Voice-centred Relational Method Research Articles

Two-Spirit Peoples' experiences accessing and receiving care from community pharmacies.

Two-Spirit Peoples face unique challenges in accessing and receiving health care in Canada due to health services, including community pharmacy services, being built on hetero- and cis-normative models that impede appropriate care for this group. Currently, there is limited published information on Two-Spirit Peoples' experiences accessing and receiving care in community pharmacy settings. To address the lack of published information, 21 Two-Spirit individuals shared their experiences in a focus group setting. Four different focus groups were held across Canada, including 1 in Saskatoon, Vancouver, Edmonton, and Toronto. Informed by Indigenous methodologies, data were recorded via audio recording and notetaking, and the audio was transcribed and then analyzed for themes using the Voice-Centred Relational Method. Three major structural systems that affect the experiences of Two-Spirit Peoples in community pharmacies were identified: 1) white supremacy, 2) capitalism, and 3) heteronormativity. These 3 systemic issues presented themselves via racism, homophobia, transphobia, pharmacists' lack of knowledge about Two-Spirit individuals and their health and lack of time spent educating or building relationships with Two-Spirit Peoples. Participants provided suggestions for how community pharmacists can better serve the Two-Spirit community, such as using inclusive language, adding pronouns and preferred names to patient files, increasing knowledge about Two-Spirit health and advocating for Two-Spirit Peoples. The results suggest that dismantling current structures and ideologies in community pharmacy and society are required to overcome the identified issues. Two-Spirit Peoples face barriers when it comes to accessing and receiving care in community pharmacies, resulting in many Two-Spirit individuals avoiding health care to save themselves from unsafe and uncomfortable interactions. Pre- and postlicensure pharmacy education about Two-Spirit Peoples is required to improve Two-Spirit Peoples' experiences accessing and receiving care in community pharmacies.

Sources and perceptions of hope: A qualitative study involving younger people with dementia.

Hope is an important but overlooked phenomenon in dementia studies. Few studies have examined how people with dementia experience or perceive hope, possibly because it is seen as a diagnosis without hope. In this article, we report on a doctoral study, the aim of which was to examine the phenomenon of hope from the perspective of younger people with dementia to generate new understanding and enable community-based healthcare professionals to support well-being. The study was conducted in the Midlands, England, and used a modified diary-interview method. Six participants were given a camera and asked to take pictures of whatever made them feel hopeful. During a post-diary semi-structured interview, a conversation about hope took place. Interviews were transcribed and interpreted using the 'Voice-Centred Relational Method'. Findings show that hope is important to younger people with dementia. Sources of hope were the surrounding environment, keeping connected, taking action, and drawing on internal resources. An over-arching theme was 'defying dementia' and participants demonstrated resistance to negative stereotypes. Living with dementia did not curtail hope, although it could be weakened when participants felt 'cast adrift' by services. The In vivo codes generated were fear of dementia, threats to identity, disconnection from others, and frustrations and restrictions. It is concluded that hope should be a more central part of practice-based conversations with people with dementia.

‘It is a university where I felt welcome’: poems of asylum-seeking students’ sense of coherence in Australian higher education

ABSTRACT Current social and political arrangements of higher education are inequitable for students from asylum-seeking backgrounds. In many countries, their access to university is limited and if they are accepted, their status as forced migrants puts them at multiple disadvantages. This inequity is in contrast with the universal aim of higher education institutions to serve all people and their societies. Utilising a voice centred relational method (VCRM) and the theoretical lens of Aaron Antonovsky’s salutogenesis, this article is a poetic presentation of the experiences of asylum-seeking students in Australian universities. We show that higher education can provide asylum-seeking students with the means for safety (making life manageable), belonging (making life comprehensible), and success (making life meaningful). Thus, we argue that higher education institutions have the potential to help facilitate students’ sense of coherence, which in salutogenetic terms refers to their ability to comprehend their own situation, and the capacity to use the resources available. However, asylum-seeking status poses barriers in achieving this, and this inequity should be addressed.

Voices of Australian Mature-Age Bachelor of Counselling Students: Telling Stories of Learning and Teaching Transitions

The COVID-19 pandemic imposed transformations on the higher education context of the twenty-first century that adversely impact students’ learning in certain disciplines. On a mission to adopt ethics of care in research and practice, this research focuses on counselling education and its unique characteristics, by signifying counselling students’ voices in such changing contexts. A qualitative exploratory multiple case study design informed by narrative inquiry was used, followed by a voice-centred relational method of analysis. Findings revealed voices, relationships, dominant narratives and power relations that influence counselling students’ learning experiences. Implications for future research and practice for counselling education are highlighted.

