Nursing Supervision: Studying the “Case” of the
phenomenon of interorganizational articulation
Nursing School and Hospital
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Ana Paula Morais de Carvalho Macedo1
SuperviSão em enfermagem: eStudar o “CaSo” do fenómeno de artiCulação interorganizaCional eSCola de enfermagem e HoSpital
SuperviSión en enfermería: eStudiar el “CaSo” del fenómeno de la artiCulaCión interorganizaCional eSCuela de enfermería y HoSpital
* this work has been extracted from the doctorate dissertation entitled Nursing Internship Supervision in the Interorganizational Articulation School and Hospital,
presented to institute for education and psychology (instituto de educação e psicologia) of university of minho. 1 ana paula morais de Carvalho macedo, d.ed.
doi: 10.1590/S0080-623420140000800028
resuMo
A história desta invesigação encontrou um ethos propício não só pelo percurso da
invesigadora, mas também pelas atuais políicas públicas de modernização e de reforma capazes de regular e transformar os sistemas educaivos e de saúde, bem como os seus grupos proissionais. A rele -xão entretanto desenvolvida suscitara uma perceção vincada dos processos organiza -cionais de mudança pelos quais estes inter -feriam na ariculação interorganizacional Escola de Enfermagem e Hospital, onde a supervisão de estágios seria a grande protagonista, sustentada pelos signiica -dos que os atores intervenientes lhes têm atribuído. A pesquisa explícita de opções epistemológicas e metodológicas levou a olhar para o problema de uma forma mais atenta, apurando-o, tendo em conta as di -mensões organizacionais. A opção por um
estudo de caso prendeu-se com o facto de
o método permiir responder ao propósito de conhecer e compreender o fenómeno da ariculação interorganizacional Escola de Enfermagem e Hospital, concretamente através da supervisão de estágios.
desCritores Supervisão de enfermagem Organizações
Escolas de enfermagem Hospitais de ensino Estudo de caso AbstrACt
The history of this research found a suit -able ethos not only by the route of the researcher, but also by the current public policies of modernizaion and reform that are capable of regulaing and transform -ing the educaional and health systems, as well as their professional groups. The relecion meanime developed had raised a clear percepion of the organizaional change processes by which they interfered with the interorganizaional coordinaion between School of Nursing and Hospital, where internship supervision would be the main protagonist, supported by the mean -ings that intervening actors have assigned to them. In this context, the search for explicit epistemological and methodologi -cal choices leads to look more atenively at the problem, ascertaining it, taking into account the organizaional dimensions. In this regard, the choice of a case study was related to the fact that the method allowed to answer the purpose of knowing and un -derstanding the interorganizaional coor -dinaion phenomenon between School of Nursing and Hospital, namely through the supervision of internships.
desCriPtors
Clinical supervision in nursing Organizaions
Nursing schools Teaching hospitals Case study
resuMen
La historia de esta invesigación encontró un ethos propicio no solamente por la ruta
de la invesigadora, pero también por las actuales políicas públicas de moderniza -ción y de reformas capaces de regular y transformar los sistemas educaivos y de salud, y sus grupos profesionales. La re -lexión mientras desarrollada ha suscita -do una percepción incrementada, aunque algo difusa, sobre los procesos de cambio organizacionales, pelos cuales se interfe -ría en la ariculación interorganizacional Escuela de Enfermería y Hospital, y como tal, la supervisión de prácicas seria la gran protagonista sustentada pelos signiicados que los actores intervinientes les ienen atribuido. En este alcance, al procurarse explicitar las opciones epistemológicas y metodológicas se mira el problema de una forma más atenta, apurándolo, teniendo en cuenta las dimensiones organizacionales. En este senido, la opción por un estudio de caso se ha prendido con el hecho de que el método permite responder al propósito de conocer y comprender el fenómeno de la ariculación interorganizacional Escuela de Enfermería y Hospital, concretamente a través de la supervisión de prácicas.
desCriPtores Supervisión de enfermería Organizaciones
introduCtion
We have situated this study at the historical conluen
-ce of Nursing teaching and the emergen-ce of internship supervision, with relevance to organizaional dimensions of the ariculaion between School of Nursing and Hospi
-tal. The methodology supporing the study of this aricula
-ion in a context of internship supervis-ion, as far as object of empirical inquiry, is close to ethnographic research, or, in a more systemaic perspecive, to a naturalisic resear
-ch paradigm, whose method is a case study.
