
communicative process of knowledge construction (Denzin & Lincoln 2005, p. 204) is
most appropriate. If such inquiry is pursued within a supportive, ethical context, and
with critical intent, then the result can be intrapersonal and interpersonal
experiences that can generate understanding and, potentially foster positive change.
In exemplifying such an approach to inquiry I have argued that all data in this
research is interpretive in nature, and that context, history, values and other
impacting factors can be embraced in a credible and useful exploration of nursing
care of suicidal mental health care consumers. Furthermore, it has been asserted
that different ‘voices’ providing multiple perspectives and data types (words and
numbers) are valuable in enabling an exploration of such complex interactive
interpretations. Indeed, I believe that the combination of methods (on an
interpretive paradigmatic foundation) can be seen as ‘a strategy that adds rigor,
breadth, complexity, richness, and depth to an inquiry’ (Flick 2002, p. 229, in Denzin
& Lincoln 2005, p.5). Thus I have taken a particular focus on legitimation according to
criteria identified with the interpretive tradition. The final claim to legitimation must,
however, be established by an audience engaging with (constructing) the ‘final’ text,
particularly in regards to the presentation and discussion of findings, to which the
following chapters turn.
4.6.
Conclusion
Current limitations to how people at risk of suicide are understood and responded to
within mental health services may be reinforced by a paucity of relevant research
underpinned by appropriate inquiry approaches. Thus, I have argued that there is a
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broader contextual data into an exploration of experiences of suicidal crisis and
related mental health nursing care. This infers the need to engage stakeholders in
research so that their ‘voices’ can be heard and their expertise integrated into an
evolution of knowledge and practice. In the present project this endeavour was
underpinned by constructing accounts with consumers and nurses which focused on
the experiences and needs of consumers and nurses in the context at hand, the
extent to which needs were met, the potential role that interpersonal interaction
had in that context, and what contextual factors mediated the quality of care.
Establishing the rationale to interview consumers who had experienced suicidal crisis
and related nursing care, and to survey and interview nurses regarding that context,
was the first step in what evolved to be a challenging and complex inquiry process.
Creating a pathway ‘in’ to MHS in order to access, construct and find a way ‘out’ for
the participant’s accounts, required extensive practical and ‘political’ efforts.
Fundamental to a successful foray into a challenging field of research which had
arguably remained largely unexplored was interpersonal engagement within a
structured but flexible framework of inquiry. It was ‘partnerships’ with a range of
stakeholders that helped develop and sustain the comprehensive framework
required to engage and support participants. Furthermore, it was a particular quality
of engagement with nurse and consumer participants that enabled collaborative
construction of data concerned with a very personal, significant and sensitive issue
and experience. Engagement at these levels identified and countered something of
the problematic ‘silence’ and fear around suicide.
It must also be noted that implementing a project sustained by my coordination of
so many relationships and processes, while a great strength of the project,
consumed a lot of time and energy within the constraints inherent to a PhD project.
Furthermore, this level of complexity, combined with the possibility of adverse
outcomes for participants, presented the possibility that the project might suffer
serious setbacks. Challenges were also inherent to construction, analysis and
interpretation of data. These factors were taken as serious concerns not only
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but also because of the nature of the subject at hand, and the intention that findings
might be used to inform clinical practice. In particular, I felt a great obligation to
represent the participants faithfully, and to ensure that any findings which might
ultimately affect people around suicidality or nursing care were optimally relevant
and trustworthy. I feel confident that my foray into the research field created a
‘pathway’ that may be utilised and developed by others in comparable contexts, that
generated positive and interesting processes and experiences, and that did yield
valuable data.
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Chapter
5
–
Suicidal
and
alone:
suicidal
crisis, intersection with services, and lack
of therapeutic engagement
This chapter draws upon consumer and nurse participant data to highlight the
multidimensional (holistic) nature of consumer suicidal crisis, and to identify
consumers’ mental health service‐related needs in that context. As a first step in
revealing something of the consumers’ service ‘journeys’, a particular focus is given
to initial intersection with services around suicidal crisis.
The participant data reinforces that suicidal crisis typically involved an experience of
intense suffering and desperation, and then pursuit of death as an escape from that
experience. In line with a holistic construction, the chapter identifies that the
principle needs, understood by both nurses and suicidal people to exist at a time of
suicidal crisis and intersection with mental health services, revolved around gaining
access to service, the provision of physical care and safety, treatment of psychiatric
symptoms, and appropriate interpersonal engagement with others (including family
and friends, nurses and other healthcare staff). It is argued that intrapersonal and
interpersonal factors were of primary concern in respect to these needs and that the
nature of engagement between nurses and consumers was of particular importance.
The data also indicates, however, that needs were only partially met, particularly as
meaningful engagement between nurses and consumers was experienced as
minimal. This implies that consumers remained overly isolated as they entered
inpatient unit settings and were not fully engaged in respect to their intrapersonal
experiences. From the nurses’ perspectives it is evident that some nurses also felt
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interpersonally engaging with consumers. This lack of engagement is amplified as
being problematic because the data suggests that consumer suicidal crisis presented
very real risk of harm or death and was something that nurses regularly encountered
in their practice. In exploring these issues the chapter serves as an introduction to
further consideration of the ‘gap’ between the rhetoric of therapeutic engagement
(encompassing holism, recovery and alliance), and the medicalised, difficult to
navigate, and sometimes coercive model of care that participants’ predominately
experienced.