USING ACTION RESEARCH AS METHODOLOGY IN CHANGING

NURSES’ PERCEPTION AND ATTITUDE TOWARDS HEALTH SERVICE

FOR ELDERLY IN COMMUNITY: INDONESIAN CASE

Author: Kusrini Kadar

Senor Lecturer School of Nursing,
Faculty of Medicine, University of Hasanuddin Indonesia
E-mail: kusrini.kadar@gmail.com

ABSTRACT

Introduction:
Action research’s primary purpose is to facilitate change in specific situations in local and
real world environments and to solve real problems maintains and can encourage positive
change in the physical, emotional and social status of people.
Aim
The study employs an action research approach. It aims to investigate what services and
programs are needed to support elders in rural Indonesia to maintain and enhance their quality
of life.
Method:
Focus group discussions were held to investigates how community based health professionals
and the health care team identifies service gaps that potentially impact on the quality of life of
elderly people, develop strategies to address those service gaps and to change the practice
Result:
A series of group discussion named Action Research Group (ARG) were held during 10
weeks. It aimed to discuss the health professional’s roles in providing health services for
elderly in community. The discussion based on the phase one results where it was found that
the health staff only focused on curative tasks than promotif and preventive activities.
The results of the ARG meetings changed some nurses perception and attitude to provide
more preventive and promotif tasks.
Conclusion:
I believe action research was an appropriate methodology for this study that sought to
investigate the possibilities for developing the practice of health staff involved in the delivery
of a community based health program for the elderly. Characterized by democratic,
participatory, collaborative and critical reflective processes, critical action research seeks to
bring together action and reflection, theory and practice in participation with others. This
conditional relationship can offer a range of possibilities to the staff members involved in this
study, for change and improvement.

Keywords: Action Research, Elderly, Community Health Nursing, Indonesia

Fulltext

USING ACTION RESEARCH AS METHODOLOGY IN CHANGING

NURSES’ PERCEPTION AND ATTITUDE TOWARDS HEALTH SERVICE
FOR ELDERLY IN COMMUNITY: INDONESIAN CASE

Introduction

Research, maybe defined as a process of systematic investigation leading to increased

understanding of a phenomenon or issue of interest (Stringer & Genat, 2004). Burns,
Grove, and Gray (2013) have defined research as an activity concerned with validating
old and generating and understanding new knowledge. Nurses in recent years have been
challenged to provide documentation to support what they do and how their
interventions make a difference to people (Speziale & Carpenter, 2007). Many nurses
have focused on what they do to patients rather than working with them to discover
what results in overall best outcomes for them (Greenwood, 1984). This preponderance
for testing actions maybe influenced by traditional research methods that value
objectivity (Parkin, 2009). Nurses who have embraced broader research traditions,
such as action research, work with other nurses, health professionals and their patients
to discover what they value and what will make a difference in their lives and facilitate
agreed change (Greenwood, 1984; Parkin, 2009; Speziale & Carpenter, 2007; Stringer
& Genat, 2004).

This study employed a critical research methodology, action research design to enhance
the practice of nurses who work with elderly people in Indonesia. The rationale for the
study was based on the premise that by supporting community based nurses to identify
methods for enhancing their practice, the health and wellbeing of elderly adults in
community settings would be improved (Stringer & Genat, 2004). In this report, the
origins of Action Research (AR) are explicated followed by a detailed discussion of the
cyclical nature of the methodology. The data generation methods employed for this
study, which included survey, interview and focus group are also explicated.

Aim
This paper evaluate the using of an action research as methodology to change nurses
perception and attitude in delivering health service from curative to promotive activities
based on bigger study of what services and programs are needed to support elders in
rural Indonesia to maintain and enhance their quality of life.

Method
Mixed methods comprising quantitative (survey) and qualitative (interview) were used
as data collection methods (Francis 2013). In action research, data can be gathered
using quantitative and qualitative approaches in both exploratory and evaluation
contexts due to its applicability to survey, evaluation and field research (Koshy 2005;
Phillips & Davidson 2009).

