the importance of emancipatory research to contemporary nursing practice

INTRODUCTION

Emancipatory frameworks provide a broadlens through which nursing knowledge can

be explored and developed.The authors discussthe significance of emancipatory research tocurrent nursing practice arguing its place increating opportunities for transformation andchange.This paper will begin by raising atten-

tion to current issues in contemporary nursingpractice before exploring contemporary research.Methodological issues associated with qualita-tive, quantitative and mixed methods will bebriefly outlined followed by a discussion ofresearch paradigms. Emancipatory researchwill be introduced and its contribution to con-temporary nursing research addressed. Finally a

Key Wordsnursing research;emancipation;feminist theory;critical socialscience;communitynurses; emotionalwell-being CN

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The importance of emancipatoryresearch to contemporary

nursing practice

ABSTRACT When considering the significant changes that continue to transform nursingpractice, a focus on evidenced-based practice has clearly placed nursing researchat the forefront of professional practice.The aim of this paper is to highlight theimportant contribution that emancipatory research methodologies can make tothe ongoing development of contemporary nursing practice.A research exampledemonstrates how an emancipatory framework was applied to a recent doctoralstudy undertaken with Australian community nurses who provided palliativecare.The research focus was on exploring the relationship between the nurse’semotional well-being and their professional practice.The research was epistemo-logically located within a critical and feminist framework. Emancipatoryresearch is well situated to address the subjective experiences of nurses and tocontribute strongly to the future of nursing practice.

Received 30 August 2007 Accepted 26 February 2008

NEL GLASSAssociate ProfessorDepartment ofNursing and HealthCare PracticesSouthern CrossUniversityLismore NSW,Australia

JAYLN ROSEPhD CandidateDepartment ofNursing and HealthCare PracticesSouthern CrossUniversityLismore NSW,Australia

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research example will be provided to demon-strate the application of the emancipatory pro-cess and its importance to the development ofnursing knowledge.The research example illus-trated has been taken from a current PhD studyundertaken with community nurses who pro-vide palliative care within New South Wales,Australia.

CONTEMPORARY NURSINGPRACTICEIt has been recognised across nursing interna-tionally that evidenced-based practice (EBP)remains central to the production of profession-al nursing knowledge (Flemming 2007; ReimerKirkham et al 2007).Whilst EBP was reportedin the discourse as being contested by manycritics, its contribution to advancing nursingpractice undisputedly locates nursing researchat the forefront of profession development;however, the move to develop the research/practice nexus in the workplace can be fraughtwith compounding pressures for nurses andresearchers.

Workplace environments remain challengedas health care organisations experience sig-nificant change (O’Connor 2002) compounded by economic restraints (Reimer Kirkham et al2007). Nurses must face up to workplace vio-lence and oppressive structures that have thepotential to hinder effective nursing practiceand decrease the motivation to undertake anyadditional responsibilities such as conductingresearch (Glass 2007; Giddings 2005). The complex issues (Chinn 2007) and increasingdemands placed upon contemporary nursesresult in additional stress, susceptibility toimpaired well-being and emotional, physicaland psychological distress (Preston 2002;Taylor& Barling 2002).

Whilst nursing research must engage in‘approaches that progress beyond that of tra-ditional science’ (Chinn 2007: 1) and arguablyencompass epistemologies that are transforma-tive (Reimer Kirkham et al 2007), conducting

research and ensuring EBP can be problematic asthe current nursing landscape creates difficultiesfor nurse clinicians to have the time to under-take research. Such concerns can be aligned withincreasing competing responsibilities in theworkplace, however added pressures and theproblem of retention/recruitment heightensfurther the pressing need for research.

Raising awareness of culturally inherentissues and organisational structures that impedethe growth and professional development ofnurses is critically important to nursing. Thenature of nursing is philosophically aligned withcaring and healing and is ‘grounded almostentirely on human relations’ (Kuokkanen &Leino-Kilpi 2000: 240) yet nursing researchthat seeks to explore and examine emotions israrely undertaken (Herdman 2004).Therefore,the implementation of contemporary researchcentred on human experience and aimed atexamining and critiquing the complex realitiesfaced by nurses, is strongly argued as critical tocurrent nursing practice.