Adapting voice-centred relational method to understand students’ experiences of synchronous online tuition

ABSTRACT This article presents the methodological approach taken to investigate students’ experiences of synchronous online tuition in health and social care at a large, distance learning university in the UK. Seeing the students as the ‘privileged knowers’ on the topic of their tutorial experiences, this study took an experience-centred narrative approach and used voice-centred relational method to analyse the data. This paper will explain and then discuss the two ways in which voice-centred relational method was adapted for the purposes of this research: firstly, the particular approach taken to the construction of the I poems in the second stage of the analysis and secondly, the addition of an extra listening, adding a deductive lens to seek out evidence of the different types of presence from the Community of Inquiry framework within the students’ narratives. These adaptations provided additional insights into students’ experiences and made aspects of these experiences more visible to educators.

Students’ experiences of synchronous online tuition in health and social care

This article considers the online tutorial experiences of 10 female undergraduate students studying a health and social care module at a large UK-based university that specialises in distance learning. The research uses the Community of Inquiry as a theoretical framework and takes an experience-centred narrative approach, using Voice-Centred Relational Method to analyse diaries and interviews. The analysis uncovers how tutorial experiences are embedded in the social and cultural contexts of students’ lives and are fitted around their caring roles. These students experience variation in tutorial design and in the tutors’ characteristics. They value friendly, empathetic tutors who enable students’ contributions and respond encouragingly. Students avoid using microphones in tutorials for multiple reasons but enjoy taking an active part via other tools. They appreciate hearing peers’ perspectives and prefer small group sizes. A sense of community is missing, particularly for students with fewer supportive friends, colleagues, or family members. They long to see people’s faces and build relationships. An awareness of students’ contexts and preferences can help educators to enable positive tutorial experiences.

The father absence-mother blame paradigm in child protection social work: an Italian feminist single case study

ABSTRACT International research shows how gendered and androcentric practices in child protection social services increase the risk of harmful consequences for mothers and children. This paper discusses the results of a feminist single case study carried out in Italy, extracted from a wider research project on the experiences of single mothers in the field of child protection. Adopting the voice-centred relational method, an analysis was carried out of an in-depth interview with Flora, a single mother who has survived gender-based violence and has been an addressee of child protection social services. The results show the potential consequences of the father absence-mother blame paradigm coined by Strega et al. (2007) when applied to social work practice. The method of critically discussing a paradigm used by Krumer-Nevo (2016) in developing the poverty-aware paradigm provides insight into various ontological, epistemological and axiological facets. Flora’s account highlight how harmful the father absence-mother blame paradigm can be for those experiencing it, via several means: an unquestioned ideal of the patriarchal nuclear family, actions by social workers based on positivist, risk-focused approaches, and an exclusive focus on children. The conclusion emphasises the importance of including the expert knowledge of addressees to develop more supportive social work practices.

Teacher voice for reflections on practice: using the voice-centred relational method to determine early childhood teachers’ understanding of spirituality

ABSTRACT This article presents a methodological exercise using the voice-centred relational method to show how two Australian early childhood educators recognise and address spirituality in children’s learning and wellbeing. The relational voice-centred methodology is outlined and applied to two of the transcripts of participants from an exploratory project originally involving three educators. The analysis revealed that while these participants understood spirituality in ways consistent with the literature, there is a disconnect between key statements of the regulatory framework and their daily practice, leaving them uncertain as to how to reference and document this feature of children’s development.

'Guid times wi the bad times': The meanings and experiences of befriending for people living alone with dementia.

Befriending is a service in which volunteers provide companionship and support usually to people who are lonely or isolated. Such services are promoted in Scotland’s national strategy to improve the lives of people with dementia, around a third of whom live alone. However, little is known about the perspectives of recipients. Taking a holistic qualitative case study approach, the aim of this research was to explore how people living alone with dementia experienced befriending and the contexts in which their befriending relationships were meaningful. Three people were visited on five separate occasions. Largely unstructured conversations allowed individuals to prioritise areas of importance to them within the broad topics of befriending, everyday life, social networks and biography. Participants also had the option of ‘showing’ how they spent their time with their befriender. Data were analysed using the voice-centred relational method. Three key messages emerged: befriending satisfied unmet needs and wishes for particular kinds of relationship; befriending was a facilitated friendship; and befriending was a human response to contingent and existential limitations.

