Data Collection

Data was collected by means of a qualitative one-on-one interview with the participants. The qualitative research interview has the potential to obtain access and to describe the lived everyday world of the participant. The life world may be defined as the world as it is encountered in everyday life and expressed in direct

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and immediate experience, independent of and prior to explanations. The qualitative interview is a research method that gives a privileged access to the basic experience of people of the lived world. It seeks to understand the meaning of central themes of the lived world of the subjects (Kvale & Brinkmann, 2009:29).

The qualitative interview seeks qualitative knowledge which is expressed in normal language. The descriptive qualitative interview encourages the interviewee to describe precisely what feelings, experiences and actions they relate to the event being explored. The primary task of the researcher is to identify why the participants experience and act in the way they do in response to the event being investigated (Kvale & Brinkmann, 2009:30).

According to Kvale and Brinkmann (2009:28-32) there are twelve aspects of qualitative research, of which seven were used in this research study in order to gain more insight into how to conduct a qualitative research interview. The first aspect, life world, may be defined as the focus of qualitative interviews on the lived experience of the interviewee of the world and how the interviewee relates to their world. The experience of end-of-life issues in the intensive care unit was the focus topic and how the participants experienced these events. The event of withdrawal of treatment was experienced frequently in the everyday life of the professional nurses participating in the study.

The second aspect that is important when doing a qualitative interview is meaning. The qualitative interview seeks to register and interpret the meaning that interviewees give to central themes of their lived experience (Kvale & Brinkmann, 2009:29). The researcher asked the participants to explain their experiences of end- of-life issues and what it means to them in terms of dealing with their emotions and the support structures that they used. The researcher listened to what was said by the participants and how it was said in order to interpret the meaning that participants ascribed to their experiences.

The third aspect of qualitative research is qualitative information. The researcher seeks to gain qualitative information which is expressed by the interviewee in everyday

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language (Kvale & Brinkmann, 2009:30). The researcher used open-ended questions which allowed the interviewee to respond to all questions in their own way and in their own words. The participants‟ accounts of their experiences gave informative data which focused on the quality of the data.

The fourth aspect used was description. The researcher attempts to obtain descriptions of various aspects in the life world of the interviewee (Kvale & Brinkmann, 2009:30). The researcher encouraged the interviewee to describe their experiences of end-of-life issues in the intensive care unit, as well as how they felt during the experience of these events. Furthermore, the researcher explored and described the data findings in words as understood and interpreted from the participants.

The fifth aspect is deliberate naiveté. The researcher demonstrates an open mind to new ideas or topics, rather than preconceived ideas and thoughts (Kvale & Brinkmann, 2009:30-31). The researcher accomplished this firstly, by doing only a minimal literature review prior to commencing the study and secondly, by asking open-ended questions that would allow the participants to express their thoughts and ideas.

The sixth aspect is focusing. The interview is focused on particular themes and uses a semi-structured interview approach (Kvale & Brinkmann, 2009:31). Although open-ended questions were used, a semi-structured interview schedule was used in order to stick to the theme of the study. The researcher led the interviewee toward certain themes, but allowed the interviewees to give their own interpretation and explanation of these themes.

The seventh aspect is interpersonal situation. Knowledge obtained through the interview is produced through interpersonal interaction between the interviewee and the interviewer (Kvale & Brinkmann, 2009:31). The interview was conducted face-to- face with each participant. The interaction between the interviewer and the interviewee produced the product of the interview, i.e. the data collected.

An interview should be conducted in a quiet setting, allowing privacy and comfort for both the interviewer and the interviewee. The interview setting should also be

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conducive to voice recording (Creswell, 2007:133-134). The researcher planned to interview participants in a private room in the hospital. However, the researcher had to take the circumstances of the participants into consideration, for example on- duty hours, child-care and personal preferences. Research participants were interviewed at a place of their convenience. For some the interview was conducted at their homes, whereas others preferred to be interviewed in a private room in the intensive care unit. Each individual venue proved to be conducive to tape-recording the interview and to having no distractions. The interviewees interviewed at their homes tended to be more relaxed than those interviewed at their place of work. Interviewees interviewed at home also appeared to be more expressive with their body language. It was found that the place in which the interview took place did not affect how the interviewees expressed their emotions. The venue selected by the interviewees did not appear to have any effect on the type of information shared or on the openness of the respondents.

According to Kvale and Brinkmann (2009:128) the first few minutes of the interview are decisive. Good contact may be established by briefing the interviewee again about the research topic and the process of the research interview. The interviewer gains the trust of the interviewee by listening attentively and by showing interest in the interviewee and in what he or she is saying. As a member of staff at the respective hospital, the researcher had developed relationships with the participants prior to undertaking the study. Trusting relationships had been fostered through working with one another in the ICU and dealing with critical care issues in the unit. The interviewer explained the purpose of the research; obtained informed consent from the participants; allowed the participants to ask any questions they may have had, and explained the need for recording the interview on a voice recorder and through field notes prior to commencing the interview. The interviewer reinforced the fact that confidentiality would be maintained throughout the research process.