The search for the conducing thread of the study, and for the criteria to be adopted so that it might accomplish its expected purpose, has been constructed during all the research process. As emphasized in “Case Study”, by Ro
-bert Yin (1): “A case study is an empirical inquiry that inves
-igates a contemporary phenomenon within its real-life context, especially when the boundaries between pheno
-menon and context are no clearly deined”. Another ma
-jor aspect pointed out by this author regards the scope of the method, comprising the logic of planning, of data collecion, and of speciic approaches to data analysis.
The main characterisics of case studies seem to over
-lap general characterisics of qualitaive research: i) Case studies aim to discovery; ii) Case studies emphasize “in
-terpretaion within context”; iii) Case studies aim to re
-present reality in a complete and thorough manner; iv) Case studies use a variety of informaion sources; v) Case studies reveal vicarious experience and allow naturalisic generalizaions; vi) Case studies seek to represent dife
-rent and oten conlicing points of view present in a social situaion; vii) Case study reports use language and form more accessible than other research reports. (2)
Being so, our staring point to the choice of the “me
-thodological paradigm” was guided by demonstraing the characterisics of the study - qualitaive and descripive, insofar we intended to emphasize mainly the logic of com
-prehension and discovery (3)-, rather than by theory jusii
-caion and tesing; such atribute led us to greater aware
-ness of validaion procedures like the representaive-ness of collected elements, triangulaion, contrasing and com
-paring, highlighing the meaning of rare or excepional ca
-ses, or weighing contradictory explanaions.
The comparison between the two organizaions had the following objecives: Characterize the ariculaion be
-tween the organizaion School of Nursing and the organi
-zaion Hospital; Understand the explicit and implicit logics of Nursing internship supervision between the two orga
-nizaions; Contribute to clarify some aspects regarding to the context of hospital work as the place of training and educaion for Nursing internship students; Contribute to the development of Nursing teaching in Portugal, while recognizing the importance of internship to nursing pro
-fessionals’ training.
Therefore, we tried to ind explanaions to facts rela
-ted to the forms of interorganizaional ariculaion betwe
-en School of Nursing and Hospital, observing them “from inside” (4), having as a fundamental concern to capture the
actors’ perspecives and representaions within its con
-text - their values, beliefs, rituals and representaions. In this sense, this approach starts from actor’s expe
-riences to reconstruct the logic and paricular properies of a local order, rather than the global social structure: “(…) here the priority is given to ield discovery and its always paricular and coningent structuraion, as well to the development of descripive and interpretaive models that it the ield and its pariculariies and its coningen
-cies” (4). It was important to perceive the actors’ percep
-ions about the interorganizaional ariculaion between School of Nursing and Hospital, through their implicit or explicit reference to concepions or representaions of in
-ternship supervision within the context of hospital work. The most subtle way we found to study the interorganiza
-ional ariculaion between School of Nursing and Hospital was through the analysis of internship supervision in the hospital context, staring with some analyic dimensions we have been idenifying as essenial to its study and among which we highlight: hospital organizaion (objec
-ives and preferences, and technology / procedures) (5),
funcion and control, curriculum and methods, internship supervision (supervision scenarios) and supervision stra
-tegies.
