Open reviewing process
How do I improve my practice of training midwives and nurses in the use of Q-Pulse?
My research involves the design and evaluation of the e-learning tutorial for the use of Q-Pulse. The study was conducted using an action research approach. I describe two action research cycles. First cycle involved the evaluation of Q-Pulse usage and training. Second cycle involved the design and evaluation of the e-learning tutorial. I have used McNiff (2010) action planner to explain my action research enquiry.
dissertation explains how I have generated a living educational theory of
practice as a practitioner reflection on action as I answer my research
question: “How do I improve my practice of training midwives and nurses in the
use of Q-Pulse”. Through the research process, I show how my values were used
as living standards of judgement to test and validate my claim of knowledge. I
hope that the reader would be able to see how my personal values of ‘Respect’ (Listening) and ‘Openness’ (participatory
approach) have become communicable standards of judgement (Laidlaw 1996) as I
lived during the course of my research.
Please review and provide comments and suggestions
I am excited to be reading a nursing Living Theory research account because yours is a rarity and has the opportunity to influence research methods in healthcare. You are timely in focusing on technological methods of transmitting knowledge and learning in this age of social change and widening influences. From your description of the research process it is clear that you learned from reflecting-in-action and that you made adaptations as a result. This is indeed an action research account and your learning and use of personal/professional values as standards of judgement show your commitment to using your practice values as a researcher. I would love to work with you in responding to the Editorial board comments about '... developing a clearer sense of living values being enacted in practice...' if you would like to develop the 'living' nature of your theorising and how you put it into practice for publication.
I read your paper and made comments as I read it as if I was having a conversation with you. This is never the same as having a face to face conversation but I hope it shows my immediate responses, how ideas grew and themes emerged. It is the themes emerging that I will respond to here. But first, who am I to respond to your paper? Where am I coming from as reader?
I am a UK health visitor who found living theory as a way of researching what I was actually doing in practice while I was doing it. Because of the complications and split that would have been necessary if I was to research discrete aspects of my work, as 'add on' separately from my daily tasks, I was delighted to discover that researching and reflective practice could become one and the same. This is why 'listening' and 'participatory approach' that you name as values speak to me. I called my version 'alongsideness'. The added extra that Living Theory gives that action research doesn't get near is the living, developing nature of uncovering and explaining uniquely personal knowledge you as practitioner (midwife manager, researcher) brings to the social context you work in. Your research will speak to other midwives and managers in ways traditional research avoids and can give practitioners in your field hope they can explain what is really important to them in how they work effectively. This is so important at this time when nurses feel stretched and constrained and unheard.
For your research to be a livng theory it needs to give the reader access to who is speaking. I was not clear if you were a midwife until the end when you called yourself a midwife manager. I needed to know that to begin to understand where your values were coming from. To build an understanding bigger than the words. I as a nurse began to form assumptions that I was reading words of another nurse. My assumptions may not have been accurate but we all use our own current knowledge as a start in understanding another person. Readers look to the text to tell us what unique perspective the writer holds and if we need to put our own perspective to one side to truly hear the other. I believe this is what you are referring to in your value of 'listening' and 'participatory approach.'
Is it possible to know more about you as practitioner and the social/practical context that leads you to value listening and a participatory approach. I know developing Q-Pulse was your aim but there needs to be some lead in to explain why Q-pulse is a useful option for training midwives. I am not questioning it, but your reasoning seems important if colleague resitance is to be tackled because they don't know what you know about the usefulness of this technology. I needed to wait to page 66 to see values of midwives mentions.
'My values have developed from the espoused midwifery values such as normality, woman-centered and partnership in care, respect, client-first, evidence-based care and advocacy (ABA, 2000). All of these values mentioned can only be lived by listening to and involving women in their care, hence my values of listening and participatory approach evolved'.
Moving your closing paragraphs to the start by way of introduction would be useful. I can only guess, having practiced in health care during similar training evolution, that resistance might be grounded in practitioners' fear that their own values/ interpretation of ABA values may be dismissed as unimportant by on-line training? I wonder if you can set Q-pulse into the context of the bigger picture of training so midwives can be reassured that the qualities of relationship and partnership they value so much can be acknowledged and developed either in this or in parallel training. If I know midwives at all, I would suggest there is a strong healthy belief that they each have special complex knowledge of relationship, how to be with women and how to fine tune their midwifery skills for good outcomes for the person in front of them. You are on to a winner if you can firmly embed the specific advantages of Q-pulse learning and wider technology into their bigger picture of the midwifery training that they already value. If midwives could be invited into a Living Theory approach as part of their training they would feel heard and valued as practitioners. Acknowledging their exisitng practice knowledge, including the relational aspects not currently accessible through written text ot technology, would present the bigger picture of midwifery training in which Q-pulse has a useful place. I do hope this makes sense.
