Methodology of the model development

The grounded theory coding stages of Charmaz (2014) and the concept synthesis method of Walker and Avant (1995:58) have similarities in terms of model development. A detailed discussion of the methodology of the model development is in Chapter 6, Section 6.2.

The reduction and synthesis of concepts were iterative, until the properties of the concepts were evident. The process was cyclic and data saturation was obtained by forward and backward cycles. Through diagramming (Annexure N), the final layout of the model and relationships between the categories and sub-categories laid the foundation of the newly developed model. Components of the model were identified. As Giles et al (2016:33) indicate, a secondary literature review is necessary for the final refinement of the model; the researcher conducted a literature review and integrated existing literature, models and theories in the discussion to substantiate the model. The interrelated themes, categories and sub-categories were identified. The relationship statements of the model were formulated and properties of the components were described. Hardy (2012:318) explains that a symbolic model is a set of connected symbols or concepts that represent a phenomenon of interest and indicate the relationships among symbols to increase the understanding of what is going on and why. The model developed in this study is symbolically representing the phenomenon of trust and indicates the relationships of components, themes, categories and sub- categories to increase the understanding of trust and trusting relationships in nursing

education. Hence, this model is substantive in nature and meets the criteria of Strauss and Corbin (1998) as it is described in Holloway and Todres (2006:201), namely:

 Showing systematic relationships between concepts and links between categories.

 Variation should be built into the model in order for it to hold truth under a number of conditions and circumstances.

 The model should demonstrate a social and/or psychological process.  The findings should be significant and remain important over time.

To summarise, the researcher followed the cyclic, concurrent and comparison processes during initial, focused and theoretical coding in the data generation and analysis processes, according to Charmaz’s (2014) grounded theory. The data generation and coding took place cyclically and iteratively. After each face-to-face interview and focus group interview the raw data were transcribed and analysed. First, the researcher brought herself to understanding the preliminary data and the meaning thereof; then, in the second place, she developed codes to identify categories and sub- categories derived from the data; thirdly she linked the relationships of categories and sub-categories to identify a core category; fourthly, she utilised findings (quotes) and literature in the story line description, and finally, developed and presented a substantive model for trust in nursing education. All processes contributed to the trustworthiness of the model and study.

2.10 TRUSTWORTHINESS

Trustworthiness and validity in research ensure that qualitative research is plausible, credible, trustworthy and defensible (Johnson & Christensen 2012:264). The term ‘qualitative rigor’ ensures validity and reliability in qualitative research (Thomas & Magilvy 2011:151). The model of trustworthiness proposed by Lincoln and Guba (1985) addresses five components, namely credibility; transferability, dependability, confirmability and authenticity. These five criteria are important to judge the rigor of qualitative research (Lichtman 2014:195; Streubert& Carpenter 2011:47-49). In Table 2.1 these criteria are concisely summarised to indicate how the researcher implemented strategies to ensure trustworthiness in the research process.

2.10.1 Credibility

Credibility refers to the ability and effort of the researcher to ensure accurate description of information and interpretation of the information (Lichtman 2014:386; Thomas & Magilvy 2011:152). Topping (2006:169) indicates credibility is assured when there is a ‘fit’ between the participants’ views and the researcher’s representation of these views. Hence, Polit and Beck (2016:559) point out this is what enhances the believability of the findings. Quality checks enhance the quality of data with the implementation of common strategies such as independent coding and critical comparison by expert panels; feedback from the participants; and the provision of audit trails (King 2012:433).

It was important for the researcher to ensure credibility of and consistency in the interpretation. Therefore, the researcher was motivated and committed to complete the study. The implementation of quality processes as described in Section 2.8.3 served as a credibility criterion. The researcher obtained knowledge on the research processes by completing a research methodology module. The researcher was previously involved in research during her master’s studies that entailed qualitative research. Methodological congruence was confirmed by using memos, reflexivity, bracketing and intuiting in the research. The researcher had opportunities at national and international conferences to present the methodology and findings of the study. The presentations were scrutinised by academics and peers, which increases the credibility of the study. According to Sinkovics and Alfoldi (2012:126), the credibility and authenticity of research may be enhanced by the inclusion of data displays, coding schemes, as well as an understandable and consistent explanation of each step of the research process. The researcher demonstrated procedural logic by maintaining an audit trail, and managing the data and resources. Memoing and field notes were made by using mind maps and mapping of research activities. Johnson and Christensen (2012:265) indicate researcher reflexivity ensures credibility through critical self-reflection regarding potential biases and predispositions. The researcher reviewed the interviews and transcripts for similarities throughout the research process. The reflexivity included an active introspection about experiences and questioning of the way of doing. Bracketing entailed that the researcher deliberately bracketed out expectations, thoughts and feelings. Through intuiting the researcher developed an awareness of the views of the participants.

