Moffat, Mary Dissertation 11-8-17
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Certified Case Managers’ Lived Experiences in Hospital Networks: A Phenomenological Inquiry A dissertation presented to the faculty of The Patton College of Education of Ohio University In partial fulfillment of requirements for the degree Doctor of Philosophy Mary I. Moffat December 2017 © 2017 Mary I. Moffat. All Rights Reserved. 2 This dissertation titled Certified Case Managers’ Lived Experiences in Hospital Networks: A Phenomenological Inquiry by MARY I. MOFFAT has been approved for the Department of Teacher Education and The Patton College of Education by Ginger Weade Professor of Teacher Education Renée A. Middleton Dean, The Patton College of Education 3 Abstract MOFFAT, MARY I., Ph.D., December 2017, Curriculum and Instruction Certified Case Managers’ Lived Experiences in Hospital Networks: A Phenomenological Inquiry Director of Dissertation: Ginger Weade The purpose of this qualitative phenomenological study was to understand the shared lived experience of registered nurses certified in case management (RN-CCM) employed in hospital networks. For this project, the phenomena of problem-solving conflicts are generally defined as the experience of work-related conflicts, meaning- making given to phenomena, and strategies to reconcile unsatisfying outcomes as advocate. Phenomenology theory is most applicable because the lived experience can contribute to the depth and breadth of understanding of ethical and practical conflicts occurring in health care delivery. Participants were interviewed about their work and self- care interests. In the context of health care, a relationship emerged between outstanding conflict themes and problem-solving skills. Ethical principles established in codes of conduct contribute to perceptions of dilemmas leading to conflicts: benevolence, nonmaleficence, autonomy, and justice. Personal attributes of empathy and emotional intelligence contribute in collaboration skills. Self-care actions change lives by reducing internalized responses to conflict and reinforce personal identify and values. The meaning-making of certification is placed in the self-care theme because it is experienced as a validation of professional expertise, networking, and accruing required CEUs. Three conflict themes emerged in the interviews: change, task-relation, and caring. Of these 4 three themes, conflict of caring presents a unique and meaningful engagement for RN- CCMs in complex health-care systems today. The data informs the reader on the perception and experience of conflicts and self-care for seasoned RN-CCM and may be of interest for further study about experiences and coping skills of those who collaborate on patient care within healthcare networks. 5 Dedication In gratitude for ethical and empathetic caretakers and educators who are inspired to mitigate the suffering of others. 6 Acknowledgments This project survived because of the diligence and mentoring of Drs. Ginger Weade, Adah Ward-Randolph, and Dwan Robinson; the gracious assistance of my peers; and the infinite wisdom-keepers of our natural world, guiding us through cycles of a conscious life if we humbly abide. 7 Table of Contents Page Abstract ................................................................................................................................3 Dedication ............................................................................................................................5 Acknowledgments ................................................................................................................6 List of Tables .....................................................................................................................10 List of Figures ....................................................................................................................11 Chapter One: Introduction .................................................................................................12 Significance of the Study .............................................................................................16 Research Questions ......................................................................................................17 Methodology ................................................................................................................18 Limitations ...................................................................................................................19 Delimitations ................................................................................................................20 Research Ethics ............................................................................................................21 Definitions ....................................................................................................................21 Accountable Care Organization (ACO). ................................................................21 Acute care. .............................................................................................................22 Acute-care hospital. ...............................................................................................22 Advocate. ...............................................................................................................22 Case manager. ........................................................................................................22 Conflict phenomena for RN-CCM. ........................................................................23 Conflict of interest. ................................................................................................23 Contractualism. ......................................................................................................23 Deontology. ............................................................................................................23 Emotional intelligence. ..........................................................................................23 Ethic. ......................................................................................................................23 Interqual. ................................................................................................................24 Summary ......................................................................................................................24 Chapter Two: Literature Review .......................................................................................26 8 Ethics, Codes of Conduct, Empathy, and Emotional Intelligence ...............................28 Ethics ......................................................................................................................29 Codes of conduct. ...................................................................................................37 Empathy. ................................................................................................................38 Emotional Intelligence and Empathic Maturity. ....................................................40 Problem-Solving Process, Ethical vs. Practical Conflicts, and Moral Distress ...........45 Problem solving .....................................................................................................45 Ethical vs. practical conflicts .................................................................................47 Moral distress. ........................................................................................................47 Historical Health Care Context and Case Management Duty .....................................51 How social governance begat professional case management advocacy. .............51 Standards of practice and codes of conduct ...........................................................58 RN-CCM scope of practice ....................................................................................60 Summary ......................................................................................................................63 Chapter Three: Methodology .............................................................................................65 Historical Evolution of Phenomenology Philosophy ...................................................65 Research Design ...........................................................................................................67 Interpretive Phenomenological Methodology ..............................................................68 Tools of Research ........................................................................................................71 Data Collection ............................................................................................................75 Data Analysis ...............................................................................................................76 Self as Researcher: Disclosure .....................................................................................80 Chapter Four: Those Who Care: Reflections of RN-CCMs ..............................................82 Finding RN-CCMs to Participate.................................................................................82 Being an RN-CCM: Attributes, Self-Care, and Work Interactions .............................83 Attributes ................................................................................................................83 Self-care .................................................................................................................86