Browsing by Author "Rankin, Janet"

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    Assessing the Sustainability of Tsunami-Impacted Communities of Thailand’s Andaman Coast: An Institutional Ethnography
    (2013-01-25) Williams, Aaron; Draper, Dianne; Rankin, Janet
    The 2004 Andaman Sea-Indian Ocean tsunami had a profound and enduring effect on communities, environment, and the overall livelihood of survivors. For impacted regions, the nature of reconstruction and recovery efforts has permanent implications for the long-term sustainability of communities and the livelihood of individuals. This institutional ethnography (IE) study assesses the sustainability of reconstruction aid and recovery in the four tsunami-impacted communities of Ban Nam Khem, Bangkaya, Thuungwa, and Khao Lak in Phang Nga province of Southern Thailand. The purpose of this study is to describe the post-tsunami landscape of recovery within these communities, and to document how survivors have experienced the processes of reconstruction, aid and recovery in their everyday world. Employing IE, the research exposes the broader influence of policies and plans created by institutions and government bodies that dictated the ruling relations of recovery within communities of focus. Analysis of data collected from February 2011 to December 2012 revealed an uneven pattern of aid and recovery not only between villages, but within villages. These patterns are delineated by divergent policies for aid and recovery that set people and communities on different trajectories in the reconstruction and recovery process. This has resulted in varying and uneven outcomes for long-term recovery both between and within communities of study. The emerging problematic within the study centres on the struggle for valuable land within the region. Furthermore, the emerging issues surrounding land and varying policies and plans for aid and recovery appear to shed light on fundamental flaws in reconstruction policies as a top down approach, while revealing the benefits of a grass-roots approach to reconstruction, aid, and recovery cultivated through non-governmental organization support, and enacted by people within the community. The overall outcomes and assessment of sustainable development in the reconstruction and aid recovery are discussed as are recommendations regarding how they can be linked to broader global and domestic forces impacting recovery. It is hoped that this study will not only help the people of the selected communities better understand the policies and processes that dictated the reconstruction and recovery effort in their communities, but also allow for NGOs and levels of government to understand more effective ways to rebuild communities following a disaster.
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    Conducting Analysis in Institutional Ethnography
    (SAGE, 2017-12-01) Rankin, Janet
    Institutional ethnography (IE) is being taken up by researchers across diverse disciplines, many who do not have a background in sociology and the antecedents and influences that underpin Dorothy Smith’s distinctive IE method. Novice IEers, who often work with advisors who have not studied or conducted an IE, are at risk of straying from IE’s core epistemology and ontology. This second of a two-volume set provides a broad overview to approaching analysis once the IE design and fieldwork are well under way. The purpose of two-volume series is to offer practical guidance and cautions that have been generated from my experiences of supervising graduate students and my involvement in reviewing and examining IE work that has gone “off track.” With a particular focus on the practicalities of conducting analysis, the paper includes examples of the application of IE’s theoretical framework with techniques for approaching and managing data: mapping, indexing, and building preliminary accounts/“analytic chunks.” I suggest these techniques are useful tactics to work with data and to refine the formulation of the research problematic(s) to be explicated.
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    Conducting Analysis in Institutional Ethnography: Analytical Work Prior to Commencing Data Collection
    (SAGE, 2017-10-30) Rankin, Janet
    Institutional ethnography (IE) is an innovative approach to research that requires a significant shift in researchers’ ordinary habits of thinking. There is a growing body of methodological resources for IE researchers however advice about how to proceed with analysis remains somewhat scattered and cryptic. The purpose of the first of a two-paper series is to contribute to publications focused exclusively on analysis. The aim is to provide practical tips to support researchers to shift their ordinary habits of thinking. This first paper outlines how this must happen at the outset of the research design. Analysis of the phenomenon under study commences as the research is being formulated. The approaches to analytical thinking outlined in this paper are based on my own IE research and also my experience working with graduate students since 2008. In this first volume of the two-paper set I provide a brief background to the method and direct readers to important IE resources. I outline three core methodological concepts: standpoint, problematic and ruling relations. I discuss how these concepts guide the early analytical thinking that is embedded in the research design and the critical analysis of the literature that is part of the process of analysis in IE. The second paper provides practical advice for working with data.
