Macro Level (Phase one): Documentary Analysis

The first phase of this study is the analysis of MoH documents with the purpose of understanding the influence of degree entry policy and assessing the intended outcomes for national nursing workforce planning in SA. This process of documentary analysis included mapping the thematic content analysis and allowed scoping the envisaged requirements of degree-educated nurses in practice.

5.2.1

Sampling

The documents used for this study were the minutes of the last six meetings conducted by the GCC Nursing Technical Committee, who introduced the recommendation of degree education as the minimum entry for nursing practice. The introduction of this new policy within the Saudi MoH was a suggestion of the WHO, who supported its implementation. This form of documentation was located in the organisational committee’s files of the MoH. Since these files are the property of the MoH and are used as data for research purposes, I came to an agreement with the MoH about how the contents could and could not be used and how confidentiality would be preserved; these ethical considerations for the study were discussed in Section 4.9. Specific inclusion criteria for documents were implemented (Section 4.6.1), which included primary source documents relating only to policy implementations that were written in the Arabic language, which is the formal language used in communication for all ministries in SA. Other, unrelated attached reports and lists were excluded. Documents that included the decision process for degree entry requirement for nursing practice in Saudi Arabia were subjected to review. The summary of the sample documents is identified and illustrated in Table 5-1.

108

Table 5-1: The summary of the GCC documents

Documents selected No. of

Pages

Date of meeting

Key findings theme D1 Meetings of the GCC Nursing Technical

Committee in Jeddah, Kingdom of Saudi Arabia (KSA), no. 30

16 18-19 March, 2015

Rationale for change A Good Decision

D2 Meetings of the GCC Nursing Technical Committee in Dubai, United Arab Emirates (UAE) no. 29

14 13-14 April, 2014

Rationale for change A Good Decision

D3 Meetings of the GCC Nursing Technical Committee in Bahrain, no. 28

14 5-6 March, 2013

Rationale for change A Good Decision

D4 Meetings of the GCC Nursing Technical Committee in Oman, no. 27

20 5-4 March, 2012

Rationale for change A Good Decision

D5 Meetings of the GCC Nursing Technical committee in Kuwait, no. 26

14 24-25 April, 2011

Steps toward change

D 6 Meetings of the GCC Nursing Technical Committee, Abu Dhabi, UAE, no. 25

14 30-31 March, 2010

Steps toward change Global direction

D7 Booklet GCC (Challenge and achievement of nursing in Gulf countries for the period 1993-2013).

79 Published in 2014

Steps toward change

Challenge and achievement of nursing in Gulf countries for the period 1993-2013.

Total number of pages 171

5.2.2

Data Collection Procedure

In the first instance, the central office of the MoH in Riyadh was contacted to gain permission to collect the overall data for this study (Section 4.9). This included the documents that met the inclusion criteria of the study (Section 4.6.1) that served to build the evidence about the decision process for the degree entry requirement for qualified nurses in SA, and to fill the gap in knowledge related to workforce planning and development. This prepared me, as a researcher, to become more oriented and familiar with all the processes that had been applied when implementing the decision before conducting the interview (Prior, 1974).

I accessed the files that contained these documents, which were kept in printed form in a special folder, and placed in the office of the General Director of Nursing. I conducted a brief overview of the documents to exclude any unrelated papers. The documents

109 comprised 629 pages, with 171 pages containing the exact meeting records being included and 458 pages including attached reports, tables and lists related to other Gulf countries that were excluded as illustrated in Figure 5-2.

Figure 5-2: Document searching strategy

All of the included meeting records have the pages numbered consecutively as separate documents, and the excluded pages were attached in an unorganised manner without page numbers. I scanned the documents and saved the electronic copies onto my encrypted computer. I also developed a database on my personal computer that contained secure files for each phase of the study (documents, macro, meso and, micro level interviews and focus groups transcripts), to organise and save the large amounts of data that I had collected, as suggested by Stake (2003) and Yin (2013). Each file contained electronic records of multiple sources of data that I made, along with my reflective notes.

However, most of the documents are not easily accessible and contain evidence that would take a researcher a long time and much effort to gather alone. The most important advantage of using documents in social research is their stability. Unlike other sources of data, such as interviews or observations, the presence of the researcher does not alter what is being investigated. According to Merriam (2002) documents in qualitative research are

110 objective sources of data unlike other forms, indicating that documents are a good source for my case study research because they ground my exploration in the context of the phenomenon being studied and they validated and triangulated evidence from interviews and field notes (Guba & Lincoln, 1994). Indeed, these documents work as valuable social facts to confirm the information obtained from other sources (Prior, 1974), and it is very important to check whether these documents can assure objectivity, consistency and accuracy. The collected documents for this study are primary sources, which increases their trustworthiness and credibility. They were used for the purpose of this study only.

