According to Guba, paradigm is a basic set of beliefs that guide action. It is an interpretative framework which is guided by a set of feelings and beliefs relating to the world and how it is usually studied and understood. From the literature, there are many theoretical paradigms such as positivist, constructivist, interpretivist, transformative, critical, pragmatism and deconstructivist. Paradigm for human inquiry in the field of health and social care was conducted mainly in two broads: positivism and naturalistic or sometimes named constructivist paradigm. Paradigm guide how we make decisions and carry out research. Therefore, different paradigm and approach seek to answer different research question. However, Greenhalgh (2006) encompasses ontology (the nature of existence), epistemology (what it is possible to know) and the methodology (how we gain knowledge).
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Boyle (2007) & Garfield & McCarthy (2005) suggested that in spite of having good system of education in Iraq the leadership of nursing in the Iraq is thought to be affected by numerous aspects including lack of nursing leadership development, isolation, and low image (Al-Da’mi & Boyle 2011). The review of literature section of this dissertation revealed that a wide range of literature exist in from the perspective of Western nursing leadership, however, limited literature is available from the Middle East state specifically from Iraq that explains and examines the nurses of Iraq perceives characteristics of effective leadership. In the clinical area, the decisions were made for exploring the Iraqi nurse’s perceptions and experiences for effectively dealing the nursing leadership in the clinical area. This chapter will therefore, discuss the theoretical framework, translation of interview documents, ethical considerations related to interviewing internationally, methodology and research design employed in this study foe explaining and identifying what the Iraqi nurses perceive as effective leadership along with its characteristics in the clinical settings of Iraq.
For this study, Social Constructionism is chosen as a theoretical framework as it will primarily focus on the perceptions of an individual for describing their experiences. The qualitative study methods are one of a primary method which is used in the research process. The qualitative design methods are mainly conducted in depth so that it can be easy for the researcher to offer more viable results. This qualitative study will make use of interpretive descriptive research for interpretation because this search is helpful to determine the human perceptions and behaviour. This study uses this method as the main purpose is to interview the Iraqi nurses. The construction of themes and constructs will be involved in this method. Thorn et al (1997) and Sandelowski (2000b) stated that this method complements the social constructionist framework. For interview data analysis thematic analysis will be employed.
This chapter firstly discusses the use of social constructionism as a theoretical framework and then discussed the interpretive descriptive qualitative approach and, the use of interviews in qualitative research. This discussion includes the followings: interpretive descriptive methods including strategies used in the present research, research settings, ethical considerations, recruitment and sample, data collection procedures, data quality and analysis. Finally, the use of interviews is discussed.
3.2 Theoretical Framework: Social Constructionism
This research will be approached by the social constructivist point of view. Behind the constructivism the social idea is that an individual builds up the experience and knowledge explained previously. Burns and Grove (2001) stated that the method of every research is a sketch by which a researcher can appropriately follow the flow of research (usually in a logical way) and gather information that can help researchers to answer the proposed questions. It enables any researcher to link the findings to the existing body of knowledge on nursing in Iraq. The qualitative study also aids to offer solution for the issues by taking the general population perception about the concern. By extracting the information from the nurses the researcher will interpret the results. Burr (1995) suggested that social constructionism is the way in which the meanings are extracted from the situations, events, and experiences. The social constructionism attempts to come in terms with the nature of reality and it has a social focus.