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    Factors that Influence Adequacy of Bowel Preparation in Inpatients Undergoing Colonoscopy: A Scoping Review Protocol
    (2023-07-12) Marchildon, Marianne; Jackson, Jennifer; Hayden, Alix; Rankin, Janet
    Objective: The objective of this scoping review is to examine the extent and type of research related to the rate of adequate bowel preparation in adult inpatients undergoing colonoscopy. Our intent is to establish an understanding the factors, both modifiable and non-modifiable, that influence the rate of adequate bowel preparation hospitalized patients undergoing colonoscopy. Introduction: Adequate bowel cleansing is necessary to perform successful colonoscopies, detect adenomas, and identify sources of gastrointestinal bleeding. Inpatients, however, experience a higher-than-average rate of inadequate bowel preparation leading to cancelled procedures, increased stress for the patient, increased time in hospital, and increased cost to the healthcare system. Inclusion criteria: This scoping review will consider all studies examining factors that influence the adequacy of bowel preparation in adult inpatients 18 years and older undergoing colonoscopy who have been admitted to hospital as inpatients. Studies published in English between 2000 and 2023 will be included. Methods: An initial search of MEDLINE, CINAHL, SCOPUS, and EMBASE was undertaken to identify seed articles, followed by a systematic search using keywords and subject headings. Study abstracts will be independently screened by two reviewers against inclusion criteria. Discrepancies will be resolved by consensus. Data extraction will be performed in tabular form and include data related to modifiable and non-modifiable factors that influence bowel preparation in adult inpatients.
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    Inside triage: the social organization of emergency nursing work
    (2012-04) Melon, Karen Anne; Rankin, Janet; Scott, Cathie; White, Deborah
    Emergency care in large urban hospitals across the country is in the midst of major redesign intended to improve access, decrease wait times and maximize efficiency. Using Institutional Ethnography, I was able to document critical, empiric evidence that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses. The Canadian Triage and Acuity Scale figures prominently in the analysis as a high level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. The core argument throughout is that industrial production line values and principles that have infiltrated health care management and reframe patient care, are having serious consequences. This critical analysis uncovers a number of deleterious effects as rapid patient processing disrupts expert nursing work, and will contribute to a broader understanding of health system quality.
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    An Interpretive Description of New Graduate Nurses’ Transition into Professional Practice
    (2022-07-05) McDonald, Stephanie Ann; Rankin, Janet; Venturrato, Lorraine; Ferreria, Carla
    Background. Newly graduated nurses (NGNs) have one of the highest turnover rates within the nursing profession, leaving their first job or the profession altogether within the first 12 months of professional practice. Not only is this costly to the healthcare system, but high turnover causes significant instability within the workforce, which affects the safety and quality of patient care. Also, NGNs are an essential human resource for addressing the nursing shortage. Understanding why high turnover is occurring among NGNs, is vital for the future stability of the nursing profession. Aim. The aim of this research was to explore the experiences of bachelor prepared nurses during the first year of nursing employment. A gap in the literature was identified, as recent studies have focused on socialization tactics based on NGN research from the earlier 2000s. As healthcare is constantly changing, it is important to understand what NGNs are experiencing at the current time. Thus, the findings from this study can inform clinical practice, leading to improved transition and socialization of NGN into professional practice. Method. An interpretive description research design was utilised to understand the phenomenon. Ten NGN study participants, who graduated within the last 18 months, were interviewed. Data was analyzed using thematic analysis and an interpretative description was developed and used to inform clinical practice. Findings. NGN transition remains a highly complex and nuanced process. Three broad categories emerged: NGN disposition, collegial supports, and work environment. The findings offer a contemporary and expanded understanding of NGNs’ transition experiences.