Prolonged engagement of the researcher in the field until data saturation was reached, establishes the credibility of the findings (Brink et al 2012:172; Streubert & Carpenter 2011:48). The interviewing techniques and communication skills were practised using pilot interviews and by testing the introductory question. The supervisor and co- supervisor checked whether the pilot interviews and interpretations were consistent. The supervisors’ approval served as peer debriefing. Four pilot interviews were conducted before the commencement of the face-to-face interviews with the educators and focus group interviews with students. The prolonged engagement over four years with the topic under investigation supported the credibility. Coding of data was done by the researcher without utilising software. The researcher was intensely involved in the coding and development of categories and sub-categories. After transcribing the interviews and analysing data for the initial coding, the researcher returned to the participants to obtain their opinions on whether the interviews were a true reflection of their point of view regarding trust in nursing education. The supervisors and co-coder did the peer cross-checking and debriefing of the findings for accuracy and representation of the findings. The confirmation of the interpretation of the findings supported credibility of the study.

Triangulation means using different sources and methods of data generation (Brink 2012:172). The participants were from different levels, backgrounds and NEIs. Students who participated were third- and fourth-year students. The participating educators possessed bachelors, masters’ and PhD degrees. The NEIs were in different geographical areas with differences pertaining to being university and public NEIs. These differences ensured triangulation as the data were obtained from different points of views. Different views were obtained from educators and students through face-to- face and focus group interviews. Structural coherence was obtained through the integration of data in a logical manner such as the story line in the findings and discussion chapters. Structural coherence includes the whole process of interviewing techniques, transcripts, coding processes and compiling the final report.

2.10.2 Transferability

Transferring research findings to another population is equivalent to external validity (Brink 2012:127; Cope 2014:89; Thomas & Magilvy 2011:153). Transferability relates to the applicability should the findings be transferred to another context (Polit & Beck

2016:650). Transferability might be a weakness in qualitative research due to purposive selection of the population and findings being applicable in a particular environment (Johnson & Christensen 2012:270). Transferability is also labelled as fittingness. This refers to the expectation that findings should fit or be transferable to other potential settings (Brink 2012:127; Lichtman 2014:387; Streubert & Carpenter 2011:49). Measures the researcher took to ensure transferability are summarised in Table 2.1.

The participants were from different NEIs situated in urban, semi-rural and rural areas. The participants were purposively and convenient sampled. Face-to-face and focus group interviews were conducted until data saturation was achieved and a model could be developed and refined; therefore, the number of participants sampled was determined by data saturation.

In Chapter 3 a dense description is provided of the findings based on educators’ views and in Chapter 4 the findings that emanated from participating students’ views are reported. The in-depth interviews resulted in dense descriptions of categories and sub- categories. The rich and thick descriptions of findings were checked by the supervisor and co-supervisor as expert researchers. The emerging categories and sub-categories were saturated and no new themes emerged. Experts contributed by evaluating the model and indicated the transferability of the model to similar situations in nursing education and higher education institutions.

2.10.3 Dependability

Dependability occurs with credibility of a study. Dependability refers to the consistency and is a criterion by which to determine whether the researcher demonstrates credibility and trustworthiness in the findings (Brink et al 2012:173; Cope 2014:89; Streubert & Carpenter 2011:49). Dependability is also referred to as the stability of data and conditions (Polit & Beck 2016:559). If another researcher is transparent and follows the decision trail used in the current study, it confirms dependability (Lichtman 2014:387; Thomas & Magilvy 2011:153). During enquiry audits the documentations, process of investigation, data, findings and interpretations are examined (Brink et al 2012:173). Table 2.1 indicates the activities the researcher applied to enhance dependability.

