capacity building for western expatriate nurses and australian early career researchers

Danaherᵇ* ªClinical Planning Department, Sidra Medical & Research Centre, Qatar Foundation, Doha, Qatar ᵇCapacity-Building Research Network and School of Linguistics, Leadership, Adult

Procedia - Social and Behavioral Sciences 112 ( 2014 ) 373 – 381

1877-0428 © 2013 The Authors Published by Elsevier Ltd.

Selection and peer-review under responsibility of Cognitive-counselling, research and conference services (c-crcs).

doi: 10.1016/j.sbspro.2014.01.1177

ScienceDirect

International Conference on Education & Educational Psychology 2013 (ICEEPSY 2013)

Capacity-Building for Western Expatriate Nurses and Australian

Early Career Researchers Andy Daviesª and P A Danaherᵇ*

ªClinical Planning Department, Sidra Medical & Research Centre, Qatar Foundation, Doha, Qatar ᵇCapacity-Building Research Network and School of Linguistics, Leadership, Adult and Specialist Education, Faculty of Business, Education,

Arts and Law, University of Southern Queensland, Toowoomba, Australia

Abstract

This paper distils lessons for conceptualising capacity-building from two locations of professional learning: for western expatriate nurses in the Middle East; and Australian early career researchers The paper presents a comparative, exploratory case study, with the two sites of professional development as contextualised cases One major finding was the diversity, complexity and politicised character of the professional development opportunities and experiences provided for the two groups of participants The other finding was the dynamism and fluidity of the capacity-building approaches and outcomes demonstrated by both groups of professional learners Furthermore, capacity-building emerges as a potential lynchpin for integrating formal and informal learning in professional workplaces, thereby rendering such learning more effective and sustainable

© 2013 The Authors Published by Elsevier Ltd

Selection and peer-review under responsibility of Dr Zafer Bekirogullari

Keywords: academics; capacity-building; learning; nurses; professionalism; researchers

* Corresponding author Tel.: +61-7-4631-1190; fax: +61-7-4631-2828

E-mail address: patrick.danaher@usq.edu.au

© 2013 The Authors Published by Elsevier Ltd.

Selection and peer-review under responsibility of Cognitive-counselling, research and conference services (c-crcs).

1 Introduction

Debate abounds about the character of adult and continuing education for professional workers in contemporary institutions (see for example Fenwick, 2013; Holst, 2010) In particular, the link between capacity-building and professional learning requires ongoing scholarly attention (Hochberg & Desimone, 2010; Opfer & Pedder, 2011) This paper contributes to that focus by addressing the following research question: What are the key elements of the two sites of continuing professional development, and what do they mean for understanding capacity-building’s contributions to that development?

The purpose of the study on which the paper reports is to distil lessons for conceptualizing capacity-building from two locations of professional learning: for western expatriate nurses working in the Middle East; and early career researchers in an Australian university This is on the assumption that the provision of effective continuing professional development is neither easy nor uncontested The onus is on providers to present evidence of effectiveness for their professional communities (Petzold & Komer-Bitensky, 2010)

Against that backdrop, the paper presents a comparative, exploratory case study, with the two sites of professional development as contextualised cases The broader study integrates multiple forms of data gathering (which the paper synthesises), including documentary analysis, guided discussions with selected participants, and the authors’ critical reflections on their own and their colleagues’ experiences of professional learning and the impact of such experiences on their capacity-building outcomes

One major finding of the case study presented here was the diversity, complexity and politicised character of the professional development opportunities and experiences provided for the Middle East western expatriate nurses and the Australian early career researchers The second major finding was the dynamism and fluidity of the capacity-building approaches and outcomes demonstrated by both groups of professional learners

The significance of the study’s findings lies in identifying the challenges, opportunities, limitations and successes associated with capacity-building strategies and their influence on the outcomes of professional development for the two groups of professionals More specifically, capacity-building emerges as a potential lynchpin for integrating formal and informal learning in professional workplaces, thereby rendering such learning more effective and sustainable

The paper consists of the following four sections:

x Literature review, conceptual framework and research design

x Selected findings

x Concluding implications for professional learning and capacity-building

2 Literature Review, Conceptual Framework and Research Design

The scholarly field of adult and continuing education continues to expand exponentially (see for example Foley & Kaiser, 2013; Kasworm, Rose, & Ross-Gordon, 2010; Lawrence, 2012; LeNoue, Hall, & Eighmy, 2011) That expansion is evident geographically, with studies referring variously to Eastern Africa (Openjuru, 2011), Hong Kong (Chan, 2010) and the Nordic countries (Wahlgren & Geiger, 2011) That expansion is evident also in terms of professions, with research being reported about higher education (Kasworm, 2012), police work (Donavant, 2009) and teaching (Beavers, 2009) Similar diversity attends the foci of that research, ranging from the knowledge society (Kasworm, 2011) to student persistence (Cohen & Greenberg, 2011) to vulnerable adults