I really believe you do have a contribution to make here in bringing together the relational qualities you value and the knowledge created by all individual practitioners in the course of their work with training using on-line technology. If you like these ideas you will find the comments i made on first reading attached here.
I agree with Robyn that this is indeed a worthwhile piece of research and is of significance not only to your own practice but also for the field of midwifery in general.
My query throughout my reading and re-reading of your paper was to do with your values. I can see that from the outset of the paper that you are able to articulate your values clearly. I think readers can see how your values guided your research methods and data collecting strategies clearly in terms of how you listened to your co-researchers carefully in a ‘listening’ and ‘participatory approach’ manner.
However, I am missing the sense of your identity and how you attempt to live your values in your everyday practice. I would love to read more about how listening and participatory approach form the foundations of your practice and how they are linked to the concerns you hold; why you were concerned and the connection between your concerns around Q-Pulse and your values. I suspect from reading your paper that you know these links innately, but I think it would be helpful for readers of your paper to see them stated more explicitly.
On p. 56, you talk about how you experienced yourself as a living contradiction, but it would be helpful if you could point out where exactly the contradiction arose in relation to your values in your practice. I agree with Robyn also that while finding that we are not living as closely to our values as we would like can be demoralising, it is important not to perceive this as a failure but more as an opportunity to take action; to learn more about ourselves or maybe to become an activist.
The section at the beginning of Significance of action research in midwifery on p. 65 where you talk about your values is elucidating and I think it might strengthen your paper if you put that section or a similar, more detailed piece about your values in towards the beginning of your paper.
As an aside, I recently attended the Collaborative Action Research Network (CARN) conference and was chatting to someone who works and researches in the field of adult literacy. They talked about how the sense of embarrassment adults used feel around printed literacy difficulties is now similarly felt in the area of digital literacy. This is something I had never thought of myself and has been resonating with me as I write to you today and reflect on the difficulties you have outlined in your paper with regard to Q-pulse!
I think this an exciting and worthwhile piece of research and I enjoyed it and learned from it. I hope my comments are clear and helpful am looking forward to seeing how you progress it! Please let me know if I can clarify anything for you.
Re: How do I improve my practice of training midwives and nurses in the use of Q-Pulse?
Although we share a valuing of living theory, I am reading and reviewing your article from quite a different context and perspective otherwise. I am an independent educational psychologist, retired teacher (secondary school and university), and active teacher-researcher, living in Canada. Currently, I mentor secondary and university level teachers in their professional development within a framework of action research, living theory, and narrative inquiry. I found living theory during my doctoral studies when I experienced myself as a living contradiction, claiming to love and value my students above all else, and discovering, on careful scrutiny of evidence gathered over many years of teaching, that I had put my students at risk when they left my self-contained special education classroom for mainstream education.
I will begin this review by saying that I am enjoying reading and rereading your article very much. I sense your dedication to the profession and to the action research process. I believe that practitioners in the service of the public have a great deal of knowledge to offer to theorists and policy makers, and your report is evidence of that. I am grateful for this opportunity, and hope you find my comments useful and supportive. Next, I will offer comments on context.. Finally, I will comment on the action research process as you have reported it.
Contextualizing the Research
I began to read your article from a distance – I am neither a nurse, midwife, manager, nor have I any idea of what is means to be a health-care worker in a woman/infant facility in Ireland. An internet search explained Q-Pulse to me, and introduced me to the history of The Coombe, giving me a picture, and some feeling of connection. I imagine that, like teaching, the work in your hospital can be ill-defined, messy, tiring, yet very rewarding. I know that when faced with school reforms, particularly in the area of technology, there was reticence approaching rebellion on the part of many teachers, the cry being, “It takes more time than it saves!”
While my search gave me a better idea of your context and practice, I feel that there is more to your story to be told that may benefit both your report and the reader. A more elaborate description of your (and your participants’) experience and context would bring all of us out here into a bigger picture. Connelly and Clandinin (1995) write “Humans are storytelling creatures who, individually and socially, lead storied lives and tell stories of those lives.” We engage with others, become participants in their stories, make meaning of experience, and learn. So, I find myself, asking, “Who is Anne, beyond her title of manager?” “Who are the participants (co-researchers?) in this endeavour?” “To whom does Anne listen, and what does she hear?” Who are the people who have earned her respect?” “In what, beyond this inquiry, do they participate?” I wonder, too, “Is gender an issue?” Jack Whitehead and Jean McNiff (2006) ask, as action researchers, “What experiences can we describe to show why we are concerned?” and they answer with examples of stories of learning from experience, stories with a generative transformational capacity.