The dense descriptions of the research methodology and findings ensured dependability. The researcher documented an audit trail, that is, a step-by-step description of how the study was conducted under the close supervision of the supervision of the supervisor and co-supervisor. A co-coder confirmed similar findings as the researcher. The iterative process of coding and constant comparison of themes, codes, categories and sub-categories served as a stepwise replication in the study. Memoing and continuously writing notes during and after the interviews supported dependability. The supervisors as experts and experienced researchers audited the decision trail, research process and findings of the researcher, and verified and approved the methodology, data analysis and interpretation of the research findings.

2.10.4 Confirmability

When credibility, transferability and dependability are established, the research meets confirmability (Thomas & Magilvy 2011:154). Confirmability is established when the data, findings and interpretation are clearly linked (Topping 2006:169) and can be confirmed or corroborated by others (Lichtman 2014:387). Confirmability refers to participants’ responses and not viewpoints of the researcher (Cope 2014:89). In Table 2.1, it can be observed that confirmability includes an audit trail and reflexivity.

The researcher ensured an audit trail and provided rich and in-depth data from the interviews by using quotes of participants in categories and sub-categories. The researcher implemented the set of criteria of Porter (2007:85) to increase confirmability and rigor in this research project:

 Transparency in the process of knowledge generation. The researcher was open for external feedback and reviews from participants and peers.

 The knowledge gained from the research contributed to the knowledge of the teaching and learning environment of nursing education.

 The data and findings presented the codes, categories, sub-categories and the core category in a storyline and model which are easily accessible and understandable.

 The recommendations and model derived from the research were new scientific knowledge in the teaching and learning environment of nursing education.

 The implementation of ethical considerations as discussed in Section 2.11 contributed to the trustworthiness of the study.

Self-reflection on the part of the researcher made the researcher aware of biases and predisposition. The researcher used memoing, reflexivity and bracketing to put all personal feelings and insights aside during the interviews and analysis of the data. The face-to-face and focus group interviews were recorded electronically, transcribed and analysed. There was a conscious effort to exclude personal views and to capture the real views of the educators and students. Thus, records of all activities, evidence and thought processes that led to the final writing up in a story line and model development allowed the production of new insights and therefore confirmability in the study was evident.

2.10.5 Authenticity

Polit and Beck (2016:560) allude to authenticity as the extent to which researchers show a range of realities fairly and faithfully. According to Cope (2014:89), authenticity refers to the ability of the researcher to interpret the emotions and feeling of the participants in a faithful manner. The researcher wrote a story line on the data in the third and fourth chapter, using direct quotes of participants. The presentation in the third, fourth and fifth chapter gave an understanding of what educators and students consider as important for trust, trusting relationships and the importance of trust in nursing education. The process of authenticity allowed the researcher to be critically reflective when data were interpreted.

Table 2.1: Trustworthiness

Strategy Criteria Application by researcher

Credibility Researcher expertise  Self-awareness, clarity, commitment and motivation to complete the research

 Completed a research methodology module  Experiences and exposure to research during

master’s degree studies Methodological

congruence

 Implemented memoing, reflexivity, bracketing and intuiting in the research

 Presentation of finding at a conference Procedural precision  Maintained an audit trail

Strategy Criteria Application by researcher  Managed data and resources  Demonstrated procedural logic Memoing and field

notes

 Mind maps and mapping of activities

 Field notes made on information received in the nursing education environment

Reflexivity  Actively implemented, which involved thinking about experiences and questioning the way of doing

Bracketing  Deliberately ‘bracketed out’ expectations, thoughts, feelings and perceptions

Intuiting  Developed an awareness of the views of the participants

Prolonged engagement in research with a special interest

 Conducted four pilot interviews  Face-to-face interviews conducted  Four years ‘involvement in the research  Member checks and interpretation of data  Conducted 14 face-to-face interviews with

educators

 Conducted 15 focus group interviews with students

Member check  Co-coders’ inputs; supervisor and co- supervisor’s feedbacks

 Co-coder and supervisors verified the themes, codes, categories and sub-categories that emerged

