Sample and sampling technique

The population of interest in this study was three specific groups of nurses. The first group consisted of registered nurses that were identified as working in the role of a clinical nurse. The second group consisted of nurse managers with the final group being nurse educators. Clinical nurses are the bedside nurses who care for the patients and constitute the largest proportion of nurses in a hospital. Hospitals are arranged into wards which usually has one nurse manager per ward. Nurse educators usually oversee a number of wards and usually constitute the lowest number proportionally. Accordingly, the target population for this study included registered nurses working in the role of either clinical nurse, nurse managers or educators at the selected hospitals in Riyadh city and who met the eligibility criteria specified in the next section.

The study employed a convenience sample which is widely utilised in quantitative studies. Convenience sampling is a type of non-probability sampling technique that involves using the most available people for participation in the study, and is considered a sampling method that is easy to implement as it is inexpensive and accessible (Polit & Beck, 2008). The overall aim of this type of sample is to achieve good representation of the population, and it is a method of selecting subjects who are available or easy to be accessed and which provides results with minimum cost or time required to select a sample (Panacek & Thompson, 2007). In contrast, random sampling

in clinical research may be difficult to achieve sometimes due to the variation of nurses numbers or inequality of their characteristics or demographics across study hospitals. Furthermore, time, cost and ethical considerations may often limit or sometimes prevent investigators from making the required arrangements, and securing the necessary approvals to access subjects from one or more facilities or professional practices to test a hypothesis. In comparison, the convenience sampling approach enables the researcher to achieve the sample size in a reasonably fast and inexpensive manner.

4.7.1. Inclusion and exclusion criteria

Nurses in the five selected hospitals were invited to be included in the study if they were registered nurses and had a minimum experience of two years in nursing. A minimum of two years of nursing experience was needed to confirm that nurses were successfully oriented to their work including the hospital’s policies, procedures, protocols, and practice guidelines. Non-registered nurses such as nursing students and nurse-assistants were excluded from this study as they were not the focus of this study.

4.7.2. Sample size

To avoid bias and assure representativeness of all study settings, a clustered technique within the sampling strategy was used with the percentages of the samples obtained from each selected hospital decided in accordance with the size and number of total nurses in each hospital. Sample size calculation was not needed because this was a survey. Moreover, in order to obtain a sample size, would need to obtain an estimate of an experimental treatment effect which was not the purpose of this study. All nurses in each hospital were recruited. Accordingly, the sample percentages were 34%, 11%, 8%, 36% and 11% for the King Faisal Research Centre, King Salman Hospital, Al-Yamamah Hospital, King Fahad Medical City, and Prince Mohammed Hospital respectively (Figure 4.1).

Figure 4.1. The percentage distribution of the sample across hospitals 4.7.3. Recruitment and data collection

For the collection of data for this study, the recruitment procedure commenced in June 2015 and was completed in November 2015. After gaining all ethical approvals to conduct the study (described in Section 4.12 in this chapter), the data collection was accomplished as follows:

 Formal letters were sent to nursing directors at the selected five hospitals seeking permission for data collection. A detailed description of the study proposal and copies of the ethics approvals were attached with the formal letters;  The researcher then contacted head nurses in hospital wards and explained the purpose of the study to facilitate meeting the potential participants of the study, as well as providing information about the study. This information included the data collection instruments used, estimated time participants required to complete the questionnaires, and inclusion and exclusion criteria;

 Next, an invitation poster with information as described above was placed on noticeboards in each staff room and staff development departments of the selected hospitals inviting nurses to participate in the study. Also, the

researcher’s contact details were included on the invitation poster for nurses seeking further details about the study;

 Following this, an up-to-date register of all eligible nurses employed in the target hospital wards was obtained from the head nurses of the individual wards;  The researcher also contacted the wards’ head nurses in the selected hospitals

and provided sufficient information about the purposes of the study. Subsequent to this meeting, the head nurses informed the nurses in the different wards about the research and encouraged their participation;

 Research packages including a cover letter, plain language statement and questionnaire, were then left in each ward for distribution;

 Information sessions were also conducted for nurses prior to this to inform them of the research;

 Participants were informed that participation was voluntary. In addition, they were informed about their right to withdraw from the study prior to completing the questions or to refuse to answer any particular question. They were also informed that data would be aggregated and therefore impossible to remove once questionnaire has been submitted;

 Each participant was encouraged prior to the completion of the survey to examine the questionnaire carefully to assist them in their decision as to participation in the study. As the questionnaires were anonymous, informed consent was implied by submission of the completed survey;

 Nurses were asked to return the survey in a stamped, self-addressed envelope that was provided or submit completed questionnaires in a locked return box which was located at the nursing management office for each hospital in the study;

 Nurses who were on leave at the time of data collection were contacted by the main nursing management office for the researcher where possible via email to invite them to participate in the study. The surveys were sent to them electronically (email) or by return mail (two-way paid);

 Nurses were given two weeks to complete and submit the questionnaires in each selected hospital and a reminder was posted on the staff notice board after that time;

 Upon collection, the questionnaires were screened, checked, coded and prepared for analysis.