Initial Line by Line Coding

Strauss and Corbin (2008) refer to the process of analysing data as coding. The first fundamental analytic phase of the research project consisted of initial coding. This involved the analysis of data starting with the first interviews and the beginning of identification of the fundamental concepts. Originally, Glaser and Strauss (1967) refer to this phase as “open coding”. In this study, a comparison of the first two interviews yielded basic codes and some initial categories in their infancy. This initial coding process was used to fracture the data (Glaser and Strauss, 1967), coding the data line by line, word by word (Glaser, 1978), illustrated in extract from interview with participant 1. However, line by line coding can be a discretionary process and can produce a “helter skelter” (Glaser, 1992: 40) approach of over- conceptualised incidents that generates too many codes. Yet “line-by-line” coding helps you to see the familiar in new light” (Charmaz, 2014: 38). Incident by incident coding assisted with the discovery of patterns and themes in the data. This was the starting point of the constant comparison method of looking back and forward at the two transcripts to identify emerging codes and themes. Charmaz (2014) recommends that careful initial coding prevents the researcher from inputting their own motives, fears, and assumptions.

This initial coding phase yielded extensive codes yet a pause in data collection assisted with a period of reflection, as illustrated in the image 1. This process assisted with the decisions of what kinds of data were needed next. Theoretical sampling commenced after reviewing the two interviews a few weeks later and a discussion with the supervisory team.

78

Semi structured questions

Explore participant’s substantial experience Probe and ask challenging questions for clarification

Commence initial coding

Manage the data. Consider frequent and significant statements in the interviews as theoretically conceivable

Start to develop contingent categories Make decisions about the theoretical steer

Continue to recruit and interview Conduct focused theoretical coding and

categorising Focus on participant’s reactions, non-verbal cues. Following participant response consider emerging theoretical questions Focus on the significance of the points for future interviews Follow up on earlier significant points in previous interviews

Focus on the final interview questions to clarify significant points Saturation point Memo Writing Constant Comparative Method Move to theory building

Theoretical Sampling Diagram 12 A Visual

Representation of the Interview Process using Grounded Theory Methods

79

So her insight was completely non-existent. As a result of that she was only going to be unsafe doing a drug round but unsafe

because she wasn’t able to recognise the conditions of a deteriorating patient and all the other things that go on. With that she argued and they argued it was unfair.

And so in order to make it, and my responsibility as much as to get her to acknowledge her lack of competence to herself, so rather that dismiss her there and then I actually stopped the hearing.

And I spoke very frankly to her about her of understanding was a concern to me and that I wanted her to do one last drug round and she can choice the assessor, she chose the ward she chose everything. On the understanding that if she failed that would need to acknowledge she was lacking competence to complete a drug round. This was quite effective because she failed. And she was very clear at that point that if she failed again then the next step would be for me to refer her to the NMC. So for me the major impact for me was the lack of insight to the code so I think the issues for me was it not just being that she couldn’t do a drug round and by omitting something that was also part of the code that her actions could have put someone in danger. To be honest, for the people I refer the people that I see as part of the disciplinary process a lack of general understanding of the code and the implications of the code, so when I chair a disciplinary I have the code in front of me. And I have the various sections highlighted, and my questioning is in relation to the code and the incident.

Lack of insight

Inability to practise safely Medication error

RN lack of knowledge, competence and skill

RN lack of responsibility Compromised patient safety Internal processes and support mechanisms

Fair employer

Managing risk of repetition Breach of the Code, UK standards, law

Lack of understanding of the code RN Lack of awareness - Employers responsibility to ensure RN recognises their inability to practice safely

Lack of competence

Internal processes and support mechanisms

RN engagement with support Lack of insight

Medication error Breach of code

Compromised patient safety Public protection

Lack of understanding of the code Internal processes

Employer responsibility to protect the public

The Code The situation

Intal coding Extract from Interview with Participant 1

80

The interviews were read and re-read, the recordings listened to, and this helped gain insight and understanding into the participants’ experiences. Initially, NVIVO 10 was used but due to the lack of skills of the researcher, NVIVO was not useful and thereby abandoned. The volume of data generated by the transcripts meant that some NVIVO functions were not intuitive and therefore took considerable time to learn by reading the manual or by viewing the online tutorials. Thus, a decision to use traditional analytical techniques was adopted, using colour codes on a word document, illustrated by an extract one from an interview with participant one. This also involved manually cutting out key sentences and placing them into labelled envelopes.

The key concepts were put into themes and documented onto large sheets of paper, to gain a fuller picture of the participants lived experience. This was an overwhelming, time- consuming process, but it focused my thoughts and provoked ideas about the types of cases and the participant’s experiences of referring to the NMC for misconduct and lack of competence, that could have been missed when reading the data for a general thematic analysis. It also facilitated discussion with the supervisory team constituting to form ‘peer review’ (Lincoln and Guba, 1989). Diagram 13 represents the initial coding and fracturing of the data to explore the concept of why employers refer within the first five years of registration. This process helped with theoretical sampling.