dual-tasking: wordplay and introductions
G’day KTTC,
I’m double tasking today: I have a “KT Working Group” meeting this aft at the rehab hospital where i work (part-time), and as a new member of that group, I’m to introduce my KT-self and current research … in five or so minutes. My understanding is that this hospital-based working group wants to form a forum where KT researchers at/in Western University / London can learn of each other, each other’s KT work, and, ideally, collaborate. So I’m needing to pull my thoughts together about how to introduce myKTself to them this aft …
… and, the dual-task, I’ve been wanting/needing to make the time to introduce my KT-self to the KTTC too. It’s a remarkable characteristic about being in the KTTC: the time one spends as an active member is precious and oft-times required elsewhere. Being in the KTTC, i’ve sometimes said, is an extra-curricular activity. But as this point in my (our?) lives, everything’s curricular, isn’t it? Work is school, school is work, schoolwork is Life.
In any case, I hope you’ll forgive the dual-tasking.
If we’d never met before, I’d likely start by telling you the following: I’m a PhD candidate in Western’s Faculty of Health Sciences | Health & Rehab Sciences | Health Promotion stream. I finished my comps about 18 months ago (a paper that troubles m/y/our responses to performances of masculinity, and a second paper that calls upon health promoters to draw their theoretical musings from not just behavioral but also relational and socio-political waters), and for a variety of legitimate reasons and unexpected delays, I’m just now about to begin my fieldwork. Ie: ethics are approved, my research site (a long-term care home) is willing to work with me, my committee has approved my proposal … i’m just waiting for the final “Okay we’re ready for you, come on in” email from the nursing home. (They’ve been diligently albeit slowly preparing for my “arrival” by putting in place an internal communication plan; I’m counting on the payoff being more buy-in, but the opportunity cost has been about a term’s worth of time/tuition).
My KT-self? I’d say I’ve always located my conceptions of KT in PARIHS (wouldn’t that be Nice?). Y’know: Kitson et al, 1998, 2008 … “the Successful Implementation of Change is a function of the Evidence one is trying to put in place, the Context into which one is implementing that Evidence, and the way in which the change processes are Facilitated … or, SIECF for short. I’ve followed the lit as the PARIHS folk have tweaked their model (by suggesting a two-phase, diagnostic assessment of C to inform E-needs and F-strategies), and I’ve followed others who’ve critiqued and/or built upon PARIHS – eg. Helfrich et al, 2010; Stetler et al, 2011 – … the latter of whom have suggested a re-characterization of the F. My (doctoral) research focuses primarily on ‘the assessment of Context’, then (perhaps fleshed out in post-doc work) on Facilitation strategies that might, potentially, transform a culture and its relationship with Evidence.
My lit review found that:
(i) there’s an identified need for KT in LTC (citing concerns re: quality of life, quality of care, quality of worklife, resource/financial/utility woes/projections);
(ii) that few researchers have used qualitative methods to ‘assess Context’ (especially of a LTC home) as part of a KT project;
(iii) that even fewer have used a Critical theory lens to shape their methodology; and
(iv) there’s a continued call for Critical qualitative researchers to hone their critical-methodological skills & knowledge-claims.
A brief aside re: “Critical” … i like to write the word with a big C to denote a particular worldview that’s characterized by a concern with social injustices (read: especially inequities — ie, issues of ‘fairness’) and how social ‘structures’ (eg: discourses, policies, ideological norms, centres of ‘power’) condition and shape individuals’ behavior, often invisibly. Applied to the current LTC landscape, I’m theorizing a priori that the easily identified working and living conditions in LTC (ie, those measurable outcomes re: quality of life, care, and worklife) are conditioned by particular structures that remain either hidden from our consideration and/or, more simply, are taken for granted. My “Critical” task is to uncover those taken-for-granted values, beliefs, and behaviors that collectively constitute the culture (context?) of a particular LTC home.