Case study, as a methodological strategy that includes a set of research methods, aims to achieve a wide com
-prehension of the phenomenon in its totality (6). This idea
relected on our global concerns - to understand, as far as possible, the dynamics and organizaional processes of both organizaions studied. Therefore, we intended to start the empirical study with a socio-historical construc
-ion of some of the characterisics and speciiciies of our object of study, triangulaing data from discourses and pracices of internship supervision (very close to the ac
-tors) and data from documental sources, from the School of Nursing as well as from the Hospital. We passed then to another stage of the empirical study, which means pas
-sing to the case study, “an example in acion” (7), studying
some incidents and speciic facts with selecive data col
-lecion, which allowed us to capture and relect signiicant elements.
The case study comprised several phases, staring with the delimitaion of the ield for analysis (the problemaic, the iniial quesions and some iniial explicaive supposi
-ions). The following phases were: ideniicaion of the con
-text characterisics; construcion of tools to data collecion (inquiries by quesionnaire and by interview, observaion scripts, analysis grid for unoicial documents and minu
al framework progressively built did not result exclusively from a theoreical deducion process (arising from organi
-zaional and supervision models which support it) but also from the interacion between theoreical conceptualizaion and empirical research data. This means that we assume social sciences as theoreical and pracical approach to so
-cial reality. There´s no sense in sole theory, neither in sole pracice, but only in their dialecic, though operaing their disincion. This procedure meets the “process of con
-inuous regulaion of ield research pracice and of coni
-nuous regulaion of data analysis” (8), which is fundamental
to allow the researcher to build his/ her idenity and to es
-tablish a series of social roles.
Method
According the relecions above, the ield research component consisted of themaized relecion on the ma
-terials “collected” in one or another of the organizaions, or simultaneously in both during the internship supervi
-sion. As all specialized literature highlights, access to ield work is fundamental, as it might determinate the success or the failure of the research (9). One of the aspects we
tried to keep on our mind was the relaive weight of im
-pact in the social unit we were studying. We were deeply familiar by previous socializaion or proximity (8). This fea
-ture became evident during all the research process. Our behavior within ield work was openly and publicly assu
-med and we tried to keep a low proile; nevertheless, our roles were easily confused since we had a regular presen
-ce in the social context. At imes, actors would recogni
-ze us as researching on that context (namely because we asked their previous authorizaion to do interviews, or to collect data otherwise), other imes they just would forget this status and we would hold another - as supervisor, co
--worker or teacher. In this sense there was a low impact; the muliplicity of roles led to a more frequent and longer permanence at the organizaions School of Nursing and Hospital, so that the actors got used to our frequent pre
-sence without relaing it to a disincive role - as a resear
-cher, as a supervisor or as a teacher.
The “crystallized” presence of the researcher in the work ield, occurring ater an iniial integraion period, “cuts both ways”, and we have been aware of this du
-ring the research. If it is true that it is a major require
-ment for the efeciveness of observaion, it is also true that it necessarily implies a local social deiniion, within the researcher’s behavior, of what overlaps with normal daily rouine and what draws atenion, leading therefore to the emergence of barriers to focus on the observaion ield (8). We were conscious that we had to keep a perma
-nent focus on our object of study, which lead us to parial disrupions that generated some conlict; the inal balan
-ce was posiive, our personal and professional idenity moivated many conversaions and acted oten as an ap
-proximaion strategy.
The guiding quesions of the study were the following: i) Does the ariculaion between School of Nursing and Hospital, insofar as it reveals the similariies / diferences between the two organizaions, favor internship supervi
-sion? ii) Does the ariculaion between School of Nursing and Hospital favor the integraion of Nursing internship students in the context of hospital work?
At this point, we think it is essenial to clarify some as
-pects related to the main methods of direct data collec
-ion in the ield and to the speciic nature of procedures, according to the theoreical references framework and to the characterisics of the object of study.
