inga heyman insider outsider - leph2016 conference · 2017-05-15 · insider and outsider...

Insider/Outsidercollaborativepoliceandhealthresearch.Thechallengesandfacilitators

IngaHeymanPrincipalSupervisorProf.CatrionaKennedy

SecondarySupervisorsDr.SteveSmith.Dr.SheelaghMartindale

Aim• ToexploreanddiscussthetensionsofInsider/Outsiderpositionsinpractitionerresearchthroughtheexperienceofoneresearcherwhohasgrappledwithholdingacomplexmixofhealth/police/researcheridentities.

• Thechallenges,facilitatorsandmanagementofsuchapositionwithinresearchwillbediscussedalongwiththeacknowledgementofthebenefitssuchacomplexpositionbrings.

Professionalbackground• Lecturerinmentalhealthnursing,researcherandPhDstudent

• Adultandmentalhealthnurseinclinicalpracticefor30yearsinAustraliaandScotland

• Workedinpublichealth,mentalhealthandpoliceservices.

• Dualprofessionalinsights• Wellestablishedandvaluedprofessionalrelationshipsinhealthandpolice

• PhDstudyoftheinterfaceandpathwaybetweenpolice,thoseinmentalhealthdistressandemergencyhealthservices

• Passionateabouttheissueandstrongdesiretobridgeagapinunderstanding

• Understoodthephenomenathroughbothprofessionallensesandinsightsintotheexperiencesofthoseinmentalhealthdistressthroughworkinginthisarea.

Benefits• Organisationalknowledgewereinfluentialandbeneficialtothestudydesign(AlvessonandSkoldberg2000).

• Positiveandtrustingrelationshipswithgatekeeperssupportingaccesstodata,participantsandknowledgewithinbothservices-clearbenefits.

• ClinicalexperienceengagingwithPWEMDofferedopportunitiestofullyengagewithallthreeagentsinthestudy.

StudyaimTounderstandthepathwaysandinterfacebetweenpoliceofficers,healthservicepractitionersandthoseinmentalhealthdistresswhoinitiallypresentto,andarereturnedto,policeservicesforsubsequentmanagementfollowingmentalhealthassessment.

Whatcouldgetintheway?!• Atensiondevelopedbetweenthesubjectiveassumptionsmadeasapractitionerandtheobjectivityofbeingaresearcher

• Ethicalchallenges,potentialbiasandpossiblethreatstostudyviabilitywereaconstantconsiderationthroughtheresearchmethoddevelopmentphase.

• Becomehighlysensitiveandapprehensiveregardingthepossiblenegativeconsequencesmypracticerelationships,familiarityandassumptionswouldhaveonthevalidityofthestudy.

Searchforapositiontomakesenseofthis…

• Challengesandopportunitiesof‘Insider’and‘Outsider’researcharewelldocumented.• Brown(1996)takesthisonestepfurtherinrelationtopoliceresearchandsuggestsfourpotentialpositions.Insider/insider,insideroutsider,outsider/outsiderandoutsider/insider.Allwithcomplexitiesandchallenges

• Foundmyselfinapositionofbeinganinsiderandoutsiderandneitherinbothservicesinvolvedinthestudyallatthesametime.

• Insider- Canovercomebarriersofaccesstoparticipantsanddata.Insightsandgoodsubjectknowledgesupportinterpretation.Yet,perceptionofrelativepower,familiarityandpotentialbiasparticularlyinrelationtodatacollectionandanalysis.

• Outsider- Biasislesslikely.Fresheyesontopic.However,canmisinterpretdatathroughlackofsubjectknowledge.FloydandArthur(2012)suggestthatoncetheresearchhasbeencompletedandwrittenup,ethicalconcernsfadenaturallyintothebackgroundforsome‘outsiders’whichcanbedangerous

Challengesforthisresearcher• Viewedasaninsiderbybothservices.• Forcedagreaterconsciousnessofthesituation(Moule2015).Developmentofthestudyapproachtooktime

• Casestudyapproachedallowedviewingthroughtheagentlenses

• Needfortransparencythroughoutthestudy(Latimar2003)

Facilitators

• Viewedasaninsiderbybothservices…• Mantzoukas(2005)- biasisnotbydefinitioncounterproductiveiftheresearcher’sbiasisfullyincorporatedandapparentthroughoutthestudy.Needtoidentifymybias!

• Ethicalconsiderationshavebeenattheforefrontofthisstudystrengtheningthework.

Findingacomfortableplace

• Ratherthanconsiderthisissuefromadichotomousperspective,thereisaspacebetweenwhichallowsresearcherstooccupythepositionofboth‘insider’and‘outsider’ratherthan‘insider’or‘outsider’.Thispositioncanbeuniqueandthusbringincreasedflexibilityandunderstandingtoexplorethe‘complexityandrichness’oftheresearch.(CorbinDwyerandBuckle2009)

Management

• Participateinareflexiveinterviewtosupportherownunderstanding,transparencywithinthestudyandidentifyauthenticityofevidenceandethicalissues(HollowayandFreshwater2007).

• Fornon-positiviststudies,reflectionisusedtorevealtheresearcherbias,andshouldbeincludedratherthanexcludedfromthestudy(Mantzoukas2005).

Ethics

• Studydesign- considerationsinthecontextofacomplexhumansituation

• Ethicsapproval– NHS–intensescrutiny,needforconstantjustificationandchallengeethicscommitteeswhohadlimitedinsightsintopoliceresearchandprocesses.9months.

• PoliceScotlandresearchprocessesclearerandsupportive

Benefits

• Familiarityofprocessesandsystemswhendesigningstudyapproach

• Clinicalbackgroundtosupportscreeningtopreventharm

• Insightintovulnerability,disclosureofriskandconsiderationsofharminrecounting‘story’

• Gatekeeperbuyinbybothservices• Awelcomedstudybybothpoliceandhealth

ManagementDatacollection

• Consciousofinterviewtechnique.Needtobecleveraboutquestioningtogetdepthofnarrative

• Easytofallintofamiliarconversationsandmovefrominterviewschedule

Analysis

• Templateanalysisallowedforqualitychecksandreflexivity.

• Audittrail• Codingcheckingofsametranscriptswithresearcheroutwithstudy.

Constantreflectionandjustification

• Assumptionsabouttheresearcherasadetached,objectiveobserver– arguethisnottrue.

• Constantselfreflectionandcheckingoutassumptionswithcolleagues

Conclusion

• Researcherswithmultipleidentitiesmust considertheirinsiderandoutsiderperspectivesandmanagethisisopenly.

• Auniquepositionwhichhasbeenvalued• Ratherthanlimitthestudyithasbroughtarichnessand

depth• Ethicaldilemmasandtusslesbroughtheadaches,sleepless

nightsyetgreatlearning• Constantstrivetobetransparentandreflectivehas

strengthenthework• Sincereappreciationofthetrustaffordedtomebyservice

users,gatekeepers,policeandhealthserviceparticipants

Thankyou

IngaHeymanSchoolofNursingandMidwifery

RobertGordonUniversityGarthdeeRoad

AberdeenAB107QG

i.heyman@rgu.ac.uk