(de Greef, Segers, & Verte, 2012) A unifying theme in the midst of this expansion and diversity is the proposition of reciprocal individual and institutional responsibility for creating and building on opportunity for adult and continuing education that is at once personally empowering and collectively beneficial, while acknowledging the inevitable constraints on such an outcome (Grace, 2012; Stevenson & Clegg, 2011)

A distinctive strand of the adult and continuing education scholarship focuses on specific kinds of professional learning For example, the location of professional learning within the practices of professional work (Boud & Hager, 2012; Cranton, 2011; Kilminster, Bradbury, Frost, & Zukas, 2012), as well as within complex networks of multiple groups of stakeholders (Atencio, Jess, & Dewar, 2012), has emerged as significant Likewise the value of experiential learning in promoting professional growth (Stevens, Gerber, & Hendra, 2010), and also the need for authenticity to underpin effective professional development (Webster-Wright, 2009), have been highlighted

The conceptual framework that the authors have deployed to analyse the data collected in the respective cases outlined below is centred on the place of capacity-building in facilitating longer-term and sometimes transformative professional learning (see also Makopoulou & Armour, 2011) This posited link has been explored

in the literature from a range of perspectives, including those of post-conflict areas (Berkvens, Kalyanpur, Kuiper, & Van den Akker, 2012), school improvement (Stoll, 2009) and social work (Abbott, Burtney, & Wall,

in press) Against this backdrop, it is appropriate to acknowledge the complexity of defining and conceptualising capacity-building (Lovell, Kearns, & Rosenberg, 2011) The approach taken in this study is to highlight the association between capacity-building and a set of specific concepts, including agency, authenticity, autonomy and empowerment, while recognising the politicised character of capacity-building by acknowledging its potential links with mobilisation and resistance (Kuttab, 2010)

The research design deployed in the study exhibited the features of a comparative, exploratory case study (Piekkari, Welch, & Paavilainen, 2009; Taylor, Dossick, & Garvin, 2011; Thomas, 2011), with the two sites of professional development as contextualised cases (see also Lo, Clarke, Luk, Chigaeva, & Lam, 2012) The first-named author’s case focused on the professional learning opportunities and outcomes of nurses employed at a new health centre in Qatar, Doha, with data gathering occurring in 2012–2013 The second named author’s case was centred on doctoral students and early career researchers in an Australian regional university, with data being collected incidentally throughout 2005–2013 The data corpus in each case consisted of varied combinations of documentary analysis, guided discussions and informal conversations with selected participants, and the authors’ critical reflections their own and their colleagues’ access to, experiences of and value adding from diverse types

of professional learning Data analysis combined content and thematic analysis (Buetow, 2010; Sandelovski, 2010) directed at addressing the project’s overarching research question: What are the key elements of the two sites of continuing professional development, and what do they mean for understanding capacity-building’s contributions to that development?

3 Selected Findings

3.1 Western expatriate nurses

Sidra Medical & Research Centre is located at Qatar, Doha It is an ambitious vision of Qatari royalty, whose major goal is to provide world class patient care to a previously under-served, disempowered population of women and children (Lincoln, Lynham, & Guba, 2011) Through its academic partnership with the United States satellite university Weill Cornell Medical College, and the employment of international leaders in health, its two

other primary goals are to provide world class medical education and to advance biomedical research (Sidra Medical & Research Centre, 2013)

The nursing cohort whose professional learning and capacity-building experiences have been analysed in this case has developed during a transitional phase in which Sidra is shifting from a project into an operational hospital Building the hospital is a staged and staggered process A timeline is set out, with the on-boarding of minimum requisite staff at predetermined stages The current, newly on-boarded staff members have been employed to help to develop evidence-based and best practice-based care pathways, process flow maps, and articulations between computer and information systems and care At the time of writing this paper, the majority

of specialties have one, or occasionally two, specialist nurses on-boarded Invariably they themselves are transitioning from the procedural world of hospitals to the less tangible culture of a project, where they are intended to be the co-authors and co-constructionists of knowledge (Brandon & All, 2010) Adding to this culture shock (Stewart & Leggat, 2006), the nurses come from the United States, the United Kingdom, Continental Europe and Australasia Although they are all qualified nurses, their respective cultural contexts are distinctively their own Nursing jargon is neither global nor easily interpretable, even within specialties (Cowan & Norman, 2006)

