The lived experiences of student midwives subjected to inappropriate behaviour

228 Pages·2017·1.6 MB·English

UNIVERSITY OF SOUTHAMPTON

Faculty of Social and Human and Mathematical Sciences

The lived experiences of student midwives subjected to
inappropriate behaviour.

By

Jane Johnston

Thesis for the degree of Doctorate of Education

May 2016
University UNIVERSITY OF
SOUTHAMPTON

Name of Faculty FACULTY OF SOCIAL AND
HUMAN AND MATHEMATICAL
SCIENCES

Discipline: Education

Degree for which thesis is submitted: DOCTORATE OF EDUCATION

Title of thesis: THE LIVED EXPERIENCES OF
STUDENT MIDWIVES
SUBJECTED TO
INAPPROPRIATE BEHAVIOUR

Full name of author: Jane Johnston

ABSTRACT

The lived experiences of student midwives subjected to
inappropriate behaviour.
‘Inappropriate behaviour’ can be described as the thousand ‘slings and arrows’ that,
on a daily basis, eat away at civility; such behaviours may be one-off events, or
individual put-downs, that nevertheless cause the receiver significant harm. In this
thesis, inappropriate behaviour is conceptualised as different from bullying, which
involves the repetition of behaviours and is defined and supported within various
legislation. Whilst there is research that focuses on the nature and impact of
workplace bullying, there is very limited research that considers the impact that
inappropriate behaviours can have on an individual.
This interpretive phenomenological investigation, whereby Heidegger’s philosophical
approach to phenomenology was used as a methodological framework support,
explored the lived experiences of eight student midwives, who had experienced
inappropriate behaviour within their academic and clinical environments. The
research illustrates the nature of such experiences and further explores the resulting
effects.
The experiences disclosed by individual participants were initially identified as
struggling, being out of sight out of mind and loss and bereavement. The main
findings revealed three interpretative themes that described what inappropriate
behaviour represented for the participants and how it impacted upon them. These
were: ‘Breaching Covenant’, ‘Dispossession’ and ‘Liminality’. Each theme
incorporated one super-ordinate theme, betrayal and struggling (Breaching
Covenant), loss and bereavement (Dispossession) and finally angst and anonymity
(Liminality).
For the participants, inappropriate behaviour was seen as single acts most
commonly perpetrated by clinical midwives, without a sense of malice or intention to
cause harm. It is important that the difference between bullying and inappropriate
behavioural acts become known by of all those involved with student midwives’
education and a concerted effort in changing attitudes is made to enable the
development of both clinical and academic environments, where inappropriate
behaviour is strongly contested and vigorously opposed.
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Table of Contents
ABSTRACT ............................................................................................................ 1
Table of Contents .................................................................................................. 3
Table of Tables ...................................................................................................... 9
Declaration of Authorship .................................................................................. 11
Chapter 1 INTRODUCTION AND BACKGROUND .............................................. 13
1.1 Study aim ............................................................................................. 13
1.2 Rationale for undertaking this study ..................................................... 13
1.2.1 My positioning ................................................................................... 15
1.3 Student midwife education ................................................................... 17
1.4 The central role of midwives in health care practice............................. 18
1.5 Midwifery and culture ........................................................................... 20
1.6 Inappropriate behaviour ....................................................................... 21
1.7 The literature ........................................................................................ 22
1.8 Defining the research question ............................................................ 23
1.9 Research design .................................................................................. 24
1.10 Methodology and conceptual framework .............................................. 24
1.11 Data collection ..................................................................................... 25
1.12 Reflexivity ............................................................................................. 25
1.13 Data analysis ....................................................................................... 26
1.14 Expectations and anticipated benefits of this study .............................. 26
1.15 Overview of thesis ................................................................................ 27
1.16 Chapter conclusion .............................................................................. 27
Chapter 2 LITERATURE REVIEW ....................................................................... 29
2.1 Introduction and purpose ..................................................................... 29
2.2 Inappropriate behaviour as opposed to Bullying .................................. 31
2.2.1 Impact ............................................................................................... 41
2.2.2 Socialisation into a profession. .......................................................... 43
2.3 Chapter conclusion .............................................................................. 45
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Chapter 3 METHODOLOGY ................................................................................. 47
3.1 Introduction and study aim ................................................................... 47
3.2 My position in developing the research study ...................................... 47
3.3 Selecting my methodology ................................................................... 49
3.4 Choosing my method ........................................................................... 50
3.5 Phenomenological overview................................................................. 51
3.6 Study design ........................................................................................ 55
3.7 The ‘Style of Phenomenology’ selection .............................................. 55
3.7.1 Hermeneutics, the Hermeneutic Circle and Dasein ........................... 55
3.7.2 Being-in-the-world (In-der-welt-sein) ................................................. 56
3.7.3 Fore-structures .................................................................................. 57
3.7.4 Care (Sorge) ...................................................................................... 57
3.7.5 Authenticity ........................................................................................ 58
3.7.6 Disposition (Befindlichkeit) ................................................................ 59
3.7.7 Time (Temporality) ............................................................................ 59
3.7.8 Space (Spaciality) ............................................................................. 60
3.7.9 Mitsein (Being-with-others) ................................................................ 60
3.8 Justification .......................................................................................... 61
3.8.1 Heidegger: examining the argument ................................................. 61
3.8.2 Ethical considerations ....................................................................... 62