Inquiry by quesionnaire
In a preliminary stage of research, we needed to recur to this data collecion technique. Quesionnaires were ap
-plied to the internship students of the 2nd year of Liceniate
Degree course in Nursing (three classes), corresponding to 135 internship students. This criterion was selected to be
-it us, since -it was easy to accede to the ields of Medicine internship. This iniial study had an exploratory scope, and was developed at two diferent imes and with diferent objecives corresponding to the applicaion of two ques
-ionnaires. On a irst stage, we aimed to know internship students representaions related to Hospital as an organi
-zaion and as training place, as well as the appreniceships they value and what they really learn - essenially relaing to their iniial experiences on a context of Hospital work. This exploratory approach had as objecive to understand if internship students learning ited the objecives outli
-ned to Nursing Teaching, idenifying privileged training models, or if, otherwise, students’ appreniceships could be accomplished within diferent training models - dife
-rent of those expected for future nurses (10). This prelimi
-nary study allowed us to systemaize and deepen some aspects related to internship in Liceniate Degree course in Nursing, adding new elements to research.
Inquiry by interview
In a irst phase of the study we interviewed, within both contexts, twenty three actors suitable to sample (nurses of the Hospital and teachers, most of them for
-mer students at the School), staring from a script of semi
--structured quesions. In this study, interview presented methodological possibiliies that we have not ideniied in other methodologies, by recourse to narraives. In some cases, narraive turned into biographies, insofar that sub
-jects’ informaion assumed real sense and meaning be
-cause temporal dimension was made explicit and integra
-ted into the problemaic, which allowed us to understand the phenomenon within ime course (11).
from their past in the organizaions under study, on the other hand the actors needed to remind their past as stu
-dents, or even as professionals, once again moivated by the quesions. When quesions touched to a more or less remote past, and deviaion showed as a probability through memory shortage denounced by less clear reports, we con
-irmed the need to recur to other techniques. In some situ
-aions it was easy to get around the progressive weakening
of interviewed actors by collecing the desired informaion from diferent subjects of the interview script. Almost all teachers and nurses interviewed had a characterisic in common, since they had been students at the School. This criterion for our convenience allowed us to recur to past ex
-periences without major constraints. Another strategy we have selected was to address to an internship supervisor (who accompanied a group of internship students) a ques
-ion that did not integrate our script, but had the purpose to evaluate a precise and punctual behavior, as the example
that follows: “As a teacher, how have you concreized su
-pervision during today’s internship training?”
All interviews had place outside the Hospital organi
-zaion and always had into account the acceptance and availability of interviewed. The relaionship of proximity with the interviewed and the comprehensive nature of interviews led us the opion of recording them for pos
-terior full transcripion. Anonymity having been assured, the majority of the interviewed (with excepion of three of them) accepted it without hesitaing. By this we do not intend to say that we exclude the inluence of contextual factors. An interview, like any face to face relaionship, is always a paricular social interacion, subjected to diverse readings and evaluaions from part to part, which are sus
-cepible of introducing biases in data collecion (12).
As a methodological strategy of convenience, in the next step (phase of case study or of “an example in ac
-ion” (1)), eight internship students from the 2nd year of
Liceniate Degree course in Nursing, ive nurses and the supervisor were also interviewed, privileging two moda
-liies of interview - semi-direcive interview and direcive interview.
Semi-direcive interview was based on the use of a script, allowing the interviewed to express them following the low of their own thoughts. This means that we stood on a middle ground, between two compelling and opposed requirements. On the one hand we wanted the interviewed to structure its thoughts around the envisaged object (a parially “non-direcive aitude”). On the other hand, we did not want their atenion to be diverted to other con
-sideraions not connected to the object, easing therefore the deepening of non-explicit aspects (11). Being so, parially
“direcive” aitude was recorded on interviewer interven
-ions. This type of interview may also be classiied in a
con-inuum: “[…] in one of its poles, interviewer favors a freer
expression from his interlocutor, intervening as less as pos
-sible; in the other pole, the interviewer structures the inter
-view from a strictly deined object of study” .
