Individual interviews with ICU doctors

Individual interviews were carried out with eight ICU doctors at various locations to explore their views and opinions about pain management in the CT-ICU. Since pain management is a team effort, the input of the doctors is considered valuable in developing a guideline for pain management in the ICU. Doctors are the prescribers of pain medication, it is therefore very important to elicit their views on the subject.

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2.5.2.5 Research Design and Method

• Research design

The exploratory, descriptive, qualitative design was used to elicit the opinions of doctors on pain, its assessment, treatment and measures that they think can improve the management of patients’ pain in the CT-ICU.

• Research method Population

The statistics obtained from the CT-ICU allocation list indicated that the number of full time medical doctors practicing in the CT-ICU was ten (n=10), which included two cardiothoracic surgeons, one cardiologists, three anaesthesiologists, one senior registrar and three registrars.

Sample and Sampling Method

Of the 10 (n=10) full-time CT-ICU doctors who work in the unit, eight (n=8) were purposively sampled with their consent and took part in the individual interviews. Doctors were recruited by talking to them and following up with calls and by recommendation from the Medical Manager of the ICU. Each doctor included in the study had worked in the CT- ICU for more than six months. This was to ensure the doctors would have some level of experience in the ICU to share and assist in the development of the guideline.

Inclusion criteria:

• Doctors registered with the Medical and Dental Council of Ghana. • Have practiced for at least six months in the CT-ICU.

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Data Collection Procedure

Permission was obtained in writing from the management of the hospital (nursing and medical) (Appendix E & F) with the consent of the Medical and Nursing Directors of the CT-ICU. Permission was also obtained from the nurse and doctor managing the CT-ICU to undertake the data collection in the unit. The doctors’ individual interviews were carried out to determine the opinions of the doctors on their pain management practices in the CT-ICU and how according to them, pain management can be improved. Eight doctors were purposively sampled, with the help of the ICU Medical Manager, and participated in the individual interviews. The initial plan was to have focus group interviews with doctors as was done with nurses but after several attempts to get the doctors together for the focus group discussion failed, the researcher in consultation with her supervisor decided to have individual interviews with the doctors.

The researcher went to the study setting on several occasions to recruit participants before the interviews. Those who agreed to participate were given the doctors’ information sheet (Appendix I). The doctors were called the day prior to or on the day of the interview, depending on the appointment, to confirm the interview and the venue. The interviews were carried out at different locations at the convenience of the doctors after consent was obtained (Appendix H). Interviews with three doctors were carried out in the consulting room after they had seen their patients. Two doctors were interviewed in an empty High Care Unit next to the CT-ICU, which was not being used by the hospital, two were interviewed in their offices and one in the CTU Nurse Managers’ office. All the interviews were tape-recorded and notes were taken.

On the day of the interview, the doctors were again informed about the aim of the study and they agreed to take part in the interview. They were asked to complete a form with their demographic data and the analgesics they give in the CT-ICU, according to their protocol (Appendix D). Each CT-ICU doctor was allocated a research code to ensure anonymity. The interviews were then conducted and tape-recorded. Field notes were also taken by the researcher as an additional source of information. The doctors were given a chance to review the transcripts and elaborate on statements to assist with interpretation.

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The doctors were asked their opinions regarding the management of pain in the CT-ICU. To probe further to get a better understanding of their opinions, six probes were introduced (Appendix D).

2.5.2.6 Data Analysis

Data saturation was achieved after eight individual interviews, since no new information was emerging the interviews. Verbatim transcription of the tapes was carried out after each interview to understand the data, prepare for subsequent interviews, and prepare the data for analysis (Creswell, 2014). Data collection and data analysis occurred simultaneously to obtain a better understanding and appreciation of the data (De Vos, et al., 2011). After transcribing each interview, the researcher checked for accuracy by listening to the tape while reading the transcripts to make necessary corrections (Kvale, 2009). The recordings were listened to repeatedly until the researcher was sure all the statements were transcribed as stated by the doctors. The transcribed data was also compared to the field notes to ensure all the notes taken during the interview were captured.

Data analysis was done by employing the six steps of qualitative analysis by Creswell (2014) and coding using the eight steps of Tesch (1990 in Creswell, 2014). After ensuring the transcripts were accurate, the researcher printed them all. Each interview transcript was then read through to get a general sense of the information and to reflect on the overall meaning of what each doctor said about pain to understand the totality of the data (Creswell, 2014). Data was then coded by organising it by bracketing chunks and writing a word representing a category in the margins (Rossman & Rallis, 2012 in Creswell, 2014:198). This involved segmenting sentences or paragraphs into categories, and labelling the categories. The detailed coding process followed the steps of Tesch’s (1990) approach.

After getting a sense of the whole, each transcription was read thoroughly and thoughts about the data written down. After accomplishing this for all the transcripts, lists of similar topics were clustered together into major topics. The topics were converted into codes and the codes written next to the appropriate segments, sentences and paragraphs. The most descriptive wording was identified and turned into categories. To reduce the categories, similar topics or topics that related to each other were grouped together. Data material belonging to each

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category was grouped together. Each category was grouped by writing down the category then identifying how many doctors made a similar statement.

After the coding process, the analysis continued with the steps of Creswell (2014). Themes and subthemes were generated for the analysis. The themes form the major findings in the study supported by sub-themes, which are smaller groups that fall under the major group. The study was then presented as a narrative with all the themes and sub-themes supported by doctors’ actual quotations about pain in the CT-ICU. A discussion of the study findings compared the findings of the study to what is already known about pain in the critical care population. Lessons learned and conclusions drawn, in addition to the systematic review and interview with nurses, informed the guideline. It will also help to determine how pain assessment and management can be improved in the opinion of doctors, considering our resource constraints as a developing country. Three major themes and 10 subthemes were identified in the interviews with the doctors and presented in Table 4.6 in Chapter Four.