Peter Ashworth

Developing evidence‐based practice: experiences of senior and junior clinical nurses

AIM This paper is a report of a study to compare factors influencing the development of evidence-based practice identified by junior and senior nurses. BACKGROUND Assessing factors influencing the achievement of evidence-based practice is complex. Consideration needs to be given to a range of factors including different types of evidence, the skills nurses require to achieve evidence-based practice together with barriers and facilitators. To date, little is known about the relative skills of junior and senior clinical nurses in relation to evidence-based practice. METHOD A cross-sectional survey was undertaken at two hospitals in England, using the Developing Evidence-Based Practice Questionnaire administered to Registered Nurses (n = 1411). A useable sample of 598 (response rate 42%) was achieved. Data were collected in 2003, with comparisons undertaken between junior and senior nurses. FINDINGS Nurses relied heavily on personal experience and communication with colleagues rather than formal sources of knowledge. All respondents demonstrated confidence in accessing and using evidence for practice. Senior nurses were more confident in accessing all sources of evidence including published sources and the Internet, and felt able to initiate change. Junior nurses perceived more barriers in implementing change, and were less confident in accessing organizational evidence. Junior nurses perceived lack of time and resources as major barriers, whereas senior nurses felt empowered to overcome these constraints. CONCLUSION Senior nurses are developing skills in evidence-based practice. However, the nursing culture seems to disempower junior nurses so that they are unable to develop autonomy in implementing evidence-based practice.

What is the ‘World’ of Phenomenography?

Abstract Phenomenographic research (especially that which aims to uncover student conceptions of key disciplinary concepts) is subjected to critical review on two main fronts. (1) We consider the adequacy with which research procedures for revealing student conceptions are stipulated. There are clear methodological requirements for the study of life worlds, not all of which phenomenography consistently meets. (2) The product of phenomenographic research is to arrive at a structure of categories of description. This aim threatens to subvert entry into the actual student life world, which may well have less coherence than phenomenography requires. Additionally, phenomenography can show over‐concern with ‘authorized conceptions’: student perceptions of the world are implicitly seen as deficient versions of the official views. The article advocate that phenomenographic research should give more active consideration to the process of research in revealing the actual lived worlds of students.

Presuppose Nothing! the Suspension of Assumptions in Phenomenological Psychological Methodology

Historically, the suspension of presuppositions (the epoche, or bracketing) arose as part of the philosophical procedure of the transcendental reduction which, Husserl taught, led to the distinct realm of phenomenological research: pure consciousness. With such an origin, it may seem surprising that bracketing remains a methodological concept of modern phenomenological psychology, in which the focus is on the life-world. Such a focus of investigation is, on the face of it, incompatible with transcendental idealism. The gap was bridged largely by Merleau-Ponty, who found it possible to interpret Husserls later work in an existentialist way, and thus enabled the process of bracketing to refer, not to a turning away from the world and a concentration on detached consciousness, but to the resolve to set aside theories, research presuppositions, ready-made interpretations, etc., in order to reveal engaged, lived experience. This paper outlines the history of the suspension of presuppositions and discusses the scope and limitations of bracketing in its new sense within existential phenomenology. The emphasis is on research practice and on the phenomenological quest for entry into the life-world of the research participant. It is argued that the bracketing of presuppositions throughout the process of research should be a cardinal feature of phenomenological psychology. Of equal importance is the investigators sensitive awareness that the investigation of the life-world and the phenomena which appear within it is a thoroughly interpersonal process, necessarily entailing the taken-for-granted assumptions implicit in all social interaction. These presuppositions are not open to bracketing.

Problems of competence-based nurse education

The system of nurse education in the UK is undergoing a radical shake-up. Many new courses are being designed and implemented along the lines of the Project 2000 framework. New curricula and course structures are required to meet the changing role of the nurse of the future. Many curriculum design teams are adopting a competence-based model of curriculum to meet these needs. This approach is receiving central encouragement (UKCC 1986). In this paper it is argued that this strategy is faulty and ill-conceived; the inherent difficulties of the competence-based model of curriculum design are highlighted. These issues are of fundamental concern to nurse educators and students in the UK.