The interview was semi-structured in nature. Semi-structured interviews are defined as interview methods with a limited number of pre-planned questions which allows great flexibility in following the responses of the participants to guide the discussion. The predetermined questions are merely a guide for the interview process (Kvale &

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Brinkmann, 2009:133). The researcher decided to use a semi-structured interview in order to guide the interviewee in gaining information related to the research topic, but also to allow flexibility in the answers obtained from the interviewee. Semi-structured interviews allowed for the interviewee truly to express personal thoughts and feelings related to their experience of the event of end-of-life issues in the intensive care unit.

The researcher used various interview questions. An introducing question is one that yields a response from the participant which allows the participant to divulge spontaneous and rich information from his or her lived experiences (Kvale & Brinkmann, 2009:135). The introducing question was open-ended in nature and allowed the participants the time to respond to the question and to describe their experiences in their own words.

A follow-up question is led by the answers provided by the participant in response to the preceding question. W ith a probing question the interviewer probes deeper into an answer given by the interviewee. Follow-up and probing questions were used effectively to gain a deeper insight into the comments made by the participants. Interpreting questions are used by the interviewer to seek clarification of an answer or point made by the interviewee (Kvale & Brinkmann, 2009:136). The researcher used interpreting questions in order to ensure that she had a clear interpretation of what the interviewee intended in a statement.

Silence is used by the researcher and allows for a pause in the conversation in order to give the interviewee time to reflect on a statement or question (Kvale & Brinkmann, 2009:136). Silence was used by the researcher to allow for the interviewee to think about statements or answers. At certain times in some interviews silence was used to allow the interviewees time to compose themselves again when they had become tearful or emotional.

The researcher planned to ask two open-ended questions during the interview. After a pilot interview was conducted, the researcher found that many more questions needed to be asked in order to gain sufficient information. An interview schedule was then designed and the following questions were used by researcher:

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 How long have you been nursing in the intensive care unit?

 Have you previously had to nurse a patient where the treating medical team decided to withdraw treatment?

 Tell me about your experiences of end-of-life issues in the intensive care unit.

 How did this make you feel?

 Tell me about the support you received during your experience with end-of-life issues in the intensive care unit.

 What would you suggest can be done to assist professional nurses to deal with end-of-life issues more effectively?

The interview technique used by the researcher followed the Elton Mayo Method of Interviewing as described by Kvale and Brinkmann (2009:45). The Elton Mayo Method of Interviewing incorporated giving your whole attention to the interviewee; listening and not talking; not arguing or giving advice; active listening in order to plan follow-up questions; and maintaining participant‟s information in confidence. The interviewer demonstrated complete attention to the interviewee by showing interest in the interviewee and in what the interviewee was saying. Active listening and not just talking is important in conducting the interview. Active listening entails maintaining an open body position in front of the participant; leaning forward; and maintaining eye contact with the participant. Active listening also entails listening to what the interviewee says; what he or she does not say; and what he cannot say without help. The researcher used these active listening skills throughout the interview process.

Furthermore, the researcher should avoid arguing a point and should refrain from giving advice during the interview (Kvale & Brinkmann, 2009:45). The intent of the researcher was to gain insight into the experiences of the interviewee. Therefore, she refrained from voicing personal opinions or giving guidance as to how situations should be dealt with. As the interviewer listens to the responses of the participant notes can be made to identify follow-up questions or clarification statements.

An interview schedule (see Annexure G) was designed after the pilot interview and used to conduct subsequent interviews. An interview schedule is defined by Creswell (2007:133-135) as a predesigned form used to record information which has been collected during the interview. The schedule assisted the researcher to organize

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thoughts; gave information on starting the interview and ending the interview; as well as thanking the interviewee and informing the participant of what will become of the results of the study. The schedule consisted of a brief description of the research, followed by five questions centred round the two research questions. Space was left between each question in order for the researcher to write down relevant non-verbal cues and to follow up on concepts brought forward by the interviewee. The interview schedule was refined through the process of pilot testing. The research schedule containing the interview sequence and suggested questions was used by the researcher. The research schedule allowed the researcher to use her own judgement in determining when the guide was to be followed strictly, or whether a follow-up question was to be asked related to the answer from the participant.

Adequate recording procedures should be used when conducting an interview in order to hear clearly what has been said by the interviewee (Creswell, 2007:132-

133). The interviews were voice recorded. The recording devices proved to be effective as they were easy to use, information was easily stored and the recordings were clearly understandable. A written consent form was signed by the participants prior to conducting the interviews in order to conduct and record the interview (See Annexure E).