CONTEMPORARY RESEARCHIt is important to acknowledge there exists avast degree of theoretical and methodologicaldiversity within contemporary nursing litera-ture. National and international research contri-butions continue to enhance the scholarship.Whilst acknowledging diversity in contribu-tions, it remains essential to consider theoreticalframeworks underpinning research studies andtheir subsequent contribution to the nursingprofession.Although there are an extensive vari-ety of methodological approaches to research,all share the central aim of informing nursingthrough the generation of new knowledge.

However if the development of nursingknowledge hinges on diversity (Chinn 2007;Edwards 2002), research methodologies thatseek to explore workplace issues in healthcaremust expand beyond boundaries of descriptionand understanding of practice. It is necessaryfor nurse researchers to also engage in a critical

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examination and analysis of the social struc-tures that affect nursing. It is therefore arguedresearchers need to utilise holistic and human-istic approaches to create opportunities for em-powerment and transformation and to movebeyond the explanation of ‘what has been’ andcurrently ‘what is’ in nursing, to most im-portantly, enhance the opportunities of ‘whatcould be’.

With researchers endeavouring to meet themany challenges faced by nurses in their en-deavours to effect change for the better, thecontemporary nursing scholarship has beendescribed as reflecting ‘a maturity that acknowl-edges the worth of a wide array of approachesto develop knowledge needed for excellent, evi-denced based nursing practice’ (Chinn 2004:161). Moreover, the potential to change thecurrent socio-political context of nursing can becreated by the use of emancipatory research, anapproach that is focused on diversity, marginali-sation and inequities (Irwin 2006).

Emancipatory frameworks are well suited toresearch carried out with nurses and that relatesto their workplace experiences, see for exam-ple, studies on: contemporary nursing practice;professional development of the nurse; nurses’well-being; destructive behaviours at work suchas violence and bullying (Glass 2007, 2003a,b;Hutchinson et al 2006; Jacobs et al 2005; Luck,Jackson & Usher 2006). In addition, when nurs-es are involved in research that is focused ontheir own emotions and/or performance atwork, such ‘from the heart’ issues have thepotential to make visible their experiences andthese research processes may transform prac-tice. As Jacobs et al (2005: 6) asserted, ‘the out-come of an emancipatory study is reflected inthe power of the process’.

However emancipatory research is not suit-able for all types of research questions. Like allresearch methodologies, emancipatory researchrequires an integral epistemological/ontologicallink, therefore theoretical intent and assump-tions needs to be linked to process. Unquestion-

ably, both qualitative and quantitative method-ologies, contribute to nursing knowledge, as do empirical, interpretative and emancipatoryresearch frameworks.The research epistemolo-gy must always remain congruent with theintent of the study and the nursing disciplinaryfocus requires a ‘broad range of thought’ (Chinn2007: 1). It is therefore without question thatboth the methods and the paradigm are criticalto successful nursing research and nursing prac-tice. Before discussing emancipatory researchmore comprehensively a brief overview of qual-itative and quantitative research is necessary tospecifically highlight the major differences with-in the theoretical premises.

QUALITATIVE AND/ORQUANTITATIVE RESEARCHBoth qualitative and quantitative methodologiesare regarded in nursing as valuable to knowl-edge development and neither approach wouldbe considered by the authors as ‘less than’ theother (Byrne 2001: 207). Both paradigms offerdiverse qualities.

The division of both has been regarded as dis-advantageous to nursing practice (Flemming2007). As Rolfe argued ‘the distinction betweenthe qualitative and quantitative paradigms isunhelpful’ (2006: 308); however, both para-digmatic views need to be considered for theirunique attributes.

Quantitative research has been referred to asa scientific method that values objectivity, witha key interest in standardisation of measurement(Sprague 2005).The most common distinctioncan be recognised in the ‘techniques used to col-lect and analyze methods’ (Flemming 2007: 43)with the findings often seen as predictive, gen-eralisable (Taylor 2002, 2007) and trustworthy(Sprague 2005) and for investigators with afocus on large numbers, quantitative studiesmust be acknowledged as valuable in its contri-bution to nursing knowledge (Bonell 1999).

