Multiple hands forming a circle

If you’ve been paying attention and following along every month, you’ll note that blog posts are all over the place. For example, waaay back in September I briefly mentioned that there are four principles of video reflexive ethnography (VRE), but didn’t identify them. Sheesh! It wasn’t until the December 2019 blog that I finally got around to telling you all what the four principles are: exnovation, collaboration, reflexivity, and care. Exnovation was the topic of December’s blog. In January the blog explored the principle of reflexivity, leaving us with two principles to discuss: collaboration and care.

The focus of this month’s blog is on care, leaving us with one more principle, that of collaboration and we’ll take up that subject next month. The picture accompanying this month’s blog exemplifies providing care: many soft hands forming a circle. The circle idea is especially relevant to the VRE principle of care and I’ll get to that idea in a bit. As humans we care for each other and we also care for animals and plants. I think of care in relation to other living things, although of course people also care for inanimate objects whether they be antique furniture or new cars. But whatever way you think of care, across all definitions are themes of paying attention to and protecting someone or something.

An emphasis on care is especially relevant to VRE. VRE cares for participants’ psychological safety as they engage with the VRE process to explore clinical care complexity. Psychological safety refers to a person’s perception that it is safe to speak up about something and not experience adverse consequences as a result (such as being censured or embarrassed). There are both intra-personal and inter-personal aspects to psychological safety that require our care during the VRE process. Using an intra-personal lens, there is a potential for participants to feel shame and vulnerability while engaging in practice improvement activities. Be prepared for comments from participants such as, “They say the camera adds 10 pounds” and “What if I’m having a bad hair day?” as such comments speak to vulnerabilities that require our care. There is no one correct response to these comments, other than to reassure the participant that the video will focus on the clinical practice being investigated, not the participant. Remind the participant that as part of the VRE process, immediately after the video is over the participant will have the opportunity to view the footage and will have the right (the power) to request that the video be deleted, without giving a reason. The inter-personal aspects of psychological safety may be easier to understand because reflexivity sessions are held in groups so there is always the chance that co-workers will judge one’s performance as below par compared to that of others’ on a video. An adept facilitator can forestall inappropriate comments by setting ground rules at the beginning of reflexivity sessions that everyone can honor and by reminding individuals of those ground rules should that become necessary during the session.

Now it’s time to bring up the idea of the circle when talking about care during VRE. Because VRE is a multi-stage process participants and researchers engage in a relationship over time, and these relationships require monitoring to make sure that they do not become exploitative or worse. Our usual way of protecting – demonstrating care for – human subjects in research is to obtain informed consent from participants. Because informed consent takes the form of a written document, obtaining it is a one-time event. However, VRE is a process (think of that circle of care), and while it would be unwieldy and likely infeasible to obtain written informed consent from all participants at every step of VRE, a researcher demonstrates care when s/he verbally checks in with participants to ask “Is it still ok to use the video that you participated in?” The literature does describe a process of ongoing informed consent, so please check out the references at the end of this blog to learn more about that, if you are interested. Although institutional review board (IRB) approval requires explaining how to minimize any risk of an adverse effect through a video’s potential to be used for performance monitoring and risk mitigation, the risk still exists and needs to be explicitly addressed by the researcher rather than be brought up by a participant to demonstrate care. Researchers who fully describe all risks associated with VRE are demonstrating care that they understand the fears and anxieties associated with being filmed.

In summary, for all of the amazing benefits of VRE, participants may feel a lack of power and control and it is up to us as researchers to ensure that participants feel cared for and safe taking risks by having videos viewed, edited, and scrutinized by others. Participants also should feel comfortable speaking up in reflexivity sessions about their own and others’ practices without the fear of rejection and punishment, and without embarrassment. While IRB consent allays concerns related to the protection of human subjects, the principle of “care” in VRE goes beyond obtaining IRB approval.

REFERENCES

Iedema, R., Carroll, K., Collier, A., Hor, S.-Y., Mesman, J., & Wyer, M. (2019). Video Reflexive Ethnography in Health Research and Healthcare Improvement: Theory and Application (1st ed.). Taylor & Francis Group, LLC.

O’Reilly, M., Parker, N., & Hutchby, I. (2011). Ongoing processes of managing consent: The empirical ethics of using video-recording in clinical practice and research. Clinical Ethics, 6(4), 179–185. https://doi.org/10.1258/ce.2011.011040

Blog Entry – March 2020 – Care