Why do some medical graduates lose their intention to practise rurally?

Chronic medical workforce shortage and maldistribution continue to be a significant challenge in rural Australia. The Rural Clinical Schools (RCSs) program helps to alleviate this problem with evidence of increased rural location in graduates of rural training programs. However, rural work intent may change during the years after completing a rural placement. This qualitative study investigated the factors involved in the change of career intention from rural to urban work location among the Australian National University Medical School (ANUMS) Rural Stream (RS) alumni. A purposive sampling method was utilised to recruit ANUMS RS 2006-2016 graduates who expressed that their work plans had changed. Data collected with the use of in-depth, semi-structured interviews were transcribed verbatim. Transcripts were interpreted using thematic analysis and a modified version of I-poems, a component of Voice-Centred Relational Method or the Listening Guide. Thematic analysis produced three main themes. First, 'impacts of the working environment' highlighted some participants' views that career progression and sustenance, high-quality training and agreeable working conditions could not be achieved rurally. Second, 'ramifications of isolation' described the experienced or predicted feelings of social and professional isolation. Third, 'familial considerations' explained how the wishes and requirements of partners and families strongly influenced the participants' future work decisions. These findings were supplemented by the 'committed voice' and 'voice of uncertainty', heard through the use of I-poems. The 'committed voice' communicated the participants' dedication to their careers and partners. The 'voice of uncertainty' expressed confusion of intentions as participants attempted to balance the bidimensional needs of the 'committed voice'. The complex interaction between the availability of high-quality training positions, support issues and work-life balance is associated with the change of rural work intention of RCS graduates. Career and partner/family commitments are significant factors. Meanwhile, uncertainty towards future work location provides the opportunity for carefully developed and appropriate rural workforce strategies to intervene.

Undisturbed Physiological Birth: Insights from Women Who Freebirth in the United Kingdom

ObjectiveTo understand women's experiences of undisturbed physiological birth by exploring the narratives of women who have freebirthed their babies in the United Kingdom (intentionally giving birth without midwives or doctors present). DesignUnstructured narrative face-to-face interviews were carried out and data were analysed using the Voice Centred Relational Method (VCRM). ParticipantsSixteen women who had freebirthed their babies. FindingsWomen discussed a range of phenomena including birth positions, the fetus ejection reflex, pain, altered states of consciousness, physiological third stages and postnatal experiences that were physically and emotionally positive. Key conclusionsThere is a paucity of literature on physiological birth and limited opportunity for practitioners to witness it. Further research is required on phenomena related to physiological birth so as to better understand how to promote it within the maternity setting and when intervention is justified. Implications for practiceStandard maternity settings and practice may not be conducive to or reflective of physiological birth. Better understanding of physiological birth is required so that pregnant women and people can be appropriately supported during labour and birth.

Investigating language teachers’ ideals in images and interviews

Ideals have been linked to identity, motivation and stamina. To investigate language teachers’ ideals in depth, this study employs a novel complex, three-step method, analysing data collected through drawings and one-to-one reflective interviews with a voice centred relational method (VCRM) for analysis. VCRM conserves the interviewees’ personal voice and includes the researcher as part of the process of analysis. This paper will show how the complex method can be employed and how the findings derived from it allow insights into the forces that keep teachers going, their origins, and their potential for integrating change. Thus, qualitative data collection methods combined with a voice-centred analysis method can be harnessed to enhance our understanding of teacher ideals and the tensions between external demands, internal standards, and different cultures language teachers have to cope with.

Change fatigue in nurses: A qualitative study.

To provide a conceptual update on change fatigue in nursing as it relates to rapid and continuous change implementation. This doctoral dissertation examined nurses' experiences of rapid and continuous organizational change, with a core component of the study examining the concept of change fatigue. Change fatigue is understood as the overwhelming feelings of stress, exhaustion and burnout fuelled by feelings of ambivalence and powerlessness associated with rapid and continuous change in the workplace. Change fatigue may cause workers to become withdrawn and greatly influences their decision to leave the workplace and even their profession. Little research to date has explored change fatigue in nurses. Were qualitative in nature. A critical hermeneutic approach was used. Face-to-face interviews were conducted with 14 Registered Nurses. Open-ended questions were used. Theoretical thematic analysis and inductive analysis of data were completed using Brown and Gilligan's voice-centred relational method. The study spanned from 2015 - 2018. Nurses did experience many of the core elements of change fatigue noted in the non-nursing literature, including exhaustion, apathy, powerlessness, and burnout. Two additional themes emerged pertaining to nurses' understandings of why they were experiencing change fatigue. These themes included the intensification of nursing work and repeated and ongoing self-sacrifice. Participants offered important insight into an emergent concept in the discipline of nursing. The negative experiences associated with change fatigue are important for administrators and other stakeholders to recognize and acknowledge, as they must work to alleviate change fatigue in their institutions to preserve the well-being of the nursing workforce. This knowledge is also important to nursing scholars, who may further research the topic and embed it into nursing curricula.