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    Nurses' Medication Work: The Social Organization of Rule Breaking to Keep Patients Safe
    (2015-01-26) Dyjur, Louise; White, Debbie; Rankin, Janet
    Patient safety has emerged as one of the most important and widely accepted aims of contemporary health care organizations. Medication errors are common and pose potentially serious threats to the safety of patients. Consequently, initiatives to improve patient safety often target nurses’ work with medications. A plethora of research studies examine medication errors and contribute to dominant formulations that impose stringent rules thought to enhance medication safety. However, little literature has examined the materiality of medication work and few research studies are oriented to the knowledge practices of nurses. This study used an institutional ethnographic approach, grounded in nurses’ everyday experiences, to contribute a different way of knowing about medication work. The study findings revealed a disquieting disjuncture between theoretical accounts of medication work and the actual everyday practices of nurses working with medications. Nurses routinely use their professional judgment and discretion to adapt stringent rules in order to keep patients safe and accomplish medication work effectively. However necessary and sensible it may be, nursing work that does not adhere to standard practice and institutional policy may be perceived as “breaking the rules”. Rule breaking is risky for nurses, as their professional competence is scrutinized and evaluated through regulatory and theoretical frameworks that value adherence to rules as the only way to demonstrate safety. The core argument developed in this analysis is that discretion is an essential element of competent medication practice, and that framing discretionary work within a rule based discourse obscures the safety work that nurses are routinely and regularly engaged in.
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    Pediatric Psychiatry Inpatients' Perspectives of Aggression Management: Discernment in the Doorway
    (2023-04-14) Adrian, Melissa Jacqueline; McCaffrey, Graham Philip; McCaffrey, Graham Philip; Raffin Bouchal, Donna Shelley; Rankin, Janet; Kelly, Martina Ann
    Aggressive behavior is common on psychiatry inpatient units (Bonner et al., 2002). Seclusion rooms and restraints used as interventions for patients’ aggressive behaviour may have the consequence of being traumatizing for patients (O’Brien & Cole, 2004). The voices of many stakeholders involved in the controversial conversation of the use of seclusion and restraint interventions are represented in the literature. In pediatric psychiatry, however, the voices of the children are not represented, even though they hold the most vulnerable position with the most at stake in the practice of seclusion and restraint interventions for aggression management. This hermeneutic nursing research study asked the question “How might we understand children’s experiences of seclusion and restraint on an inpatient psychiatry unit?”. Four pediatric psychiatry inpatients responded to the invitation to be research participants and shared their hospitalization experiences that occurred within the past year when they were 10 years old. Their interviews lead to the interpretation of the importance of nursing discernment in decision making upon the entrance to each room that holds a patient, physically and metaphorically, to ensure the most therapeutic, ethical, and beneficial care is provided to the patient. The text of the research interviews was compared to the theories and models of Attachment Theory (Bowlby, 1980), Trauma Informed Care (Harris & Fallot, 2001), and Collaborative Problem Solving (Greene, 2014) for practical application, and the fairy tale of Hansel and Gretel (The Brothers Grimm, 1812) for a historical illustration of the relevant social-cultural issue regarding the maltreatment of children that continues to resonate today. Key Words: Nursing, aggression, seclusion, trauma, discernment, relationships, healing
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    The Social Organization of Mothering Work for a First Nations Mother
    (2014-01-07) Ingstrup, Andrea; Rankin, Janet
    Abstract The research described in this thesis investigated the social organization of First Nations (1) mothering as it arose within the ongoing historical and contemporary sequences of events in which mothering work is embedded. The aim of this research is to gain an understanding of how the everyday activities of mothers unfold, what mothers do by looking at the happenings in the daily routines of mothers who are situated within the socio-economic-political position of a First Nations mother. I examined parenting using Institutional Ethnography as a method of inquiry to reveal how activities in the everyday world are socially organized through relations of ruling with professionals, agencies, institutions and the written or spoken communication or discourse, to uncover how those activities arose as supportive of women to develop relationships with their children. This research reveals how programs despite best intentions contribute to relationship disconnection and frustration that these mothers encounter in trying to meet authorized program expectations and professional judgments. 1 As in the report of the Royal Commission on Aboriginal People (Government of Canada, 2006), for the purpose of this research the term First Nations is the reference to indigenous peoples of Canada that are not Metis or Inuit but may fall under the umbrella term Aboriginal people.