Legendre (1993, p. 549) defines Constructivism as “the critical study of knowledge, its foundations, principles, methods, findings and eligibility of its proposals”. The epistemology proposes to take a look at the status, method and value of knowledge by providing answers to three main questions: “What is knowledge? How is it made or created? And how to appreciate its value or validity?” (Schwandt, 2007) This knowledge is critical questioning that invites the Permanent researcher to stand out from the systematic and docile adherence to scientific knowledge by questioning their explicit logic of production and to notify their ethical and practical implications. Epistemological reflection can usually distinguish several research paradigms which are the two main positivist paradigms and the constructivist paradigm. The Constructivism is important for the collection of data as the researcher extracts as much knowledge as possible from the participants. It is thought there are no two individuals who exactly think; interpret knowledge and events in a similar way. During this discovery efforts were made to construct a methodology which can be suitably studied. Mills (1959) argues that for the individuals to have an inclusive understanding of the issue they are confronted with, their lies a need to position themselves within their era, as per the making and history of connections between the mainstream policies and personal ordeals within the society in which they stay. Furthermore, Mill stated that the issues occur within an individual character and within the range of his o her own immediate relations with each other. He also stated that they have to define the social life with which an individual becomes intimately and directly aware (Mills, 1959). Nu this sense, the capability is centre to one’s self and every individual involved personally in every intellectual product upon which an individual works.
Juhila and Po¨so¨ (1999) described Social constructionism as an essential and helpful framework as it helps to investigate the social work (such as of nurses) as an activity which helps to create reality and emphasizes on how any reality is defined both through and in activity. Juhila and Po¨so¨ (1999) also suggested that the thematic analysis is founded on the framework of Social Constructionism mainly focusing on how the use of language creates meaning to any reality. It was also stated that such kind of analysis is based on how an individual interprets their social life experiences, identifies and labels diverse phenomenon and works together for constructing a mutual understanding. Also it focuses on the varied positions of any clients and social workers who construct it during any conversation. These thematic analysis features were taken into an account for choosing the researcher to analyse any data.
The social constructionism is founded suggesting that ultimate truth is not there instead a range of constructed truths arise which are out of position along with an individual’s role in the social context (Phillips & Hardy 2002). Cruickshank and Potter (2012) made clear that the individual perspective is associated to the power which holds the organisational context.
Social constructionism is known to acknowledge diverse point of views; individuals do make sense by considering the experiences of human through constructing its meaning. During perspective and view analysis offered by different individuals it is important to understand the manner in which an individual constructs any meaning and their position in any social group (White 2004). White (2004) furthermore added that it is important to take into notice how these constructs influences an individual action. The process also needs identification of possible conflicts between diverse constructs of the meaning. It is essential to understand that the power conflicts operates in social conditions and their potentially contributes towards diverse constructions of meanings (Phillips & Hardy 2002).
Within any context of research study id is essential to identify the nurse social position along with offering the responses and for that reason the respondents are in diverse positions, some are managers, or nurses or leaders and there are numerous positional aspects which may influence varied perceptions. Therefore, it will lead to explore single situation of respondents and individual may differ their way of expression and thinking which may get affected by their position. Whenever, any researcher thinks that when an individual downgrades their situation they will experience some unsatisfied feelings and will give even more evidences and reality. Comparing different individuals who upgrade situations they might give all the positive expressions for the reason that they feel contented. Both are considered true but by this study the researcher claims to have identified more data which is supportive to the research about the nursing leadership in Iraq.
Social constructionism can be easily operated at micro and macro levels. At the macro level it is important to consider how the position power of an individual influences the manner in which its meaning is constructed (Cruickshank 2012). The medical context can therefore, influence it and this approach can be adopted towards the facilitation and promotion of the nurse leadership. It is essential to consider the impact and nature of discourse it has on the functioning of the participants during the process of health (Phillips & Hardy 2002).
Cruickshank (2012) suggested that at micro level the social constructionism is mainly concerned with a variety of interpersonal interactions which reshapes the macro influences. The individual distinct individual characteristics will influence the nature of discourse and the elements will be recorded by the researcher. The immediate environment will power the relations hence impacting the interactions which occur and the perception of the nurses will be effective to note leadership (Cruickshank 2012).
