Reflexivity

This section presents my experience, beliefs, values, position and perspectives during the data collection process that may shape or effect the research method. Indeed, these factors are considered important issues in all research types, but particularly in qualitative research. To ensure that I am aware of my own influence on the research process I developed a reflexive journal (Appendix 5.13), a type of personal diary where I made regular entries during the research process, specifically highlighting those whereby I can take any necessary action (Guba & Lincoln, 1994). For example, in the documentary analysis phase, I faced a lot of difficulty in analysing the documents, as the documents were in the original professional Arabic language that contained certain words with a broader meaning. I could not use the NVivo programme in this phase because of the language. Therefore, I tried to search for a framework to analyse the documents. I found that the documentary analysis guidelines were the best to guide me to reach, select, and analyse these documents (Prior, 1974). Analysing documents was time consuming, and for me was the worst stage of this study. I read the documents many times, and every time I discovered something significant to the research aim. On the other hand, this stage made me more confident, knowledgeable and oriented to the whole system and process of policy implementation.

Throughout the data collection process, a number of elements were kept consistent in the three levels (macro, meso and micro), such as the importance of confidentiality (Section 4.9), achieved through coding, and ensuring that all participants in the interviews and focus groups for each level were comfortable within the discussion environment. Creswell (2013) described an insider researcher as one who is part of the social group they are studying. Being an insider researcher can have several advantages, such as: a greater understanding of the culture being studied; not altering the flow of social interaction

127 unnaturally; promoting a rapport with interviewees, access and ethics; knowing how to ask for and where to gather data; having empathy for the interviewees’ perspective as suggested by researchers (Stake, 2003; Merriam, 2009a; Yin, 2009; Creswell, 2013). However, there are also some disadvantages of the insider role that have the potential to impact on the trustworthiness of the findings. For example, as an ‘insider researcher’ in the macro and meso levels, I was aware that decision makers and regional directors may respond to me in my other roles; as a ‘colleague’ of those participants who were decision makers at the macro level and as a ‘director’ to the meso level participants. During the interviews, some participants asked for encouragement that they were saying the right things and I had to offer them reassurance that I was not looking for a particular answer, only their opinions on the subject matter. Meso level participants looked uncomfortable during pauses and expressed their desire to help me as much as possible to obtain the adequate data.

Participants at the meso level frequently said ‘as you know’ as they knew I was aware of their issues, which shows the problem of assuming understanding in this situation of familiarity in the research field. The frequency of this phrase was especially apparent when I reviewed the verbatim transcripts. (Miles et al., 2014) points out the problem associated with taken-for-granted perspective and difficulties with critically examining something that can appear self-evident. I was aware of the need to counteract any assumption made on my behalf, so I responded to this comment by asking the participant to explain what they meant. I was very conscious to view the participants’ responses as objectively as possible by not assuming understanding, questioning phrases and comments, interpreting the comments correctly and thinking about all the possible interpretations.

In the micro level focus group, I was partly an insider researcher by virtue of my role as a director, and an outsider researcher as I was not employed in the hospital and did not know any of the participants (staff nurses with Diplomas and Bachelor’s degrees). This insider/outsider role was helpful as it allowed the benefits of insider status but the limitations of the researcher/participant relationship were easier to retain. In this situation, participants would possibly not have perceived any internal risk to revealing detailed information about the organisation, even if this was negative. I was able to focus on being predominantly a researcher in this environment, as I did not have the responsibility of a director.

128 As a confident and organised interviewer, I was able to quickly build a trusting relationship with the participants and put them at ease, giving them the time and opportunity to express their views. This is consistent with the interpretivist perspective, based on the interaction between myself as a researcher and the participant (Polit & Beck, 2013). I was conscious of my influence on this interaction, especially in terms of influencing the flow of the interview by being interested in some of their comments more than others, thus leading the interview in a certain direction.

In order to ensure that the participants had the freedom to respond without adverse influence, the interview schedule began with some introductory questions about their views on degree education as a minimum requirement to enter practice before asking key questions. The semi-structured interview allowed the participants to identify and discuss their response freely while I continued to be aware of the potential for me to direct the conversation. In addition, I sought confirmation of my interpretations of interview data throughout the interview, and at the end of the interview, I summarised key points and asked the interviewees to add any related information. I was open-minded about issues raised and probed for further information in order to fully understand the significant information each interviewee possessed.

The interpretation of the data was affected by the connections made between the data within each level and across levels and involved comparing and contrasting data for similarities and differences. The differences were delicate and sometimes difficult to extract, but important information is explained in the findings. For example, the participants at the micro and meso levels expressed mixed opinions about the importance of degree education as a minimum requirement to enter practice as a professional nurse. These could have been negatively influenced considering that some of them were Diploma-educated nurses and could not take a degree due to many factors such as age, limited places on the programme, and requirements for high scores in English test (IELTS). On the other hand, macro level participants, like governors, opposed the views of micro and meso level participants, claiming that there were no obstacles to join the programmes. As a researcher, I am aware of the importance of being highly alert to subtle aspects of data, to make these clear and to adapt to collecting data from different people functioning at different levels and from different areas of the country in order to portray a holistic view in the study.

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5.7

Summary and Conclusion

This chapter has discussed the data collection protocol for three levels of the framework (four phases), detailing the sampling, data collection procedure, and data analysis of each group within the MoH (macro, meso and micro levels). The documentary analysis (phase one) has been used to gain more information from the documents of the GCC nursing committee about the policy to introducing degree education as a requirement for qualified nurse’s in SA, to critically assess the implications of this policy and to determine a baseline from which to develop a national nursing strategy for future workforce planning. The face-to-face interviews with macro level (phase two) participants has been undertaken with a sample of decision makers at the MoH to understand their perspectives of the influence of the degree education policy on nursing workforce planning and development. The meso level data collection (phase three) has been conducted with one focus group to determine the views of a sample of practising nurses at the middle management/meso levels of nursing practice, regarding the influence of degree entry requirements on nursing workforce planning. The micro level data collection (phase four) has been undertaken within the frontline/micro level people engaged in nursing practice, regarding degree education as a minimum requirement for entry to the nursing profession and a meticulous explanation of the data transcription and analysis is given.

Using documentary analysis in combination with interview techniques allowed me, as a researcher, to gain in-depth and rich information about the situation under study (Creswell, 2013; Merriam, 2009a; Yin, 2009; Stake, 2003). Finally, the chapter concluded with my personal reflections throughout the data collection process.

The next chapter presents the results of documentary analysis summarised in three important thematic categories evident across all documents analysed, from which common sub-themes were revealed in the data related to each category.

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