However, when one considers that nursing iscentred on human experiences related to health


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and well-being, the fundamental nature of thenursing encounter and the meaning placed uponthose encounters by nurses can been margin-alised if only explored quantitatively. Herdmanstrongly argued that quantitative research isunable to contend with uncountable or unmea-surable issues associated with the critical aspectsof ‘suffering, insight, misery, anguish and emo-tion’ (2004: 98). However, the choice to apply aquantitative paradigm should be related to thepracticality and value in investigating the partic-ular research questions (Bonell 1999).

For qualitative researchers, it is the subjec-tive human experience that is most valued(Edwards 2002) and the data obtained can beconsidered unique and context dependent.However the focus on subjective human experi-ence has resulted in the opposing argument bysome scholars who believed that qualitativeresearch is unreliable and invalid (Morse 1999),a viewpoint that may explain why qualitativeresearch remains generally undervalued andunder funded (Herdman 2004; Bonell 1999).The critical factor for nurse researchers must be

to select an approach that will best meet theresearch aims and objectives.

An alternative methodology for researchersis to consider a combined quantitative/quali-tative approach. Often referred to as mixedmethods, this option removes the barriers asso-ciated with the concept of binary oppositions inthe qualitative/quantitative debate (Flemming2007). Utilising mixed methods can prove ad-vantageous for researchers as the combinationacts as a complementary process (Flemming2007) optimising outcomes as a result of multi-ple data sources and ultimately enriching theresearch.The key points related to the variousmethodological approaches discussed above areoutlined in Figure 1.

SELECTING THE RESEARCHPARADIGMIn order to strengthen qualitative inquiries,the aims of the study must determine the mostrelevant paradigm. Qualitative researchers maychoose to apply an interpretative or criticalfocus however the ‘findings will differ according



FIGURE 1: METHODOLOGICAL APPROACHES

Adapted from Flemming 2007; Taylor 2007; Glass 2005; Sprague 2005


to the underlying theoretical assumptions of theapproach and the intentions of the research’(Taylor 2002:454). Byrne (2001) maintainedthat the philosophical underpinnings of thestudy, the epistemology, and the researchprocesses necessitate congruency.

Differences within interpretive and criticalparadigms are outlined in the Table 1.The tabledraws attention to the links between theresearch focus and aims whilst showing exam-ples of the epistemological approaches that areconsistent with research in each paradigm.

THE RESEARCH PROCESSQualitative researchers seek to ensure reliabilityand validity, however the assessment of thequality of this type of research remains con-tentious, with validity being the central focus(Rolfe 2006; Taylor 2007). Morrow (2005)noted that whilst qualitative research across var-ious disciplines embraced multiple standards ofquality, one way to enhance quality would befor researchers to apply the process of critiqueand replication. Such a process was based on thescientific premise highlighted by Chinn (1998:vi) who stated that ‘knowledge develops asstrong and worthy when it is subjected to thechallenges of critique and replication’.

Whilst involving self reflection, the process isaimed specifically to bring to the forefront thetheoretical philosophies that had informed pre-vious inquiries, extending nursing knowledge,

creating new possibilities and contributing newinsights into nursing phenomena. Many scholarsincluding Ogle and Glass (2006) and Walter,Davis and Glass (1999) have competently appliedthe elements of critique and replication to theirresearch with positive results bringing newunderstandings to nursing knowledge. More-over, in strong support of nurse researchersapplying the process of critical reflection tonursing studies, Chinn emphasised that critiqueand replication are:

[m]uch more than simply reviewing what has been. Rather, it requires placing a newand different lens that focuses on, and seesbeyond, that which was formerly seen orunderstood… The best critiques often arisefrom recognising the hard truth that prob-lems that persist despite every effort tochange they are not changing, and thenexamining what lies beyond the obvious,unveiling dynamics that might reveal newsolutions and new paths of inquiry (Chinn2002: v).

With significant research being undertakenacross all nursing disciplines the integrity ofqualitative studies are open to assessment basedon what Morrow (2005) suggested involvedboth the paradigmatic underpinnings of thestudy and the standards of the discipline. Mostimportantly, the research process should be



TABLE 1: RESEARCH PARADIGMS

Research Paradigm Research Aims Research Examples

Interpretive focus To generate meaning ie explain and describe to make sense of things of interest; may focus directly on the lived experience.

Critical focus Transform and/or empower people who are marginal-ised by the identification of emancipatory solutions and moreover, bring about change to the status quo.

