Action Research in Nursing and Healthcare

G.R. Williamson, Loretta Bellman, Jonathan Webster

• Publisher: SAGE Publications Ltd
• Year: 2011
• ISBN:
  9781446291962
• Edition: 1
• Topic: Medizin
• Subtopic: Krankenpflege

Action Research is becoming more popular in nursing and healthcare. It is used by practitioners who want to better understand and improve the quality of their work, and by students who need to do a research project for their course. An Action Research approach enables evidence-based care and links research directly to practice, making it the ideal method for a researcher in these fields.

This book introduces readers to Action Research by presenting its key concepts and backing these up with practical examples throughout, often drawn from the authors? own extensive experience. Topics include:

- Action research to advance patient care

- Collaborative working

- Ethics

- Participatory Action Research

- Writing up and disseminating projects

Williamson, Bellman, and Webster - leading figures in the field - provide practical advice for using Action Research in healthcare settings, with patients and alongside other practitioners. Their book presents a flexible approach that can be adapted to researchers? real needs.

SECTION 1

WHAT IS ACTION RESEARCH?

1

FOUNDATIONS OF ACTION RESEARCH

Graham R Williamson

It is important to understand the foundations of action research and to explore different approaches to action research as there are subtle differences of emphasis and suitability for different situations.

Chapter objectives

This chapter will examine:

• some of the philosophical issues underpinning action research and outline the work of early theorists, including Kurt Lewin’s pioneering work and the influence of critical theory

• some of the key theoretical and interrelated aspects of action research, including:

human inquiry, cooperative inquiry and action science/action inquiry

participatory action research

action research and feminsim

appreciative inquiry

Introduction

Simply put, action research is a process by which change is achieved and new knowledge about a situation is generated. These two objectives go hand-in-hand to a greater or lesser degree in most action research studies: it is difficult to change a situation without working to understand it more fully, and in trying better to understand things, the possibilities for change often emerge.

Coghlan and Brannick (2010) outline four broad characteristics of action research. These are:

1. Action research is about research in action rather than about action. Thus a ‘scientific’ process of inquiry is used in social settings to link important issues with those who experience them.
2. It is a collaborative, democratic process, meaning that there is active participation of those who experience the situation in working towards solutions. This is distinct from traditional research approaches, both quantitative and qualitative, where research participants are subjects rather than collaborators.
3. Action and knowledge are joined so that change occurs while there is a simultaneous process of knowledge generation.
4. It is a sequence of events and an approach to problem solving which contributes to knowledge and understanding.

Box 1.1

This is a lengthy quote, which illustrates the challenge of being able clearly to define AR! For Waterman et al. (2001: iii), action research is

a period of inquiry that describes, interprets and explains social situations while executing a change intervention aimed at improvement and involvement. It is problem-focused, context-specific and future-oriented…founded on partnership…educative and empowering. … Knowledge may be advanced through reflection and research, and qualitative and quantitative research methods may be employed to collect data.

Action research has been described (Reason and Bradbury 2006) as a ‘new paradigm’ in its focusing of research on participation and change. Research approaches are frequently discussed as coming from qualitative or quantitative paradigms, and although there is discussion and debate in the methodological literature concerning the underpinning theoretical positions each occupies, they are still frequently discussed as quite different ways of thinking about and doing research (there is more on this in Chapter 2). Quantitative research seeks to demonstrate an external reality through manipulation and control of variables and is based on a tradition of objectivity and positivism. This is frequently contrasted with qualitative research, which comes from a hermeneutic or interpretivist paradigm, in which the ability of human beings to construct and understand their lives is emphasised, and there is no fixed external reality (these arguments are more fully explored in Chapter 2). While some argue that this qualitative/quantitative dichotomy is a false one (Morrow and Brown 1994), it is clear that action research fits fully with neither of these traditions, but has features of each, in that a process of change is applied to social life, whereas the reflexive nature of individuals and groups within any setting is also emphasised. This can be radical as it challenges traditional research approaches, existing forms of social organisation in the workplace and in society (Coghlan and Brannick 2010), and is described as democratic and participatory.

Action research has been quite recently adopted by healthcare professionals seeking to develop aspects of their practice and that of their organisations. It is not simply a ‘tool’ for practice development or change management; it has a long history in many sectors, and roots and a philosophical tradition which, arguably, go back to the early part of the twentieth century.

Philosophical issues and action research

The philosophical issues encompass the extent to which participation and change can be fostered in action research, and it is important to consider these because they provide a different emphasis and intention from traditional research approaches. A foundation stone for action research appears to lie in the political philosophy of the critical theorists.

Critical theory

Originally a term associated with the Marxist-oriented Frankfurt Institute for Social Research, which was founded in Germany in 1923, ‘critical theory’ is now taken to mean an approach to social sciences that offers a critique of existing social relations as well as a perspective on how things should be changed, developed or improved. The original Frankfurt School included ‘famous names’ from the broad field of sociology and psychology, such as Horkheimer, Adorno, Marcuse and Fromm, many of whom moved to Columbia University in the USA in the 1930s to avoid Nazism. A ‘second generation’, including figures such as Offe, and Habermas, was influential in the 1960s and beyond, with Marcuse in particular influencing democratic and political reforms in favour of the ‘new social movements’, which sought greater freedoms for groups such as women, ethnic minorities and followers of single-issue politics such as the Green movement (Bronner and Kellner 1989).