In what concerns to data statute, it must also be refer
-red that there a wide possibility to obtain data, these pre
-sening nevertheless their own limitaions: “What people declare about their pracices is not enough to reveal the logics that underlie to them” (11). In other words, though
interviews allow an approximaion to subjects’ represen
-taions (whether they are opinions, aspiraions or repre
-sentaions), they only provide data on the pracices in an imperfect form.
The direcive or structured interview was also applied
to actors. I was based on a quesionnaire with standardi
-zed quesions and had a pre-established sequence. Accor
-ding to respecive situaions, interviewed were invited to: select the most appropriate answer; select a given number of answers from a set and order them according to priori
-ty sequence; answer briely; choose scenarios within limi
-ted opions. In each quesion with a wide set of answers we included the opion “other(s)”, providing a blank space for speciicaion. At the end of the quesionnaire we pla
-ced an open quesion; interviewed seldom illed it up and, when they did so, answers were very succinct. In this type of inquiry, the same quesions were addressed to both populaions; for some of the actors, pariculars quesions were added, relaing to their statute or their funcion wi
-thin the organizaion School of Nursing / Hospital.
Analysis of documental corpus
Within their framework, documents stand as “vesiges”
(12) that shape the historical-educaive nature of the rese
-arch underlying to study. The analysis of the documents appeared therefore as adequate to this research, since it concerned a study that required the analysis of organizaio
-nal features both from School of Nursing and Hospital - en
-visaged as social eniies developing within a given context. In this sense this research method is jusiied by the need to explain the reasons, as well as the legal and ethi
-cal bases, which moivated and jusiied pracices during a signiicant ime period.
Data collecion was deduced from both contexts un
-der study. In what concerns the School, data were collec
-ted from: Study Plans and Course Regulaions; internship Pedagogical Files; meeings’ minute books; Annual Asses
-sment Reports, School newspapers; documents issued from School, of data on student populaion and daily school management; poliical-strategic documents (Eu
-ropean regulaions). In what touches to Hospital, data were collected from: Newsleters from the Hospital Bo
-ard; Service Orders; Acivity Reports; Plans of “In-service Training” and Training Plans from the Department of Trai
The richness and relevance of data showed its poten
-ial in ariculaion with “privileged informants” who took part in both contexts in diferent imes.
Paricipant observaion
This opion within ield research arises from our fami
-liarizaion with the social context we intended to study. The study implied a long permanence of researcher in the ield and comprised the observaion of a muliplicity of so
-cial reality dimensions. Therefore, it required a systemaic confrontaion between the perspecives of social local ac
-tors on world and society (collected through various types of verbal statements), and the data collected by direct and paricipant observaion. This procedure allows to decode the meaning of objects and symbols, spaial coniguraions and rhythms, behaviors and strategies, statements and si
-lences, acing and thinking styles; its methodological design framework points to an exhausive work which is limited to a situaion and to a ime for data collecion (13).
Throughout clinical internship we recurred to this me
-thod, using an observaion grid to record events judged signiicant to the type of study. The observaion grid in
-cluded two topics: i) Relaionship with Organizaion / Ca
-re Unity; ii) Interacion with work context (spaces, imes, professionals, internship students). This script included blanks for our ield notes, and the records were accom
-plished ater having been at the care unit, generally in the reunion room of another care unity where we accom
-panying another group of internship students.
In this sense we selected as main criteria the situaion or aitude as observer, the observaion process and the observaion ground. We may say that, in our case, the observaion was paricipant, systemaic (regarding the “process”) and verbal (regarding the “ground”). This par
-icipant observaion corresponds to an observaion where the observer may in some way paricipate in the acivity of the observed, sill performing, however, his/her role as observer and therefore maintaining this statute. We may say that there was an ideniiable polarizaion, enough to keep us alert no to pass to one of the sides - going over to the other side(14). The “auscultaion” of our feelings and
emoions during this procedure was a signiicant help. We should also add that our observaion addressed phe
-nomena, tasks or speciic situaions where the observed actor was centered.