Grounded theoryPhenomenology

EthnographyHistorical research

Feminist researchAction research

EthnographyFocus groups

Adapted from Glass 2005: 5–6; Taylor 2002.


clearly demonstrated, remain transparent andmost significantly, supportive of reflective critique throughout the qualitative process.Research methodologies that endeavour tobring about social change must reflect aresearch process that is in itself emancipatory.

EMANCIPATORY RESEARCHEmancipatory research has the intent to challenge inequities and disrupt the status quowhere necessary. It has oppression as its centralfocus, social change as its key objective and fos-ters an ideology based on the belief that knowl-edge is ‘socially constituted, historically situatedand valuationally based’ (Henderson 1995: 58).If oppression was more fully understood, socie-ty could be transformed through political actionin order to bring about necessary social change(Ramazanoglu 2002). Applying emancipatorymethodology in nursing practice has beenregarded as having an immense impact (Irwin2006), however positive outcomes have beenrealised when oppressive health care practiceshave been challenged, resulting in positivechanges for nurses and the recipients of care(Glass 2007; Irwin 2006; Rose 2002).

Evolving from the critical theorists at theFrankfurt School in the 1920’s (Scrambler2001) emancipation became a central tenet ofcritical social science and feminist theories dueto the acknowledgement of oppression and thedesire to engage in political action to createchange. Both philosophies aim ‘to probe beneaththe surface in order to find what may lie hiddenthere’ (Tew 2002: 17).The significant differencebetween critical social science and feminism is that the latter focuses its attention on genderand the sociopolitical position of women in soci-ety (Mooney & Nolan 2006). Roberts (2000)believed that knowledge and understanding ofthe oppressive and complex circumstances thatwomen experience can result in liberation andfreedom for both women and nurses.

It is essential that feminist researchers applymethodologies that challenge the silencing of

women’s voices in society (Burns & Walker2004). The challenges community nurses canface was revealed in the research by Davis:

[t]he unspeakable is complex. It is shroudedin the silence that women and nurses keep.Generally nurses and women do not rock theboat by breaking the silence over personalsituations and/or the way in which they areconstrained by oppressive structures. (1998:113)

However, when undertaking research in theemancipatory paradigms, it remains crucial thatresearchers apply methods for data collectionthat are congruent with the chosen epistemolo-gy, focusing on the essential features that arephilosophically based. In critical and feministinquiries, the emancipatory methodologies fos-ter processes that promote opportunities fortransformation and as Jacobs et al (2005) con-curred, could also create in a philosophicalsense, a healing therapeusis. What follows is acloser exploration of emancipatory researchmethods.

RESEARCH METHODSResearch methods differ from the researchmethodology in that they are the means bywhich data is collected and analysed.There are avariety of methods that can be used to generateknowledge, however, the crucial element is thatthe methods applied must remain methodo-logically congruent as stated above. Emanci-patory research methods should thereforeintegrate intersubjectivity and reflexivity asvital processes.

Intersubjectivity is a process applied in femi-nist research that draws together the epistemo-logical/ontological links within the inquiry.Intersubjectivity incorporates the contestedexperiences people encounter in their lifeworld having been grounded in change, histori-cal relations of experience and the transforma-tive processes through which the subjective




meaning has been created (Zeedyk 2006; Driver2005). Intersubjectivity is designed to enhancereciprocity between research participant andresearcher and to generate meaning within thedialogical exchange (Summerfield 2000).

Reflexivity, although debated by some as elu-sive and nebulous (Dowling 2006; Carolan2003; Atkinson & Coffey 2002), has also beenconsidered by other scholars to be interchange-able with self-reflection (Morrow 2005).Reflexivity remains central to qualitative in-quiry and is important to feminist researchersas it endeavours to ‘identify acknowledge, anddo something about the limitation of theresearch, which may impair the emancipatorygoal of the inquiry’ (Fontana 2004: 99).

When selecting the most suitable methods fordata collection in emancipatory research it is important to attain epistemological and on-tological congruence. Methods such as semi-structured interviews and storytelling enableopportunities for the research participants andresearcher to explore the unique experiencesthat they have encountered in their life worlds,whilst working together toward making meaningof their stories. Storytelling can provide womenwith an opportunity to express many voices(Trinder 2000) whilst simultaneously creatingpossibilities for emancipation.The next sectionwill outline the role that emancipatory researchcan contribute to current nursing practice.

