Qualitative Shadowing of Nurse Managers Using Smartpen

A qualitative shadowing method using a
Livescribe™ Pulse™ Smartpen for
organizational research in hospitals
Studying daily work of nurse managers in context

Pieterbas Lalleman RN, MA

Elmhurst Hospital Center’s
Department of Nursing
6th Annual Research Conference
October 20, 2011
Nursing Research: Building Trust through Scientific Inquiry

Introduction

• Who am I…

• The Netherlands

• Research project in progress

• Shadowing as qualitative research method

• Livescribe™ Pulse™ Smartpen as a qualitative
research tool

Research Centre for
Innovations in Health Care
www.kenniscentrumivz.hu.nl

Pieterbas Lalleman, MA RN

• Registered Nurse

• Organizational Sociologist

• Dutch

• Visiting Research Scholar at Pace

• Working on an International
Nursing Leadership research
project
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The Netherlands

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Background:
Nursing shortage and role Nurse manager

• Shortage of nurses increases in the Netherlands (Klein
Breteler, J.J.A.H., et al. 2009)

• Importance of the Nurse Manager in retaining and attracting
nurses for the ward (Tomey 2009, McNeese-Smith 1999,
Mintzberg 1994, Pearlin 1962)

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Background:
Boundary spanning in Four Worlds

• Importance of boundary spanning behavior (Roberts
Callister, Wall 2001)

• The four worlds or field in the Hospital (Glouberman,
Mintzberg 2001)

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Background:
Four worlds of Glouberman and Mintzberg

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Design:
Exploratory case study

• Bourdieusian perspective (Bourdieu, Wacquant 1992)
• Managerial Work and Behavior approach (Stewart 2008)
• 4 case studies (hospitals)
• In each case 4 Nurse Managers are observed
• Each Nurse Manager is shadowed for 4 days

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Study in progress

• First two cases in transcription and analyses

• Half way the empirical data collection

• Awareness of bias

• Analysis with Nvivo a qualitative software tool:
– Coding
– Clustering
– Commuting between empirical material and theoretical
concept

• Focus today is on Shadowing and Smartpen use
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Shadowing:
Research method: What is it…

• It involves a research closely following a member on an
organization over a extended period of time

• A research technique that is developed to uncover not just
the shape of a nurse manager’s day in terms of the actions
performed, but also reveal the subtleties of perspective and
purpose shaping those actions in the real-time context of a
hospital (McDonald 2005)
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Shadowing:
Contributions of Shadowing

Characteristics that distinguishes shadowing:
1. Level of analysis
a) more detailed,
b) first hand data
c) Access to the trivial, mundane and difficult to articulate
2. Potential to extend ways organizations are researched:
a) Not a specific unit of analysis but itinerant.
b) Concentrating on the individual in a holistic way
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Shadowing:
Accoording to Weick

• Weick says about shadowing: “shadowing has the ability to
capture the brief, fragmented, varied, verbal and
interrupted nature of organizational life” (Weick 1974).

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Shadowing:
challenges accoording to McDonald

1. Access-negotiation process
2. Data management
3. Relationship shadower and shadowed
4. Hawthorne or observer effect
5. Going native

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Shadowing:
Practical recommendations

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Shadowing:
3 different forms in social science literature

1. Shadowing as a means of understanding roles and
perspectives.
2. Shadowing as a means of recording behavior
3. Shadowing as experiential learning

• Shadowing as potential for Management Development
programs in Hospital organizations
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Shadowing:
Management Development Tool

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Shadowing and field notes
Livescribe™ Pulse™ Smartpen

• Why using a smart pen for observational field notes?
• Writing and observing
• Pace of work
• Capturing the brief moment
• Accurate and precise
• Non obtrusive

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How it works and Demonstration

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Conclusion:

• Rich and accurate data
• Software in early development, instable
• Link notes to audio
• Search for words in notes
• Enhanced transparency of research data
• Transcribing audio is time consuming
• Perfect for shadowing in dynamic context like hospital!
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Literature

• Bourdieu, P., & Wacquant, L.J.D. 1992, An invitation to reflexive sociology, University of Chicago Press,
Chicago.
• Glouberman, S. & Mintzberg, H. 2001, "Managing the Care of Health and the Cure of Disease-Part I:
Differentiation", Health care management review, vol. 26, no. 1, pp. 56-69.
• Klein Breteler, J.J.A.H., et al. 2009, Zorg voor mensen, mensen voor de zorg. Arbeidsmarktbeleid voor
de zorgsector richting 2025 (Towards a labor market policy for Healthcare in 2025) ,
Zorginnovatieplatform.
• McDonald, S. 2005, "Studying actions in context: a qualitative shadowing method for organizational
research", Qualitative Research, vol. 5, no. 4, pp. 455-473.
• McNeese-Smith, D.K. 1999, "The Relationship between Managerial Motivation, Leadership, Nurse
Outcomes and Patient Satisfaction", Journal of Organizational Behavior, vol. 20, no. 2, pp. 243-259.
• Mintzberg, H. 1997, "Toward Healthier Hospitals", Health care management review, vol. 22, no. 4, pp. 9-
18.

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Literature

• Mintzberg, H. 1994, "Managing as Blended Care", Journal of Nursing Administration, vol. 24, no. 9, pp.
29-36.
• Pearlin, L.I. 1962, "Alienation from Work: A Study of Nursing Personnel", American Sociological Review,
vol. 27, no. 3, pp. 314-326.
• Roberts Callister, R. & Wall, J.A. 2001, "Conflict Across Organizational Boundaries: Managed Care
Organizations Versus Health Care Providers,", Journal of Applied Psychology, vol. 86, no. 4, pp. 754-
763.
• Stewart, R. 2008, "A Tougher World; Managerial Work and Behaviour" in Mapping the Management
Journey; Practice, Theory, and Context, eds. S. Dopson, M. Earl & P. Snow, Oxford university press,
Oxford, pp. 49.
• Tomey, A. 2009, Nursing leadership and management effects work environments, - Blackwell Publishing
Ltd.

• Weick, K.E. 1995, Sensemaking in organizations, Sage Publications, Thousand Oaks.
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Qualitative Shadowing of Nurse Managers Using Smartpen

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