3.8.3 Potential harm ................................................................................... 62
3.9 Informed consent ................................................................................. 64
3.10 Data protection ..................................................................................... 64
3.11 Sampling criteria .................................................................................. 65
3.12 Recruitment to the study ...................................................................... 66
3.13 Interview process ................................................................................. 67
3.14 Equipment ............................................................................................ 69
3.15 Describing the phenomenon ................................................................ 69
3.16 Trustworthiness .................................................................................... 69
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3.17 Credibility ............................................................................................. 70
3.18 Transferability ...................................................................................... 71
3.19 Dependability ....................................................................................... 72
3.20 Confirmability ....................................................................................... 72
3.21 Chapter conclusion .............................................................................. 73
Chapter 4 PROCESS OF ANALYSIS .................................................................. 75
4.1 Introduction .......................................................................................... 75
4.2 Participants’ biography ......................................................................... 75
4.3 Justification and the process of analysis .............................................. 78
4.4 Data analysis – saturation .................................................................... 80
4.5 Stages of analysis - Identifying initial ideas and emerging themes ...... 81
4.5.1 Stage 2 – Sub-ordinate themes ......................................................... 84
4.5.2 Stage Three – Super-ordinate themes .............................................. 85
4.5.3 Stage Four – Final interpretive themes ............................................. 86
4.6 Chapter conclusion .............................................................................. 89
Chapter 5 FINDINGS ............................................................................................ 91
5.1 Introduction .......................................................................................... 91
5.2 Inappropriate behaviour – not bullying ................................................. 91
5.3 Vignettes .............................................................................................. 92
rd
5.3.1 Lisa – 3 year student midwife .......................................................... 92
nd
5.3.2 Anne – 2 year student midwife ....................................................... 93
rd
5.3.3 Debbie – 3 year student midwife ..................................................... 93
5.3.4 Barbara - 2nd year student midwife ................................................... 94
5.3.5 Emma - 2nd year student midwife ..................................................... 94
5.3.6 Grace - 2nd year student midwife...................................................... 95
5.3.7 Jane - 2nd year student midwife ....................................................... 95
rd
5.3.8 Lucy – 3 year student midwife ......................................................... 96
5.4 Breaching covenant ............................................................................. 97
5.5 Dispossession .................................................................................... 102
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5.6 Liminality ............................................................................................ 105
5.7 Chapter conclusion ............................................................................ 109
Chapter 6 DISCUSSION OF ANALYSIS AND SYNTHESIS OF FINDINGS TO
THE WIDER LITERATURE ............................................................... 111
6.1 Introduction ........................................................................................ 111
6.2 Breaching covenant ........................................................................... 111
6.2.1 Betrayal and Struggling ................................................................... 112
6.3 Dispossession .................................................................................... 120
6.3.1 Loss and bereavement .................................................................... 120
6.4 Liminality ............................................................................................ 122
6.4.1 Angst and anonymity ....................................................................... 123
6.5 Breaching covenant ........................................................................... 124
6.6 Dispossession .................................................................................... 125
6.7 Liminality ............................................................................................ 125
6.8 Hermeneutic circle ............................................................................. 126
6.9 Summary of main findings .................................................................. 127
6.10 Reflexive account ............................................................................... 128
6.11 The interview process ........................................................................ 129
6.12 Student midwife experiences ............................................................. 130
6.13 Reflexive diary .................................................................................... 131
6.14 Chapter conclusion ............................................................................ 132
Chapter 7 CONCLUSION AND RECOMMENDATIONS FOR PRACTICE ........ 133
7.1 Introduction ........................................................................................ 133
7.2 Study conclusions .............................................................................. 133
7.3 Recommendations ............................................................................. 134
7.4 Possibilities for further research ......................................................... 136
7.5 Evaluation of study and limitations ..................................................... 137
REFERENCES ................................................................................................... 139
Appendix 1 - Literature Selection – incorporating key texts identified within
pre and post data analysis .............................................................. 171
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Appendix 2 - Ethical Approval ......................................................................... 185
Appendix 3 - Consent ....................................................................................... 189
Appendix 4 - Thank you letter .......................................................................... 191
Appendix 5 - Participants’ Information Sheet ................................................. 193
Appendix 6 - Reply slip .................................................................................... 197
Appendix 7 - Prompt sheet............................................................................... 199
Appendix 8 - Full Transcript of Interview – ‘Debbie’ ...................................... 201
Appendix 9 - Excerpts from my Reflexive Diary ............................................. 225

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