Although our presence as observer in such context (in
-ternship) was quite long, direct contact with observed and its selecive and systemaic record occurred during two weeks, for periods of one hour. Data collected in this ob
-servaion allowed data crossing and comprehension, star
-ing from inquiries by quesionnaire and interview. This technique avoided the isolaion of variables by not con
-trolling or eliminaing them, since it uses the technique of reducion of the observaion ield in accord to emerging perspecives all along the research process. It began to be
descripive, so its categories arise from experience, not from an apriorisic order. Therefore, it aims to avoid the dangers of reducionism and bias. The main inconvenient to be pointed out is the lack of generalizaion. However, this diiculty may be parially surpassed by the analysis of what there is in common between the diverse situaions under analysis (13).
This research method was put into pracice in a Me
-dical Unit of a Central Hospital in North Portugal Zone. At this point we must also make explicit that our opion was, since the beginning, not to disclose the name of the care unit or the ideniicaion of the actors paricipaing in the study, because we considered these would feel more comfortable to reveal their thoughts and less em
-barrassed when describing episodes that might give an unfavorable image of themselves. By this we mean that we respected the norms of ethics in research with human subjects - “informed consent and protecion of subjects against any kind of harm” (9).
Characterizaion of respondents
According to the theoreical-methodological design of this research, built by phases, the actors integraing this study were successively introduced all along research course. In this sense, the sample choice was determined by their adequacy to research objecives in each one of the phases, having as a principle the diversiicaion of res
-pondent persons and assuring that none of the signiicant dimensions for the study would be forgoten. Therefore, in
the 1st and 2nd phases we applied a quesionnaire to 2nd ye
-ar internship students. In these two phases our concerns centered in the ideniicaion of situaional constraints related with supervision, and on the interorganizaional ariculaion between School of Nursing and Hospital. The quesion about sample and its representaiveness leads us to confront two points of view that do not necessarily oppose - those of staisical technique and of sociological interpretaion (15).
The irst of these techniques requires the existence of relaionships to the distribuion of respondents by ca
-tegory, while the second one requires discovery of new categories theoreically suitable. Being so, staisically we
-ak correlaions might be theoreically relevant. Staisical and theoreical relevance may not be coincident. In the
3rd phase of this study we selected actors convenient to
sample: 11 teachers (former students of the School under study); 12 nurses from the Hospital under study (former nurses directors, supervising nurses, chief nurses, nurse that integrated the Scieniic and Pedagogic Commission of Training and Research Department, Assistant Nurse to Director of Nursing, Quality Coordinator Nurse, Specialist Nurse and Nurse of Reference of Medicine Service, Tea
-ching Assistant Nurses); the actors intervening in the case study (eight students of Liceniate Degree course in Nur
When empirical study started, the choice of the sample, “opportunity sample” (16), was determined by its adequacy
to the objecives of research, taking as a principle the diver
-siicaion of respondent persons and assuring that none of the signiicant dimensions for the study would be forgot
-ten. Within this reasoning, “individuals were not selected according to numerical importance of the category that they represented, but rather due to their exemplary charac
-ter” (11). In our case, to assure the exemplary character pre
-supposed to assure the actors convenient to sample, tho
-se who-se professional statute implied responsibility in the organizaion and supervision of internship, or who where implied in the very process of supervision.
results
To atain the research results it was necessary to analyze data, one of the more important and complex task of em
-pirical research, consising in the systemaizaion and orga
-nizaion of collected materials in order to amplify its com
-prehension (15). The reading of data collected in a Medicine
service (through inquiry by quesionnaire and interview, analysis of documental corpus and ield notes) obeyed to diferent phases. The 1st and 2nd phases sill corresponded to the exploratory phase whose data allowed the conirma
-ion of a problemaic. The analysis latu sensu of documen
-tal corpus and data collected trough inquiry by quesion
-naire allowed to idenify emergent and signiicant units of meaning. The operaions leading to an internal categoriza
-ion of data a posteriori(17) aimed to establish categories,
by an inducive process, to the construcion of two analysis grids in order to the reading of the observed reality. Simul
-taneously, other inquiries by interview were improved, as
-sessed and validated, as well as the observaion grids, to be applied in the 3rd phase of the research project.