Seeing oneself as a carer in the activity of caring: Attending to the lifeworld of a person with Alzheimer's disease

In this paper, I show that the notion of lifeworld is central to phenomenology, and that (in particular) it is only in our reflection on the lifeworld that we have a grasp of our selves. If this is so, it provides an approach to the task of caring. In hard instances, such as caring for the person with Alzheimers disease, the main difficulty is one of sociality—to see the patient as a person. A suggested answer is that a carer who tries to grasp the lifeworld of the patient may be enabled to see the personhood of the patient, to have their own project of caring thereby enhanced, and (on reflection) to see themselves as a carer in the activity of caring.

Some Social Consequences of Non-compliance with Pelvic Floor Exercises

Summary Simple exercises aimed at strengthening the pelvic floor (Kegel exercises) are normally recommended to mothers post partum. There is some evidence (albeit not entirely conclusive) that such exercises can be effective in preventing or ameliorating urinary incontinence. However, patient compliance is often lacking. In this paper we outline some of the socio-emotional consequences of such non-complicity, and their implications for the continued care of patients with urinary incontinence. The evidence is drawn from in-depth qualitative research interviews.

Understanding as the transformation of what is already known

The conventional image is that we (and other students) reach an understanding of something after a period of puzzled wrestling with the material. Understanding is the end‐point of learning. However, there is an important sense in which understanding (of a rudimentary kind) precedes effective learning. Trying to develop this conceptually, I draw on Heideggers account of hermeneutics in Being and Time (1962). The individual is seen as dwelling in an already‐interpreted world with which they have to come to terms. The focus (especially in university and other adult education) becomes the learner as the puzzled, would‐be interpreter of the writing and speech with which they are confronted. The interpretation is attempted on the basis of what is already known. However, the struggle is not purely individual. I argue that the paradigm of meaning–interpretation in the context of learning is conversation in that human learning is best considered participatory.The conventional image is that we (and other students) reach an understanding of something after a period of puzzled wrestling with the material. Understanding is the end‐point of learning. However, there is an important sense in which understanding (of a rudimentary kind) precedes effective learning. Trying to develop this conceptually, I draw on Heideggers account of hermeneutics in Being and Time (1962). The individual is seen as dwelling in an already‐interpreted world with which they have to come to terms. The focus (especially in university and other adult education) becomes the learner as the puzzled, would‐be interpreter of the writing and speech with which they are confronted. The interpretation is attempted on the basis of what is already known. However, the struggle is not purely individual. I argue that the paradigm of meaning–interpretation in the context of learning is conversation in that human learning is best considered participatory.

The Lifeworld as Phenomenon and as Research Heuristic, Exemplified by a Study of the Lifeworld of a Person Suffering Alzheimer's Disease

The carer of the person with dementia is enjoined to maintain respect, and to reinforce this a bill of rights has been established (Bell and Troxel, 1994). Of course, talk of rights does not guarantee respectful behaviour. In this paper it is argued that the discovery that the sufferer continues to be a person, with a unique lifeworld, can assist the carer to conform willingly to the demand that they act respectfully.The current research project makes central the idiographic description of the individual case.

“Can't Really Trust That, So What Can I Trust?”: A Polyvocal, Qualitative Analysis of the Psychology of Mistrust

This paper describes an experiment in carrying out, as a group, a phenomenological analysis of a qualitative interview on the topic of mistrust. One in-depth interview was analyzed phenomenologically by each of the six members of our group. We then shared and discussed our individual analyses to generate a consensual analysis. Finally, additional or divergent perspectives were offered by individual group members to add further contextual and reflexive dimensions. We consider what we gained from this exercise and the difficulties encountered. We also reflect on the insights into the topic of mistrust produced by our analyses.

The variety of qualitative research. Part one: introduction to the problem

For a number of reasons qualitative techniques have taken firm root in nursing research generally and are of growing importance in research undertaken by nurse educators. But there is a great deal of confusion about the nature of the data which are produced by qualitative research, the way such data must be handled, and the use to which such data can be put. The confusion often results from a failure to differentiate between several orientations to qualitative data. Positivist research may use qualitative data (something not always recognized). It presupposes that there is some underlying, true, unequivocal reality, and a theory covering this is to be sought by the research. There must be evidence of validity-in the sense of a match between the data and the reality they are supposed to reveal. Non-positivist research is of a number of kinds, despite often being treated as unified. These will be treated in the second part of this paper.