Action Research A Methodology for Change and Development

42 ACTION RESEARCH
validation of knowledge. Discussions at the meetings were lively, in part
because of Alison and Angie’s passionate engagement with the work, and in
part as a result of the critical questions that Donald McIntyre raised and
pursued relentlessly. Donald had a particular interest in social science
research methods but did not count himself as an advocate of action
research. Angie was his doctoral student so the Advisory Board meetings
inevitably became extensions to his teaching and, as Ron Elder was to say
in 2002 when he presented Donald for an honorary degree at the University
of Dundee: ‘Doing a thesis with Donald is like being dragged through an
intellectual hedge longways. You emerge as a different and wiser person.’
I learnt an enormous amount from my very peripheral participation in
this action research project. I came to a new understanding of the importance
of action research as a methodology for researching the process of
change in social practices and the meticulous care needed to ensure that
action research went beyond the professional development of the participants
and contributed to the generation of knowledge to inform others
engaged in the same or similar changes to nursing practice. At the same
time, I was introduced vicariously to the pressures under which nurses
worked within the British National Health Service (NHS), to their proud tradition
of caring for patients and the complex ethical considerations raised
by the effort to combine this with efficiency of service provision within
limited budgets and resources. Over the two years, meetings often involved
Alison and Angie discussing the impact of policy changes emanating from
central government, which at the time involved the introduction of new
ways of tracking efficiency and cutting down ‘waste’ by the introduction of
an element of competition through setting up ‘an internal market’ between
service providers and ‘clients’. The shifts in discourse, underpinning values
and regulatory frameworks paralleled similar changes being introduced at
the same time into the education service in which I was primarily working.
Alison Kitson, who as project director chaired the Advisory Board meetings,
had frequent access to policy makers and at the time was developing on
behalf of government a new system for auditing nursing practice in the NHS.
This public service discourse was in sharp contrast to the discourse of the
‘medical model’, which instantiated the hegemony of the consultants (the
most senior medical practitioners), who were in daily contact with nurses on
the ward but in most cases held themselves aloof from the action research
being undertaken there. The medical model was based on concepts of
illness/disease and treatment and was predicated on realist assumptions
about the nature of knowledge; it set methodological norms for research
design involving randomized controlled trials to establish statistically the
percentage of patients likely to respond positively to a specific treatment. It
seems to me that the shadow of the medical model hung over the daily
enactment of the action research project, setting an expectation of academic
rigour of a kind that Titchen and Binnie both rejected and respected.