EMANCIPATORY RESEARCH ANDCONTEMPORARY NURSINGPRACTICEThe role of emancipatory research in contem-porary nursing practice is significant as it setsout to raise the consciousness of nurses who arelocated in marginalised and oppressed positions.Whilst violence and oppression in nursing hasbeen well documented by many scholars (Heg-ney et al 2006; Luck et al 2006; Glass 2003a,b;Scarry 1999) the methods applied to deal with oppression should continue to extend far beyond rhetoric, engaging methodological

approaches that create opportunities for posi-tive social change.

It has been consistently documented thathorizontal violence and bullying exists in health-care environments to a point where the nurse’swell-being has been impaired (Glass 2007; Heg-ney et al 2006; Rose & Glass 2006; Davis 1998).The social injustices that persist remain prob-lematic in a variety of settings with McMurray(2006: v–x) strongly contending:

[t]he insidious nature of violence challengesnursing as a caring profession; at times, over-whelming our private and professional lives,distracting our pursuit of gender equality,and violating the very notion of a civil andjust society… only when all people have aright to speak for themselves, a right to dig-nity, a right to work safely, in equitable con-ditions will we be able to declare ours asocially just society.

Scholars have clearly argued that horizontal violence and bullying in Australia are deeplyembedded within our nursing culture, report-ing that such actions involve a physical compo-nent (Glass 2003b) and can result in ‘profoundharm’ (Hutchinson et al (2006: 28). Further-more, the resulting harm could be further per-petuated within organisations that arecharacterised by a culture of acceptance orthose that may foster a fear of reprisal (Speedy2006). It is therefore necessary for nurses togain a deepening awareness of the importanceof looking after themselves in their workplace.In the recent research by Glass (2007) on nurseand midwifery academics and clinicians it wasfound that nurses emphatically neededresilience to work in nursing and hope and opti-mism was critically linked to job satisfaction.

One of the issues is that if nurses are not ableto build a personal strength in order to deal withworkplace violence, patient care may be com-promised. As Hegney et al (2006: 230) conclud-ed from their recent study of Queenslandnurses, ‘regardless of the source or frequency,




an environment that is considered unsafe is not good for clients, employees or employers’.Wittmann-Price (2004) argued that the firststep toward creating an emancipated healthcareenvironment is by first recognising the existenceof oppression and in turn its impact upon nurs-ing care delivery. It was stated that ‘nurses them-selves need emancipation from the constraintsimposed on them by the systems in which theypractice’ (Wittmann-Price 2004: 444).

The study undertaken by Jacobs et al (2005)addressed workplace practice issues associatedwith those raised by Wittmann-Price (2004).With a focus on the changes in the health care system and the resulting stress caused by staff shortages, the scholars explored nurse’sperceptions of their workplace conditions andthe processes through which changes couldoccur. The emancipatory framework not onlyacknowledged the oppression and strugglesencountered by the nurses but moreover,highlighted the nurses’ endeavours to actively formulate solutions for positive change. Theauthors concluded that the research process wasenlightening, therapeutic and emancipatory forthe participants.

The authors of this paper contend that byacknowledging the value of emancipatoryresearch undertaken with nurses, new oppor-tunities are created for nurses and for theadvancement of professional nursing practice.What now follows is a research example that isaimed to demonstrate the application of anemancipatory process applied to a current studyundertaken as a PhD in nursing.

RESEARCH EXAMPLE

Research topic

The research was entitled: Emotional work, emo-tional well-being and professional practice:The livedexperiences of women community health nurses pro-viding palliative care in the home environment inAustralia. By way of a qualitative design, thestudy was theoretically underpinned by critical

social science and feminism.The research aimedto explore community health nurses’ (CNs)experiences of providing palliative care with thecentral focus on the CNs emotional well-being.

Exploring community nursingpracticeWhilst the diverse roles in community nursinghave been acknowledged in the literature(Goodman Knight, Machen & Hunt 1998; Rose& Glass 2005; Annells 2007) there is minimalexploration of the role community nurses havein palliative care provision. Hence there is asense of professional invisibility and marginali-sation in their roles. Involvement in palliativecare of clients remains a core aspect of commu-nity nursing practice regardless of the client’sdiagnosis (Aranda 2003) and draws on a widerange of professional skills and clinical knowl-edge including the nurse’s emotional resources(Wilkes & Beale 2001; Luker et al 2000).