While i think it’s erroneous to conflate culture and context, my research has for its focus a culture … specifically: “the culture of dementia care knowledge in (this) LTC”. My chosen methodology is Critical ethnography, and my aim is twofold: (i) to explore and better understand* the culture of dementia care knowledge in this LTC home, and (ii) to re-present* those ethnographic findings/insights to the LTC home staff, residents and families … so as to transform* their respective perspectives just enough so that they, of their own collective volition, initiate their ‘bottom-up quality-improvement’. Three things* need unpacking here:
• How am I going to *understand* their culture?
• How am I going to *re-present* the critical ethnographic findings?
• What do I mean by *transform* their respective perspectives?
Unpacking:
• UNDERSTANDING: I’m an outsider, a non-clinician, a relatively young, healthy, (upper?) middle class, male scholar … doing my research with/among insiders: clinicians, ethnically & economically diverse, (mostly) female health care providers/recipients. Acknowledging and reflecting upon my outsiderness, taken-for-granted privileges, and subjectivities is fundamental to my project if it is to be epistemologically critical; such reflections will, I’m sure, be ongoing and, hopefully, as productive as they are introspective. My strategy for understanding ‘a culture of dementia care knowledge’ is to follow the methodological tenets of Carspecken (1996, 1999, 2001) … by (i) positioning myself, as above, Critically; (ii) by doing approximately 200 hours of non-participant observation and concurrently analyzing those field notes so as to prep for (iii) interviewing staff, families, and residents about the values, beliefs, and norms I observed and began to analyze, and (iv) by sharing my emerging insights with the participants so as to essentially ‘member check’ the validity of my findings. The analysis of the observational and interview data is intricate: more than just line-by-line coding followed by focused coding followed by thematic analysis, Carspecken requires a researcher to reconstruct meaningful moments that are observed. By ‘reconstruct’ he means to say, If what I just observed probably meant that A, what else could it have meant? B? C? D? E? Of those, have I spent enough time in the field (observing, member checking) to know that it’s A that was meant? Okay, if it’s A, how was it that the participants in the meaningful moment (which, let’s just say, were about deciding how to respond to a resident with dementia who refuses to come to breakfast) … how was it that those participants consented to the outcome of that moment? Who made claims that others consented to? What was the nature of that consent? of those claims? Carspecken offers a set of heuristics that reconstruct such moments along three person-to-world relationships (which is an epistemological shift away from the single “observer – objective world” traditional worldview): (i) subject to object relations (giving us a presupposed objective world supporting objective truth claims open to multiple access); (ii) subject to subject claims (giving us a presupposed social world supporting normative truth claims or claims based on intersubjectivity); and (iii) subject to self relations (giving us a presupposed subjective world supporting subjective truth claims or claims based on privileged access). Sound heady? I think so too. And/but one of the beneficial consequences of being delayed in getting into the field is that I’ve tried to wrap my head around all this, and I understand my task to be one of reconstructing the implied, unstated claims that are conferred in intersubjectively meaningful moments of creating, sharing, and/or applying dementia care in LTC, with a particular eye for the unspoken yet omni-present norms that people invoke when agreeing with/convincing others.
