Using meta-synthesis to support application of qualitative methods findings in practice: a discussion of meta-ethnography, narrative synthesis, and critical interpretive synthesis

Meta-synthesis refers to a range of approaches by which existing qualitative studies in healthcare can bereviewed and compared. There is increasing use of meta-synthesis to ensure the clinical applicability offindings from qualitative studies, in healthcare generally, and in the creative arts therapies specifically.Qualitative method research can sometimes lack immediate clinical relevance, as such studies usuallyfocus on the experiences of a small number of participants. Additionally, the results are often presented ingreat detail; finely elaborated, and described conceptually. Findings reported in this way can be engaging,and even emotionally compelling, however the utility of these outcomes for clinical practice can belimited. Meta-synthesis of multiple studies aims to ensure that findings from qualitative methods studiescan be more easily, and effectively, applied in health and social care programs. Three approaches to metasynthesisare briefly presented here; meta-ethnography, narrative synthesis, and critical interpretivesynthesis. A procedure for presentation of meta-synthesis reviews is provided.

An ethnography of bitcoin: towards a future research agenda

Cryptocurrencies such as Bitcoin are a recent socio-technical innovation that seeks to disrupt the existing monetary system. Through mundane uses of this new digital cash, they provide a social critique of the centralised infrastructures of the banking industry. This paper outlines an ethnographic research agenda that considers how the social uptake and use of cryptocurrencies such as Bitcoin represents alternative views towards value exchange and critiques existing financial structures. We begin by arguing that the use of Bitcoin can be seen as an act of social resistance that is intended to bridge socio-economic inequalities within the context of a digital community. We then outline the disruptive nature of borderless, affordable and instantaneous international transfers in the form of remittances within social practice. Finally, we identify the possible permutations of trust that may be found in the technical affordances of Bitcoin technology and how these relate to user (pseudo)anonymity, cybertheft, cyberfraud, and consumer protection. Bringing together these three key areas, we highlight the importance of understanding the ordinary (rather than extra-ordinary) uses of cryptocurrencies such as Bitcoin. We contend that focusing upon users’ interactions with Bitcoin as a payments system and community culture will shed light upon mundane acts of socio-technical disruption, acts that critique and provide alternative financial exchange practices to the payments and regulatory financial infrastructures of the banking industry.

Active engagement with stigmatised communities through digital ethnography

Conducting research in the rapidly evolving fields constituting the digital social sciences raises challenging ethical and technical issues, especially when the subject matter includes activities of stigmatised populations. Our study of a dark-web drug-use community provides a case example of ‘how to’ conduct studies in digital environments where sensitive and illicit activities are discussed. In this paper we present the workflow from our digital ethnography and consider the consequences of particular choices of action upon knowledge production. Key considerations that our workflow responded to include adapting to volatile field-sites, researcher safety in digital environments, data security and encryption, and ethical-legal challenges. We anticipate that this workflow may assist other researchers to emulate, test and adapt our approach to the diverse range of illicit studies online. In this paper we argue that active engagement with stigmatised communities through multi-sited digital ethnography can complement and augment the findings of digital trace analyses.

Negotiating motherhood: the struggles of teenage mothers

Aims. This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting.

Background. Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support.

Design. This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12-month period from five homeless Australian sole-supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants.

Findings. The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives.

Conclusions. It was concluded that becoming a sole-supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.

Adolescent parenthood : a costly mistake or a search for love?

Family life is changing worldwide and an increasing number of women are choosing single parenthood. Adolescents who become pregnant and early childbearers do not always become pregnant unintentionally; some actively plan pregnancy while others are ambivalent mainly about the timing. This paper reports on a study using an ethnographic approach that explored the mothering experiences of five sole-supporting Australian teenage mothers who had a child over six months of age. It focuses on the story of one of them, a young woman who gave birth at 16 and set up home for herself and her son. Early childbearing is often a response to adverse social conditions such as poverty or homelessness and is not uncommonly chosen by teenage girls from socially deprived backgrounds. Educational and employment opportunities may be limited, whilst motherhood may provide a purpose in life when few other options are possible. Young women who make this choice need comprehensive services to support them in the parenting role, including appropriate health care, welfare and housing benefits, and support in dealing with parenting, a role which they may greatly desire but are not automatically well prepared for.