5.2.3

Data Analysis

Documentary analysis is mainly applicable to rigorous, qualitative case studies, constructing rich descriptions of a single phenomenon, event, organisation, or programme (Stake, 1995; Yin, 2009). The documents for this study were analysed using Prior's (2003) framework and included careful reading and re-reading as well as annotated commentary about any important information relevant to the purpose of the study. The initial coding of the documentary analysis was based on the questions of (Prior, 2003) who has conducted inclusive work on using documents in social research, which I used as a guideline to understand and analyse the documents.

Prior's (2003:P.26) provides valuable information about the nature of documents in organisations as illustrated:

 Documents form a field of research in their own right, and should not be considered as mere props for action.

 Documents need to be considered as situated products, rather than as fixed and stable things in the world.

Documents are produced in social settings and are always to be regarded as collective (social) products.

Determining how documents are consumed and used in organised settings – that is, how they function – should form an important part of any social scientific research project. In approaching documents as a field for research, we should always keep in mind the dynamic involved in the relationships between production, consumption, and content.

111 When I entered the fieldwork to collect documents related to degree education policy, I was challenged with decisions as to which documents were the most relevant to the situation. I found that (Caulley, 1983: P.23) provided four important rules for choosing documents that guided me to decide the appropriate documents for my research as illustrated:

1. Incomplete observation and faulty memory are reasons for the inadequacy of testimony.

2. The longer the time interval between the incident described and the writing of the document, the less reliable the document. Therefore, choose the document that is closer to the event described.

3. Some documents are intended as aids to one’s memory, some are reports to others, some as apologia, some as propaganda, and so on. Therefore, documents differ as to their purpose.

The more serious the writer’s intention to make a mere record, the more dependable the document is. The more confidential the document (for example, the fewer eyes that are allowed to see it), the more ‘naked” the truth revealed by the document.

The documents comprise seven documents, six meeting records including policy related to degree nurse education and practice, various Gulf countries’ reports include strategic planning, action plans, curriculum outlines for different level of nursing programme; the booklet summarising the overall meeting achievements and challenges. The seven documents comprising 171 pages meeting the inclusion criteria and were subsequently analysed, while the unrelated documents were excluded.

Each meeting record commenced with minutes of the meeting, which included the date and time of the meeting, a list of the meeting members and those unable to attend, acceptance or corrections/amendments to previous meeting minutes, decisions made about each agenda item – for example: action agreed, next steps, outcomes, items to be held over to another meeting, recommendations, and date and time of the next meeting. This meeting was conducted once or twice per year and the GCC members included two representatives from each of the six countries of the Council: Saudi Arabia, Kuwait, Bahrain, Oman, Qatar, and the United Arab Emirates, and 2 from Yemen, whose accession to various GCC authorities has been approved by the GCC.

112 Prior (2003) analysis procedures for analysis began with a complete reading of the meeting records. I then re-read the documents, making notes in the side margins. A third reading entailed the actual coding of the sentences/phrases/words of the minutes of the meetings. To code the document data, I highlighted each relevant statement (irrelevant material was not coded; this process of determining what data is relevant to the topic under investigation is termed “data reduction”) (Merriam, 2002). I could not use NVivo to arrange and organise the data because the documents were written in Arabic, so data was organised manually to include using notes and memos to document initial thoughts. Memos helped me to move from an empirical to a conceptual level and to identify the issues that required further exploration in the data analysis (Caulley, 1983).

However, Mogalakwe (2009) provides quality control criteria to assess documents, these are authenticity, credibility, comprehensiveness and meaning. As a researcher, I was aware of the potential risks of being misinformed by evidence when collecting documents and a number of protective steps were taken. These included: identifying the authenticity of the document to ensure the source used for analysis was correct, ensuring that the texts within the document were consistent with the context and that the information was clear, accurate and consequently from the original version. Some documents are partly in the public domain because they are published and freely accessible, such as the booklet of the Gulf Cooperation Council’s (GCC) achievements, whereas other documents may be classified, confidential or otherwise unavailable to the public, such as the actual minutes of the GCC meetings, which are not published or accessible even for nurses.