Expanding data collection

Following the planned data collection, it became apparent that the data collected was insufficient in depth and breadth to answer one of the main research questions that deals with possible transfer of Advanced Practice Nursing roles to other specialities within the

Palestinian health care context. This was mainly due to poor information obtained from interviewing the two policy makers.

Following discussion with the researcher’s supervisors, it was pointed out that some de facto APN roles, which are not regulated, may already be present in some accident and emergency departments in Palestine. Therefore, the researcher extended data collection to include

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nursing and nursing management staff working at another hospital in Jerusalem. Individual one to one interviews with staff nurses and a nurse manager working at a general accident and emergency department were conducted to explore informants’ views about advanced nursing roles in their practice environment. The 10 practicing nurses in the department were invited to participate, but only 7 agreed to participate in the interviews. In addition, the Nursing Director of the Hospital was interviewed to explore her views about potential advanced roles at the accident and emergency department. Nurses, at the department, worked a three shift pattern, morning, evening and night. Nurses who were interviewed provided a good representation of nurses undertaking their duties across the three shifts. This was important to ensure that the experiences of nurses from all spans were taken into consideration.

The interview protocol (presented in appendix 4) covered areas related to nurses’ knowledge about APN roles, nature of advanced roles (if they exist), teaching and training, regulation and governance of such role. Data generated from those interviews enabled the researcher to explore contextual factors surrounding the creation of such roles. This also provided an insight into how such unregulated roles may have influenced the care of patients. Exploring the views and experiences of nurses and managers undertaking such unplanned roles has enhanced understanding of the factors that may have facilitated or hindered such role development. This also provided an excellent opportunity to enrich discussions and comparisons between planned advanced nurses’ roles (ONPs) with those that have developed ad hoc. By exploring educational and training needs in addition to nurses’ perception of role impact and rationale has enriched understanding of such ad hoc

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nursing roles. When comparing such roles with the planned ONP role, it clearly

demonstrates how various contextual factors are critical for the successful introduction of APN roles into the Palestinian health care settings. Therefore, exploring the views of concerned nursing staff has provided in-depth knowledge with regards to the possibility of APN role transfer to other areas of health care.

3.5.9 Sampling:

As a qualitative paradigm was guiding this study, a non-probabilistic sampling technique was used. Qualitative research is concerned with providing rich, in-depth understanding of a phenomenon which stems from personal accounts of participants (Poat et al, 2007). This study therefore, employed a purposive sampling method where

participants of theoretical relevance were selected (Poat et al, 2007). In qualitative research, it is normal practice that data is collected until no new information is

forthcoming. It is therefore inappropriate to decide on the number of participants prior to data collection (Talbot, 1995). However, when planning a research a framework for data collection is needed. Stake (2005) advocates that the researcher selects cases relevant to the phenomenon of interest. He further asserts that the researcher selects cases that “seem to offer opportunity to learn’’ Stake (2005, P 465). This approach advocates a purposive sampling method for the study that intends to construct knowledge from collected data. As the number of potential informants was not clear, for both the focus group and the personal interviews involving ONPs, all of the 10 practicing Ophthalmic Nurse

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Practitioners in St. John Eye Hospital, were approached to participate in the study. For the focus group 6 ONPs agreed and consented to participate in the study. Following this, individualized personal interviews were held with 4 of whom 2 participated in the focus group as well. It was felt that this number of informants will provide rich data that will help the researcher to construct the development ONP roles.

One former Nursing Director was interviewed to explore reasons and circumstances that lead to the development of the role of ONPs. In addition two key nursing policy

makers were interviewed to explore their views and opinions about the role development and the possible transfer of this role to other subspecialties within the Palestinian Health care system. Although such officials were not involved in the role development but exploring their views about such role development proved critical in supporting and licensing APN roles especially if the role is to be transferred to other subspecialties within the Palestinian health care system.

As for the 10 nurses practicing ad hoc APN roles at a general Hospital, seven agreed to participate in addition to the Nursing Director. Extending data collection to include informants undertaking ad hoc APN roles was essential to explore the rational for such development and also the processes used in developing such roles. In addition, this has provided an insight as how such roles can be successfully planned and introduced in other health care settings.

With regards to official and archival documents, samples from ONPs’ job

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curriculum and assessment. Minutes of meetings pertinent to the role development and management were also retrieved and reviewed. Where appropriate, hospital reports including general and human resources statistics, and patient satisfaction reports were also reviewed.