Tensions and constraints for nurses in hospital-in-home programmes

Economic necessity constrains health-care expenditure and waiting lists for hospital treatments remain high. As a result, more care is delivered via alternative means, such as same-day surgery initiatives and home-care programmes. Acute care delivered in the home to patients who would otherwise require hospitalization is becoming an increasingly acceptable means of treatment. These Hospital-in-the-Home programmes offer increased comfort while delivering comparable outcomes to many patient groups. The purpose of this paper is to generate discussion concerning the tensions that exist for nurses who practice in the home under the auspices of acute-care institutions. Data drawn from field work that formed part of a critical ethnography is used to generate the discussion. The larger research project explored the constructions of the role of the nurse in four Hospital-in-the-Home programmes in Victoria, Australia. It will be argued that there is significant pressure exerted upon nurses to support the imperative to reduce bed days in acute hospitals by transferring people to their home. At times, this agenda clashes with the nurses’ professional commitment to provide holistic patient care yet the dilemmas are largely unacknowledged and/or unrecognized by the nurses despite the tension they generate.

Putting the power in power, politics, and MIS implementation : a reworking of Markus (1983) 20 years on

This paper examines Markus' (1983) paper, using literature from the sociological and philosophical disciplines to provide an updated view of power and its influence on politics and Information Systems (IS). Using these different literature sources, which are becoming more accepted in the IS discipline, provides a richer understanding of power and politics in Information Systems. An alternative research methodology, critical ethnography, has also been described in the context of Markus' study and a case study has been provided which adopts this alternate approach.

Hearing what older consumers say about participation in their care

A study exploring older people's participation in their care in acute hospital settings reveals both consumers' and nurses' views of participation. Using a critical ethnographic design, data were collected through participant observation and interviews from consumers in acute care settings who were over 70 years old and nurses who were caring from them. Thematic analysis identified that older people equated participation with being independent. Importantly, consumers highlighted the complexity of the notion of participation when describing situations where they were unable to participate in their own care. The difficulties in communicating with health professionals and an inability to administer their own medications in inpatient settings were identified as barriers to participation. Understanding what consumers believe participation means provides a starting point for developing meaningful partnerships between health professionals and people receiving care.

Rules and resources: a structuration approach to understanding the coordination of childrens`s inpatient health care

Aim. This paper presents findings from a multi-method study exploring the process of care coordination in children's inpatient health care.

Background. Existing work on care coordination is typified by 'black-box' type studies that measure inputs to and outcomes of care coordination roles and practices, without addressing the process of coordination.

Method. Using questionnaires, interviews and observation to collect data in multiple sites in the United Kingdom and Denmark between 1999 and 2005, the study gathered the perceptions of staff and compared these with observed practice. Giddens' structuration theory was used to provide an analytical and explanatory framework.

Findings. Current care coordination practice is diverse and inconsistent. It involves a wide range of clinical and non-clinical staff, many of whom perceive a lack of clarity about who should perform specific coordination activities. Staff draw upon a wide range of different material and non-material resources in coordinating care, the use of which is governed by largely tacit and informal rules.

Conclusions. Care coordination can be usefully conceptualized as a 'structurated' process – one that is continually produced and reproduced by staff using rules and resources to 'instantiate' or bring about care coordination through action. Potentially negative implications of this are manifested in diversity and inconsistency in care coordination practice. However, positive aspects such as the opportunity this provides to tailor care to the needs of the individual patient can be realized.

'Skeleton budget', 'intranet', 'dole', and other strange Words: Bridging the cultural divide in a multicultural classroom

This paper examines the experiences of two academics who had been international students themselves and currently teaching in multicultural settings at tertiary level, with regards to the issues of the teacher using culture specific slang and idiom with otherwise keen and bright groups of students, in Australia. Using the research method of auto-ethnography, it examines and categorises the themes of issues most often faced by the staff members and students-such as the use of different vocabulary and keywords and the prior knowledge required of both the teacher and the students in reaching a shared understanding or inter-subjectivity. These will be discussed in terms of the various realities experienced by the students coming from a diversity of countries and cultures. The paper discusses how these challenges can be identified and addressed and how to prepare for future situations more effectively and in advance. They will be examined within the contexts of culturally responsive teaching, communication competence, the hidden curriculum, instructional scaffolding, understanding and being open to other cultures and acknowledgement of the richness and relevance of the multicultural students’ varied experiences and social realities, from the point of view of the academic discipline of communication studies.

Housing service officers : agents of the state or customer service officers?

Staff employed in the Victorian Office of Housing are invariably required to exercise discretion in their day-to-day work managing housing assets and providing services to public housing tenants. Policies specify processes but they never cover all situations and do not provide guidance on competing objectives. For example, preparing a property for reletting is a process with protocols and budget constraints. However, staff can make procedural variations that compy with policy. These variations, generally learnt from peers on the job, often result in budget over runs, but do result in improved properties for new tenants. Discretion is being exercised in balancing housing asset, budget control and tenant service objectives. A housing officer sums up the enduring tension in balancing objectives in the question and statement:’ Am I an agent of the state or a customer service officer? Because I can’t be both’. Organisationally these tensions are spoken about as ‘management issues’, ‘policy reengineering’ and ‘unrealistic understandings’. Using data from an ethnographic study in the Victorian Office of Housing, the paper addresses the question: ‘What do we know about the way in which front line housing officers manage competing objectives in their daily work and how might this knowledge be usefully used in the development of operational policy?’ The paper will explore the way in which complex administrative rules are used as a device to align staff to the Office of Housing objectives and limit the exercise of discretion by frontline staff. Against the background of this analysis the paper will consider the limitations of rule making and the extent to which other organisational strategies might be important for improvements in service provision in a context of constrained resources and limited resources.