Whilst CNs historically work in partnershipwith other healthcare professionals in the multi-disciplinary team (Appelin & Bertero 2004;Simpson 2003), the emotional challenges facedin CNs’ client encounters can be complex andstressful (Aranda 2005; Vachon 2004). Mostimportantly, Payne (2001) added that exposureto death, dying and suffering can potentiallyresult in burnout. It is strongly argued that forcommunity nurses involved in palliative care,paying attention to self-care remains a signifi-cant issue and that ‘healing yourself is an essen-tial foundation for healing others’ (Birx 2003:46). With that in mind, the methodologicalframework applied to the study needed to havean emancipatory intent.

MethodologyThe methodology incorporated critical socialscience and feminism, both designed to critiqueand analyse the sociopolitical worlds of indi-viduals and groups that are marginalised andoppressed.The methodologies aimed to presenta critical lens through which the experiences of




CNs providing palliative care could be exploredin order to gain an increased understanding andprovide opportunities for emancipatory solu-tions to be realised. As Mooney and Nolan(2006: 245) have asserted:

in order to overcome the prejudices that haveexisted in nursing in the past, it is essentialthat nursing continues to grow, acquire andfurther define its body of knowledge as ameans to achieve sociopolitical understand-ing and change. Critical engagement is ameans to knowledge development and eman-cipation of nursing.

With power imbalances in nursing environ-ments gaining attention in the nursing literature(Glass 2007; Rose & Glass 2006; Rose 2002;Kuakkanen & Leino-Kilpi 2000; Hall 1999), thecritical feminist framework intentionally tookinto consideration the hierarchical structuresthat continue to permeate nursing environ-ments. It has been noted that some communitynurses perceive their work to be unacknowl-edged and regarded as invisible (Goodman

2001; Falk Rafael 1998; SmithBattle, Drake &Diekemper 1997).With that in mind, applying afeminist approach to the study sought to ensurethat the nurses were supported to reclaim theirvoices (Glass 1998) and speak out about theirunique workplace experiences.The emancipato-ry framework applied to the study has been out-lined in Figure 2.

ParticipantsResearch participants were sought from ruraland urban New South Wales. Phone calls andelectronic mail were used to access communityhealth centre managers and to engage withpotential participants. Following universityhuman research ethics approval and subse-quently health service site approval, the in-formation and consent forms were distributedto community health nursing teams. Direct contact was made with all interested CNs andfollowing informed consent, interviews werearranged. Although ten participants were origi-nally estimated, a keen interest in the studyresulted in fifteen CN participants. All the



FIGURE 2: EMANCIPATORY FRAMEWORK


women were over the age of eighteen years andall were actively involved in the provision ofpalliative care.

Research methods

Reflective journalling

Reflective journalling was implemented as amethod by the researcher to bring into focusher thoughts, feelings and behaviours related tothis research. Such a process has been advocatedas a notable strategy for scholars and cliniciansto promote reflexivity (Taylor 2004; Manias &Street 2001; Rowling 1999; Walter, Davis &Glass 1999).The researcher was also a co-par-ticipant in the study and the reflective jour-nalling was significant in her efforts to be fullyimmersed in the study.

The reflective journalling also provided ameans for the researcher/participant voice/s tobe made visible and those reflections acting asadditional analytical data. Furthermore, reflec-tive journalling was utilised as a self-healingstrategy, enabling the expression of any emo-tions that arose from the sensitive nature of thestudy, thus acting as a tool for therapeutic con-versation (Glass 2001). The aim was to bereflexive and as such the journals became aclose companion of the researcher and a tool for scribing critical dialogue and subjectivethoughts. For instance, the following reflectionswere journalled by the researcher after oneinterview.

There were smiles, laughter and tears, speak-ing openly and freely as the interview wenton clearly feeling safe to speak about verysensitive issues. [The participant] was clearlypassionate about her practice and had highexpectations of herself professionally. Hersmile and confidence were warming, yetbehind the mask of confidence lay feelings ofinsecurity… The storytelling proved impor-tant in the reflexive process and assured con-structive feedback in regard to professional

practice. I observed emancipatory opportuni-ties, psychologically, emotionally and spiritu-ality… We parted, leaving a mental list ofnew strategies aimed to enhance her well-being. Our time spent was valuable andrewarding.

