Sampling and recruitment Sample selection

Participants were chosen using the principles of Grounded Theory theoretical sampling (Strauss and Corbin, 1990). This process commenced with a sample of student nurses who were selected because they had all received similar training in oral care during their training and had recently undertaken their first placements in hospital wards. Data emerging from the first focus group were considered systematically in accordance with this version of Grounded Theory. Data were examined for context and phenomena and questions were generated from these data, these questions were then used to inform sample selection for each subsequent group. This process continued until no new themes emerged; the theoretical process for this is outlined in Figure 2.1. The selected sample included student nurses, qualified nurses from both medical and surgical wards and student

hygienists. The sampling process and sample used in the study is described in Table 2.1.

Figure 2.1 Illustration of the theoretical sampling process used in the study, based on Strauss and Corbin (1990)

Table 2.1 Illustration of the theoretical sampling process, group features, sample description and justification of sample

Group

Features of Group Description of

participants in sample

Brief justification of sample and procedures Procedures

1 Number of Participants:5 All female

Age 20-50

Relationships: Knew each other through course of study

Student nurses year 1, from a single University

All had undertaken first placement on ward (this sample included students who had experience of working as care assistants)

Initial sample to examine range of responses to oral care in a cohort of student nurses with similar background and training experience. Further group in the same cohort selected for next sample.

5 questions 10 probes used 2 Number involved: 5 All female Age 20-40

Relationships: Knew each other through course of study

Student nurses year 1, From same population frame as group 1, all had undertaken first placement on ward (this sample included students who had experience of working as care assistants)

Second sample from same cohort to understand which responses were similar, which were new and which were not similar to the previous group. Procedure adjusted to use more probes for further detail. Absence of male participants noted

Further group containing more male participants in the same/ similar cohort selected for next sample.

5 questions 17 probes

3 Number involved: 3 2 male 1 female Age 20-45

Relationships: Knew each other through course of study

Student nurses from a cohort of student nurses 6 months ahead of the sample in group 1 and 2 (this sample included students who had experience of working as care assistants)

Predominantly male group in similar cohort to previous groups to examine similarities and differences in responses. To reduce missing data, at the end of the focus group participants were invited to give further comments. To reduce errors in analysis participants were invited to respond to a summary from the researcher.

As a student nurses’ role in care role appeared to be important for emotions, a sample student hygienists was selected to better understand which responses related to being a nurse or student nurse. This was to understand whether student nurses were fundamentally different to hygienists in their perceptions, roles and emotions. It was also to see student nurses and hygienists if they dealt with their emotions towards oral care in the same way.

6 questions 11 probes

Table 2.1 Illustration of the theoretical sampling process, group features, sample description and justification of sample

Group Features of Group Description of

participant sample

Brief justification of sample and procedures Procedures

4 Number involved: 4 1 male 3 female Age 18-30

Relationships: Knew each other through course

Student hygienists in the second year of study with experience of working as a hygienist on clinics and providing oral hygiene care and treatment for over a year.

Student hygienists were selected as a comparison group in order examine differences and similarities in responses with the previous groups. This was to understand why hygienists could and did carry out oral care whereas student nurses’ did not always do this. The selected student hygienists were at a similar stage of training to the student nurses in the study. Two questions not asked, as question generated automatically by participants in discussion.

Experience raised by both student nurses and hygienists, qualified nurses with experience of care selected to help understand how experience does and does not influence emotions and care.

Questions 4 Probes 24

5 Number involved: 7 With an 8th arriving during the group. Age 30-50

Knew each other well

Experienced qualified nurses from multidisciplinary backgrounds. With experience of an with an expressed role in oral care

Group to explore the responses of in qualified nurses with more, experience (higher grades) to see whether the themes were consistent with students or if new themes were generated. Probes used for more detail but questions answered automatically by participants.

A second group in a cohort of qualified nurses who worked on the wards selected to help examine and understand findings from previous group.

3 questions 10 probes

6 Number involved:10 Age 25-55

All female.

Some of the group knew each other.

Experienced qualified nurses of a multi- disciplinary background

Group to explore the responses of in qualified nurses with experience (mid and low grades) to see whether the themes were consistent with students or experienced nurses. This was to test the emerging theoretical model. The group was larger than ideal and shorter in duration to space being made available on a study day for this group. The conduct was the same as previously. No new themes emerged.

A second group of hygienists was selected to help examine and understand findings from previous group of student hygienists.

6 questions 15 probes

Table 2.1 Illustration of the theoretical sampling process, group features, sample description and justification of sample

Group Features of Group Description of

participant sample

Brief justification of sample and procedures Procedures

7 Number involved: 4 All female.

Knew each other well

Student hygienists Group recruited to compare and confirm themes with the student hygienists in the previous hygienist group. Also to compare student hygienists to qualified nurses and student nurses. This was to allow further exploration of individuals who have an explicit recognised role within the mouth. No new themes emerged. A group of intensive care nurses was then selected to test the theoretical model because they deal with totally dependent patients.

6 questions 6 probes

8 Number involved: 2 All female. Knew each other well

Qualified ITU nurses This group was smaller than previous groups as one of the participants was unable to attend on the day. Conduct remained consistent, maintaining the end question inviting comments. No new themes emerged.

5 questions 10 probes

Recruitment of participants

Networks to conduct the research were established with nurses at the University of Glamorgan and Cardiff and Vale NHS Hospitals Trust. Staff at each site provided assistance with identifying times and places to invite participants and with booking suitable rooms for focus groups.

The first stage of recruitment was undertaken at Glamorgan University. A verbal invitation was issued to the first year student nurses at the end of a lecture. Participant information sheets (Appendix 2.3) including a copy of the consent form were distributed. Students were invited to ask questions as a group or individually after the announcement; details were provided to allow further information to be obtained if required. Volunteers provided a contact number or e-mail address that was used to confirm the date and venue for the focus group and the receipt of participant information. Contact details were managed as confidential data. These procedures were also followed for student hygienists within Cardiff University School of Dentistry.

In Cardiff and Vale Hospital NHS Trust, two research nurses identified groups of qualified nurses, issued invitations to participate and distributed participant information. Two groups of nurses with pre-arranged meetings agreed to participate. One further group was convened at a later date. Informed consent was obtained and recorded for all participants.

2.3.2. Data collection and preparation