Data analysis using Immersion/Crystallisation

The process of immersion/crystallisation was central to the data analysis process across all data collected as part of my study. The process emphasises an open approach that progresses through a number of stages: initial description of the data, crystallising the core messages in data extracts, considering these in relation to all other data, reflecting these back to participants, and creative synthesis and corroboration of the themes.

Details of how this process was used in my study are provided in Table 9. The Table also specifies where the analysis process was shared with, and independent of the wider LCCP. It should be noted that in accounts of the process of analysis described by the LCCP, thematic analysis is reported rather than immersion/crystallisation.

Table 9 - The Process of Immersion/Crystallisation as applied in this study

Elements of

immersion/crystallisation process

How elements were carried out in my study

Initial engagement with the topic/reflexivity (Collaborative activity with wider LCCP)

Recognising and reflecting on hunches and prior knowledge and experience debated with other senior nurses and documented in reflective diary (also see my beliefs and values articulated in Chapter 1).

Describing (Collaborative activity with wider LCCP)

Initial introduction to the field and beginning data generation. Reflections with the team on 6 broad key themes to form framework for initial data analysis (this was eventually reduced to 5). These derived from all team members‟ initial orientation and early data (mainly informal observation), and previous knowledge and experience of practice development, action research and caring. Crystallisation during data

generation (Specific analysis as part of my study)

This began as soon as first questions were asked in the research. I considered consciously what struck me about the data, are there „aha‟ moments, what stands out, what is at the heart of what people are saying, are there any surprises? What elicited an emotion in me and why this was the case? Noticing the mundane, noticing the exceptions.

Generated questions for further inquiry and analysis.

Summarised these points and reflected back in transcript summary or in discussion for

Elements of

immersion/crystallisation process

How elements were carried out in my study

consideration by participants.

Made changes in data generation activities in the light of new insights.

Immersion and illumination of emergent insights from collected data and texts

(Presentation of sub-themes back to core research team-Collaborative activity with wider LCCP)

Systematic review of all data. Read through again each piece of data and began to develop sub-themes from the key messages within each piece of data. Organise sub-themes around main themes.

Present these sub-themes back to core research team. Read through all data with core research team and collectively debate sub-themes, patterns, connections.

Concentrated on vertical look at the data – where each sub-theme was scrutinised to check for occurrence across other data extracts and representations from key stakeholders – patient, staff and family. In particular, if a sub-theme had been developed from data from a member of staff, all data were reviewed, particularly, the relative and patient data, to see if there were data that could be themed in this sub-theme. If there was no

evidence of this, I integrated the sub-theme into questions that I asked in the field during subsequent visits to the ward.

Elements of

immersion/crystallisation process

How elements were carried out in my study

Explication and creative synthesis (Specific analysis as part of my study)

Re-examine initial data analysis and refine themes and sub-themes paying particular attention to overlap, patterns and relationships.

Once all data were assigned sub-themes and situated under different key themes these were reread to check that each data entry continued to reflect the overall sub-theme and theme.

Where metaphor or quote is used as heading of sub-theme check out clarity of this meaning with other groups.

Corroboration/legitimation and consideration of alternative interpretations

(Specific analysis as part of my study)

Pose alternative questions on the themes and sub- themes to force consideration of alternative responses.

Search for alternative responses in literature and with colleagues and participants.

Review reflective diary to enable more thorough understanding of my interpretations.

Representing the account/reporting (Specific analysis as part of my study)

Organise textual accounts for dissemination. Provide detailed description of both process and outcome of analysis.

Table 9 shows the different stages that I progressed through to analyse the data. In reality the analysis process was less linear than the table implies. Rather an iterative process took place where there was movement backward and forward between data, initial analyses and further data. Analysis was therefore a continuous and inductive joint activity between participants (primarily staff) and myself as the researcher.

To illustrate the iterative and continual process, I made notes of initial themes, thoughts and questions and presented these alongside their words. I had a conversation with the participant after they had read the transcript to ask if they had any further reflections or points for discussion. We also discussed the learning that we had both gleaned from the process. They often had further comments, and these were then added to the story. Thus the conversations included reflections and learning about the story for both myself and the participant. This made the interview a more democratic process where there was a more equal relationship between myself and the participant. An example of a story excerpt, analysis and discussion is shown in Table 10.