Moreover, Walter et al (1999: 14) maintainedthat reflective journaling also encourages theresearchers own ‘disclosure of emotion andexperience, and as such works to make theresearch more equal and non-hierarchical’.Applying an intersubjective approach to thestudy also produced an increased depth of analy-sis related to all aspects of the research, whilstsimultaneously presenting a self analysis placingthe researcher ‘on the same critical plane as the researched, leaving the researcher open to critical scrutiny from the readers’ (Bloom1998: 148).The following excerpt provides an example of the researcher’s reflections follow-ing an initial visit to a healthcare centre. Theresearcher wrote:

I felt an underlying tension that remainedaloof. Greeted with a warm welcome I was conscientiously escorted to the meetingroom. My time was brief yet animated.Attentive smiles throughout the crowdedroom of nurses yet few questions.That sur-prised me given their prior knowledge of thestudy. A softly spoken CN accompanied mydeparture. Quietly and quickly I was to learnof the disharmony and the power issues thatinfiltrated the environment. My feelings oftension were validated, reflected in the briefconversation we held. The situation was complex, vulnerability infiltrating the team,reluctance to speak was revealed. It was thesilence that spoke the loudest.

Interviews/storytellingThe interviews were semi-structured incorpo-rating open-ended questions. The choice ofmethod was congruent with feminist inquiry




at it sought to validate the unique and diverseexperiences of the women participants.

The interviews process was undertaken overa twelve-month period allowing for travelbetween rural and urban areas of New SouthWales. The majority of the interviews werewhat Davis and Taylor (2006: 201) described as having ‘resembled a conversation betweenfriends’. However, it was essential that theresearcher remained cognisant of her role as aresearcher ensuring that she did not to influencethe storytelling process.

The interviews took place in places that weredeemed ‘emotionally safe’ by the women. Thechosen venues included community health cen-tres, cafés and private homes. The storytellingprocess incorporated self-reflection, self-aware-ness and intersubjectivity with the women’s sto-ries valued by the researcher as a gift (Donalek2005). Storytelling provided an opportunity forthe women to be heard, a framework that tooknotice of the many voices drawn on by thewomen to describe their experiences (Trinder2000).

Each interview was recorded on an iPod digi-tal recorder following signed consent from theparticipant. The individual interviews variedbetween one to two hours in duration with fif-teen interviews conducted.The recordings wereconverted to WAV or MP3 format, copied toCD and returned to the individual participants.That process ensured that credibility andauthenticity were achieved as it provided theparticipants with opportunities to add or deleteany aspect of the interview should they have feltit necessary.

Research discussionThe research demonstrated the way in whichcritical social science and feminist theory couldbe applied to explore the unique challenges thatcommunity nurses experienced in their provi-sion of palliative care. With an emancipatoryintent, the women nurse participants wereencouraged and supported to speak openly,

sharing meaningful stories related to their pro-fessional practice. The conversations provedinsightful as the nurses were able to hear theirown stories and create further meaning fromtheir reflective accounts. The nurses raisedmany issues that were significant and inclusiveof communication, education, professionalboundaries and self-care; however, two areasthat held prominence for many of the nurseswere be addressed under the headings of: pallia-tive care provision and emotional support/clinicalsupervision.When speaking of the challenges inpalliative care provision a strong self-awarenesswas evident of numerous issues that could chal-lenge the nurse’s well-being. With a focus onclient care Joy remarked:

Not getting involved… not taking too muchon board. That’s probably the hardest thingfor me… It’s quite emotionally demandingwork.

Di extended her thoughts beyond client carewhen she commented:

It’s not the person you are looking after thatis the challenge but its quite often the rela-tives… [and] if other people in the team arenot emotionally stable either then that’s hard!

Issues related to emotional support/clinical super-vision were significant and all participants withthe nurses being resourceful in seeking someform of support.Whilst clinical supervision wasregarded as one form of formal support, theissue was contentious due to the absence ofavailability to the CNs as was reflected in thefollowing comments.Tiche emphasised:

We don’t have any clinical supervision whichis a huge gap I feel. We have each other. Welaugh together and cry together and that’show we survive emotionally.

