Data collection/procedures A summary of the retrospective study data

collection procedures, role of participants, and number of participants is provided in Table 2.2. Data collection for the retrospective study began in February 2012 and was completed at the end of January 2013. The researcher spent approximately two days every two months in each home collecting data using semi-structured interviews (Gochros, 2005) with managers, DOCs, administrators, a CNL, nurses, and GPA Coaches. Focus groups (Marshall & Rossman, 2011) were conducted with NAs. The manager/DOC/administrator was contacted via email prior to the data collection phase to schedule dates and times for their interviews and focus groups. An information poster (Appendices A and B) was sent to each home approximately two weeks prior to the scheduled date of the site visit inviting staff to participate in the study. GPA Coaches were contacted by email to schedule their interviews. All interviews and focus groups were audio- taped and transcribed by the researcher. The data from each home were analyzed prior to entering the next LTC home.

2.4.1.4.1 Semi-structured interviews. For the retrospective and prospective studies,

administrators, managers, and DOCs were classified as “formal leaders.” Their interviews in this study were grouped together to explore their perspectives of factors that influenced sustainability of the GPA program. GPA Coaches were interviewed to learn about their experiences as

Coaches and their perspectives on factors associated with sustainability of the program. Nurses and the CNL were also interviewed to discuss whether they felt the GPA program was sustained in their LTC homes, the impact the training had on the staff they supervise, and the role of

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facilitation in sustainability. The focus group interview guide was used with the NA in Home 4 to learn about the barriers and facilitators to using GPA skills in resident care. See Appendix D for the semi-structured interviews and focus group guides. The interview guides were modified iteratively over time as the interviews were conducted to gain an understanding of (a) the philosophy of care within the home (task focused or person-centered); (b) the ability of staff to identify, develop, and communicate care plans to help minimize responsive behaviours; (c) the balance of power between and across employee groups in each home; and (d) the roles, skills, and attributes of individuals who were using the GPA skills in their daily practice.

In Home 1, four semi-structured interviews (n=4) were completed, one with a GPA Coach, one with the manager, one with an RN, and one with the CNL (telephone interview). The CNL in this study was an RN. In Home 2, three semi-structured interviews (n=3) were completed with the administrator, a GPA Coach, and an RN. In Home 3, two semi-structured interviews (n=2) were completed with the DOC and the two GPA Coaches (interviewed together). In Home 4, five semi-structured interviews (n=5) were completed with the administrator and DOC

(interviewed together), one RN, one GPA Coach, one RT (telephone interview) and one NA. An NA from Home 4 was interviewed as she was the only person who attended the focus group. In the last home (Home 5), only the administrator was interviewed. The DOC (who is also the regular floor RN) participated in the focus group, and the GPA Coaches were not available for interviews.

2.4.1.4.2 Focus groups. Focus groups were held in four of the five homes within the retrospective study to maximize the number of NAs who were able to participate in each home. Three NAs (n=3) participated in the focus group in Home 1. Three NAs (n=3) participated in the focus group in Home 2, and four NAs (n=4) participated in the focus group in Home 3. A focus group was not held in Home 4 as the leadership cancelled twice due to other priorities (i.e., health region training and having to work short staffed). A third date was set but only one NA participated. She was interviewed using the focus group interview guide. Finally, a focus group was conducted in Home 5 where four NAs (n=4) and the DOC (also the regular RN on the floor) (n=1) participated. Appendix D was used to guide the focus groups in the four homes.

The aim of the focus groups was to learn about the experiences of direct care staff with respect to the GPA program and to explore how facilitation could contribute to their ability to apply the knowledge gained from the training over the long-term. As the focus groups were

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conducted, questions were added to the interview guide as participants identified additional factors that impacted the implementation and sustainability of the GPA program. Questions were added to gain an understanding of (a) whether or not the NAs would make changes to the GPA program, (b) what additional information care staff felt should be included in the program, and (c) reasons behind staff not charting or reporting a responsive behaviour. Staff were also asked to discuss their views on the philosophy of care within the home, power imbalances and bullying between staff, and whether or not they were able to identify and create a care plan to help manage a responsive behaviour displayed by a resident with dementia.

74 Table 2.2

Retrospective Study Data Collection Procedures and Participant Roles Home Data

Collection Procedures

Role of Participants Number of Participants Total Number of Participants Home 1 Semi- structured Interviews Manager, GPA Coach, RN, CNL

Formal Leaders Interviewed: Manager (n=1)

4

Direct Care Staff Interviewed: GPA Coach (n=1), RN (n=1), CNL (n=1)

Focus Group

Direct Care Staff NAs (n=3) 3

Home 2 Semi- structured Interviews

Administrator, GPA Coach, RN

Formal Leaders Interviewed: Administrator (n=1)

3

Direct Care Staff Interviewed: GPA Coach (n=1), RN (n=1) Focus

Group

Direct Care Staff NAs (n=3) 3

Home 3 Semi- structured Interviews

DOC, GPA Coaches Formal Leaders Interviewed: DOC (n=1)

3

Direct Care Staff Interviewed: GPA Coaches (n=2)

Focus Group

Direct Care Staff NAs (n=4) 4

Home 4 Semi- structured Interviews Administrator, DOC, RN, GPA Coach, RT, NA

Formal Leaders Interviewed: Administrator (n=1), DOC (n=1)

Direct Care Staff Interviewed: RN (n=1), GPA Coach (n=1), RT (n=1), NA (n=1) 6 Home 5 Semi- structured Interviews

Administrator Formal Leaders Interviewed: Administrator (n=1)

1

Focus Group

DOC, Direct Care Staff

DOC (n=1), NAs (n=4) 5

Total 32

Note. Director of Care = DOC. Clinical Nurse Leader = CNL. Registered Nurse= RN. Nursing aides = NAs. Recreation Therapist = RT. Direct Care Staff included CNL, Nurses, NAs, RTs, and GPA Coaches. Formal Leaders included Administrators, Managers, and Directors of Care. No focus group was held in Home 4.

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2.4.1.5 Data analysis of semi-structured interviews and focus groups. The aim of the