It is important to tell your story in a way that others might learn from your experience (Whitehaed and McNiff, 2001). In the abstract, you have referenced Jean McNiff’s (2010) action planner as guide for your action research, however the source is not included in your list of references, therefore, I have used the following points to guide my reading of your cycles and steps:
· What is my concern?
· Why am I concerned?
· What kind of evidence can I generate to show the situation as it is and as it unfolds?
· What can I do about it?
· How will I ensure that any conclusions I come to are reasonably fair and justified?
· How do I modify my ideas and my practice in light of my evaluation? (Whitehead 1989; McNiff and Whitehead 2006; Whitehead and McNiff 2006)
I recognise your research as systematic, however, I do not see a clear design to for your study. I wonder when, how and why the managers were brought in as participants. A data collection/analysis schedule might help the reader. An important question for me here is “How will I ensure that any conclusions I come to are reasonably fair and justified?” Your descriptive statistics might be tabled with a breakdown across questions, and groups of participants. The voices of those supporting your living standards of judgement are clear and encouraging, and additional verbatim data chunks would further support your claim. How was your validation group formed? What might others have had to say? Their voices combined with yours would serve as a linguistic description of embodied values, and put a human face on the work that you are doing together. Other questions came to mind. Your values of openness and a participatory approach, of respect and listening are claimed in your report. Would you say this work is democratic? Are you doing research with the managers, nurses and midwives, or on them, or for them?
Anne, I hear a strong commitment to solving a problem, a commitment to the learning of nurses and midwives thus contributing to quality caregiving in your hospital, and to a living theory approach. I have asked lots of questions (my nature) and hope that these are of use to you.
Looking forward to the conversation,
Thanks Robyn, Máirín and Judith for you valuable comments.
I have made the necessary amendments in my paper.
Dear Anne, I am so impressed by the difference in this next iteration. You have really grasped and dealt with the context of the research, the roots to your values and how you use them in your practice. You obviously have a wealth of data on your reflections, changes in your knowledge and practice to draw on. I love your honesty about the contradictions. This is truly wonderful to see in nursing. It is a real issue and becomes so much more authentic and inclusive now for me as a reader. With attention to the points I commented on in the attached paper it could stand as a paper for EJOLTS about the emergence of your living theory of an aspect of your practice.
It would be interesting to think about how you name the context. Is full naming necessary? Some of the data sections are lengthy and could be summarised to form 'evidence' of your claims and referenced to your thesis, or another source such as the Appendix. Similarly, the films could still be available but it would be great if the links went to short edited clips that show exactly what you are claiming or alternately you could direct the reader to the place in the video where the evidence for your claim can be found. I am meaning evidence of the values, contradictions, moments of insight or change. I hope this makes sense.
Lastly, you appear modest about some of your statements and I wondered if you can be more certain about your achievements? You really do know what you are talking about because you have reflected, discussed and tested your insights in your practice. However, tentativeness that things might always be different is also useful to hold on to. Balance seems to be the challenge. You have transformed the original and I really enjoyed all the effort and clarity you have created. I congratulate you and look forward to seeing this paper in its next stage. I am certain I will be able to refer to it as an example for nursing. Thank you Anne,
I think this is a much stronger paper now. I believe that it is much easier for the reader to see what your values are and how you work towards your values both in your practice and in your research methods.
Drawing on the first criterion for accepting a paper for EJOLTS, I think that there is ‘sufficient detail for a reader to understand the value-based explanation of the author for their educational influence in …the learning of others and the learning of the social formations where they live and work’. I would love to hear a little more about your educational influence on your own learning as outlined in the criterion. You have outlined it in ‘Reflection on Cycle 1’ beginning ‘Reflecting on my practice based…’ but I think the paper would be stronger with more reference to it and more evidence for it.
Just checking that you can verify that you have permission to use the video clips in the public domain as well as the permission to use the names of the people in the emails in your appendices? Also, there are some typos and small misprints in the paper which I’m sure you would like to clear up before your next submission.
Like Robyn, while I acknowledge that data collated at your focus groups and interviews is strong, I think the paper would be more convincing with some more snippets of evidence to support your claims throughout. The Abstract could be tightened up a little also.
I think your work has some very important implications for the professionalism of the nursing staff and care of patients in your hospital – and this of significance, without doubt.
I love the final section of your paper, which in my opinion is very strong, where there is no doubt as to the authenticity of your values and your desire to enact them in your practice and to work towards the flourishing of humanity in general.
