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Participation as a multi-voiced process: Action research in the acute hospital environment

Action research in the acute hospital environment is made complex by competing and unequal voices. Acute hospitals and care in this sense refer to those intended for short-term treatment of illnesses. Care is provided by specialist teams comprising members of different disciplines/professions and is overseen by a complex hospital management and administrative structure. The respective voices of different specialist fields, disciplines, managers and patients must continually interact with each expressing a different personal and professional worldview. Gaining support from managers, medical providers and medical teams usually requires an emphasis on the presentation of evidence in which objectivity and parsimony is ascribed greater value than more detailed narratives that include a patient’s personal details and biography. A cooperative inquiry project with respiratory and palliative care nurses explored how palliative care needs of patients with advanced chronic obstructive pulmonary disease might be better addressed and comfort provided. This inquiry brought to the fore the value-based nature of everyday speech in which voices reflecting narratives of management, medicine, nursing, illness and disease were continually shifting. We came to understand meaningful participation as an invitation to consciously engage competing voices that are inherent in everyday practice with a view to delivering better comfort care to patients.