However, Mills (1959) stated the problems and issues have a lot to do with matters that surpasses the local social surroundings of an individual and the scope of her and his inner life. The author asserted that these issues are usually interwoven with the larger classification issues of any society where the policies are implemented as well as the public issues (summers 2006; Aronowitz 2003). Hoover (1996) stated the basic elements of constructivism that were founded in psychology, education, and sociology. “Constructivism is a theory of knowledge (epistemology) with the intention of arguing that humans generate meaning and knowledge from their experiences”. The feedback is offered by a research through which it is assessed on the respondent position as a ward nurse, head nurse or an educator. The study will also take into consideration the impact which the power of relations has on the attitudes and views adopted by the respondents. It will help and lead the researcher for analysing and constructing the sub themes and themes of research and then the consequences will present a thought how these nurses understands effective nursing leadership.
3.3 Research design
As social constructionism has decided to be the framework of the study and because it is compatible with the interpretive descriptive qualitative approach, thus leads the researcher to use it to guide this study “What do nurses in Iraq identify as effective nursing leadership?”The adoption of an interpretive descriptive approach to this research uses inductive data collection. The approach to this research as Mills et al. (2006) is one in which the researcher holds no preconceived ideas or beliefs. The researcher use semi structured interview to apply this approach, the interview will need to be viewed as a ‘story’ (Cruickshank 2012, p. 77). These stories reveal issues of importance of effective nursing leadership in Iraq as viewed by the interviewee. The responses are coded and then compared across the interviewees (Mills et al. 2006). Rather than seek to prove or establish a pre-existing reality, the research seeks to explore the differing perspectives that exist in respect to effective nursing leadership.
3.3.1. Interpretive descriptive approach
The research was framed around; “What do nurses in Iraq identify as effective nursing leadership?” Denzin and Lincoln (2008) suggested that the interpretation of data collection by any researcher must entail understanding of an event for a researcher related to the participants, in other words the interpretation is considered to be a cognitive and subjective process which commences various considerations of the multiple meanings of any object, event, or experience. This is particularly a transformation which makes clear, refines and enhances what any researcher sees or hears. From a researcher perspective the description, interpretation and meaning are deeply intertwined in one another (Holroyd 2003; Denzin 1998). The term interpretive research is mainly engaged with an understanding and meaning of another individual action or words (Schwandt 2007).
Schwandt (2007) states that for all the qualitative studies the term interprtivism is at times use as a synonym, as it obscures noteworthy discernments in rational traditions. On the other hand, Schwandt suggests and argues that for a wider extent of an accurate interpretation for the term mainly signifies such approaches for studying the social life that mainly presents a significant role to Verstehen as a human science process. It was claimed by Schwandt that the meanings of human actions presumptions is usually intrinsic in action and the researcher job is to discover its meaning. In the range of quantitative and qualitative methodology after a powerful research it was thought that by using the descriptive approach which is interpretive because this particular method was suited best for forming any untaken research. It is essential that the researcher interprets specifically what a participant says in the interview. During the validation stage, it was carried out by checking all the participants.
Creswell (2003) stated that the interpretive descriptive researcher chiefly has a tendency for depending upon the views of the participant of the situations and it acknowledges the research effect on their own experiences and history. Interpretive descriptive approach will be applied well to the research study for the knowledge and experience research strategies mainly undertaken for communicating effectively with the choice of nurses which was to use the participants’ experience and backgrounds for the collection of data. The interpretive descriptive framework mainly offered an understanding that every individual will be having their own perspective to formulate strategies which are either being successful or not. This approach was acknowledged by the contextual and constructed nature of an individual experience as well as at the same time acknowledging shared all the realities which exist with an individual’s experience (Stajduhar et al. 2008). This approach was used by the researcher as this interpretive factor assist to reveal the participants’ information meaning and they understand about the effective leadership of nurses. This study will focus to assist in explaining the real life experiences of a participant. Hence using the descriptive and interpretative approach to guide they study for drawing a picture of how an Iraqi nurse describes and identifies an effective nursing leadership. The Semi structured interviews were employed for obtaining information and it helps the researcher to gain in depth information hence allowing a broader range of educators of nursing, ward nurses and head nurses for offering views regarding the effective nursing leadership and its developmental strategy.
