Data Collection Instruments

The current study employed two different tools in order to collect data from participants.

4.9.1 Phase One Quantitative

4.9.1.1 Demographic Data

Part A of the research instrument sought demographic information from the participants, including gender, age range, whether the participant was a RN or EN, if the participant held a mental health nursing qualification and if so, what type of

qualification, the participant’s current position, the type of hospital where the nurse was

working, years of experience as a mental health nurse, years of nursing experience in any field generally, employment whether in a public or private facility, educational achievements, and whether they were employed in a metropolitan or rural service. (Refer Appendix A). The demographic data collected was unidentifiable. The demographic survey items were developed in consultation with the researcher’s

supervisor’s expert opinion, the researchers own extensive experience and was additionally informed by the literature (Patton, 2002).

4.9.1.2 Research Instruments

Questionnaires are the most common instruments used by researchers to collect data (Polit & Beck, 2012). The questionnaire in this study was formulated by using two previously tested questionnaires in the literature: the Attitudes Towards Deliberate Self- Harm Questionnaire - ATDSHQ (McAllister et al., 2002b) and the Self-Harm Antipathy Scale - SHAS (Patterson et al., 2007). Prior approval to utilise the questionnaires was obtained from the respective authors. Professor Richard Whittington, on behalf of

Professor Patterson who had recently retired, was contacted and approval provided for use of theSHAS Questionnaire (2007). For the ATDSHQ (2002b) questionnaire, approval was sought and obtained from Professor Margaret McAllister. Permission to utilise both questionaries was obtained in mid-2011.

Phase One used a software product, referred to as Qualtrics, to create an anonymous online questionnaire. Qualtrics is a web-based tool for creating and

conducting online surveys which was first developed by the Qualtrics Company in 2002 in Provo, Utah. For the online survey, both questionnaires were used as some items in the ATDSHQ (2002) were similar to items in the SHAS (2007). This was a cross- sectional survey method aimed to elicit information on the demographics, attitudes, knowledge and beliefs of nurses’ towards self-injuring individuals who present to the ED and/or acute adult mental health inpatient units within Australia. Forty-three Likert Scale items were derived from the SHAS (Patterson et al., 2007) and ATDSHQ

(McAllister et al., 2002b). Items 1 to 28 within the Likert Scale were from the SHAS (Patterson et al., 2007) and items 29 to 43 were taken from the ATDSHQ (McAllister et al., 2002b) (refer to Appendix D – SHAS and Appendix E - ATDSHQ). For the

Qualtrics survey, all of the SHAS (Patterson et al., 2007) Likert Scale questions were used in the questionnaire and the questions of the ATDSHQ (McAllister et al., 2002b) that were eliminated were a repeat of the questions found in the SHAS (Patterson et al., 2007). The items from the ATDSHQ (McAllister et al., 2002b) that were measuring whether or not the attitudes of nurses’ towards self-injury were positive or negative and the depth of knowledge nurses’ held about NSSI, the educational needs of nurses’ about SI and feelings towards self-injury and consequential feelings of disempowermentwere included in the on-line questionnaire. The SHAS (Patterson et al., 2007) assessed beliefs and knowledge of the nurses towards NSSI, moral concerns the participant held about

NSSI and the individual who self-injurers. Positive or negative attitudes towards NSSI, and thoughts that the nurse held about the individuals who engaged in such behaviour were also surveyed from the SHAS and the ATDSHQ. The 43 item Likert Scale online survey included questions around the themes of attitudes towards NSSI (items 17-24 and 31-33), knowledge about NSSI (items 28, 10-12, 36-37 and 41), beliefs about NSSI (items 4, 14, 25 -26, 27, 29, 33, 38, 40 and 42-43 ) and moral beliefs about individuals who self-injure (items 3, 5-7, 9, 14, 28, 34,and 39). Thus, this was not a new instrument but the combination of two tested and reliable research instruments (McAllister et al., 2002b; Patterson et al., 2007).

