Data evaluation and analysis

Data analysis in reviews requires the data from primary sources to be ordered, coded, categorised and summarised (Whittemore & Knafl 2005). This process began with data

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evaluation which is the process of obtaining the necessary information about study characteristics and findings from the included studies (CRD 2009). To do this I constructed a data extraction form (see appendix 1) that enabled the same data to be extracted from each study thus reducing the risk of bias and improving the validity and reliability of the analysis (CRD 2009). The CRD (2009) recommends that this form should include the information such as study details, participants’ demographics, geographical location, research design and study findings, along with any additional information that is specific to meeting the aims of the review and the research question. The additional information was the timing of the data collection as this was significant to the analysis of the timing and stages of newly qualified nurses’ experiences of transition.

Rolfe (2006) and Thomas and Harden (2008) indicate that there are no accepted or empirically tested methods for excluding qualitative studies from synthesis on the basis of their quality. Lucas et al., (2007) concur and suggest that the rigid application of quality criteria may lead to the exclusion of relevant studies that fail to meet particular reporting requirements. While no study was excluded on the grounds of poor quality when poor quality research was identified, the limitations for inclusion in the findings reported here have been acknowledged. Moreover, research of low rigour contributed less to the analytic process. I assessed the quality of the studies using the questions identified by the Critical Appraisal Skills Programme (CASP) critical appraisals checklists4 as a guide. As noted earlier the quality of the studies varied. While some studies provided a detailed rationale for choosing the research approach adopted and its application to the study (for Dearmun 1997 example Boychuk Duchscher 2007; Farasat 2011), some provided some rationale (for example

4

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Gerrish 2000; Andersson and Edberg 2010) however others did not (for example Bick 1999; Amos 2001). To some extent this may have been dependent on the requirements of the publication and type of study. Twenty six of the studies included in the review were qualitative (see appendix 1). This is not surprising as the studies were seeking to describe and explain newly qualified health care practitioners’ experiences and behaviours in social contexts and they were seeking to understand human experiences through description and interpretation of their social world (Creswell 1998; Fossey et al., 2002; Vivar et al., 2007). Of these 26 qualitative studies, 6 studies were influenced by phenomenology with 3 described as phenomenological (Jackson 2005; O’Shea and Kelly 2007; Farasat 2011), and the other 3 described using a phenomenological approach (Tryseenaar & Perkins 2001; Toal- Sullivan 2006; van der Putten 2008). A further 4 studies were described as being grounded theory studies (Gerrish 2000; Runcapadiachy, Madill, & Gough, 2006; Boychuk Duchscher 2007; Mooney 2007), but 2 of these being described as using a grounded theory approach (Gerrish 2000; Runcapadiachy, Madill, & Gough, 2006). Some researchers that claimed to be using a particular approach guided by a philosophical framework used some or all of the elements congruent with that approach. For example see Gerrish (2000). However some elements of the approach were not described i.e. theoretical sampling. Other researchers were less rigorous in reporting all aspects of the work. For example Jackson (2005) described her study as phenomenological but did not describe how the data was analysed. Of note however that was no ethnographic studies were found. That said Dearmun (1997) discussed how ethnographic approaches had informed her study though she had not undertaken any participant observation or fieldwork.

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A further 6 of the studies were described as evaluations. These studies ranged from a small scale evaluation of 10 newly qualified nurses’ experiences of transition working in one acute care setting in the UK (Amos 2001) to a large scale national review of pre-registration nursing and midwifery education exploring the impact of Fitness For Practice (UKCC 1999) and the early implementation of Flying Start NHS©, a structured programme for newly qualified nurses in Scotland. This study had 2011 participants, which was the largest sample size reported (Lauder et al., 2008). Of these 5 studies sought to evaluate strategies put in place to ease the transition experiences for nurses and newly qualified health care practitioners including an evaluation of Flying Start©, mentorship, preceptorship and orientation programmes in the USA, UK and Australia (Beecroft et al., 2006 (USA); Berridge et al., 2007 (UK); Lauder et al., 2008 (UK); O‘Malley Floyd, Kretschmann, & Young 2005 (USA); and Smith & Pilling 2007 (Australia). The other study evaluated the staff nurse role transition (Amos 2001). All of the evaluation studies included some qualitative approaches to data collection and data analysis.

A further 2 studies were described as surveys (Bick 1999 and Cave et al., 2007). Both used questionnaires as the data collection tool which elicited both quantitative and qualitative data. A further 2 studies were described as longitudinal studies (Brown & Edelmann 2000; and Maben, Latter and Macleod Clark 2006). Another 2 studies used mixed methods design and a combination of data collection tools which elicited both qualitative and quantitative data (Ross & Clifford 2002; Brumfitt, Enderby & Hoben 2005,). No single method was appropriate to investigate the phenomena of newly qualified nurses entering children’s community teams. Indeed as Mason (2006) notes multi-method designs are appropriate and

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can enhance the understanding of the problem. It is also worth noting that funding bodies may favour studies that contain both qualitative and quantitative methods and such approaches may lead to greater confidence in reported findings (Bryman 1988). However, as Mason (2006) suggests, multi-method approaches are not without criticism. For instance there may be difficulty in meshing the findings from the analysis of narrative and numerical data. This difficulty may explain why some researchers failed to report all aspects of their work. For example Ross and Clifford (2002) only presented the qualitative findings.

Overall the data collection tools used in individual studies was congruent with the research approach reported. Quantitative studies used a variety of appropriate data collection tools (see appendix 1), but the most frequently used was questionnaires. The most frequently used data collection tool used in the qualitative studies was interviews. Other methods included focus groups, self report written accounts and journaling (see appendix 1). There were no examples of fieldwork or participant observation as methods of data collection reported in any of the studies. This was surprising given that the use of field work methods can enable deeper understanding of the informants’ world compared to data collection methods which are restricted to verbal inquiry (Savage 2000).

