Experienced Nurse Job Rotation Scheme
Phase two final evaluation

Section Two
Methodolgy & Methods
Table of Contents
Previous
Next

Section Two — Methodology and Methods

2.1 Introduction

As discussed in 1.1, this study is the continuation of an earlier piece of work entitled ‘Experienced Nurse Rotation Scheme: phase one evaluation’ (Lucock & Coyne 2003). That work, carried out some two years previous to the data collection for this second phase, dealt with the perceptions, expectations and concerns of a small group of experienced nurses as they entered into a work based learning scheme designed to lead to either an undergraduate degree or a master’s degree. The level of the degree was to be determined by the outcomes of a RAL module (see below) and the depth of study undertaken. In either case, the work undertaken included the following:

As was also 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.

In the first paragraph above it was mentioned that 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 (August 2006), Nurse Job Rotation Scheme: Perceptions of a sample of cohort four rotation nurses; 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 is a highly time consuming activity, particularly when there is a partnership between an internal and an external researcher. Finally, an enormous amount of time has been spent on ensuring consistency across the four interpretive studies: a process which generates 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 an Experienced 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’, 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’.

Essentially, but with one exception (see 2.2.5), methodology and methods remain the same as in the initial study ‘Experienced Nurse Rotation Scheme: phase one evaluation’ (Lucock & Coyne 2003) although the purpose of the research has changed. The purpose of the initial study was to elicit data that could help in the search for common or individual factors that might influence the eventual level of success of the experienced nurse scheme in general or the success of a particular individual in that scheme. The purpose of the present research was to elicit data that would demonstrate the extent to which the scheme had lived up to the hopes and expectations of the practitioners involved in it and the extent to which any concerns they had expressed about the scheme had, or had not, materialised. The data collected could then be used to determine the overall success, or failure, of the scheme.

2.2.2 Participants

The participants in this study included the representatives of a key stakeholder group. They were seven of the ten nurses from the two NHS Trusts in NW London (see 1.3.3) who were members of the experienced nurse job rotations scheme.

Initially ten experienced nurses joined the scheme but two, Marion and Ruth, left in the very early stages of the scheme before they had completed any of the work detailed above. Both took part and were quoted in the initial research study, but were not re-interviewed as they had nothing to add.

One more of the participants from the first study was not interviewed, namely Jane. In spite of much effort by a number of people, it was not possible to trace her. She moved to a Trust in the Home Counties whilst still involved in the scheme and then moved again. Unfortunately her telephone and e-mail addresses changed with the move. After the completion of data collection and analysis of the data, Jane contacted the main organiser of the scheme but it was reluctantly decided that collecting more data was not an option because it would hold up the presentation of the report.

There was one other participant involved; the original Senior Nurse Advisor for research for the two Trusts (Patrick Coyne).

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 holders of leadership roles that contribute to the modernisation and leadership of the NHS. As experienced professionals they 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. 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 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 been of great value in the analysis and interpretation of the data from this study of experienced nurses.

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 all but one of the experienced nurses on the scheme was interviewed.

2.2.3 Gaining access and ethical issues

The experienced nurses were approached individually by e-mail to ask if they were still willing to take part in a second interview. When they responded with a return e-mail I then, by telephone, made arrangements for the interview.

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

This was the second and final interview for this group of nurses and as such, a somewhat different approach to ‘topics’ was used. I explained that on this occasion I wanted to find out the extent to which the scheme had, or had not, been a success when compared to what they had hoped for in the initial study.

To remind them of what had been discussed at that point, I provided a slightly amended list of some of the topics they had covered in their first interview (see 2.5.4 in Lucock & Coyne 2003, Experienced Nurse Rotation Scheme: Phase one evaluation). Certain topics were now irrelevant because the information was already available. They included the background of the practitioner, why they decided to join the scheme and what the scheme might consist of.

Because the participants were now looking back on their participation in the scheme and on any influence that scheme may have had on the Trust and on colleagues and patients/clients as well as on their own present and future career prospects, the topic areas were slightly amended to:

In the course of the many interviews undertaken with the senior nurse research advisor he was asked to talk about the success or otherwise of the scheme as he 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.

For this research, the same methodological framework was used as in the first study and data were collected and analysed using the same methods. However, of those who were interviewed, only four of the five practitioners who remained in the Trust were interviewed face to face. The other practitioners, one still in the Trust and two who had moved to work in other parts of the country were, for practical reasons, interviewed over the telephone. Telephone interviews can be far from ideal because they do not offer any visual cues between interviewer and interviewee but because these interviews were with people whom I had previously interviewed face to face and with whom I had built up a degree of rapport, it is felt that the data obtained is of a high quality.

The other four participants chose the place to be interviewed. One chose her place of work and agreed to find a room where we would be neither disturbed nor overheard. The other three 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, and two of the planned interviews had to be rescheduled. Consequently the interviews were spread over a number of weeks.

Whilst the recording equipment was being set up and tested, the participants completed informed consent forms, or in the case of the telephone interviewees, gave verbal consent, 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 or had been sent by e-mail. 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 technical quality of the telephone interviews was not compromised because the interviews were taped using the same approach as explained above.

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.

The pseudonyms that were given to the participants for the first study in order to further their anonymity and confidentiality were used for this study. It should be remembered that, for the same purpose, some of the women had been given men’s names and some of the men had been given women’s names.

In this second study it has been more difficult to maintain confidentiality and anonymity than in the initial study (Experienced Nurse Rotation Scheme: Phase one evaluation, Lucock & Coyne, 2003). In that study the participants were just starting the scheme and there was thus no reference to their rotations, their research and projects and their present work. These activities play a prominent part in the findings and discussion of the present study but every effort has been made to hide the identities of the participants. Consequently, in Section 3 the quotes do not always flow evenly because words had to be omitted. Where they are omitted, four dots have been included in their place. Three dots are used where, for the sake of brevity, words that do not contribute to the meaning of the quote have been omitted.

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 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.