The interview should be rounded off with the interviewer mentioning some of the main points gathered during the interview (Kvale & Brinkmann, 2009:129). The interviewer allows for the interviewee to make any last comments or to ask any questions related to the research. The researcher thanked the participants for their co- operation and participation in the study, thereby concluding the interview. Two of the transcripts of the interviews may be found in Annexures H and J.

Once data saturation occurs the interview process is discontinued. Data saturation may be defined as “the point at which all new information collected is redundant of information already collected” (Rebar, et al, 2011:391). In other words, data saturation occurs when sufficient data has been collected and no new themes are emerging from the research interviews. Toward the end of the interviews the researcher noticed that the same information was obtained from each participant. At

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the end of the ninth interview the researcher discontinued the data collection process. Through the assistance of the independent coder it was established that data saturation had occurred.

2.3.3. Field Notes

Field notes are a summary of observations made during the data collection process. These may include notes on the participant‟s body language, facial expressions, change in tone of voice and so forth. Field notes represent written notes that assist in painting a picture of a social situation in order to have a more general sense of the circumstances in which data collection occurs (LoBiondo-Wood & Haber, 2010:272).

Field notes serve as a record of observations made by the researcher and should be recorded during or soon after the event in order to ensure accuracy. Researchers may keep a journal or diary with field notes in order to identify personal reflections, feelings and thoughts that may influence their views on the data collected. Field notes may be used later to assist the researcher in remembering important issues, follow-up questions, or specific incidents in the data collection interview. Excerpts of the field notes may prove to be valuable as data collected in the interview process (Gerrish & Lacey, 2010:387).

Field notes, i.e. hand written notes were made during the interview and were used by the researcher to document various responses from the participants. The researcher used these notes to record certain facial expressions, emotions and body language of the interviewee to add to the recorded data. During data transcription these field notes were used to assist the researcher to interpret the non-verbal cues from participants in order to have a deeper understanding of the meanings ascribed to the event in question. Examples of the field notes made for the two transcripts may be found in Annexures I and K.

2.3.4. Pilot Study

A small research study, which is known as a pilot study, may be conducted prior to commencing with the larger study in order to develop and to demonstrate the effectiveness of the methods chosen to conduct the study (Rebar, et al, 2011:232).

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Burns and Grove (2011:49) define the pilot study as a smaller version of the larger study. The pilot study is frequently used by researchers in order to refine the methodology used to conduct the study.

A pilot study may be used to demonstrate the ability of the researcher to implement the study and can be an important first step in the research process (Rebar, et al,

2011:232). Researchers conduct the pilot study in the same manner as that of the proposed study. They may use similar subjects, similar settings, and the same data collection methods (Burns & Grove, 2011:49).

The following reasons justify the implementation of a pilot study in this research study: it assists the researcher in identifying problems with the research design; it determines whether the sample is representative of the population and whether the sampling technique is effective; it assists in refining the data collection process; and it gives the researcher experience with the participants, the setting, and the methodology to be used in the larger study (Burns & Grove, 2011:49).

A pilot study was conducted prior to commencing the study in order to test and to orientate the researcher to the process of the research being done. One interview was conducted as the pilot interview. The pilot study assisted the researcher in identifying problems that had not been identified in the initial phases of the research planning, such as appropriate interview questions and adequate allocation of time to conduct the interview. The researcher had to allow for more time to be allocated to interviewing sessions owing to the fact that informed consent had to be obtained before conducting the interview and questions regarding the research process from the participants had to be answered prior to the commencement of the interview.

The pilot study assisted the researcher in identifying whether the questions asked yielded information relevant to the event being explored. The pilot study allowed for changes to be made in the interview questions and the session schedules in order to conduct the research more efficiently. The interview schedule was revisited and relevant questions were added to elicit relevant responses. A second interview was then conducted in order to test the new interview schedule. This yielded a

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satisfactory result. The data obtained from the pilot study has been included in the data analysis for the study.

2.3.5. Data Analysis

Creswell (2007:160) states that data analysis is an on-going process which involves continuous reflection, asking analytical questions, and writing memoranda regarding the data throughout the study. Data collected is analysed to identify themes or perspectives. Themes are selected to be presented in the research findings. Once researchers have explicated all themes relevant to a study, they will report them in a way that is meaningful to the intended audience. Data was analysed according to the Tesch method of data analysis (Creswell, 2003:192). The use of literature from previous studies assisted in controlling data analysis. An independent coder was used in order to verify the findings of the researcher.

Before data collection or data analysis could begin, the researcher needed to clarify her own preconceptions regarding the topic being investigated. This is called bracketing. Bracketing refers to putting aside one‟s own meanings and interpretations of the topic being investigated, and then entering into the world of the interviewee and listening to their meaning and interpretation of the topic experienced (Creswell, 2003:192). Bracketing was done by the researcher through discussing her preconceived ideas with her peers, as well as by documenting these thoughts and