Interviews commenced during the third month of data collection (See Appendix 9a, 9bi, 9bii, 9c). This time period allowed relationships to build with participants and allowed time to reduce anxiety about the study. This was important because by the time interviews commenced, some nurses had relaxed in my presence, which enabled them to feel they could share information about their concerns and difficulties experienced with infection control practice. However building trust and rapport was ongoing as new nurses were met at different stages of data collection, for example, some returned to the ward from leave. Some nurses
consented to an interview many months into the field work and confided that they had perceived my presence as a threat, because it involved the investigation of practice. Some nurses perceived that it was a management strategy with the intention of reducing the number of nurses on the ward.
Participants were chosen for interview because they had experience of the phenomena under investigation. The characteristics of the staff population were considered to ensure a range of roles, professional groups, hierarchy, gender and number of years in post, as these factors may influence their perceptions. Interviews were only carried out with participants who had given their written consent. Verbal consent was also re-negotiated. A total of 40 staff interviews were completed. Interviews were also undertaken with 8 patients and 1 visitor (See Summary of Data Collected p.135). All participants that took part in the study gave their time generously.
Agreement was made with the ward manager that a side room outside the ward could be used for the purpose of interviewing. This room was used for the majority of the interviews. Sometimes it was not possible to use the room as it was used for meetings. When the room was unavailable, the ward office was used, if it was available. This room was difficult to conduct interviews in as there were often disruptions from people entering to use the computer. On one occasion, a nurse was interviewed in the corner of the ward, as she was continually monitoring a patient and there was no cover. This was not ideal as the
ward was noisy due to machine alarms sounding, the nurse was interrupted by other nurses and the interview was carried out quietly, as other patients were close by. Staff rooms were occasionally used for interviews, which was difficult as the interview had to be stopped and re-started as people entered and left. Interviews with patients and visitors were conducted by the bedside or in the day room.
Fitting in interviews with staff was problematic due to their busy schedules. The ward manager gave permission for staff to be interviewed during their shift as long as work commitments permitted and other nurses gave their permission that they could manage for a short while. It was perceived to be unfair to expect nurses to be interviewed after their 12 hour shift had ended, as they were often mentally and physically exhausted. Some nurses chose to be interviewed at the start of their shift and a few nurses offered to be interviewed during their break. The best time for interviewing nurses during a day shift was often between 2 - 3pm, and between 1 - 2 am during a night shift, as these appeared to be the quietest times. Doctors and ancillary staff were interviewed on the ward and usually appointments were made to fit in with their schedules. Waiting for staff and rescheduling appointments was common practice and needed a great deal of energy and persistence.
On one occasion the ward manager prohibited an interview being carried out, even though the nurse said she had completed her work and the ward was quiet. This nurse had said to me afterwards‘‘see, I told you she wouldn’t let you talk to me.’’
On another occasion the ward manager sent another nurse to the interview room and requested the nurse to return to the ward. The interview was cut short after twenty minutes and had been particularly interesting. The nurse was later asked if she would like to continue with the interview another time, however she declined. On reflection, this may have been a way of the ward manager preventing certain people from expressing their views. A strategy developed to overcome the ward manager obstructing data collection was to find out which area she was working on, and collect data from the opposite ward.
Interviewing patients was much easier as they were often glad to have someone to talk to. Interviews with patients were arranged to fit around physiotherapy, meal times and visiting hours. Only one patient who had suffered from C.difficile infection was interviewed, although eight patients were interviewed in total. The difficulties with interviewing such patients were many. For example, patients were extremely unwell or dying. Some patients died. Other patients were moved to a different ward or a care home between the researcher’s hospital visits. Sometimes information about patients infected with C.difficile was not communicated to the researcher.
Only one visitor was interviewed and she was the wife of a patient who had recovered from C.difficile infection. This case was unusual as the visitor was involved with caring for the patient on the ward. The interview took place during visiting hours with the patient at the bedside. Attempting to obtain interviews
with visitors was fraught with difficulties. Several visitors declined attempts to talk to them once the word ‘study’ was mentioned. This is understandable as patients on the ward were extremely ill and their time on the ward with the patient was valuable.
At the start of each interview, a few minutes was given to introductions, to explain the purpose of the study and the interview format. The purpose was to set the scene and relax the participant. Sometimes nurses and doctors would take coffee into the interview room which made the atmosphere more relaxing. Interviews lasted from 20 to 60 minutes. All participants consented to interviews being tape- recorded. General information was noted about each interviewee, to contextualise the answers given. For staff this included age, gender, role, number of hours worked and number of years employed. A note was made of each patients age, gender and whether currently infected with a healthcare-associated infection. Patients with infection were not approached unless they had already been informed by hospital staff of their condition which made them eligible.
Staff interviewees were presented with one key question asking what is it like trying to manage infections such as C.difficile on the ward. A series of open questions were used as prompts to allow the participant to provide a deeper response (Bryman, 2008). Care was given to being sensitive to using the person’s own language when framing questions (Krueger, 1994). Every effort was made to practice good listening skills and not to lead the conversation (Denscombe, 2003),
yet sometimes it felt difficult knowing to what extent the interviewer should become part of the conversation. As an extended period of time was spent on the ward and due to the closeness of work with nurses it was difficult to become completely detached from ward life. Some nurses occasionally asked questions during the interview to obtain a reaction to matters that were raised in relation to constraints to practice. Where this happened, every effort was taken to empathise with the difficulties they experienced without giving judgement. This opportunity was used to probe further, to find out what if any effect the constraint was having on them and their practice. During interviews, if participants appeared uncomfortable, anxious or hesitant and/or their reactions or body language suggested that a sensitive area had been touched, no further probing was undertaken. This happened in one particular instance where a nurse slipped out in conversation that he/she was an asymptomatic carrier for C.difficile infection. Embarrassment was sensed and no further questions were asked in relation to this. At the end of each interview, participants were given the opportunity to ask questions and thanked for their time and co-operation.