A grounded theory inquiry: establishing communities of practice among Hiv/Aids nurse practitioners through the use of critical reflection at selected hospitals in KwaZulu-Natal.
Naidoo, Joanne Rachel.
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Introduction: Nurse practitioners in South Africa are challenged daily to provide comprehensive care under resource constrained conditions while at the same time trying to cope with the changes and care strategies related to HIV/Aids. The use of critical reflection within a shared learning space fostered by Communities of Practice is a plausible strategy to support ongoing meaningful learning that can support nurse practitioners to deal with the challenges related to the dynamic nature of HIV/Aids. Aim of the Study: This study aimed to analyze the processes of developing critical reflective skills and establishing Communities of Practice among a sample of nurse practitioners working in the field of HIV/Aids and to develop a middle range theory which explains the process of establishing Communities of Practice (CoP) among HIV/Aids nurse practitioners grounded in critical reflection. Methodology: Using a qualitative approach, a grounded theory design guided by Strauss and Corbin (1990) was used. Two district level hospitals from the province of KwaZulu-Natal, was sampled, within which a group of nurse practitioners working in the discipline of maternal and child health was sampled. Data collection was progressive over a period of seven months. The use of focus group discussion, in-depth individual interviews, reflective journals and researcher observation was used to elicit the data. Concurrent with data collection, open axial and selective coding was used to make sense of the data. Results: The results of this study revealed that there are a number of causal conditions which relates to the need for establishing a CoP and that the process of establishing a CoP requires engagement with the relevant stakeholders and members of the group. Three phases characterized the process of participants becoming critically reflective and a fully functional CoP. The concept of a CoP for HIV/Aids nurse practitioners is made up of core characteristics namely that it is an organic practice space, it promotes flexibility in learning, it is a support network where collaborative purpose driven working occurs and that it promotes learning on demand to name a few. There were also a number of intervening conditions which influenced the process of establishing the CoP and the findings of this study led to the emergence of a middle range theory which is both process and outcomes focused. This theory and its related model, demonstrates that establishing a CoP for HIV/Aids nurse practitioners occurs within a context and is made up of six major concepts namely (i) Context; (ii) Group Formation; (iii) CoP Establishment Process; (iv) Fully Functional CoP; (v) Outcomes; (vi) Sustainability and Continuity, and several sub-concepts. Conclusion and Recommendation: The recommendations of this study were classified into areas of practice, education and research, with regard to the usability of this theory in encouraging a transformed way of nursing aimed at improving nursing practice. In summary, this research lends insight into the complex challenges of nursing in a dynamic context of HIV/Aids. It further demonstrated that one of the overall outcomes was engagement in evidence informed practice and knowledge stewarding in HIV/Aids knowledge generation. Keywords: Communities of Practice (CoP); HIV/Aids Nurse Practitioners; Critical Reflection; Transformation; Knowledge Generation; Process; Outcomes.