Phase 1: Part 2 Interviews with Stakeholders

The second part of Phase 1 of the study partly addressed the first objective of the study by interviewing key stakeholders (CT-ICU nurse experts, CT-ICU doctors, patients who received care and their relatives). The exploratory phase informed the development of the clinical guideline. This part is made up of four different interviews and the methods of data collection will be presented separately for each interview. The data collected in the interviews is presented and discussed in Chapter Four.

2.5.2.1 Focus group interviews with ICU nurse experts

The focus group interview method was used to collect data from CT-ICU nurse experts who worked in the research setting. The nurses’ demographic data was collected and they were asked to answer a questionnaire about the analgesics they used in the ICU, then the focus group interview was carried out (Appendix D). The demographic data of the ICU nurse experts who participated in the focus group interview was analysed descriptively and the focus group interviews analysed using the six steps of qualitative analysis by Creswell (2014:197) and coding using the eight steps of Tesch (1990 in Creswell, 2014:198).

2.5.2.2 Research design and method

• Research design

The exploratory, descriptive, qualitative design was used to elicit the views and opinions of nurse experts on pain, its assessment and treatment in the CT-ICU.

• Research method Population

According to the statistics obtained from the CT-ICU, there are 17 (n=17) full time registered nurses who work in the six-bed unit. Out of this number, 14 (n=14) are trained and certified by the Nursing and Midwifery Council of Ghana as critical care nurses.

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Sample and Sampling Method

Of the 14 full-time ICU nurses who work in the unit, 12 (n=12) were purposively sampled with their consent and included in two focus group interviews with six (n=6) in each focus group. Purposive sampling is the researcher’s intentional choice of individuals or groups of people who will assist in the study (Polit & Beck, 2012). The researchers earlier described it as a method of sampling in which “participants are handpicked for inclusion in the sample, based on the researcher’s knowledge about the population” (Polit & Beck, 2004:311).

Nurses were recruited with the help of a gatekeeper (nurse manager), who are individuals who provide access to the site and allow or permit the research to be done (Creswell, 2014:188). It is important to gain access to a research site by seeking the approval of gatekeepers (Creswell, 2014:188). Each nurse included in the study had worked in the CT- ICU for at least three years. ICU nurses on leave or off duty were also invited.

Inclusion criteria

Inclusion criteria are a set of characteristics that are predefined and used to identify subjects who will be included in a research study (Salkind, 2010).

• Registered nurses with ICU training and certification by the Nurses and Midwives’ Council of Ghana.

• ICU nurses who have practiced in the ICU for at least three years. • ICU nurses on day or night shifts.

Data Collection Procedure

Two focus group interviews were conducted with two groups of CT-ICU nurse experts with six nurses (n=6) using an interview guide (Appendix D). A focus group interview is a validated method of qualitative data collection and involves a group of six to 12 individuals usually brought together in a room to engage in a guided discussion on a selected topic (Crossman, 2014). Sullivan and Foltz (2000) found there are positive aspects to using focus groups for collecting data in nursing research, as participants gain support and acceptance as they share their attitudes and beliefs. According to Asbury (1995), exploration of health-

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related topics from a specific population of interest, using the focus group design, can be an effective method to validate experiences. Goss (1998) found that focus group design is an appropriate method for exploring and validating beliefs, thoughts, and intentions of individuals.

Written permission (Appendices E & F) was obtained from the management of the hospital (nursing and medical) with the consent of the medical and nursing directors of the CT-ICU. Permission was also obtained from the nurses and doctors managing the CT-ICU to undertake the data collection in the unit. The two focus group interviews with six (n=6) nurse experts each were carried out to determine the nurses’ opinion of their pain management practices in the CT-ICU and how they can be improved. The focus groups were carried out within one week of each other. Twelve (n=12) nurse experts with more than three years of experience in the CT-ICU were purposively sampled and participated in the focus groups.

The researcher made several trips to the hospital, specifically the CT-ICU, to personally inform the nurses about the focus groups and answer all questions with the help of the gatekeeper (Nurse Manager). Goss (1998) stated that one of the principal concepts to consider is the identification of a contact person from the population of interest to the researcher. This person is usually valuable in helping to establish trust within the population, encouraging participation and identifying an appropriate time and venue for the study.

Nurses who were not available during the visits of the researcher were informed by telephone about the focus groups and their purpose. A time convenient for the nurses was also agreed upon days before the interview. The nurse’s information sheet (Appendix G) was made available to nurses who agreed to take part in the focus group; they were then asked to complete a form with their demographic data (Appendix D), and the interview was conducted using the interview guide in Appendix D. Each ICU nurse was allocated a research code to ensure anonymity. Participation was confirmed a day before the focus group by phone. All the nurses were invited, including those who were on leave and off duty. The interviews were organised in the afternoon so those who were on morning shift could join after their shift. The researcher tape-recorded the interviews and took notes. Refreshment was offered during and after the interview but no other incentive was given.

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Ten (n=10) nurses agreed to take part in the first focus group, but only six (n=6) made it and the other four (n=4) joined the second focus group. The first interview was carried out in the conference room of the hospital with the permission of the Nursing Director of the Cardiothoracic Centre. The researcher and an assistant arrived before the time agreed for the interview to prepare the venue. As the nurses arrived they were welcomed, given seats and asked to read the information sheet again, sign the consent form (Appendix H) and complete their demographic data before the discussion.

Six (n=6) nurses took part in the second focus group which took place a week after the first focus group in the conference room with permission. As the nurses arrived they were welcomed, asked to complete a form with their demographic data and sign a consent form after reading the information letter before the discussion. The interview was tape-recorded and notes were taken as part of the data collection.

Nurses were asked their opinion regarding the management of pain in the CT-ICU as the main question. Probes were then introduced to get a better understanding of their opinions. Six probes in all were introduced regarding their views and opinions about pain management in the CT-ICU (Appendix D).

2.5.2.3 Data Analysis

After the two focus groups, it was seen that nurses in both groups had similar opinions about pain, its assessment and treatment in the CT- ICU and no new information emerged, thus data saturation was achieved (Charmaz, 2006). After the first focus group discussion, verbatim transcription of the tape was carried out to understand the issues raised by the nurses and to prepare for the second interview and data analysis. In qualitative studies, data collection and data analysis occur simultaneously (De Vos, Strydom, Fouche, Delport, 2011). Verbatim transcription was again done following the second interview to organise and prepare the data for analysis (Creswell, 2014). After transcribing each interview, the researcher checked for accuracy by listening to the tape while reading the transcripts to make necessary corrections (Kvale, 2009). The recordings were listened to repeatedly until the researcher was sure all statements were transcribed as stated by the nurses. The transcribed data were also compared to the field notes to ensure that all notes taken during the interview were captured. Data analysis was done by employing the six steps of qualitative analysis by

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Creswell (2014: I97) and coding using the eight steps of Tesch (1990:142-145 in Creswell, 2014:198). According to Creswell (2014:197), the following steps must be applied in qualitative data analysis:

Step 1 – Organise and get the data ready for analysis. This involves transcribing interviews, scanning material if necessary, typing of field notes, cataloguing all the audio and visual materials and also sorting and arranging the data into different types of format depending on the sources of information. This was done by the researcher by ensuring that the interviews and field notes were typed, transcripts were accurate and printed out.

Step 2 – Look through and read all the data. This provides an overview of the information