There were notable differences in the amount of detail reported regarding the development of data collection tools. For example while Runcapadiachy, Madill, & Gough (2006) discussed the rigour involved in the development of their interview schedule no example of the schedule was provided. At times the lack of detailed description made it difficult to assess which topic areas were explored in depth. The studies that used more than one data collection

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method did so to enable researchers to confirm and verify the findings and develop them further. For example see Brumfitt, Enderby and Holden (2005).

There were also differences in the timeline used to collect data for instance Dearmun 1997; Brown & Edelmann 2000; Tryssenaar & Perkins 2001; Ross & Clifford 2002; Brumfitt Enderby & Holden 2005; Maben, Latter & Macleod Clark 2006; Berridge et al., 2007; Boychuk Duchscher 2007; Newton & McKenna 2007; Smith and Pilling 2007; Morley 2009a Morley 2009b; Brennan et al., 2010; and Farasat 2011) collected data on a number of occasions. The benefits of doing include the ability to determine significance of how the experience might change over time. Those studies that used a one off data collection strategy were interested in retrospective accounts and events. A strength of this was that participants could recollect their experience and the meanings they attached to them.

As expected, a variety of data analysis techniques were used appropriately. These included descriptive statistics, and inferential statistical analysis to analyse quantitative data (see appendix 1). Qualitative content analysis, thematic analysis, constant comparative analysis, template analysis and Colaizzi’s framework analysis was used to analyse qualitative data (see appendix 1). This reflects the rich variety of qualitative analysis strategies available as noted by Patton (2002). However, each has distinct elements that can generate creative approaches as each study is unique and depends on the insights and style of the inquiry and inquirer (Patton 2002). Regardless it is important to report the details of the analysis to ensure rigour (Rolfe 2006). At times the procedures relating to data analysis were poorly described. Three studies did not report the type of data analysis used (Bick 1999; Jackson 2005; Smith & Pilling 2007). Some studies named the method used but did not attribute this to a published

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source (for example Toal-Sullivan 2006). Others provided a comprehensive discussion of the analysis for example Farasat (2011).

Of the 39 studies included in this review 26 of the papers explored the experiences of newly qualified nurses during their transition into qualified posts, another 2 included both nurses and health care professionals the remaining 11 considered the experiences of non nursing health care professionals including doctors and midwives. In total 27 of the studies were UK based, 4 completed in the USA, 2 undertaken in Canada, 2 in Australia, 2 in Ireland and a further 2 in Sweden.

Just 6 of the studies focused solely on children’s nurses alone reporting on their experiences of their first employment (Dearmun 1997 (UK); Evans 2001 (UK); Andersson, Cederfjäll and Klang 2005 (Sweden); Jackson 2005 (UK); Beecroft et al., 2006 (USA); and Farasat 2011 (UK). A further 2 studies included nurses working with children, Thomas et al.,(2008) (UK) included 6 children’s nurses as well as other health care professionals while Boychuk Duchscher (2007) (Canada) reported that the participants in her study worked in adult and paediatric settings. This supports the contention that children’s nurses are under- reported in this body of work and that more research is needed to further understand the experiences of this particular group. All of these studies report experiences of participants in acute care settings apart from Maxwell et al., (2011). No studies were found that focused on children’s nurses’ experiences of transition into community settings as a first post destination.

As the majority of the studies were qualitative the sample sizes were generally small with the smallest number being 4 participants (Morley 2009). This is not surprising given the fact that

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the purpose of qualitative research is to provide valuable in-depth and rich information from a small number of participants (Patton 2002). However, the selection of participants was not always well described. Some studies lacked any detail regarding the rationale for participant inclusion while others did. For example several studies reported the use of purposive sampling (see appendix 1). An example was O’Shea and Kelly (2007) who discussed that the participants in their research would have enough experience to describe adequately what the experience was like for them. This is consistent with the views of Spiezale and Carpenter (2003) who note that individual participants should be selected based on their first hand experience of the topic being investigated. Unfortunately, in other studies the sampling strategies were poorly reported. Sample sizes in the quantitative studies ranged from 31 (Brennan et al., 2010) to 2011 (Lauder et al., 2008).

Data analysis

According to Whittemore and Knafl (2005) the next step in an integrative review involves an iterative process of examining the data to identify patterns, themes or relationships. To do this I used an approach illustrated by Boyatzis, (1998) who described a systematic approach to the organisation, analysis, synthesis and presentation of the findings derived from different sources of literature. This involves encoding information and focuses on identifying themes and patterns in the data (Boyatzis 1998). The coding process involved recognising (seeing) an important moment and encoding it (seeing it as something) prior to the process of interpretation (Boyatzis, 1998). Encoding the information helps to organise the findings in order to derive themes from them. In this context a theme is defined as:

“a pattern in the information that at minimum describes and organizes the possible observations and at maximum interprets aspects of the phenomenon”

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(Boyatzis (1998) p. 161).

Braun and Clarke (2007) add that once descriptive themes have been identified from the studies synthesis of analytical themes can be generated. This stage was the most difficult as it depended on my insight and judgment and there were some challenges to this process; not least that the views of research participants were often presented through the descriptive themes generated by individual researchers which had already been interpreted. However, an iterative approach to this aspect of the review helped. This cyclical process of reading and re-reading papers was repeated until the themes generated were sufficiently abstract to describe or explain what was known. What follows here, the synthesis, goes beyond reporting the content of the original studies by presenting a coherent overview of the current body of knowledge to answer the review question under the headings of’ stages of new graduate experiences of transition, a disconnect between education and the realities of practice; responsibility and accountability; preparedness; confidence; support; and the outcome of experiences of transition.