Narrative and portfolio approaches to teacher professional standards

This paper analyses various uses of narrative in the exploration of teacher identity. It highlights the way many contemporary education writers use terminology such as ‘storying lives’ and ‘storied landscapes’ to describe teacher processes of reflection on practice. In this paper the authors discuss some recent approaches to narrative that incorporate or suggest systematic uses of narrative theory (Conle 2003, Kamler, 2001, Richardson, 2003). Consideration is also given to the links between critical ethnography and narrative in order to critique the use of teacher portfolios, as in a recent Australian initiative for the appraisal of beginning teachers. The authors conclude with an argument for the rehabilitation and refinement of narrative theory in the ‘writing’ of teacher identity.

The second curriculum opera : Arias, assessment and methodological traces

Drawing on contemporary forms of qualitative research such as performance ethnography (McCall, 2000), autoethnography (Ellis & Bochner, 2000; Ellis & Flaherty, 1992) and using narrative and writing as forms of inquiry (Richardson, 1990; 1992; 1995a; 1995b; 1997; 1999; 2000), this research project constructs a 'learning through' (Gardner, 1983; 1993; 1995; 1999; 2003a; 2003b) approach to curriculum within pre-service teacher education. During 2002 we initiated the first curriculum opera (Dixon & White, 2003; Dixon, White, & Smerdon, 2003) in our Faculty of Education with thirty-seven students. In 2003 we developed this learning and teaching approach with twice as many students. We also reconsidered assessment of students involved in the opera for overall theoretical consistency. As students increasingly took control, they 'imagined curriculum' (Doll & Gough, 2002) and transformed their exploration of identity in the 'process of becoming' teachers (Britzman, 2003). In this paper, we outline the project and the learning involved. We also indicate future directions for learning and teaching in preservice teacher education as well as the potential uses and misuses of teacher assessment through portfolio.

Introduction to special issue on indigenous entrepreneurs

Purpose: The purpose of this paper is to introduce the content of a special issue of Journal of Enterprising Communities focusing on indigenous entrepreneurs.

Design/methodology/approach: The paper provides a brief description of the six contributions to the special issue.

Findings: The papers are found to range over New Zealand, Australia, Hawaii, Sweden Samoa and Ghana.

Originality/value: The papers comprising this special issue are of value in increasing understanding of how uniquely indigenous political, economic and social systems can explain cultural, social and political factors that both inhibit and enhance indigenous economic prosperity.

Double disability : lived experience of Australian tertiary students with ME/CFS

This research is the exploration of the lived experience of tertiary students in Australia with the medical condition usually known as ME/CFS (Myalgic Encephalomyelitis /Chronic Fatigue Syndrome) seeking to explore issues of equity and human rights from the perspective of the Disability Discrimination Act 1992. Students feel that their difficulties are not caused just by the illness itself but by the failure of the tertiary institutions to understand the effects of this illness on them, the student, especially within the areas of accommodations and assessments. Their lived experiences are studied to ascertain if their experiences differ from those of other tertiary students. Forty participants came from every state and territory of Australia and twenty -four of Australia's universities as well as eight Technical and Further Education/Open Training Education Network (TAFE/OTEN) colleges are represented. The selection of the chosen methodology, Critical Ethnography from a Habermasian perspective, has been circumscribed by the medical condition which placed limitations on methodology and also data gathering methods. Non-structured stories, in which the participants wrote of their lived experience as students, were considered the most appropriate source of data. These were transmitted by electronic mail (with some by postal mail) to the researcher. A short questionnaire provided a participant background to the stories and was also collated for a composite overview of the participants. The stories are analysed in a number of ways: six selected stories are retold and the issues arising from these stories have been weighed against the remainder of the stories. Four intertwined themes were constructed from the issues raised in each story. Apparent infringements of the Disability Discrimination Act (1992) which impact on quality of life, human rights and equity are found. No accommodations are being made by the academic institutions for the cognitive dysfunctions and learning difficulties. Students are stigmatised and lack credibility to negotiate appropriate academic accommodations. A possible means of improving the ability of students to negotiate appropriate accommodations is explored. Finally the researcher reflects on her own involvement in the research as an 'insider' researcher.