‘Having a say’: negotiation in fourth‐ generation evaluation

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on (teaching) ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation.

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“…The evaluators followed a responsive evaluation approach 6 18 – 20. The term negotiation characterises the essence of responsive evaluation.…”

Section: Method: Responsive Evaluationmentioning

confidence: 99%

Teaching ethics in the clinic. The theory and practice of moral case deliberation: Table 1

et al. 2008

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“…The outcomes are not facts but are constructions created through the interactive dialogue of all stakeholders. This hermeneutic approach accepts that participants are self interpreting and bring their construction to the negotiating table [51, 52]. Hermeneutics is the theory of text interpretation, written verbal, and non-verbal communication, and is the basic underpinning theory of this study [52].…”

Section: Methodsmentioning

confidence: 99%

“…Data analysis in FGE inherently takes a structured path. All data from phase 1 interviews were analysed as soon as possible after the event to allow for probing of issues raised with future participants [51]. Transcripts of interviews were examined to inform the study of possible themes using a systematic qualitative data management package known as NUDIST [50].…”

Section: Methodsmentioning

confidence: 99%

Non-medical prescribing of chemotherapy: engaging stakeholders to maximise success?

Lennan¹

2014

ecancer

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AimThis study report examines the views and experiences of professional stakeholders about non-medical prescribing (NMP) of chemotherapy.BackgroundThe introduction of open formulary NMP has created opportunities to radically change health-care delivery. For chemotherapy services, the most recent advice from the National Chemotherapy Advisory Group [Department of Health (2009) Chemotherapy Services in England, ensuring quality and safety: a report from the National Chemotherapy Advisory Group, London Her Majesty’s Stationary Office] clearly endorses the development of nurse- or pharmacist-led chemotherapy clinics. This is very much welcomed but is based on very limited evidence as to their effectiveness.DesignA fourth-generation evaluation study.MethodsA purposeful sample of 23 stakeholders connected with the chemotherapy service was used. A serial data collection technique with individual interviews followed by uni-professional focus groups was adopted. Finally, a multi-professional focus group was held to determine the strategic way forward. Data were collected in 2009–2010.ResultsThe study illuminated the key features necessary to maximise success of NMP in chemotherapy clinics and captures the importance of good working relationships. Whilst different practice models will emerge, fundamental and core to services is the need for good team working, established and effective communication strategies, and most importantly avoiding isolation in practice. This study additionally reinforced any evaluation takes place within preexisting political contexts and in particular medical dominance. Not all medical colleagues agreed with or wanted NMP for their patients, highlighting difficulties of developing new models of working within a resisting culture.ConclusionNo objections to NMP of chemotherapy were found, but, clearly, the context of practice needs to be agreed and supportedby all professional stakeholders.What is already known about this topicOpen formulary non-medical prescribing has been rapidly introduced over the past decade.Little research has been conducted in acute care and none in the chemotherapy setting.Cancer policy recommends the introduction of nurse-led chemotherapy clinics.What this paper addsNon-medical prescribing (NMP) in chemotherapy is appropriate with the right model of practice.Well-established professional relationships are a key to success.NMP is not appropriate in isolation of the multidisciplinary team (MDT).Implications for practice and/or policyNurses need to demonstrate the value of non-medical prescribing in chemotherapy using available metrics.Models of practice need to ensure good communication channels, MDT working, and transparency of prescribing.

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“…These included fourthgeneration evaluation (Guba & Lincoln, 1989;Koch, 2000;McCormack, Manley, & Garbett, 2004) and appreciative inquiry (Cooperrider & Whitney, 1999;Whitney & Trosten-Bloom, 2003). Although both seemed relevant, we elected to undertake a cooperative inquiry (Heron, 1996;Heron & Reason, 2001).…”

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confidence: 99%

A Cooperative Inquiry Into Action Learning and Praxis Development in a Community Nursing Module

et al. 2009

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As nurse lecturers we investigated practice development and action learning approaches aimed at enabling postregistration bachelor's- and master's-level nursing students (Community Health Studies, Nursing in the Home) to advance practice in the context of policy and professional developments. A patchwork text was used to assess summatively what students achieved (practice change/development) and how this was informed critically, via an extended epistemology. First-person inquiry supplemented by cooperative inquiry postcourse completion (including reflective discussions with 16 students and 16 practice mentors) were used to assist coresearcher constructions of meaning. A relational, tripartite approach to learning and assessment (students', teachers', and practice mentors' collective contributions) depends on continuing reflective attention. Action learning enhances interrelation of experience with dialectic thinking. The patchwork text functions to promote creative writing, evaluative thinking, and praxis development. Role modeling by all, being genuine and not just "talking" genuine, is challenging yet crucial if people are to function as mutual resources for learning.

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‘Having a say’: negotiation in fourth‐ generation evaluation

Cited by 47 publications

References 13 publications

Teaching ethics in the clinic. The theory and practice of moral case deliberation: Table 1

Teaching ethics in the clinic. The theory and practice of moral case deliberation: Table 1

Non-medical prescribing of chemotherapy: engaging stakeholders to maximise success?

A Cooperative Inquiry Into Action Learning and Praxis Development in a Community Nursing Module

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