The 3rd was concreized in the context of internship
supervision - the Hospital. The reading of data of this last phase was accomplished with basis on two analysis grids, designed to read data in two disinct moments. One of the moments involves the transversal reading of all data whi
-ch contextualized all the problemaic of internship super
-vision, hence comprising phenomena of interorganizaio
-nal ariculaion between a Nursing School and a Hospital, with a start on Nursing internship supervision models; the other moment engages the reading of discourses and prac
-ices of supervision in an internship context, with a start on a “Coniguraions of the ariculaion of Nursing School and Hospital”. The transversal and analyical reading of the data collected by interview included, to a great measure, procedures that involved data organizaion, codiicaion and categorizaion, and later content analysis. One of the irst procedures we have taken into account was idenifying with the same code the a given content in each type of in
-terview. Ater having performed content analysis in each “semi-direcive interview”, we crossed it with the content analysis of the direcive quesionnaire, whose treatment al
so recurred to simple calculaions which aimed to quanify some given dimensions of the object under analysis. This crossing of data collected by diferent ways was a signii
-cant step to help building the global sense of the represen
-taions of internship supervision, and of the interorgani
-zaional ariculaion School and Hospital, since treatment, analysis and interpretaion required data chaining, most paricularly for the comprehension of contexts underlying to percepion expressed by the actors. From that moment on, we have put into proof the archetype “Coniguraions of the ariculaion of Nursing School and Hospital in Internship supervision context” (10), from where other coniguraions
emerged; these coniguraions did not result exclusively from a theoreical deducion process, but rather from an ongoing ariculaion between theoreical conceptualizaion and empirical research data, which progressively enlighte
-ned, completed and legiimated the theoreical assump
-ions that led to our presence in school context.
This means it was possible to explore other aspects that might even not to appear explicitly in this work but contributed to consolidate our beliefs.
In what touches speciically to intern validity, it has been in some way solved through diferent strategies de
-ployed during the diverse phases, namely with recourse to triangulaion at the level of muliple sources of data and methods, to paricipaion of the actors in data interpreta
-ion, and to disclosure of researcher’s presupposiions. It has clearly been an evolving, open and exploratory pro
-cess, since it could be progressively enriched by progres
-ses on the comprehension of ield’s pariculariies.
ConClusion
The triangulaion of data about the discourses and prac
-ices in internship supervision over a signiicant period, very close to the actors, allowed us to obtain a picture of social, poliical and cultural reality of the interorganizaional inte
-racion between School of Nursing and Hospital. To a beter systemaizaion of the route of the organizaions under stu
-dy, we started the analysis of their evoluion, highlighing items that are essenial to its comprehension.
Finally, we must menion that the designed theorei
-cal-methodological route implied recourse to theoreical perspecives whose mobilizaion has later tested, making possible to reconsitute a part of research process from the data collected. We started a hermeneuical exercise with very actual data, allowing the comprehension and interpretaion of the most theoreically sustained facts, having namely into account, on the one hand the clarii
-caion of nursing internship supervision and the interor
-ganizaional ariculaion between School of Nursing and Hospital, and on the other hand the Protocol of Aricula
This triangulated route, hereby explained, surely pre
-sents insuiciencies and omissions that result either from the confrontaion between actors’ discourse and pracice,
or from lower researcher’s ability to follow a path far from the evidences, the spontaneous, the immediate or the fa
-miliar, achieving necessary ruptures with common sense(18).
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