Interviewing

The main aim of interviewing in this study was to enhance the observational data: to verify my accounts of the care, and to provide more information on its impact. Where possible, both nurses and patients were interviewed. Nurses were asked about how they responded, and why, and whether they were satisfied with their reactions to the expressed psychosocial needs. With patients I explored whether they felt their psychosocial needs had been met and what they thought about the actions the nurses took in relation to psychosocial support. Similar to

observational data, certain choices must be made before interviewing, mainly who participates in the interviews and how are they completed.

4.1.4.1 Interview Participants

As the aim of this study is to explore the conditions of nurses’ provision of psychosocial support it was important to, try to, interview both patients and nurses about the same episode of care – which I refer to as “paired interviews”. The patients provided data discussing whether they received the psychosocial support they sought and how they felt about their care. Patients could only conjecture on why the nurses acted in the way they did. The nurses could clarify why they provided care in the way they did and could explain the various constraints affecting the care they provide. However, neither patients nor nurses were likely to understand all of the factors affecting psychosocial support. It was my role to elicit and synthesise these factors and then formulate questions which patients and nurses understand and provide useful answers (Lofland

et al. 2006, Miles and Huberman 1994).

The different people involved in interviews on observations, participant/s and researcher/s, provide different views on data which should be compared to elicit valuable findings (Bryman 2012, Nelson and McGillion 2004, Heyl 2001; Pawson and Tilley 1997). In this study, patients, nurses, and I all brought different perspectives of the same episodes of care, which were analysed in combination (see section 4.2). Interviewing participants explicitly about recorded observations strengthens the rigour of research, by reducing researcher bias and misinterpretation (Bryman 2012, Heyl 2001).

Nurse and patient interviews were managed using the same techniques and will be described simultaneously.

4.1.4.1.1 Paired Interviews

My initial plan was to interview patients first from each pair, as they were likely to give most clarification as to whether their psychosocial needs were met and indicate reasons as to why, or why not, this happened. Additional questions from the patients’ interview data could then be included in the nurse interview schedules. This allowed exploration of what I observed happening and what the patient perceived as important in regards psychosocial support. Unfortunately, it was not always practical to interview the patient first.

One of the challenges was to conduct the interviews soon enough after the observed interaction for both patients and nurses to remember it clearly (Lofland et al. 2006). Writing up the observational data and designing each interview schedule (see section 4.1.4.2.1) around this data took time. I would return to the ward as soon as practically possible after this, but patients and nurses were not always available to be interviewed; they both had other priorities. Early in the study I learnt that if patients were not available, but nurses were, I should grasp the opportunity to get a nurse interview or run the risk of failing to get either. In the instances that nurses were interviewed first, they often provided further, or alternative, questions for patients. If an interview could not be completed within two days of the episode of care, the interview did not take place. In such circumstances, the remaining data for that case were included in the study. I observed 19 episodes of care where I was unsuccessful at having formal interviews with either patient or nurse.

Thirteen patient interviews were completed. Reasons for not gaining patient interview included: their conditions having deteriorated, having to prioritise treatments, and being discharged home. Eighteen (47%) of the nurses participated in interviews about their responses to psychosocial needs.

Some participants were observed on more than one occasion but only one interview per participant was requested. If informal discussions occurred around observations recorded subsequent to an interview, these statements were recorded and included within the data. This happened during nine of the twenty case occasions (45%).

4.1.4.2 Interviewing Practicalities

For an interviewer to produce high quality evidence to answer the research questions they must ensure they have the correct approach to interviewing. Consideration must be given to whether an interviewing schedule is required, and, if so, what type and how the interviewer will interact with the interviewees.

4.1.4.2.1 Interview Schedules

In order to gain appropriate answers to the research questions it is important to have an effective interviewing schedule (Robson 2002, Silverman 2013). Pawson and Tilley (1997) advocate combining both structured and unstructured interviewing methods as a means of eliciting a complete explanation of the process under investigation. As the purpose of the interviews was to identify why nurses respond to psychosocial needs in the way that they do, and what both nurses and patients think about these responses, it was important that the interview questions were based around the observed care. Therefore, semi-structured interviews were used for this study. Initially, interviews were designed around what had been observed by a process of identifying the relevant aspects of the observation; planning question topics from this around which to structure the interview; and, for paired interviews, including issues that arose in the first interview.

Each interview started with an introduction about what I was trying to achieve, and how the data would be used; this allowed for a collaborative approach to the study (Heyl 2001). Responder validation (Moore 2014 et al., Silverman 2013, Lofland et al. 2006) was gained by

sharing my observations with the interviewee and asking their opinion on my reflection. The nurse interviews finished with some standard questions on how they felt they acquired their skills and their experience. Questions from the schedule were asked in an open style.

4.1.4.2.1.1 Open Interviewing Style

A factor equally important for successful interviewing is the style of communication between researcher and participant. I kept the interviews conversational in manner to allow participants to feel comfortable enough to talk, while probing enough to show I was interested in what was being said. Although I had a script of questions to ask in each interview, I did not follow it in order or word for word. As a topic arose, I asked a similarly pertinent question to that on my schedule. As interviews were concluding, I checked that all questions had been covered. These techniques are considered to stimulate the most fruitful answers in ethnographic interviewing (Lofland et al. 2006).

I also signalled interest by writing notes (Rubin and Rubin 1995). Questions must be open enough to allow the interviewee to describe their experience, but must be focussed enough to provide data on the specific research topic (Rubin and Rubin 1995); therefore, the majority of questions were open, and usually included a probe concerning some aspect of the observed behaviour. For example:

Hazel: “Yesterday when I came in and May was giving you a wash, you were talking about things from your past and I was wondering how does it make you feel when these conversations come up about the past?”

Topics that arose from responses were followed up by reflecting them back in order to encourage clarification; reflecting the answer back also showed the interviewee that they were being truly listened to. Active listening encourages participants to be open and honest, thereby producing richer data (Heyl 2001). The process of reminding interviewees of their actions or

comments, and asking them to explain or clarify them, is known as ‘conceptual refinement’ (Pawson and Tilley 1997).

Conceptual refinement was one of two methods used in this study that Pawson and Tilley (1997) advocate for focussing questions in order to obtain answers pertinent to the research topic. The other method used was the ‘teacher-learner’ approach (Pawson and Tilley 1997), where I explained what I was exploring, and asked participants for their views. These strategies were used more often as the data collection progressed and the concurrent analyses made the key topics more apparent, so that more focussed questions were used to specifically explore the concepts of interest.

4.1.4.2.2 Using the Interview Data

Interviews were tape-recorded and transcribed by me. Doing the transcriptions myself aided in the design of subsequent interviews, and permitted analyses of the data to begin before the interview series was complete (Heyl 2001). Similar to the observational data, analyses of the interview data occurred alongside the data collection phase of the study, thus allowing refinement of the concepts and exploration to provide more robust answers to the research questions (Glaser and Strauss 1967).