Do I Belong in the Profession? The Cost of Fitting In as a Preservice Teacher With a Passion for Social Justice

Preservice teachers enter university with a range of personally held beliefs related to inclusive education and themselves as educators. This article reports on one case study from a larger qualitative research project. The study examined a preservice teacher’s perceptions of herself as an inclusive educator as she approached the final year of her undergraduate degree. Data included a metaphorical representation of being an inclusive educator, and two semi-structured interviews held 6 months apart. The use of collage and a structured written response completed the data set. Evelein and Korthagen’s model of core reflection and Voice-Centred Relational Method were used to analyze the data. Analysis exposed the dissonance between the layers that separate the preservice teacher’s core qualities and the environment. Data are presented using I-poems and discussed using the emerging themes. The consequences for her emerging identity as an inclusive educator and sense of belonging in the profession are discussed.

Using an active listening approach to consider the views of three young people on the topic of missing education

This research uses an active listening approach within a narrative inquiry methodology to consider the views of three teenage males aged 15–17 years on the topic of missing education. Missing education is a term used to describe children and young people (CYP) not receiving a suitable education or being on a school roll. The participants’ accounts were analysed using a Voice-Centred Relational Method to identify the complex interplay of systemic factors, the importance of individual experience and supportive adult–pupil relationships. The reflective accounts presented in this paper highlight implications for active and effective listening to CYP. A model was created to support the approaches educational psychologists (EPs) could use to support school staff, parents and other professionals in their work with individuals “missing education”.

Humanitarian nursing with Médecins Sans Frontières: Foregrounding the listening guide as a method for analysing oral history data.

To demonstrate how the listening guide contributed to oral history data analysis. To better understand the continuing inclination of nurses to engage in humanitarian work, foregrounding the nurses' lives. The voice-centred relational method or listening guide is a method of qualitative data analysis used to analyse oral history data. A conventional approach to oral history interviews was adopted; intervention into the "flow" of participants' narrative was kept to a minimum. A small number of prompts, how they came into nursing, recruitment to, life with and since Médecins Sans Frontières, were used. Oral history interviews were conducted with seven nurses who had worked for Médecins Sans Frontières. Interviews were digitally recorded. This paper will demonstrate the application of the listening guide to historical data analysis and critique its applicability and value. The listening guide advocates four readings (listenings) of the text. Firstly, locating the plot in the narrative; secondly, actively listening for the use of "I?" ("we", or "you"), the "self" in context of the story being told and "I poem" development; thirdly, listening for relationships and finally, locating accounts in relation to wider social, political and societal contexts. Analysis revealed: "becoming", "being" and "leaving" Médecins Sans Frontières as chronological thematic areas. At one extreme creating "I poems" foregrounded individual voices while cross-referencing to contemporaneous records of world events locates this in an International context. It is argued that subjecting historical data to the listening guide can enable legitimate, creative exploration and analysis of data.

Experiences of care labour, gender and work for men who teach young children

This paper explores five Irish male primary teachers’ daily experiences of care labour and gender in contemporary Irish schools. Taking a feminist poststructural approach, the study employs three data-collection phases using the interview as the primary method of enquiry. It employs a voice-centred relational method of data analysis, which involves four readings of data with each reading troubling the data in different ways. This paper places specific focus on three everyday phenomena: care, emotions and the body. The evolving dynamic between gender and work is discussed in terms of a socio-cultural tension that informs the experiences of men who work with young children. Overall, two major challenges are identified. First, emotions are considered as individual, internal and private responses to situations. Yet, we absorb the norms and values of our society in the form of social and cultural practices that preserve society, which bring emotions into line with the rules proposed by society. Second, teaching is considered a soft option career for men and an essentially feminised occupation rather than a masculine one. As softness is very often associated with weakness, primary teaching does not align with traditional views of masculinities that are built on rationality, individualisation and heroism. This is a further challenge for male teachers to care in schools. Overall, male teachers are required to reproduce accounts of themselves in terms of valued masculine attributes due to the historical association between women, emotionality and care.