3.3.2. In-Depth Semi-Structured Interviews
Semi-structured interviews enabled me to ask in-depth questions and were therefore a significant method for gaining detailed ethnographic data from the participants. Russell (2002) stated that interviewing semi structure has much of the freewheeling quality of unstructured interviewing and it needs similar skills but interviewing the semi-structured is based on the interview guide utilization. It is however, a written topics and question list which requires to be covered in a particular order, it demonstrated that individuals are fully in control of what an individual needs from any interview but it may leave both the respondents free to follow newer leads. It depicted that an individual is competent and prepared that they do not try to exercise excessive control (Russell 2002). The interview is one of the most extraordinary techniques through which an individual can explore some one’s experience (Richards 2005). It provides ways which cannot be expected to come in ways of the researcher. The method ordinarily can be trapped by the novice researchers who are not aware of the extra ordinary challenges behind any interview creation and it can make some food records for an interview.
Sweet (2002) suggested that the qualitative researchers prefers to use the techniques of any interview for the reason that these interviews can be employed in the descriptions and conversations for uncovering the views of any participant, however, when an interview immediately actions or clarifies any phrase or word used possibly for both the participants and researcher. In this study the researcher was used telephone interviewing as the researcher despite being an Iraqi national is currently based in Australia and the nurses participating in the study are living and working in Iraq. This is an acceptable and increasingly popular form of technique to collect data from the participants. Bowles and Bowles (2000) stated that the telephone face to face interviews helps the researcher to check comprehensions and clarifies any misunderstanding. However, they will also be permitting degree of interpersonal invisibility that will raise a potential to enhance honesty and frankness. This is very applicable in relation to this particular research project where the researcher is familiar with the participants’ culture and their sociality and their professional context which helped to build bridges with the interviewees. It is important that they had felt free to discuss their perceptions of clinical leadership in Iraq in a non-threatening environment with an interviewer who understands their cultural and professional reservations.
3.4 Study location
The researcher was plans to collect data from the nurses in Mosul city in Iraq through face to face interviews, however, the University of Southern Queensland safety policy is not cover the researcher while collecting data from Iraq because Iraq is from a list of unsafe countries which the university cannot assure or cover any of its staff or students’ safety, therefore, data was collected using a teleconference method. This method is safe and convenient, because the political situation in Iraq is unstable and there is no government forces like police who could protect the researcher from any danger that could happened over there. Further, the researcher lives in the selected city – Mosul and is familiar with its health system. This familiarity will assist her to develop a good relationship with the nurses. Therefore the researcher selected Mosul as her study location. The present political situation in Iraq have enforced some nurses who were working in health directorate in other Iraqi’s cities to migrate to Mosul city to live and work, and this give another reason to choose this city for this project to be done, this reason encourage researcher to anticipating various nurses’ background and this city is the mirror of all Iraqi nursing leaders and nurses.
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Mosul is one of well renowned city in Northern Iraq. It is some 250 miles and (400km) from the northwest of Baghdad. The original city stands on the Tigris River west bank, that is opposite to the Nineveh on the east bank, but it is also thought that metropolitan area has now grown to include substantial areas on both banks, with in total five bridges which links to both the sides. The majority population includes the Arabs and it Iraq’s second largest city after Baghdad (Butler 2003). The city’s population in the year of 2008 was estimated to be 1,800,000 (Lannen 2008). For the University of Mosul, Mosul is a home, and it is one of a largest research and educational centre in the Middle East and Iraq. It was thought that on 1 April 1967, by merging with the Medicine College it was opened in the year 1959 (University of Mosul, 2010). Further, the health system in Mosul is directed by Nineveh Health Directorate which is related to Iraqi Ministry of Health and it has the same rules in work as other Iraq’s cities (Lannen 2008). All the above characteristics helped the researcher to choose this city to collect study data. It is good example of other cities of Iraq because it is a mixture of all what Iraq has such as progressive city, large multiethnic and religious culture population, it has a good health system and thus the suitable location for the present study.