Critical theory is seen as an ‘antidote’ to the quantitative or ‘positivist’ tradition in research, which is argued to be uncritical, and therefore unlikely to generate social change (Bronner and Kellner 1989). The underlying premise of critical theory is concerned with human happiness and that this can be attained only by transforming all aspects of social life (Marcuse 1989). Critical theorists’ focus is on the issue of domination: how some groups in society control all aspects of the lives of others, and thus inhibit those in oppressed groups from realising their full potential. Following Marx, critical theorists argue that economic power and class are the roots of oppression and the crucial factor is changing these existing power relations. Some critical theorists thus have an interest in beneficial change, or ‘transformative praxis’ (Morrow and Brown 1994: 27; although it is not the case that all critical theorists unambiguously associate ‘critical theory’ and a drive towards ‘praxis’) and their work is frequently described as being concerned with emancipation (Kellner 1989).

• • • REFLECTIVE ACTIVITY 1.1 • • •

1. What is your understanding of the term ‘praxis’?
2. What is the additional meaning implied by adding ‘transformative’ to make ‘transformative praxis’?
3. How would you define the concept of ‘emancipation’?

• • • ANSWERS • • •

1. Praxis means a process by which a theory or skill is applied to the real world. It also has a political meaning: to change social relations, with connotations of theory and practice informing each other as change occurs. It can also mean ‘making visible’ and acting upon one’s values.
2. While different authors use the term differently, it seems as if adding the term ‘transformative’ implies the intention on the part of authors to change aspects of social life in conjunction with those with whom they are interacting. There is an explicit ‘looking forward’ to the achievement of greater equality, or social justice, or overturning of exploitative power relations. ‘Transformative praxis’ thus has a more overtly political tone than using the term ‘praxis’ alone.
3. Emancipation means to become free or be set free. In the context of critical theory, emancipation can mean freedom from oppression or exploitation, in terms of economic power, gender relations or ethnicity.

Habermas’s critical social science

The work of Habermas may be unfamiliar to you but it can provide a philosophical basis for change in contemporary society. Habermas (1981) identifies three knowledge-constitutive paradigms, underpinning what he calls the ‘empirical–analytical’, the ‘historical – hermeneutic’ and the ‘critical’ sciences. The empirical–analytical sciences’ base is technical control of the natural world. This instrumental knowledge generates rules, which the Natural sciences use for explanation and prediction (Carr and Kemmis 1986), for example as in quantitative research. The historical–hermeneutic sciences owe their genesis to the need for effective communication in contemporary societies, both between individuals and traditions and between different traditions. Methods in the historical–hermeneutic sciences are interpretive and ‘practical’, allowing people to understand their social worlds and their histories (Carr and Kemmis 1986), as for example in qualitative research; where communication breaks down, interaction becomes problematic. However, it would appear that only the ‘critical’ sciences offer the potential for transcending the constraints of the former two sciences, to grasp at emancipation: action research is taken as an example of a research technique from the critical sciences (Morrow and Brown 1994). This emancipation does not, for Habermas, preclude using either empirical–analytical, or historical–hermeneutic methods, but the potential for self-reflection is implicitly critical, challenging dysfunctional and oppressive structures whether they are political, economic, social or organisational. Thus an ethical dimension can be re-introduced into contemporary social life (Carr and Kemmis 1986), and praxis can be established as a guiding principle in social science research.

However, identifying and establishing praxis as a central tenet of contemporary life is problematic, not least because there may be many interpretations of what challenges there should be, how praxis can be identified and sustained, and what constitutes a new ethical dimension. For Carr and Kemmis (1986), Habermas’s critical social science cannot reconcile the need for praxis with the need to meet the ‘scientific’ positivist notions of rigour which society has come to expect in research. Even so, Habermas shows that social science can claim validity based on shared understanding rather than the laws of the natural sciences, meaning that consensus about the validity of a discourse is not subject to the measurement of objective criteria but is a democratic event, as people participate equally in what he refers to as the ‘ideal speech act’. This discourse involves four validity claims: (1) that what is said is true; (2) that the utterance is comprehensible; (3) that the speaker is sincere; and (4) that it is right for the speaker to be speaking.

For social scientists, Habermas implicitly calls for change-centred action, as critical social science is about the development of theory, the organisation of learning processes and the organisation of action: political ‘doing’, aimed at emancipation. In this manner, social scientists can facilitate ‘communicative action’, which tests the accuracy, sincerity and rightness of social processes, including organisational life. For Habermas, social life in contemporary society has been appropriated by purposive-rational action and functional reason, meaning that mutual understanding and consensus are virtually suspended in modern organisational life: people are divided and fragmented by the social relations of bureaucracy and expert systems (Kemmis 1996); they simply get on with the job but this is not cost-free, causing crises borne by individuals and systems. As work roles become increasingly elaborate and differentiated, communities are increasingly difficult to sustain, and there is an ‘uncoupling’ of system and lifeworld (see below) for those who inhabit them (Habermas 1987).

Habermas and action research

For Kemmis (2006), action researchers engage with the Habermas thesis, as they explicitly act on three kinds of lifeworld processes. These are: (1) ...