Micro Level (Phase Four): Focus Groups

This was the last phase of data collection (Section 4.6.1). I collected data at the micro level, looking at information from the nurses who worked directly with patients in hospitals and PHCs, and those who had been most affected by the introduction of the

122 policy (Caldwell & Mays, 2012).

5.5.1

Sampling and Recruitment

Focus group discussions were used to identify constructs of the issue under investigation. Focus groups reflect the epistemological commitment to a people-centred design that focuses on the importance of understanding how people think about the world and their subsequent actions (Morgan, 1997). This epistemology is of relevance to the degree education policy that requires a bachelor’s degree as a minimum requirement for entry into practice in relation to the health organisational system. At level, three focus group discussions were conducted at King Saud Medical City (KSMC) to allow sufficient exploration of the phenomena. Focus group studies frequently depend on purposive sampling wherein participants are chosen based on the objectives of the study. By using purposive sampling, I was able to place them in specific focus groups according to their professional roles and allied with their individual perspectives to link the points made in the groups’ discussion as suggested by Krueger & Casey (2015). The use of explicit placements in specific groups for the purposes of this study enabled a more consistent group discussion, thus endorsing meaningful deliberations as opposed to heated discussions (Teddlie & Tashakkori, 2010). Focus groups may comprise eight to twelve members for each group as recommended by (Billson, 2005). nurses autonomy (Varjus et al., 2011).

In this phase, three focus group discussions were conducted to allow sufficient exploration of the research topic. Conducting more than one focus group discussion has the potential to enhance the reliability of data by detecting a consensus across the different groups (Morgan, 1997). The first focus group included a purposive sample of three nurse managers of the three hospitals and one nurse educator. All were invited by email, and received the PIS and consent form (Appendix 5.11 & Appendix 5.12 respectively). The second and third focus groups included purposive random sampling of four staff nurses with bachelor’s degrees and four staff nurses with a Diploma, who were invited to participate by use of a poster covering the inclusion criteria for the study (Appendix 5.13). The sample was achieved on a first-come, first-served basis, with a reserve list established in case anyone withdrew at a later date. The total sample size for this level was twelve participants divided into three focus groups. Finally, the place, date and time for the three

123 focus groups were arranged and the information was given to participants in good time to enable them to attend.

A purposive strategy was used for all groups. Six nurse managers from three hospitals and one nurse educator attended the focus group discussion. The second and third groups included eight participants in total. The purposive random sampling strategy was used because the staff nurses working in the clinical area of KSMC represented a large number of healthcare providers with different levels of nursing education and experience. It was difficult to invite them by their name or job title because they were all staff nurses; the poster inviting them was placed in each nursing department. This helped the researcher to focus on a sample of the nursing population, both Diploma and degree educated nurses, with the inclusion criteria (Section 4.6.1). According to Patton (1990), purposive random sampling is small in size, which adds credibility to the sample when the potential purposive sample is large. The eight participants were divided into two focus groups; four of them were Bachelor’s degree nurses and four were Diploma holders, and involving them in discussion enabled the participants to talk freely about the topic. Furthermore, focus group experts commend the use of several different groupings based on characteristics such as the level of education (Morgan, 1997; Krueger & Casey, 2015). This number was still in keeping with good practice for focus groups that can work effectively, with as few as 3 or as many as 14 participants being recommended by Gill et al. (2008).

5.5.2

Data Collection Procedure

After permission was obtained from the MoH, I contacted the hospital Director of KSMC to gain their permission to access the hospitals. The Director referred me to the Nursing Director Office in KSMC with a letter of permission to conduct the interviews and facilitate the necessary arrangements. The Nursing Director assigned one nurse as Assistant Moderator (AM) for the researcher and this nurse made the practical arrangements for conducting the focus group discussions..

The three focus group discussions took place within the interviewees’ working day and lasted between 90 and 120 minutes. At the beginning of each focus group discussion, the researcher welcomed and thanked the interviewees for their involvement and introduced herself to them. The aim of the research study was explained. Each focus group discussion

124 was audio-recorded with the consent of the participants to aid accurate transcription. The audio recorder was placed in the centre of the round table to enable the sound to be recorded clearly. The confidential nature of data recording was explained in Section 5.4. Two moderators (See Table 5.3) facilitated the groups. The skills of the moderators are vital to the effectiveness of focus groups (Billson, 2005). The semi-structured technique was guided by five prepared combination types of questions (Appendix 5.9) as suggested by Krueger and Casey (2015). Opening questions were used to enable participants to feel comfortable and talk freely. For example, at the beginning of the discussion, the participants were asked to introduce themselves and their background experience. Then, introductory questions were used to get participants to focus on the topic and to start thinking. For example, I asked them about their educational pathway as registered nurses. Transition questions were used to provide links between the previous questions and the key questions. For example, I asked them about their opinions regarding the minimum requirement of a degree for entry to practise as a registered nurse. These questions guided me to the key questions that focused on the major areas of the research study. At the end, I asked them about any recommendations they would like to add in order to bring the session to a close. During the data collection process, I was able to explore the rich description in order to capture strength, direction and the inter-relationships of the influential elements relating to the research questions. This process provided context to the participants’ perceptions of how sustainability initiatives impact their engagement (Creswell 2013). The moderator debriefed participants at the end of the focus group discussion. It was important to allow sufficient time for participants to raise concerns and to make sure they had the contact details of the researcher. Again, the session was concluded and summarised and I thanked them for their participation by distributing an appreciation letter.

5.5.3

Data Analysis

All the recorded audio data obtained from the three focus groups were saved on my computer as audio files. The recorded interviews were transcribed into printed text using Microsoft Word documents. The oral conversation was transcribed verbatim and included repetition, silence and pauses. For classification purposes, I gave codes for each participant

125 within the micro level which matched the inclusion criteria (Section 4.6.1) for each group as follows:

Group One include Seven participants including senior nurse managers and educators were given different codes to ensure anonymity as illustrated in Table 5-5.

Table 5-5: Group one (nurse managers and nurse educators).

Position No Nationality Given code

Senior Nurse 1 Saudi SN1

Senior Nurse 1 Saudi SN2

Senior Nurse 1 Non-Saudi SN3

Senior Nurse 1 Saudi SN4

Senior Nurse 1 Non-Saudi SN5

Senior Nurse 1 Non- Saudi SN6

Senior Nurse 1 Saudi SN7

Group Two include four staff nurses with a Bachelor’s degree were given different codes as illustrated in Table 5-6.

Table 5-6: Group two (staff nurses with Bachelor degrees).

Position No Qualification Given code Junior Nurse 1 Bachelor’s degree JNB1 Junior Nurse 1 Bachelor’s degree JNB2 Junior Nurse 1 Bachelor’s degree JNB3 Junior Nurse 1 Bachelor’s degree JNB4

Group Three included four staff nurses with Diploma education, and they were given different codes as illustrated in Table 5-7.

Table 5-7: Group three (staff nurses with Diploma).

Position No Qualification Given code Junior Nurse 1 Nursing Diploma JND5 Junior Nurse 1 Nursing Diploma JND6 Junior Nurse 1 Nursing Diploma JND7

126 Each group included classifications that matched the inclusion criteria for that group. Moreover, transcriptions for the three focus groups were saved in a micro level database in an organised manner and uploaded to NVivo qualitative analysis software for content analysis, which followed the open-coding process (Hilal & Alabri, 2013; Zhang & Wildemuth, 2009), explained previously in the macro level analysis (Section 5.3.3). The results and discussion of the interviews and focus groups are presented in Chapter 7.