As the Manager for Education for Critical Care at the Centre, the first-named author’s purview includes the development of clinical educators and education for critical care areas The umbrella term “critical care” may imply similarities; in actuality, the knowledge requirements of each specialty are distinct, requiring years of education and experience to develop expertise (Ericson, Whyte, & Ward, 2007) The nurses hired specifically for these areas are all clinical practice specialists within their respective fields The specialties represented by the participants in this case include paediatric emergency, paediatric intensive care unit, rapid response, codes and transport for both children and women, and cardiac invasive and non-invasive services Interestingly, none of this cohort is actually clinical educators; instead they are clinical nurse leaders and one manager, all of whom answer

to a different management line

The goal has been multileveled, both holistic and strategic On the holistic and micro levels, the first-named author wanted to create a safe space for newly on-boarded staff, to develop a community with a common goal and focus, and to break down silos that impede knowledge dissemination and development A desired outcome of this process was both group cohesion and increased nursing staff satisfaction during this time period (DiMeglio et al., 2005) Recognising the phase of the project, the sheer breadth of knowledge and skills held by this critical care cohort and that they did not directly answer to his role, the first-named author realised that a Community of Practice (CoP) was an ideal platform to introduce to the Sidra project A CoP requires three components to function as more than a group or a club: a domain, a community and a practice (Lave & Wenger, 1991; Wenger, 2006; Wenger, McDermott, & Snyder, 2002) This seemingly disparate group of specialists indeed had a common locus or domain of interest – namely, the care of critically ill patients Their collective competence was greater than one person’s individual specialist knowledge Through the processes of nurturing trust, allowing this group the space and time for dialogue, and sharing and co-constructing new knowledge and new ways of knowing and practice, this group of specialists has become a community The actual practice was sharing and developing resources – shared problem-solving, storytelling, lesson sharing and co-constructed ways of addressing iterative problems

At the strategic and macro levels, the first-named author had a longer-term vision of creating an academic community within Sidra Through dialogue, he determined those interested in further study He proposed to these individuals and the CoP as a whole a writing workshop to be conducted over approximately three months, with two end goals: firstly, to complete an abstract submission to a paediatric conference being held in Doha at the end

of the year; and secondly, the submission of an article to a nursing journal specific to each participant’s specialty The workshop utilised a series of articles discussing how to write qualitative research publications (Carlson, Masters, & Pfadt, 2008; Chamberlain, 2010; Happell, 2012; Mee, 2003; Pierce, 2009; Wink, 2002) in order to contextualise dialogue and acquaint the group with pertinent concepts The workshop also used a textbook (Belcher, 2009) to guide week by week the creation of an abstract and an article This workshop is currently ongoing

It is clear from this case analysis that the construction, dissemination and application of new kinds of knowledge constitute considerable challenges for the nurses working in this brand new medical and research centre In particular, professional development, via formal and informal learning, does not necessarily transfer effectively from previous institutions In each new situation contextualised skills and understandings need to be developed and shared, with the accompanying specialist language and associated attributes and values The CoP established in this case has only just commenced, but it is showing early signs of helping to facilitate these desired outcomes of capacity-building and resultant, longer-term professional learning

3.2 Australian early career researchers

The second case being analysed here is a group of doctoral students and early career researchers at an Australian regional university The group was formed in 2004, and the second-named author has been involved in

it since 2005 In the intervening eight years, its membership has changed considerably, but a continuing feature has been fortnightly meetings whose agenda are decided based on the interests of the participants at each meeting The group has now held 11 research symposia, at which participants present about selected aspects of their research, and which have generated several edited research books and special theme issues of peer-reviewed academic journals

One of the group’s twin goals has been to create a safe, supportive space for inexperienced researchers, who often feel overwhelmed and vulnerable (Heller et al., 2011; Hughes & Bennett, 2013; Lyall & Meagher, 2012) This has been achieved by developing an informal and largely implicit code of behaviour during meetings and symposia with regard to providing feedback and demonstrating mutual interest and trust This code is now well-established, and diplomatic and hopefully subtle means are deployed to educate new group members who might unwittingly exhibit excessively direct and frank criticism which, while no doubt well-meant, does not accord with the emphasis on encouragement and constructive advice that is a hallmark of the group’s interactions

