Focused Coding

The second phase of data analysis was focused coding. This occurred after I had gained some analytic direction through initial coding. This direction was gained by tentatively identifying the core variable (Charmaz, 2006), or the main issue within the data. The core explains the story of the behavior of the individuals (Charmaz, 2006). After the core is identified, the data that relates to the core and the other concepts are set aside. This method allows for the limits of the study to be placed.

During focused coding, I was able to use the most significant codes I had developed during initial coding to quickly sift through large segments of data. This coding was more directed, selective and conceptual (Charmaz, 2006). During focused coding, I

compared the different initial codes to newly obtained data in order to develop the focused codes. I also compared the focused codes to new data in order to further refine them (Charmaz, 2006). These refined focused codes were then compared to each other and grouped into concepts according to their shared meanings. These concepts were then condensed, collapsed or hidden in order to develop more abstract categories and sub- categories and to focus the understanding on a reduced number of codes and data incidents (Charmaz, 2006).

While I performed these tasks I also paid attention to the data that did not relate to the most significant codes, in order to ensure that I did not miss any significant incidents that required new codes. Table 4 outlines illustrative examples of original in vivo coding that began the development of the core category and the parts of care that were either merged or renamed during the focused coding process.

Table 3 Merged/Renamed Coding Example

Code Evidence Merged/renamed

Codes Approaches to caring – emotional labour Spiritual care Advocacy Emotional support

Students’ images were concerned with human aspects of nursing, such as giving emotional support, helping patients or their carers cope with illness, filling them with encouragement, being their

advocate and being their ally in the face of adversity. These approaches to caring have been described by various authors as spiritual care, intimate care and emotional labour. (professional learning in nursing)

Emotional care

Desk work “A staff nurse would work on the unit, so um, they're the ones who provide the actual care to the patients. Where myself, some of the nurse clinicians would do more what we call paperwork or desk work. So, as new initiatives are coming out, new information we try to encourage staff to learn about it, we teach them. However, um, depending on what it is, we would look at that and then sort of decide is it just something, information that needs to be

disseminated or is there actual teaching that needs to go on. So, um, but the staff nurses do all the hands-on care. “

Informational Care

Takes you away

from the bedside having to do all that feels often like it takes you away from the bedside and for someone who’s been a bedside nurse for a long time, that’s always a

struggle. But I think that’s a struggle we dealt with even before we had so much technology (Gail, interview #2)

Interferes with care

80/20 rule “Like, they're thinking about the here and now and we've gotta get this stuff done, we've gotta get today done. So, I think, I went to a conference once and it talked about the 80/20 rule, I think it was called the 80/20 rule, and it was about having 80% of your time for your patient care and what-not and then 20% for learning initiatives.” (Tom, interview #1)

Not all care

Administration -

positive Yeah, I'm, I'm running a really complicated clinic. I have, right now we have a thousand people on our list. I have 300 active patients whose care I'm coordinating. And its, and at the end of the day, if something doesn't get done for them and they're not ready for surgery, I'm, I'm where the buck stops. So, it's, it's fun, and challenging and, Um, but it's all

coordination. It's all traffic directing, it's all

...unfortunately it doesn't have any of the, really doesn't have any of the hands on care, but that's overshadowed by the amount of responsibility and autonomy . . . (Becky, interview #2)

Actual care A staff nurse would work on the unit, so um, they're the ones who provide the actual care to the patients. Where myself, some of the nurse clinicians would do more what we call paperwork or desk work. So, as new initiatives are coming out, new information we try to encourage staff to learn about it, we teach them. However, um, depending on what it is, we would look at that and then sort of decide is it just something, information that needs to be

disseminated or is there actual teaching that needs to go on. So, um, but the staff nurses do all the hands-on care. (Carol interview #1)

Direct care

Informational care Organizational care

Table 5 illustrates examples of some of the original in vivo coding and how they were refined during this process.

Table 4 Refined Coding

Original Code Refined Code

Indirect care Informational care

Organizational care

Against care Against care

Interferes with care

Hands on care Direct care

Presence Emotional care

Organization task Organizational care

Care giver Care