Enabling participation

Every effort was taken to ensure that the study was participatory, that is, done by the group rather than done to the group, by checking understanding with the participants throughout the inquiry. Change and development may cause discomfort and some dissatisfaction which can lead to individual stress and

potential conflict between group members (Ghaye, 2005). I was conscious that individuals may use defensive routines to protect themselves when dealing with the real meaning of a situation and confronting these routines might heighten distress (Bray et al., 2000). In order to deal with this, I accepted any defences as a natural cultural response. The interactive exercises accepted and incorporated all contributions without drawing adverse attention to any avoidance behaviours. I took care to deal with stress immediately and directly by resolving issues as they arose. The reflective techniques promoted sharing of thoughts and feelings, whilst enabling participants to develop an understanding of themselves and others.

I organised preparatory and reflective exercises that facilitated the explorations of experience creating a constant cyclical process of interaction, action and evaluation. The intention was that this would lead to genuine, meaningful, long-lasting learning. This involved a high level of reflexivity and sensitivity to the role of self in mediating the whole research process (Somekh, 2006). In the early stages I took the lead and, over time, was able to facilitate enabling the group to take ownership of the process. The fundamental aspects of my role were in creating the conditions for collaborative inquiry that enabled the group to participate. This involved creating a safe, trusting environment; valuing experience and encouraging reflection and action.

3.6.3.1.1 Creating a safe, trusting environment

The challenge in this study was to accept and live with the cultural drive for evidence-based practice and meeting performance targets whilst balancing the need to be aware of individuality. Becoming culturally self-aware can be challenging and requires support (Daloz, 1999). To facilitate this development requires a safe learning environment where views of the inquiry group could be shared openly, explored and developed. The principles of the person-centred approach (Embleton Tudor, 2004) balanced with the adult learning approach (Mezirow, 1991a, 1991b, 2000) were chosen to demonstrate value of the participants’ experience, to reduce anxiety, to encourage participation and to challenge assumptions.

My role involved facilitating a safe learning environment that conveyed genuineness, understanding and unconditional positive regard. When a person’s feelings, anxieties and needs are accepted unconditionally, they can then express how they are, or are not coping with their circumstances (Rogers, 2004). Developing person-centred practice needs commitment to develop a deep understanding of others as thinking and feeling beings with the potential to develop and grow, as it is a way of working that is underpinned by flexibility, mutuality, respect, autonomy and care (McCormack, 2003a; Slater, 2006; Leplege, 2007). ‘Being’ person-centred requires an agreement that is built on mutual trust and a shared understanding (McCormack, 2003c). Demonstrating openness and honesty in terms of agreeing the values underpinning the study was important. This involved creating ground rules and contracting to work together in an honest open way (Dewing, 2002). A statement of ground rules was developed during meeting 1. Ideas were shared, explored and documented on a flip chart. These were written up and circulated via email post-meeting and were then revisited and agreed in meeting 2. An example of the ground rules can be found in Appendix 15.

These referred to positive behaviours within the group with regard to respect, accepting others views and treating others as we would expect to be treated. Respect for each other’s time and conflicting commitments were an important part of this. In recognition of the busy workplace and clinical responsibilities it was agreed with the group that they should aim to attend four out of eight action meetings. Building in this flexibility gave the group choice and helped reduce the potential stress of the competing demands of clinical practice and the development commitments of being involved in this research study. In recognition of the democratic working relationship the ground rules applied to all of us and could be referred to by any member of the group at any stage as a positive reminder of our agreed working arrangements. They also reinforced the participants’ right to withdraw from the study at any stage without it affecting their future relationship with me or the other participants.

The role of researcher and facilitator involved building trust by being consistent at every meeting, keeping the group on track, recognising one’s own limitations and being willing to be challenged. In order to achieve authenticity in the

relationship support needs to be constantly reviewed and adapted to suit the changing context (Zachary, 2006). This was done throughout each meeting by establishing a relationship where individuals felt welcomed, informed and involved. The details of these meetings are further explored in 3.8. In order to establish the success of this approach, evaluation was carried out at the end of each session.

The key to facilitating transitions requires a safe therapeutic learning environment where challenge and support are offered in equal measure in order for growth and mutual learning to take place (Daloz, 1999). Difficulties arise if the perceived learning environment creates high challenge and low support causing withdrawal; low challenge and high support that confirms the status quo; or low challenge and low support leading to inertia. I was aware of these attributes and as a result of the behaviours and actions within the group reflecting was able to adapt the approach as and when required. Getting to know the group involved confirming the status quo and accepting things the way they were until the group showed signs of being ready for a challenge. By acting as a role model and demonstrating the willingness to change enabled the group to challenge their own assumptions.

In order to carry out the role of facilitator effectively required support and challenge. Some of this came from the group but, to manage the data analysis and write-up of this study, support was sought through action learning, critical companionship and networking. This gave me opportunities for reflection both in a group and one to one.

3.6.3.1.2 Valuing experience

It was important to me and for the validity of the study that the group felt able to participate and to share their experiences without feeling criticised or undermined. If a person feels safe and free from anxiety then positive responses can result in a change in thinking, values and behaviour which will be evident in the form of action (Rogers, 2004). Creating an environment where experiences, views, attitudes and beliefs could be explored with openness and honesty was fundamental to this study.

The data collection processes aimed to draw on the participant’s experiences through the use of experiential learning. Experiential learning emphasises the evolving, dynamic nature of knowledge that develops as a person develops their understanding of themselves and others and in turn their interactions (Knowles, 1990; Mezirow 2000). This involved learning informally through reflection where the emphasis is placed on the nature of the participants' subjective experiences (Burnard, 2002). At the heart of collaborative enquiry is the assumption that there is a potential for learning embedded in the experience of the group (Bray et al., 2000). The experiential learning style had a strong emphasis on action that was a result of reflecting on experience.

3.6.3.1.3 Encouraging reflection and action

Experience is made up of associations, concepts, values, feelings and responses that provide a frame of reference for life and are communicated through thoughts and actions (Mezirow, 1991a). Learning from experience of practice involves critical reflection on the assumptions underpinning practice from which interpretations, beliefs and values are based. It enables the transformation of the unthinking routine practices that may have been established at a time when individuals were unable to act with the sensitivity and moral judgement characteristic of best professional practice (Somekh 2006). It enables a group to realise how attitudes, values and behaviours may be inhibiting change and to take responsibility for the unlearning of the past habitual practices and routines (Sharp, 2005). The facilitation of critical reflection increases awareness of the tension between knowledge, experience and action. This helps develop new knowledge or new ways of thinking whilst transforming culture and context of care (Manley and McCormack, 2004).

In order to promote learning in the meetings a reflective framework was chosen to stimulate reflective questioning and to help structure thinking. Critical reflection was chosen as it presents challenges that bring new relationships and experiences without allowing fear and defensiveness that may prevent us from honestly examining our own feelings (Brydon-Millar, 2008). The reflective framework can be found in Appendix 16

The process of critical thinking ensured that issues were explored in depth and resulted in agreed actions. These actions were negotiated and aimed to be realistic and achievable. Burnard (2002) argues that action is part of learning through the process of thinking and activity. In recognition of workplace pressures and respect of the participants’ wishes, agreed actions were something that they would normally be doing as part of their work rather than an added extra.