I hope your project and your thoughts flourish and I look forward to seeing your next version.
In reading the new draft of your account, I recognize your living-theory as embodied, evolving, and manifest in your practice. Your account has a strong ring-of-truth to it as you trace the living of your claimed values of listening and participation in your practice. It is a pleasure to read!
I believe that the work that you have recently done to structure your paper, explain your complex hospital context along with your perspective as caregiver/trainer/inquirer, is accessible and a welcome invitation to your reader. The evidence you have provided with the photo, audio- and video-data does more than simply provide support for the claims that you make. You have put a human face and voice on the work done by nurses, midwives, managers, and trainers, one that welcomes the reader into your practice and fosters deepening respect for those working in the field of health care. The audio file of the focus group brings the voices of urgency, passion, commitment and determination directly to your audience. I thoroughly enjoyed eavesdropping on the meeting. Some readers might find the file too long (I did not) and you might want to consider using smaller cuts throughout the paper as evidence of various points rather than all at one time.
When responding to your first draft, I questioned whether gender might be an issue in your study. I am assuming that your managers, nurses, and midwives are women, based on the audio-visual evidence that you have provided in your second draft. If I am correct in that assumption, I believe that the issue of gender ought to at least be mentioned. I feel that you have a contribution to make to the literature on gender and IT use. Your work has provided an opportunity for your participants to voice their concerns, share ideas, develop confidence in their abilities. Your research questions are important. Your values-based explanation of your educational influence is clear, and that influence could be extended to others beyond your particular context. It would be useful in other domains! Perhaps this could be something you would consider looking at in the future. This article may be of interest:
Goswami, A., & Dutta, S. (2016). Gender Differences in Technology Usage: A Literature Review. Open Journal of Business and Management, 4, pp. 51-59. Available from: https://www.researchgate.net/publication/290475791_Gender_Differences_in_Technology_Usage-A_Literature_Review [accessed Nov 25 2018].
Anne, your paper touches my inquirer and mother Selves. Thank you for that. I shall happily recommend your paper to the Editorial Board to consider for publication in EJOLTs.
Dear Robyn, Máirín and Judith
Thanks for your valuable time and your comments. I have made the amendments and edited the video to shorter audio files.
I am so impressed by your adaptability in responding to the critiques. I believe this is another sign of your openness and respect for the other. I find your report is an impressive and believable account of you making an important difference in your own learning, in that of your pupils and especially in the organisation. This is a great account for all that. I am so delighted to see a Living Theory research project in health care and even more impressed that it is in on-line technology in health care.
I have made comments through the paper, all minor, many small grammatical or spelling adjustments. It is attached below. One area for future study might be looking at the times when you can't live the values you have identified. At the moment it seems you might blame yourself but I think that if you looked at these instances when this happens, you might find there is a more pressing value overriding 'openness' or putting pressure on 'respect'? You could find more interesting aspects to your personality and approach to your work. I really liked the way you interlinked the values in the studying of Q-Pulse and the actual midwifery work.
I am pleased to recommend your paper to the Editorial Board to consider for publication in EJOLTs.Regards,
I was delighted to see the latest version of your submission.
In re/reading it I think I found a small point that needs clarification: I am not sure about the levels of interest and reluctance and preference in the following…
Midwives of the older generation are less interested in using computers in the workplace. Studies have identified that females are less reluctant to use technology, which could be a factor, as midwives and nurses working in our hospital are all females (Goswami and Dutta, 2016). Many midwives and nurses prefer a hard copy of the policies, guidelines and protocols.
I would add that I miss the visuals that accompanied the digital data. They brought me into your inquiry space. Perhaps a still shot with the hyperlink could be inserted?
Other than that, I would like to say that has been a pleasure to read your evolving report. I find your work intriguing on both a personal and professional level. Your dedication is clear and to be admired, and I happily recommend this article for publication in EJOLTS.
I look forward to seeing the online version, to the next steps in your inquiry, and perhaps, to further conversation.
Thank you for your recent revision of your paper.
Well done on the work you have done to show your reader how you are engaging in living educational theory in terms of living in the direction of your values. It is now much clearer.
I think that there is now sufficient detail for a reader to understand your value-based explanation for your educational influence in your own learning, the learning of others and indeed, in the learning of the social formations where you work.
I think though that you should do a thorough check for syntax, spelling and grammar as you prepare for publication.
I have no doubt but that the digital e-learning programme that you have designed will be of great benefit to fellow professionals and that it will help to encourage good practice in your hospital.
I recommend your paper to the Editorial Board to consider for publication in EJOLTs.