Findings and Discussion

This study revealed that using action research as methodology in one study to change
people in organization is appropriate. This study employed a modified action research
model informed by Kemmis and McTaggart (1988); a self-reflective spiral of planning,
acting, observing and reflecting as an ongoing process and the use of critical social
theory based on Habermas’ (1971) assumption that people who have been previously
silenced and oppressed can be moved to make change and act independently if there
are opportunities (Webb, 1996). This study permitted the participants to effect change
to their practice through embracing the research study with the belief they could
contribute to the wellbeing of the organization and the body of nursing knowledge.

The study started by investigating the range of health programs offered to elderly
people in the community and exploring the roles of health professionals in
implementing the program/s. This process informed the initial planning stage of the
action research study. During this phase, action researchers can involve participants as
co-researchers or the primary researcher may undertake this stage by him/herself to
generate initial understanding (Stephen Kemmis & McTaggart, 1988). Questionnaire
was developed that was subsequently distributed to health services and providers. From
this process key informants were identified who assisted me understand what services
were available and facilitated the recruitment of participants for an action research
group that explored practice and options for enhancing service delivery. The
information that I gathered was shared with participants who assisted me analyse the
data and diagnose the key issues thus enabling the AR group to build a collaborative
plan of action (Stephen Kemmis & McTaggart, 1988; Meyer, 2000; Reason &
Bradbury, 2006).

Involvement of the participants commenced with stage one of the study when data from
the preliminary study were presented. Communication among the members in the group
eventually become more ‘conversational’ (Wicks & Reason, 2009) and move from
forming to norming, to storming and finally reach the performing stage (Tuckman &
Jensen, 1977). In this stage, the health professionals were challenged to evaluate their
current practice and to develop a strategic plan to overcome the issues from the initial
data. From this point, the participants in this study were seen as co-researchers and
implementers of effective change generators, with the researcher adopting the role of a
facilitator. This provided the opportunity to ensure a collaborative process in the action
research study.

Critical theory supports the liberation of individuals from being silenced and oppressed
and takes account of their expertise and knowledge relevant to the problem/s to be
addressed (Heron & Reason, 2006; Webb, 1996; Winter, 1996). Critical theory
provided a framework for challenging the accepted values and assumptions about
health services for elderly people in the community, gave the group members a process
for investigating these practices within their workplace, and helped them to uncover
and address some practices that might result in injustice and inequity for a vulnerable
group in the community.

By the end of this study, there is a shift perception among the nurses in delivering health
service for elderly. They decided to try to employ more health promotion activities
beside their usual work such as giving medication. Setting health education in group
for elderly is one of the option that they have planned to do in health integrated posts
(Posyandu).

Conclusion
Action research is informed by critical social theory hence it was an appropriate
methodology for a study that sought to inform practice and policy. Empowering the
action research group to understand how to negotiate the bureaucratic structure that was
identified as sometimes being prohibitive enabled change in practice to occur (Heron
& Reason, 2006). The AR group reviewed, evaluated, and made recommendations on
best practice for nurses working with the elderly health program thus reducing the
theory-practice gap in their practice (Meyer, 2000; Somekh, 2006). It enables health
professionals to challenge traditional norms, uncover latent meanings and release
constraining social and political barriers. Actions are informed by our knowledge and
beliefs; and through reflection, we are permitted to change our world thus transforming
reflection (Carr & Kemmis, 1986). The AR group critiqued their existing work
conditions and practice with the purpose of improving the care they provided to elderly
people accessing the health program. This process allowed unquestioned assumptions
to be examined and challenged and it was the responsibility of the researcher to identify
constraining circumstances and assist in liberation from these oppressive constraints
(Habermas, 1989). Using these processes enlightens, empowers, and emancipates
people to change situations, for example to change practice through taking action for
change

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