Finding voice through narrative storytelling: An exploration of the career development of young African females with refugee backgrounds

Understanding the complex process of career development of young people with refugee backgrounds, who resettle in developed countries after experiencing prolonged migration journeys, is a contemporary priority at a time when the highest number of people in recorded history is in urgent need of resettlement. Moving towards anticipated futures and access to appropriate work could be challenging for these young people after resettlement, considering the effects of protracted displacement that might have silenced their agency. To propose new ways of assisting young people with refugee backgrounds with such challenges, further research that increases knowledge about their career development is needed. The current research aimed to enhance understandings of the career development of young people with refugee backgrounds through culturally and contextually sensitive exploration of their career stories. Using a qualitative exploratory multiple case study method informed by narrative inquiry, qualitative data were generated through interviews and analyzed using a voice-centred relational method. Each participant's unique career story reflected the operation of various voices, relationships, social structures and dominant narratives, influential in reshaping their future career plans. Findings revealed that narrative inquiry fostered rich storytelling for young people with refugee backgrounds. These findings suggest that narrative career counseling could assist them to re-contextualize their skills, strengths, knowledge and career plans after resettlement. Through such re-contextualization, voices that might have been lost or diminished during multiple transitions have space to re-emerge. This process may be a first step towards gaining a sense of agency that is needed for the actualization of preferred career plans.

Parents' perspectives of the transition to home when a child has complex technological health care needs.

There is an increasing number of children with complex care needs, however, there is limited evidence of the experience of families during the process of transitioning to becoming their child's primary care giver. The aim of this study was to explore parents' perspectives of the transition to home of a child with complex respiratory health care needs. Parents of children with a tracheostomy with or without other methods of respiratory assistance, who had transitioned to home from a large children's hospital in the last 5 years, were invited to participate in the interviews. Voice-centred relational method of qualitative analysis was used to analyse parent responses. Four key themes emerged from the interviews including "stepping stones: negotiating the move to home", "fighting and frustration", "questioning competence" and "coping into the future". There is a need for clear and equitable assessments and shared policies and protocols for the discharge of children with complex care needs. Direction and support are required at the level of health service policy and planning to redress these problems. This study provides evidence that the transition of children with complex care needs from hospital to home is a challenging dynamic in need of further improvement and greater negotiation between the parent and health service provider. There are tangible issues that could be addressed including the introduction of a standardised approach to assessment of the needs of the child and family in preparation for discharge and for clear timelines and criteria for reassessment of needs once at home.

The re-enactment of childhood sexual abuse in maternity care: a qualitative study.

BackgroundThe process of pregnancy and birth are profound events that can be particularly challenging for women with a history of childhood sexual abuse. The silence that surrounds childhood sexual abuse means that few women disclose it and those caring for them will often not be aware of their history. It is known from anecdotal accounts that distressing memories may be triggered by childbirth and maternity care but research data on the subject are rare. This paper explores aspects of a study on the maternity care experiences of women who were sexually abused in childhood that demonstrate ways that maternity care can be reminiscent of abuse. Its purpose is to inform those providing care for these women.MethodsThe experiences of women were explored through in-depth interviews in this feminist narrative study. The Voice-Centred Relational Method and thematic analysis were employed to examine interview data.ResultsWomen sometimes experienced re-enactment of abuse through intimate procedures but these were not necessarily problematic in themselves. How they were conducted was important. Women also experienced re-enactment of abuse through pain, loss of control, encounters with strangers and unexpected triggers. Many of these experiences were specific to the woman, often unpredictable and not necessarily avoidable. Maternity care was reminiscent of abuse for women irrespective of whether they had disclosed to midwives and was not necessarily prevented by sensitive care. ‘Re-enactment of abuse’ occurred both as a result of events that involved the crossing of a woman’s body boundaries and more subjective internal factors that related to her sense of agency.ConclusionsAs staff may not know of a woman’s history, they must be alert to unspoken messages and employ ‘universal precautions’ to mitigate hidden trauma. Demonstrating respect and enabling women to retain control is crucial. Getting to know women is important in the building of trusting relationships that will facilitate the delivery of sensitive care and enable women to feel safe so that the re-enactment of abuse in maternity care is minimised.