The purpose of the second phase of the study was to gather preliminary data from mental health nurses currently working under the MHNIP through semi structured interviews about their current role and scope of practice in general practice under the MHNIP. There was an exclusion criterion set for the MHN participation. The interviews were limited to MHNs that worked in general practice and those that worked with private psychiatrists were excluded from the study.
Sampling and recruitment for Phase 2
The establishment in July 2007 of the Australian Government MHNIP created a new cohort of mental health nurses in Australia, i.e. mental health nurses in general practice. The initiative is still in its early stages; there are no national or local bodies that specifically represent the interests of mental health nurses in general practice like those that represent practice nurses, such as the Australian Practice Nurses Association. There are pockets of groups providing ad hoc forums for the nurses working in this area. The Australian College of Mental Health Nurses established a Private Practice Special Interest Group in December 2007 to bring together and provide support for mental health nurses working in private practice across the country especially under the auspices of the MHNIP. The researcher attended the inaugural conference of the special interest group in February 2008 with the view to meeting mental health nurses working under the MHNIP. However, the mental health nurses at the conference were a heterogeneous group that comprised a proportion of mental nurses working in general practice, those working with private psychiatrists and those who have their own private practice in line with the guideline of the MHNIP. As stated earlier, this study set an
entry criterion to only include mental health nurses working in general practice, as general practice is often identified in health care policy as the key site for primary health.
One of the organisations trying to provide a forum for mental health nurses in general practice under the MHNIP is General Practice Victoria. The researcher contacted General Practice Victoria, which is the peak body for all Victorian Divisions of General Practice, to gain access to mental health nurses working in general practice. In Victoria, 90% of GPs are members of the 29 divisions across the state. As mentioned in Chapter One of this thesis, Divisions of General Practice support the development of general practice within their catchments areas by enhancing quality of care, improving access, encouraging integration and multidisciplinary care, focusing on prevention, early intervention and better management of chronic diseases such as mental illness (Department of Health & Ageing, 2009). General Practice Victoria (GPV) organised an inaugural forum with the aim of gathering together mental health nurses working under the MHNIP across various divisions of general practice under the MHNIP as a means of providing collegial support. The researcher attended this forum; a short presentation about the project was made and expressions of interest in the study distributed to all the mental health nurses present with the contact details of the researcher.
Potential participants who contacted the researcher were then sent the Plain Language
Statement of the study (Appendix D), a consent form (Appendix G) and a date was set for the interviews. Once access to mental health nurses was established, their assistance was then sought to recruit the GPs they were working with. A total of 14 mental health nurses were recruited across six divisions of general practice in Victoria, plus two mental health nurses who are directly employed by the general practice as opposed to working through the local division. Interviews were conducted with a total of 16 mental health nurses working with GPs across various divisions of general practice in Victoria. At the time of conducting the study,
there was an approximate total of 85 mental health nurses employed under the MHNIP across Victoria. This was a convenience sample of mental health nurses that indicated their
willingness to participate in the study. All of the interviews took place at the participants’ workplaces and at a time that was convenient for them. The interviews lasted for between 45– 60 minutes and questions were asked using a schedule of interview (Appendix I). The
interviews were recorded using a digital recorder. In addition, the researcher also jotted notes of some of the responses provided by the participants. The purpose of the study was explained to the participants before the beginning of the interview and the necessary consent form was signed. The researcher made the participants aware of their right to terminate the interview at any time if they wished, and that their confidentiality would be protected through the use of de-identified data. The participants were asked questions according to the interview schedule; however, if there was a particular area they wanted to emphasise, they were given the
opportunity to do so. In semi-structured interviews, the interviewer has a pre-defined set of questions; however, the interviews were conducted without following a particular or rigid manner (Polit & Beck, 2004).
With regard to the GPs, the initial plan was to conduct face-to-face or telephone interviews similar to those used for the mental health nurses. It was difficult, however, to get the time space in the GPs diary to conduct these interviews due to the busy nature of general practice. Grbich (1999) reported on the difficulty of recruiting or accessing medical practitioners for studies involving interviews. This is because they are often very busy, they distrust
researchers (especially qualitative researchers) and often interviews are interrupted by other activities going on in the busy practice. The researcher was only able to facilitate one
telephone interview with a GP; this was only possible because the GP came in on her day off to attend a practice meeting. In view of the intentions of the researcher to carry out a wider survey of GPs in Phase 3 of the study, it was decided to seek the views of the GPs only in
Phase 3. There was a limited sample population of GPs whom the researcher was able to include in the study, hence the decision to survey GPs in Phase 3 so as not to lose potential participants. This was a pragmatic consideration especially in light of the fact that the
researcher did not have the funding to reimburse GPs for their time to participate in the study.
Semi-structured interviews with mental health nurses: Phase 2 of Study Semi-structured interviews have been reported as a very powerful data collection method whereby the researcher asks the participant questions, or conducts an in-depth interview about a specific research topic (Nieswiadomy, 2008). In semi-structured interviews, the researcher utilises scheduled standardised interview questions for every respondent without necessarily following the same order; it provides the opportunity for re-phrasing/clarifying questions with the respondents (Polgar & Thomas, 2000). Semi-structured interviewing was chosen as the most appropriate method for this study as it enabled the researcher to ask the respondents the same set of questions while at the same time offering the flexibility to vary the order of questions and further clarify the responses provided. This approach is different from highly structured interviews in which the researcher uses the same set of questions and does not vary the wording or order of questions across the interviews (Polgar & Thomas, 2000).
The questions for the interview schedule (Appendix I) were developed using findings from the scoping exercise, findings from the literature and consultations with the project
supervisors who had expertise in the area, as discussed previously. The process enabled the researcher to identify the main issues to be addressed in the interviews. The questions were refined through these ‘experts’ for clarity, their ability to be understood and elicit the information sought.