Lee regarded the non-provision of clinicalsupervision to nurses as invalidating and furtherevidence of the ongoing oppression of nurses.With a raised consciousness of the emotional




impact of palliative care provision in her CNrole, the absence of clinical supervision fromthe health service had led her to pursue privatefunded supervision. The empowering strategywas deemed as an essential tool to enhance herwell-being and most importantly, her profes-sional practice. Lee remarked:

[I’ve] actually gone privately to supervi-sion… because there is not the infrastruc-ture, there has never been the recognition orthe infrastructure put in place for nurses… Iwas able to hear what I was saying, reflect onmy practice, which is why I went in, becauseit’s about moving on from that.

The research example above highlighted theway in which an emancipatory framework wasapplied to exploring the subjective experiencesof Australian CNs involved in the provision ofpalliative care.With an emphasis on emotionalwell-being and its relationship to professionalpractice, the CNs were supported through afeminist epistemology to share their storiesrelated to their clinical practice.

Whilst the value of emancipatory researchcan be significantly related to the research out-come as expressed earlier by Jacobs et al (2005)the participants involved in the above examplewere optimistic that their professional visibilitycould be improved and that transformative out-comes could be achieved for the benefit of allCNs. One of the participants declared at theonset: ‘I think that the community nurses neverreally get recognised for what they do, it’salways the specialist PC teams that get recog-nised’. In later correspondence sometime afterthe interview the CN wrote: ‘looking forwardto your continuing and very valuable research’.

CONCLUSIONIt is the intention of this paper to highlight the important contribution that emancipatoryframeworks can have to advancing contempo-rary nursing practice. Whilst it was acknowl-edged that the contribution of diverse research

methods and methodologies advance nursingpractice and enhance professional development,it is argued that emancipatory approaches pro-vide a broad lens through which issues of mar-ginalisation and oppression can be addressedand transformative opportunities can be creat-ed.The nursing profession has traditionally pro-moted holistic healthcare practice in client care,however, the holistic and humanistic care of ournurses has been long relegated to the marginsparticularly when exploring emotional issues.Emancipatory inquiries provide valuable oppor-tunities for researchers to address the complexissues faced by nurses in their quest to examineand critique the social structures that maintainoppressive workplace environments. Engagingin a research process that supports and enablesnurses to ‘speak from their heart’ can result instates of empowerment and personal liberation.An emancipatory intent can create transforma-tive opportunities that have benefits for all nurs-es, the nursing profession and recipients ofnursing care. If caring is at the heart of nursing,then let’s care for the hearts that nurse!

AcknowledgementsThe authors acknowledge the participants fortheir openness, willingness and generosity ofspirit to share their stories, and the SouthernCross University for awarding an AustralianPostgraduate Scholarship to the principal author.

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ADVANCES IN NURSING AND INTERPERSONAL VIOLENCE

Foreword by Moira CarmodyEdited by Anne McMurray and Debra Jackson

ISBN 0-978-0-9750436-6-0; x + 164 pages; May 2006

The extent and impact of workplace aggression in the health care sector is widely acknowledged by theInternational Labour Office, International Council of Nurses and World Health Organisation & Public Services

International. In Australia and New Zealand Occupational Health and Safety requirements have been amended to include provision of a safe and harassment free workplace.

Industry standards now recommend that all staff undertake compulsory training for dealing with potentiallyviolent and aggressive situations, particularly in mental health and aged care.

Violence remains a significant occupational hazard in health care. The serious nature of many attacks, and the potentially catastrophic effects of violence on victims, their families, and ultimately on the

health care profession is of grave concern to all involved. Finding solutions to such an intransigent problemrequires serious public debate and it is therefore appropriate that such a discussion be conducted with an

informed discourse in this special issue of Contemporary Nurse.

In one reader, Advances in Nursing and Interpersonal Violence provides leading opinion pieces, reviews and new research perspectives on intimate partner violence, domestic violence and workplace

violence, and policies to manage their impacts on nurses, their families and the community.

www.contemporarynurse.com/archives/vol/21/issue/2/advances-in-contemporary-nursing-and-interpersonal

eContent Management Pty Ltd, PO Box 1027, Maleny QLD 4552, AustraliaTel.: +61-7-5435-2900; Fax. +61-7-5435-2911; [email protected]

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the importance of emancipatory research to contemporary nursing practice

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