(Washington Post Foreign Service 2005).
3.5 The sample
The sample of the study was responses’ nurses who work in Mosul’s Health Directorate. A letter of invitation has been sent to each of the participant; together with an explanatory statement and the consent form which included researcher’s contact details should they wish to participate in the interview. Semi-structured questions were used in the teleconference interviews after ethics approval has been gained from both the University of Southern Queensland and Mosul health Directorate. This gave authority to contact them from their administrator, then the data will be analysed thematically.
The sample in the qualitative phase was based on purposive sampling by which the researcher intentionally chose individuals and appropriate sites to understand and learn about the subject of the study (Creswell 2005). The researcher purposively selected a number of participants considered to be knowledgeable about the issues under study (Polit & Tatano Beck 2010; Schneider & Elliott 2003). The judgmental and purposive sampling is founded on the belief that knowledge of researchers’ about the population can be employed to sample hand-pick members, and is often used productively by qualitative researchers (Polit & Tatano Beck 2010). Purposely, the researcher chooses to select subjects who are judged to be particularly knowledgeable about the concern and typical of the population under this study.
In qualitative approaches, researchers do not usually begin with a pre-set or the number of participants but will continue collecting the data until saturation is achieved, when researcher makes the decision that the data collection can be ended (Jackson et al. 2003). Creswell (2005) clarifies some points in regard to sample size and research sites in qualitative studies. Having only a few participants will enable the researcher to focus in depth on the information obtained from the interviewees and presents “…the complexity of a site or of the information provided by individuals” (p. 207). The researcher might study a single individual or a single site depending on their study. Collecting the data and the process of analysis required a large amount of time. Once the researcher selects the design of the research, the approach was indicated the required number of participants (Creswell 2005). The participants’ chosen criteria were depending on:
The title, identity and the contact numbers of the participants was checked with the directorate before doing interviews. All Skilled, Technical and Graduate Nurses will be invited to participate in the interviews.
Participants had at least three years of experience as a nurse for all three levels.
Participants had at least Diploma in nursing.
3.6 The Participants
An invitation has been made by placing information posters on notice boards in all health directorates’ branches in Mosul. The participants were advised to contact the nursing unit manager who is working in this health directorate and who is responsible of organising the samples for nursing researchers. All nursing educators, head nurses and ward nurses were invited to participate in the interviews. Also, information about the study was distributed through internal invitation newsletters and explanatory statements. The nursing educator, head nurses and ward nurses were invited to provide their views, anonymously, as a contribution to their work place and to the research. The data was collected during July and August 2012 after ethics approval has been obtained both from USQ and the Mosul Health Directorate.
3.7 Data collection
Initially a semi-structured interview schedule was prepared in English to interview the nurses (appendix 1). As Arabic is the only spoken language in Iraq the interview schedule was translated into Arabic language so that the participating nurses could understand the questions clearly and provide pertinent information to the researcher. A professional translator was used to authenticate the Arabic version of the interview schedule. Data was collected through recorded telephone interview from the selected participants. The teleconference was conducted by calling them on their private mobile phones because there are no international landlines in Iraq to reach them from Australia. The participants were assured that their responses will be kept confidential and anonymous. They were further informed that they may withdraw from the study at any time without any fear of the consequences. The researcher starts record and de-identified data only. Analysis was reported at the group level, not at the individual level (Pope & Mays 2007)
The communication may give the researcher an opportunity to ask some questions which might be missed, and help to explain some questions that may be difficult to understand by the respondents (Marshall & Rossman 2006). As this is a semi-structured interview, a guideline of questions was set but the interview allows the participants to tell their story. The open ended questions will be inquired for encouraging the participants to relate their nursing leadership experiences. Reinharz (1992) stated that stated that the research possessing open-ended interview produces non-standardised information hence permitting the researcher to make complete utilization of diversities among individuals and explores people’s view of reality, and this will be related to this project. Only one interview with each participant will need. All of the interviews were take place out the participant’s work place and last approximately 30-45 minutes each. With consent, all of the interviews were audio-taped and transcribed. Researcher was code the interviews independently to identify areas of similarity and difference.