• RE-PRESENTING: If the above analysis constitutes my critical ethnographic work, based as it is on all my observation and interview data, the KT component of my work begins, formally, during the end-of-project focus groups I’m planning to host. Rather than being occasions for additional data collection, the primary purpose of the focus groups will be to re-present my ethnographic findings to the stakeholders and to subsequently foster their critical reflection and dialogue about the findings. It’s not, by the way, just careless wordplay that prompts me to write “re-present” rather than “represent” — the “re-” signifies the presence of my interpretations, and a rejection of ‘representativeness’ … I’ve often thought of my role in these focus groups as being one where I hold up a distorted (ethnographic) mirror to the participants: it’s distorted because i don’t think I (or anyone) could hold up a mirror that fully, completely, and accurately represents the lived experience of being a member of a particular culture; rather, the best one can do is to re-present one’s interpretations of the limited data they’ve collected. Moreover, this more humble mirror will seem distorted to the participants because my Critical aims will seek to make their familiars seem strange, and to make their strange feel familiar: ie, “note these taken-for-granteds”. Of course my re-presentations can’t be too distorted, or I’ll risk not being meaningful to the participants. Which, in another sense, is also to say that my re-presentations of the ethnographic findings can’t be too ‘eggheadish’ or jargon-filled; nor can they be boring. Instead, I hope my re-presentations will engage all senses, grab hearts, stir up strong, perhaps disorienting feelings, and cause a kind of deeply felt interest in the findings that are drawn from data about themselves and their role/place in this particular (dementia care knowledge) culture. This is actually one of the most exciting yet angst-provoking elements of my proposed research, for i think it’ll require of me a kind of performativity that I cannot yet concretely imagine. (I’ve sown some seeds with a local playwright, stage director, and three artists/actors that I hope will blossom into some productive brainstorming re: rendering an aesthetically engaging, performative re-presentation of the findings; perhaps I’ll let you know another time what comes of that).
• TRANSFORMING: If I am, somehow, able to perform this aesthetically engaging re-presentation of the findings and, thereafter, am able to create and hold a kind of space where participants can safely and productively reflect and dialogue about the issues, themes, and taken-for-granteds that are raised, the theoretical aspiration is that participants’ own perspectives of their (dementia care knowledge) culture will be broadened, and, moreover, that the reconciliation of unsettled emotions and insights will yield a kind of perspective transformation that will in turn yield an organic, grassroot/bottom-up quality improvement initiative. (Recall a previous post from this blog re: perspective transformation theory — see Mezirow 1968; McWilliam 2007; Maich-Matthews 2010). Were that ‘perspective transformation’ to happen, a new set of questions arise re: me and my research (role):
o Can/should I support that new initiative, perhaps by taking on a role as knowledge broker?
o What counts as ‘successful implementation of change’? … does the fact that they reached some point of transformation constitute success? Or is ‘success’ only realized if/when that transformation results in an actual change in practice?
o At bottom: Can the process itself be the outcome?
Well, in the time it took to write these 2000 words (a day and a half, intermittently), I had the meeting with the new KT working group (yesterday), and for better or worse, my colleagues let/encouraged me go much longer than just 5-10 minutes, their rationale being that they wanted to engage in a sharing of our KT-selves that’s comprehensive and detailed. I suppose that that’s my rationale too for crafting such a long blog-post: while i accept that i probably lost a few readers several paragraphs ago, I hope that anyone who stuck it out this long found this ‘introduction of my KT-self’ to be engaging, or at least: thought-provoking. The interesting thing about writing in/to a peer-populated blog is that it’s not peer-reviewed before hitting the Post It button, but it is open to your review from here on out. Insofar that i value peer mentorship and trainee collaboration, i of course encourage any feedback or comments.
I’m happy to report, in closing, that just this morning, I received an email from my research site: I’ve (finally) been invited to a “final preparations” meeting with the senior leadership team – next Tuesday – and so I’m excitedly/anxiously heading into this long weekend filled with anticipation about understanding, re-presentating, and hopefully, becoming complicit in transforming at least one LTC home’s culture of dementia care knowledge.
See you on the flip side,
Ryan
Cheryl Cook 8:41 am on April 10, 2012 Permalink
HI Ryan
This sounds very interesting! We recently completed a CIHR funded meta-ethnography on the perspectives of paid dementia care workers about the work they do. Any type of paid worker, any setting – but majority are LTC settings. It’s been submitted for publication and hopefully we will hear about that soon. We also have a Knowledge Users report that we prepared for the KU’s who worked with us on this project, as well as groups in acute care, continuing care etc who are working with us on further projects as a result of the review , which we’ll put on our website once the main publication is accepted.
We’d be very interested in hearing about your work as it progresses.
Cheers
Cheryl