Cohort four
rotation nurses:
Perceptions

Section Two
Methodology
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Section Two — Methodology

2.1 Introduction

As discussed in 1.1, this study is one segment of an Action Research study. As is the case with many other research approaches, Action Research can be carried out from different philosophical perspectives. This study is one of four undertaken by these researchers using one specific research perspective, the social constructionist perspective; one form of Action Research, Emancipatory Action Research; and one model of evaluation, fourth generation evaluation.

The first of these studies completed was phase one of the Experienced Nurse Job Rotation Scheme (Lucock & Coyne, 2003). The report for that study provided very detailed explanations of the different research perspectives, the various forms of Action Research and of evaluation. It is not intended to repeat these explanations here. As mentioned in 1.5, the reader is referred to that report for those explanations.

The two other studies undertaken by these researchers are Lucock & Coyne (July 2006) Experienced Nurse Rotation Scheme: Phase two evaluation; Lucock & Coyne (September 2006) Nurse Job Rotation Scheme: Perceptions of a group of supervisors.

Further research evidence come from Buchan & Ball (2004) who completed a survey of the first three cohorts using questionnaires and focus groups.

2.1.1 Time associated with these Action Research studies

There are a number of important time related issues associated with the progress, completion and writing up of these research studies. First, each study was commissioned at a different time without prior guarantee of their funding. Second, intrinsically the studies collect data at different times during the course of the pilot schemes (e.g at the beginning and then the end of the experienced nurse rotation scheme). Third, there was the difficulty of negotiating research time each time the principal investigator gained a new post. Fourth, the research approach used in four of the studies necessitated in depth interviews with the concomitant transcription. Some of the transcription work took twenty five hours or more to faithfully transcribe a one hour interview because of regional accents and idiosyncratic use of English. Additionally, identifying the unique and common themes within the interviews together with their implications was a highly time consuming activity, particularly since there was a partnership between an internal and an external researcher. Finally, an enormous amount of time was spent on ensuring consistency across the four interpretive studies: a process which generated further work.

2.1.2 Meta evaluation

All of these studies will be part of a meta evaluation to identify the importance of the issues raised by the various stakeholders from the different studies. The meta evaluation will seek to describe the range of important factors associated with the job rotation model. It will also seek confirmation or non confirmation of the importance of these factors. Ultimately, the meta evaluation will provide robust guidance to policy makers, commissioners and organisational leaders about the usefulness of this model as means of service improvement.

2.1.3 Research question

What were the perceptions of the participant on a D/E Nurse Rotation Scheme about the nature of the scheme, its benefits for stakeholders and potential for the future?

The research methods of data collection and analysis used in the study are provided below.

2.2 Data collection and analysis

2.2.1 Trustworthiness

As discussed in 2.2.1 of Experienced Nurse Rotation Scheme: Phase one evaluation (Lucock and Coyne 2003), researchers working from other perspectives reject the positivist methods of determining validity and reliability. In this study various ways were used to establish its trustworthiness including meeting participants in advance of interviews to help to establish rapport and involving them in identifying the topic areas to be discussed.

2.2.1.1 Thick description and decision trail

However, the main way of ensuring the trustworthiness of this study is that of providing readers with a decision trail. A reflective diary was kept to note the experiences of data collection and the decisions made at each part of the study. These have been included here in the form of ‘thick description’ in order to turn the decision trail into an audit trail for the reader. This accounts for the care taken over explaining the overall methodology used and the methods used for data collection and analysis. The reader must decide for him/herself if the study is ‘trustworthy’ rather than depending on ‘methods’.

2.2.2 Participants

The participants in this study included the representatives of a key stakeholder group. There were thirteen nurses from two NHS Trusts in NW London who were members of the fourth cohort of the nurse rotations scheme, one senior lecturer from the educational institution involved, and the original Senior Nurse Advisor for research for the two Trusts.

The nurses were the practitioners undertaking the programme described in 1.1 As well as holding the role of students, these practitioners hold a number of roles within the community namely NHS service users; tax payers and funders of the NHS; employees of the NHS; and, in the future, holders of leadership roles that contribute to the modernisation and leadership of the NHS. As they become experienced professionals they will hold the role of advocates and lobbyists for the individual users of the NHS whilst at the same time addressing the public health needs of a civilised society.