3.8 Data Analysis
Polit and Beck (2004) explain the use of semi-structured interviews in qualitative research. The semi-structured interview is considered to be a type of self-report. To make sure that the topic is covered, researchers tend to set specific questions to ask the participants. Morse and Richards (2002) point out that the semi-structured interview is considered to be appropriate when the researcher is familiar with the research topic. This enables the researcher to frame the required discussion in advance. The researcher knows what to ask, but cannot predict what the answer is (Morse & Richards 2002; Polit & Beck 2004).
The analysis and data collection occurs concurrently. The interview data was transcribed, checked and corrected for accuracy against the tape recordings. The transcripts were read several times for identifying and recurring the illustrative examples and themes from the data. The themes and preliminary concepts developed and were employed to categorize the data. Polit and Beck (2006, p.397) defined the qualitative data analysis purpose so as to elicit meaning from the data, to provide structure and to organise. It can also be analysed through theme construction. The researcher was continuing analysing data until saturation or redundancy be reached and no new information will forthcoming from additional sources (Polit & Beck 2006). This method of analysis was chosen because this can be the most appropriate of analysis and, perhaps for this reason, it is the most commonly used in health care research (Pope & Mays 2007). Thematic analysis was congruent with the methodological aims and it involves reviewing research data systematically with the intention of sorting and classifying them into representative groups (Roberts & Taylor 2002).
As a technique for inquiry, thematic data analysis will be employed in this dissertation. This thematic analysis is thought to be the most suitable as it seeks to find out the data interpretation. It offers the elements of systematic for the analysis of data. It permits the researcher to link with the frequency of theme analysis with one of the whole content. It therefore, helps to bestow intricacy and accuracy and enhances the research meaning. Frequently, the term thematic analysis term is known as interpretive content analysis or qualitative thematic analysis, and it is a regular approach to analyse a qualitative data which do not depend on the specialised procedures of other means of analysis.
The examples of such methods include semiotic analysis, discourse analysis, grounded theory methodology, and disclosure analysis (Braun & Clarke 2006). In using such process of investigation it is essential to scrutinise the respo0ndent data individually and to assess what each individual has contributed for identifying what they say might not be similar to any other respondent but it is just kept diversely. After the transcript completion, the researcher analyses the searching of an individual transcripts for common principles and themes. So it is essential that these transcripts shall be coded for ensuring the participant confidentiality. After completing the task all the transcripts were common and analysed the noted themes. Corbin and Strauss (2008) agreed to the analysis method as it was stated that it is important that transcripts are coded by the researcher and the data is collected as it was apparent that it is conducive for the emerging themes.
The analysis and gathering of data and the use of qualitative methodology from the focus groups are usually daunting initially. The close analysis will be required in any study as it records the discussion group along with the accurate and thorough reading and interpretation of the researcher’s copious field notes. Usually a question arises about how information can be analysed and what systems are used. After a deep research a researcher will discover the thematic analysis which is known to suit particular collection of data admirably and it can be applied to most of the qualitative information. The thematic analysis is a method to make sense of the material related, culture, behaviours, group interactions, and methodically observing situations (Fereday & Muir-Cockrane 2006), hence the data will be encoded into the patterns or themes along with its qualifications, indicators, and patterns.
Furthermore, a secondary discovery was the process of analysis which involves five main pro
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