Participant debriefing  Participants viewed the transcribed dialogue and first analysis of the face-to-face and focus group interviews

Interview technique  Practiced and utilised communication skills Peer debriefing  Two pilot interviews to practise interview

techniques

 Two pilot focus group interviews to practise interview techniques with groups

Triangulation  Different data sets namely, the educators and third- and fourth-year students

 Participating educators had bachelor’s, master’s and PHD degrees

 Different NEIs in different geographical areas  Face-to-face interviews with educators  Student focus group interviews

Transferability Representativeness Purposive and

convenience sampling

 Selecting participants with knowledge to contribute to the research

 Educators and students were included  Different NEIs in different geographically

Strategy Criteria Application by researcher

Sampling  Purposive and convenience sampling

 Participants from different NEIs, urban, semi- rural and rural. A university and public multi- campus NEI

Dense description  In-depth interviews ensued in dense description of categories and sub-categories

 The research methodology was explained in detail

 Rich and thick descriptions of sampling and data collection

Data saturation  The categories and sub-categories were saturated and no new themes emerged Contribution of experts  Supervisor and co-supervisor as experts in

research

 Model expert reviewers evaluated the model and agreed to the transferability

Dependability Dense description  Dense description of research methodology Audit trail  Kept a log book and recorded events and

decisions

 Co-coder confirmed similar finding Stepwise replication  Coding and co-coding of data. Members

checked themes, codes, categories and sub- categories

Memoing  Continuous writing of notes during and after the interviews

Inquiry audit  The two supervisors audited the research process and the decision trail, and the research process id described in detail

Dependability occurs with credibility

 The researcher achieved credibility as described above

Confirmability Audit trail  All the stages of the researcher process were audited and reviewed by experts

Reflexivity  Reflective notes were made

Confirmability occurs  Recorded activities and notes on activities until data saturation was reached

Authenticity Expressed the feelings and emotions of the participants

 Utilised quotes in the story line to support the interpretations of feelings and views of the participants

2.11 ETHICAL CONSIDERATIONS

Ethical considerations were an important aspect in the research. The researcher adhered to the basic ethical principles to prevent any discomfort or exposure of participants. Brink et al (2012:35-38) emphasise the importance of implementing ethical

principles such as: autonomy, justice and beneficence and it is described below and presented in Table 2.2.

2.11.1 Autonomy

Autonomy means that the participants and institution have the right to self-determinism and protection, thus individuals and institutions have the right to be fully informed and to withdraw from the research (Brink et al 2012:35). Polit and Beck (2016:140) contend that self-determinism means participants may decide voluntarily whether to participate or not. Self-determinism is the respect for human dignity.

Ethical clearance was obtained from the Higher Degrees Committee, Department of Health Studies at the University of South Africa (HSHDC/114/2012) (Annexure A). Ethical clearance (ECUFS Nr 167/2013) was obtained from the Higher Education Institution too (Annexure B). Permission was obtained from the Free State Department of Health to conduct the research at the three campuses of the public NEI (Annexure C). At the public multi-campus NEI, permission was obtained from the principal of the NEI as well as from the three heads of campuses (Annexures D, E, F and G).

Participants in the study were informed about the aim and purpose of the research (Annexure H). Participation was voluntarily and participants gave consent by signing an agreement of voluntary participation, recording and confidentiality (Annexure I). Participants had the right to withdraw from the research should they feel that they did not want to participate anymore, but nobody withdrew. The participants’ right to privacy and confidentiality was maintained. The participants were not exploited and their anonymity was prioritised. The transcriptions of the interviews were stored in a private place, and no names were attached to the dialogues and quotes used in this or any other report. Participants in the focus group interviews signed and agreed that they would keep the views of other participants confidential. No financial remuneration was given to any person participating in the face-to-face or focus group interviews. The preliminary findings of the categories and sub-categories were made available for member checks and comments. Because the researcher is an assistant manager in one of the three campuses of the public NEI, power differentials were carefully considered. Nobody was forced to participate in the study. The researcher ensured that she acted as researcher and did not take on her management role during the interviews. The

making of field notes of experiences contributed to the researcher taking a reflective