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    The Social Organization of the Right to Mental Health and Development: An Institutional Ethnography
    (2015-09-03) Jakubec, Sonya; Rankin, Janet; McCoy, Liza
    Indicators of the “right to mental health and development” and the scale up of treatment and services have been at the forefront in the field that is known discursively as “global mental health.” Those advocating for the rights of mentally ill people within this field struggle to produce indicators that can both account for their experiences in practice, while demonstrating accountability within the rules of global development. An international mental health advocacy organization was the site of institutional ethnographic exploration for this inquiry into an international research project and what it contributed as authoritative knowledge about mental health rights. Rather than relying on abstract notions of mental health rights and development, this study illuminates how researchers and funders came together to solve the everyday problems they encountered in advocacy and research for mental health, social inclusion, and the livelihoods of mentally ill people and their care-givers. Exploring the work of practitioners in the field, bureaucrats in aid agencies, and officials in bilateral and multilateral “development” organizations provides a place to begin to explicate how global health governance frameworks are reshaping the field of mental health and development. Specifically, the study explicates (a) a participatory research model and evolving research arrangements between nongovernmental agencies and official organizations, (b) the turn toward indicators for knowing mental health needs and rights, (c) the work of managing research for development results, and (d) measuring and accounting for “mental health rights” in economic measures. At this early stage of global mental health practice, it seems especially important to pay critical attention to how rights-based approaches are coordinated. Many of the concepts of “rights” are taken for granted as beneficial for those experiencing mental illness or distress. It is within their taken-for-granted iteration that they become ideological and cease to represent the interests of frontline mental health knowledge and, instead, carry the interests of the “institution”—in this case the interests of global economic advancement. Uncovering the social organization of knowledge making through institutional ethnographic approaches is a timely critique that points the direction to alternative knowledge and forms of knowledge for mental health and development.
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    The Social Organization of the Staffing Work of Nurse Managers: A Critique of Contemporary Nursing Workload Technologies
    (2016-01-21) Fast, Olive Marlene; Rankin, Janet; Raffin Bouchal, Shelley; Zurawski, Cheryl; Suter, Esther; Hamilton, Patti; Kawalilak, Colleen
    The multifaceted work of providing hospital services on a patient care unit requires people with the ability to coordinate, monitor, and report on the work done by nurses, unit clerks, and health care aides. Nurse managers (NMs) in hospitals are responsible for doing this work. NMs devote significant time and energy to ensure enough staff are available to care for patients; however, this “staffing work” is a source of tension. Motivated by my own experience of nursing management, in this dissertation I empirically describe and analyze NMs’ activities and the tensions they experience. I applied institutional ethnography (IE) to develop an account of how NMs’ work of staffing is socially organized. IE, a method of inquiry, offers an alternate analysis to the authorized knowledge of health care, making possible a critical empirical description of what it is like to be an NM doing staffing work in contemporary Canadian hospitals. Insights into how NMs’ thinking is influenced by economic imperatives, supporting them to act in ways that undermine nurses’ ability to provide patient care, are revealed. An evidentiary trail is built of how documents and technologies (such as the workload management system) are used to plan and administer nurse staffing. This study offers a caution against the increasing reliance on knowledge produced by workload management systems and the relations of ruling into which NMs are pulled when they use such systems. My argument is that NMs’ material knowledge of how to organize safe staffing is being subordinated by knowledge produced in and by contemporary nursing workforce technologies. The loss of this material knowledge and abstracted knowledge that replaces it jeopardize how NMs can be relied on to provide adequate nursing resources to keep patients safe.
