Generating insights into what matters to emergency nurses and family members when caring for older people with dementia: how to use generativity as a principle of appreciative inquiry

Abstract

Background: Participatory research approaches aim to hear the voices of those who give and receive services in order to co-create insights into future improvements in care experiences. Appreciative inquiry is one such participatory approach. Its purpose is generativity, which is defined as helping people to see old things in new ways. Generativity shows much potential but there is little research describing the ‘how to’ of doing this in practice. This article describes the how to of generativity in the dream phase of an appreciative inquiry study. Aim: The aim was to share and co-analyse, with emergency nurses, family member experiences of being in an emergency department with an older person with dementia. Methods: Three critical methods were used to generate data – storytelling, appreciative framing and dialogue, and collaborative sensemaking. The principles of appreciative inquiry provided a framework for data analysis. Findings: In using appreciative inquiry methodology, emergency nurses were able to envision a preferred future based on what people value and what matters in approaches to care. Generativity enabled them to visualise what it would take to bring this new way of nursing to reality. Conclusion: Creative methods, when maximised, can be powerful tools in reframing narratives and helping practitioners to transcend the rut that perpetuates the status quo and obscures hope of future improvement. Generation of new insights and perspectives is critical to identifying and developing strategies for practice enhancement. Implications for practice: Generativity is an underexplored concept yet it has the potential to help practitioners to see things with new eyes Patient and/or family member stories play an important part in practice development, to determine what matters and is valued in enhancing experiences of care Finding ways to integrate the relational aspects of care provides a mechanism for nurses to articulate their skills and contribution in highly technical and task-orientated clinical environments