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Enhancing Nurse Education to Support the Provision of Quality Nursing Care for People Who Identify as Transgender: An Action Research Study

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Thesis(2.96 MB)

Date

2024

Authors

Morison, Trish

Supervisor

Palmer Du Preez, Katie
Austin, Diana
Macdiarmid, Rachel

Item type

Thesis

Degree name

Doctor of Health Science

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Publisher

Auckland University of Technology

Abstract

Aim The study discussed in this doctoral thesis sought to assess a potential mechanism through which communities, who previously did not have a voice, could influence practice and systems. The research question was: ‘How can engagement with the community influence an existing nurse education programme, with regards the provision of quality care for transgender people? It was based on a research informed perspective that transgender people experience significant disparities in health and barriers to healthcare access. The research was posited on a view that nurses are well positioned, if appropriately informed, to enhance the healthcare encounters for transgender people. Methodology The study used an action research methodology, underpinned by a social constructionist epistemology and a philosophy of practical knowing. Action research was selected for this study because, when networking, I discovered that there were people in the organisation who saw a need for action, I believed that people from the transgender community needed to inform our actions. An action research approach would enable those that could instigate change to collaboratively work with those that should inform change. Method Our study adapted a method outlined by Coghlan (2019) that provides a process for undertaking action research within the researcher’s own organisation. This method involved repeated cycles of constructing, planning, taking action and evaluation. It is an approach that contributed to knowledge through focussing on the learning that occurred throughout the research process. In total, six nurse educators, five community members, one transgender nursing student, and two student support staff members participated, at some point, in the action research project. Data were analysed thematically using reflective thematic analysis (Terry et al., 2017). Results Engagement led to a reconstruction of how education could be designed and delivered. This result was described through four themes: • Engagement made visible the impact of binary normativity. • The programme was understood to be lacking in diversity content. • Transgender group members were repositioned as experts in their field. • Organisational barriers to community engagement became visible. Engagement led to transformation beyond the nursing programme. This result was described through four themes: • Collective concern around NE’s understanding of non-binary genders. • Challenging organisational norms to support transgender engagement. • Opportunities were created that empowered transgender community members. • Reconstructing the curriculum through influencing change at a national level. Recommendations At a first-person level (the researcher), it is recommended that projects align to social change movements and researchers commit to purposeful reflection to support practical knowing. At a second person level, (the group), we found creating a safe space for engagement, was important. We also found that recognising the experiential expertise of community members and using a bottom-up (staff) alongside a top-down (executive level) approach, supported transformative action. At the third person level (wider organisation and beyond), it is recommended that community people are positioned as subject matter experts, in the co-design of new content. Conclusion This study found that an action research methodology, underpinned by a social constructionist worldview supported gender affirming practice at a programme, organisational, local community, and national level.

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http://hdl.handle.net/10292/18149

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Doctoral Theses