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    The Social Organization of Wound Clinic Work: An Institutional Ethnography
    (2016) Waters, Nicola Ruth; Rankin, Janet; Raffin Bouchal, Shelley; Ewashen, Carol
    The care of wounds (broadly defined as any break in the surface of the skin) is considered a foundational component of nursing knowledge. Whilst most wounds resolve with minimal intervention, today’s aging population and rise in chronic disease have seen a rapid escalation in the number of people living with wounds that are challenging to heal. Nurses have played an integral part in initiatives to address the identified burden of chronic wounds. Efforts centred on developing evidence-based protocols intended to simplify selection of new wound-related technologies expected to improve clinical outcomes. In contrast to these expectations, anecdotal evidence, a limited number of published critiques and a recent focus in the literature on patient “wellbeing” suggest that wound care may be a contested place of nursing practice. This research interrogates the discourse of “advanced wound care” that presupposes wound healing as a linear, predictable event dependent on objective, quantifiable outcome measures. It troubles standardized approaches to wound care that require nurses to focus on physical characteristics of wounds rather than patients’ experience of living with a wound. Developed as an institutional ethnography, the study provided a way to articulate tensions that arise for nurses working in outpatient wound clinics. My analysis began in descriptions of everyday wound work. By empirically tracing links embedded in the textual records clinic nurses complete I explicate how biophysiological models organize nurses to practice as though wounds can be abstracted from the individuals living with them. This problem is amplified when translated into the algorithmic decision-making tools of an integrated health system wherein patients are managed as cases, referred to others for intervention, and provided with information to self-manage their care. I show how, as clinic nurses participate in the ruling relations of case management, their consciousness of what wound care is and how they are able to respond to their patients has been organized in line with managerial priorities. These findings call into question the foundations on which today’s wound care knowledge is built and open up for future dialogue and research the work of nurses and others committed to the care of people with chronic wounds.
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    Tracking the Social Organization of Nurses’ Practices in Level 2 Neonatal Intensive Care Units: An Institutional Ethnography of Feeding Work
    (2017) Ringham, Catherine; Rankin, Janet; Ewashen, Carol; Premji, Shahirose; Marcellus, Lenora; Venturato, Lorraine; Carryer, Jenny
    The character of neonatal nurses’ work is episodic and discontinuous. While nurses play an integral role in mediating the ebb and flow of constantly changing priorities, in the Level 2 Neonatal Intensive Care Units (NICU) their work is also complicated by new technologies, safety work, and institutionally driven quality improvement (QI) projects. As the numbers and types of QI, safety, and standardizing strategies proliferate, they can overwhelm nurses’ responses to infant’s needs, particularly late preterm infants (LPIs) who require less technological interventions during their care in the NICU. An institutional ethnographic approach was used to examine the social organization of nurses’ work with LPIs in Level 2 NICU. Feeding work, a central organizer of nurses’ work, emerged as the main thread of analysis. The data showed that feeding work does not unfold as an orderly, stepwise procedure. Observations revealed how feeding episodes for all infants were broken up by the need for a nurse to attend to technologies developed for ‘safety’ and to meet standardized protocols. The work relies on nurses’ capacity to notice, to respond, to flex, and to adapt. However, nursing tasks are being broken into disparate pieces as nurses become subject to ideological practices that rely on a form of logical/rational thinking about how work can be planned and organized to unfold safely. Often in the milieu of nursing activity, LPIs were viewed ‘out of the corner of nurses’ eyes,’ socially organized to be rendered peripheral to nurses’ full attention. The research findings explicate serious tensions in nurses’ work, particularly with feeding LPIs. The findings call into question the foundations on which standardized protocols and practices are built and offers an opportunity for policy makers, health care leaders, and nurses themselves to understand how neonatal nurses’ work is organized and to begin creative discussions to resolve tensions and to direct further research in Level 2 NICUs.