In an Action Research study all materials and the voices of all stakeholders are looked on as potential data. At the start of this study the university tutor for the nurse job rotation scheme was interviewed to provide background information. Information from that interview was also useful in the analysis and interpretation of the data from this study.

Throughout the course of the whole Action Research study conversations were taped between the researcher and the first leader of the Action Research project (Patrick Coyne). This was also done to provide background material. The topics included the progression of that project and each of the studies within it and of any changes that were made along the way. That material has also been of great value in the analysis and interpretation of the data from this study.

Positivism favours the random selection of subjects in order to also randomise any unknown intervening variables. Purposive selection, on the other hand, looks for people who have experience of the topic under consideration and it tends to look upon those taking part in the research as participants rather than subjects. For this research an opportunity group of cohort four nurses was selected from a range of locations.

2.2.3 Gaining Access and ethical issues

All research recruits were informed that they were joining a research project in the advertising literature for the scheme, the application pack and at interview.

I recruited the rotatees at the end of a lecture session at the university. Arrangements for interviews were made by a follow up telephone call. It was explained that each interview would be taped but that only the researcher and the participant would have access to the tape and to the subsequent transcript. Confidentiality was also assured, as was anonymity to the extent that this is possible with a relatively small group whose members were well known in their own parts of the Trusts. It was pointed out that they could refuse to participate without any possibility of it affecting their position at work and that they could choose to remove themselves from the research at any time and have their data destroyed.

2.2.4 Topics addressed at interviews

The topics finally decided upon for the participants were as follows:

The tutor and the senior nurse research advisor were asked to talk about the aims, form and process of the scheme as they saw it.

2.2.5 Data Collection — unstructured interviews

As explained above, the topic areas to be discussed in the interviews were defined in advance but in keeping with an interpretive hermeneutical approach the interviews were unstructured and participant led, with the researcher intervening only to ask questions which led on from individual participant’s comments.

The participants chose the place to be interviewed and all chose their place of work and agreed to find a room where we would be neither disturbed nor overheard. The tutor chose to be interviewed in tutorial room at his place of work and the Senior Nurse Advisor for research chose to be interviewed in the interviewer’s home. Since these were all busy people, fitting in the interviews was quite difficult, indeed, on four occasions planned interviews had to be rescheduled. Consequently the interviews were spread over a number of weeks and the practitioner’s were at different stages of their rotations (1.4.1).

Whilst the recording equipment was being set up and tested, the participants completed informed consent forms and were reminded about the purpose of the research and about the ethical issues discussed under ‘gaining access’. A written reminder of the topic areas was then placed in front of them. They were assured that the order for discussion was not important and in the event they mostly moved back and forth amongst the topics with the interviewer asking probing questions where relevant. Most interviews lasted between just under one hour and just over one hour All the interviews came to an end when the participants felt that they had fully covered the topics.

The interview with the university tutor was somewhat briefer because the topic area was far more limited.

2.2.6 Data Analysis

A transcription was made of each interview and the tapes and transcriptions were kept under lock and key. No other person but the interviewer had access either to these or to the computer files holding the data.

It was at the point of transcription that pseudonyms were given to the participants to further their anonymity and confidentiality. For the same purpose, some of the women were given men’s names and some of the men were given women’s names.

Because the topic areas were quite specific it had been expected that the responses of the participants could be relatively easily grouped under those headings. However, following the transcription and analysis of the data it was realised that one theme had to be divided. Such changes are in keeping with the form of data analysis used. The reasons for the changes are explained in Section 3 and the themes changed are as follows:

This was done and then the responses in each topic area were analysed to identify commonalities and differences in views amongst the group. These were listed in order to choose comments of participants to represent these views. However, analysis showed that the explanations underlying the views expressed were so diverse that all the relevant data was used.

The responses of the tutors and of the Senior Nurse Advisor for research were used to check for agreements or differences between them and the students.

The following ‘Findings and Discussion’ section could have been much briefer had the underlying views been omitted. There were two reasons why it was decided to include them. Most importantly, any of the issues raised could have relevance for the development of one or more similar schemes that readers may intend to develop. Secondly, providing the context for the individual views provides the ‘thick description’ that allows those readers to decide whether or not their own situation is similar enough to imply the importance of a particular issue.