Table 10 - Example of Discussion and Emergent Analysis of Story

Excerpt from staff story Researcher notes/early themes

Points from discussion

While he was in hospital he was in one of the 4 bedded bays and he smelt really bad. It was hard for the other patients. The smell lingered all day. It was becoming more of a problem as the smell was really bad and nobody

wanted to go near him. I often felt sick when I went up to him and had to try hard to cover up what I was feeling (Staff Story, SS1).

Being compassionate when other factors go against it.

What does compassion mean in situations like this – covering up how you feel, ignoring the issue, confronting the issue – who says what is right? Depends on the situation – the

relationship etc.

Not sure how I would act in this situation.

How do you get support for the way you are feeling?

Real skill of making appropriate judgment on how to act depending on the person.

Compassion is hard in these situations – I did not feel able to tell the man. It did not feel right. It might have felt right if I had known him better. Talking with other staff on the ward who had similar feelings and acted in similar ways helped me.

Can we give

compassion best when we know people better?

How do we get to know people better?

Emergent findings were analysed and shared with participants on the ward for their interpretation. I was aware of the limits of an approach to co-analysis that focused purely on textual interpretation of the data and made attempts to work with staff to present analysis using both visual imagery, metaphor and poetry. This is said to engage people on both a cognitive and emotional level (Rosenbaum , Ferguson & Herwaldt 2005).In addition, I included clear examples from data that demonstrated the context of themes. Also, within the process inherent in immersion/crystallization questions such as: What struck you? What was at the heart of what was said? How did you feel about what you read? were helpful prompts in inviting participants to co-analyse data in a meaningful way in the context of their every day practice.

The creative strategies used helped people to engage with a large number of themes. Participants did offer useful commentary on the wording of particular themes and suggested ways in which they could have more meaning for staff. For example, staff felt that the term „flexible person-centred risk taking‟ (a key theme developed by the core research team) was difficult to grasp and that this was more about negotiating care, and balancing out choice for one patient versus the needs of all those involved in the care context. These comments were taken on board. What resulted were two sub-themes entitled „knowing when you can and can‟t do person-centred care‟ and „taking the time to work with processes to get the best experience for all‟. Similarly, with the theme of „knowing me knowing you‟ staff felt strongly that this should be changed to emphasise the importance of finding out what matters to people. They questioned what right we have to really know patients or each other, and wanted the theme to reflect more that the person themselves had a choice to share aspects about themselves that they felt important. Thus the theme was revised to „knowing who I am and what matters to me‟.

In addition during the process of analysis several sub-themes were grouped together where there was similar meaning. Examples follow in Table 11.

Table 11 - Secondary Analysis showing regrouping of sub-themes

Original themes Grouping and new subtheme

I‟m glad you are here today because Going beyond they’ve had a good night or we’ve had a good day

Knowing you have made a difference Power of the voice of the person who has had the experience

In my secondary analysis the framework was reduced to two knowledge domains of knowing who I am and what matters to me, and understand how I feel, and two processes of work with me to shape the way things are done and engage in appreciative caring conversations. Details of these are shown in Table 12.

Table 12 - Secondary Analysis

Knowledge Domain Theme Sub-themes

Knowing who I am and what matters to me

Knowing how to make a connection and click with the person

-a deliberate welcome and a smile costs nothing

-personal sharing

-knowing when to use banter, humour and play

- use of language to reflect personhood and a shared understanding

Knowing what is

important to the person and using that to

influence the way care is given and received

-knowing the little things that matter

- not assuming how people want to be cared for

Knowledge Domain Theme Sub themes

Understanding how I feel about my experience

Feeling safe and taking the time to ask and tell

- recognising and sharing your emotion

-proactively seeking out feedback from others – I know you are busy but…. -going beyond „they‟ve had a good night‟ or „we‟ve had a good day‟

-supporting people to hear and respond to learning how others feel

Key Process Theme Sub-theme Work with me so we can

shape the way things are done

Knowing when you can and can’t do

compassionate relationship-centred care

-working with what is in your control and what is not -taking the time to work with processes to get the best experience for all

- confidence to challenge the way things are done

-being open and real about expectations

Developing ways of working that help to shape the way things are to be done

-thinking and talking about how we do things and how we can do them even better - spotting opportunities and knowing the possibilities -being proud and sticking to principles of person-

centredness

Key process Themes

Engage in appreciative caring conversations

Being Curious

Connecting emotionally Collaborating

Considering other perspectives Being Courageous

Compromising Celebrating