The group’s other goal has been somewhat more evanescent: to establish and sustain a productive and potentially transformative research culture Research cultures are difficult to define, construct and measure (Jones, 2012; Kim, 2012; Raddon, 2011), yet in the context of this case indicative characteristics of a thriving research culture might be held to include group members anticipating and appreciating opportunities to talk about research with one another; a steadily growing list of research-based presentations and publications; developing confidence in offering advice about research and doctoral student supervision to university officers focused on those areas of activity; and a palpable sense of mutual rapport and respect Despite the definitional and measurement difficulties noted above, there is reasonably compelling evidence that the group fulfils at least some

of these characteristics For instance, the group’s continued existence nine years after its formation is telling: against a backdrop of work intensification and time poverty for all members, their commitment to attending the fortnightly meetings and to presenting at the biannual research symposia confirms their sense of receiving benefits from group membership and their desire to give back to this informal community Moreover, the presentations and publications are an indicator in themselves and they are also used to encourage new members

to join the group The alignment between the group’s modus operandi and individual members’ attitudes and values also signifies intangible but crucial elements of a successful research culture (Gysels, Evans, & Higginson, 2012)

While capacity-building is also difficult to define, construct and measure (Masten, 2011; Ó Murchu, 2011), the analysis of this second case in the study includes evidence of individual and collective capacities being developed This development is manifested explicitly through such indicators as the numbers of presentations and publications completed and the degree of depth and sophistication of contributions to group discussions It is manifested implicitly in the perceptions held of the group by its members as well as by non-members from other parts of the university For example, this group has previously collaborated with an equivalent group in a different faculty to co-host meetings between the two groups and has created publishing opportunities for members of the second group The generation of these collaborations and opportunities indicates a sense of agency and purposefulness that is associated with particular forms of capacity-building (Day & Smethem, 2009; Murray et al., 2009; Stoll, 2009)

More broadly, there is at least some evidence from this case analysis of the asserted link between capacity-building and professional learning This link derives from the assumption that both capacity-capacity-building and professional learning exhibit individual and collective dimensions that are directed at facilitating increasingly confident mastery of increasingly sophisticated knowledge and skills attendant on membership of a professional community This assumption in turn underpins the following useful synthesis of the interpretations presented in both cases in the study: “Faculty learning communities create connections for isolated teachers, establish networks for those pursuing pedagogical issues, meet early-career faculty expectations for community, foster multidisciplinary curricula, and begin to bring community to higher education” (Cox, 2004) Or as Christie and Menter (2009) stated somewhat more baldly, “ … a key element of effective capacity building lies in collaborative approaches” (p 337)

4 Conclusion

The paper concludes by distilling selected implications of the key findings of this comparative, exploratory case study of capacity-building and professional learning in two different locations The first finding was that the professional development experienced by the western expatriate nurses in the Middle East and by the early career researchers at a regional university in Australia were diverse and complex, reflecting the admixture of multiple layers and composite levels of contexts and influences For instance, in both cases participants exhibited highly divergent disciplines and varied durations and types of experience Relatedly, there was a politicised character to the participants’ professional development, represented by different networks of power and attempts to use professional development outcomes to harness some of that power by accruing relevant forms of capital that held currency in those contexts

The second finding of the case study was that the capacity-building approaches and outcomes in which both groups of professional learners engaged were dynamic and fluid Some strategies were developed within each group and arose from each group’s strong sense of professional agency and autonomy and from group members’ awareness of their responsibility to chart their own course of professional growth Other strategies were sparked

by wider developments in the respective institutions, as organisation-wide initiatives arose that took account of pressures and trends in the broader communities and sectors in which the institutions were located This highlighted the significant point that capacity-building in both cases was emergent, holistic and recursive, rather than linear, sequential and predictable (see also Friedman, 2010; Lightburn & Warren-Adamson, 2011)

The importance of these two findings lies in identifying the challenges, opportunities, limitations and successes associated with capacity-building strategies and their influence on the outcomes of professional development for the two groups of professionals involved in the study From this perspective, in both cases capacity-building efforts were only one set of possibilities and imperatives with which participants had to engage;

their working roles traversed a wide range of commitments and accountabilities On the other hand, without those capacity-building efforts it is likely that the professionals would have been less well-equipped to transact their responsibilities, and also that their professional efficacy would have been diminished

More specifically, capacity-building emerges as a potential lynchpin for integrating formal and informal learning in professional workplaces, thereby rendering such learning more effective and sustainable That is, an explicit focus on creating and disseminating widespread opportunities for authentic capacity-building should be included in any professional development program At the same time, the capacity-building strategies themselves are not sufficient to ensure that genuine and long-term professional learning will occur; that depends on a multiplicity of individual, institutional, national and global factors, many of which lie outside the control of the participants

Acknowledgements

The authors are grateful to their colleagues in the respective groups reported in this paper for their continuing encouragement and support

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