Approximately 20-30 minutes was required to complete the online

questionnaire. The participants completed the online questionnaire voluntarily and anonymously. The Likert Scale for the questionnaire included four boxes to choose from for each of the 43 items. The format for the four levels were: number one strongly agree, number two agree, number three disagree and number four strongly disagree. Neutral response was not included in the scale to avoid central tendency effect of the participant responses in the study (Li, 2013).

A reliability study of the 43 item research tool revealed an overall Cronbach’s

alpha of 0.901 demonstrating reliability of the instrument. Reliability was additionally evaluated through analysis of the individual survey themes of beliefs, knowledge, moral views and attitudes as determined by the instrument authors (McAllister et al., 2002b; Patterson et al., 2007). This analysis revealed Cronbach’s alpha values of 0.639 for beliefs (13 items), 0.686 for knowledge (10 items), 0.718 for moral views (9 items), and 0.809 for attitudes (11 items) for the combined survey used in this study.

4.9.1.3 Distribution of the Survey

After receiving ethical approval from the RMIT University Human Research Ethics Committee (refer to Appendix A) the researcher approached each professional nursing organisation and provided them with a link to the Qualtrics web-page survey for posting on their organisational webpage. The link on each professional nursing

organisation’s website to the survey also contained the RMIT University ethics approval

document, the consent form (Appendix C), PLS (Appendix B) and rationale for the research. Participants were required to view these prior to completing the survey. The PLS was available on each of the nursing organisation’s websites and provided an

explanation of the research aims in brief as well as an outline of the nature of the potential respondent’s involvement, and the importance of the study. The PLS described the study, the benefits to nurses, nursing education, future curriculum developments and positive contributions to future nursing practice. It also included the names and contact details of the researcher and the researcher’s supervisors if a

participant required further information about the study, or was distressed during or after completing the study. Reading the PLS and consent form prior to completing the anonymous Qualtrics questionnaire was required. Completion of the online

questionnaire implied that the nurse consented to be part of this study. The nurses could withdraw from the study at any stage. The nurses who elected to participate in this study were able to click on the link and go directly to the questionnaire.

4.9.1.4 Accessing Participants Online: Practical Considerations

There have been some strategies that researchers, especially in the social and health sciences, adopt to gain access to their potential participants, and one of these methods is online (Liamputtong, 2009). Special interest sites such as professional

organisation websites are useful for contacting appropriate potential participants

(Liamputtong, 2009). Accessing potential research participants can be done through the Internet. It can also be done by including email contact or website details when

advertising the research via leaflets and in journals. In addition, there can be a

combination of Internet-email or telephone (Liamputtong, 2009). For this study, use of professional organisation websites method was utilised to recruit as many nurses as possible to respond anonymously to the survey and to the telephone interviews.

4.9.2 Phase Two Qualitative

The aim of utilising over-the-telephone semi-structured interviews was to confirm the data gathered from Phase One and to provide recommendations for acknowledging nurses current thinking about individuals who engage in NSSI. The semi-structured interview questions consisted of 4 main themes surrounding NSSI (refer to Appendix F). These themes were then elaborated into 24 subthemes and semi-structured questions. The themes were extrapolated from the literature, from the expert opinion of the

supervisors and from the researcher’s own experience. Areas of concern about NSSI

were also explored.

The second phase of this research study utilised a qualitative research method using semi-structured, over-the-telephone interviews. A qualitative research method is a way to understand the individual’s experience, interpretation and practice (Schneider et

al., 2007). The semi-structured telephone interviews were designed to gain an in-depth understanding of what the concept of nurses’ attitudes towards the self-injurer and NSSI

were in general. According to Tashakkori and Teddlie (2010), using interviews for data collection can be a powerful tool to further explain and confirm research findings. Creswell (2007) argued that interviews permit participants to describe detailed personal

information. Research methods are the techniques researchers use to structure a study and gather and analyse information relevant to the research questions (Polit & Beck, 2012). Further, qualitative research explores the individual’s experience and the manner

in which individuals, groups and communities construct a collective meaning about their daily life (Welch, 2011). The qualitative research phase was included as part of this mixed methods design study as triangulation of methods can enhance the outcome of the research study and better answer the research questions (Creswell & Plano, 2007).