Chapter 3: Methodology and Method 3.1 Introduction
3.3 Study Design
This section discusses the design of the study which used semi-structured interviews as the method of data collection. Data were subsequently transcribed and analysed using Template Analysis (e.g. King, 2012) which will be discussed in more depth in section 3.4.
3.3.1 Study setting
A local mental health NHS Foundation Trust kindly supported this study in terms of agreeing the process and allowed access to the mental health nurses who took part. The NHS Trust provides specialist inpatient and community mental health and learning disability services including medium secure care. It covers a large geographical area which has both rural and urban settings where over a million people reside and it extends its regional forensic services to a large geographical region. Over 4000 people are currently employed by the Trust and this includes many qualified mental health nurses (SWYFT, 2015).
The diverse characteristics and size of the Trust as an organisation means the potential sample included mental health nurses from diverse populations. The sample was restricted to mental health nurses caring for working-age adults but covered rural and urban communities including inpatient and forensic services. This NHS Trust was approached as the source of recruitment as its mental health nurses were more likely to be representative of the whole population of mental health nurses working in adult care than specialist or private providers.
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3.3.2 Participants and recruitment
3.3.2.1 How many is enough?
Early career and even some experienced academics wonder ‘how many is enough’ when embarking on an interview study, yet there is no decisive formula of calculating ‘how many’ (Mason, 2010). Most experienced researchers if asked, would advise; it depends upon the theoretical perspective, time, context, what is being researched and practicalities. Resource implications such as finance and supervision opportunities also influence what may be an appropriate size for an individual study (Guest et al., 2006).
Notions of data ‘saturation’ can be problematic in relation to qualitative research (If we are focused on personal meaning, how is it ever possible to ‘know’ that we have indeed exhausted all possibilities, that another individual might not have something different to contribute? If we acknowledge, even welcome, subjectivity then how can we claim any researcher’s analysis is ‘final’ and confidently assert we have achieved ‘saturation’?) Nonetheless, the guiding principle for qualitative interviews is often saturation level where it is assumed once no new information is arising no further participants are needed (Mason, 2010). Creswell (1998) is more specific and recommends five to twenty-five participants for quality semi-structured interviews. Bryman (2001) however suggests it is impossible to identify a specific number of interviews at the onset of a qualitative study as data quality can affect a sample size. If participants are engaged, reflective and can communicate effectively, ‘saturation’ may be achieved with a smaller sample. The skill of the researcher may also determine the value of the interview as an experienced researcher will likely be more skilled at being able to put a participant at ease and teasing out valuable information or encouraging a participant to open up. The richness of data obtained and the depth of subsequent analysis may be more meaningful considerations in relation to assessing the quality of a qualitative study than particular sample size or saturation stipulations. Findings presented in this thesis come from in-depth interviews with seventeen participants which were analysed in depth: this process will be described in full in the remainder of this chapter.
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3.3.2.2 Recruitment
When considering the appropriateness of the participants only qualified mental health nurses who had current direct contact with service users were felt to be appropriate. Many qualified mental health nurses have a managerial or leadership role which removes them from direct contact with service users and as a result could only have discussed their historical approaches. This might have affected the results of a study intended to focus on how mental health nurses currently cared for spiritual needs of service users. That said, historical recollections might be considered appropriate if a participant describes how these have influenced their approach in the ‘here and now.’ Inclusion criteria for the study therefore specified that participants should be qualified mental health nurses from the NHS Trust who had contact with service users. Exclusion criteria specified that (1) qualified mental health nurses, who did not have contact with service users; (2) those who were not qualified mental health nurses; and (3) any eligible person who did not wish to participate.
The research sample formed part of a professional doctorate. Whilst the NHS Trust was supportive in agreeing access to potential participants, the access was time restricted to a six-month period. Following email invitations (see Appendix 2) a total of twenty-two people responded in this timescale. One of the people who responded did not meet the essential criteria because although they were a qualified nurse working in mental health, their qualification was primarily in learning disabilities. Two other respondents arranged an interview then subsequently changed their mind and cancelled. A further two responded initially but then did not take up the opportunity to participate with an interview at all.
3.3.2.3 Participants
A total of seventeen participants took part in the study: ten female and seven male participants across a range of working age brackets. They ranged from the youngest and most recently qualified nurses in their early twenties to two of the oldest participants in the 60’s age bracket, one of whom was preparing for retirement. The clinical background and experience of the participants varied including geographical location of
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where the participant worked, clinical specialism and experience. The nurses provided care from a variety of geographical locations which included semi-rural community mental health services where the service users were mainly from a white British origin. Nurses in other areas provided care in inner city or densely populated community and inpatient services where the services users represented a more culturally diverse population.
The background of the participants was equally diverse in terms of their clinical experience with many of them having several years’ experience in a variety of clinical settings. Further to this many of the participants’ previous experience in other clinical areas added valuable historical information within the interviews. All the participants were white with none who identified themselves as being from a diverse or minority background. All participants have been allocated pseudonyms which are used throughout.
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