Study site and sample

The study site was two acute wards within a large teaching acute NHS teaching hospital. Both wards were similar in that they were 28 beds, mixture of side rooms and 7-10 bed bays. Each ward had similar staffing ratios, numbers of staff and skill mix, on a day to day basis. One ward was predominately a male ward the other female, however there was usually a higher proportion of male patients within the speciality and hence on the female

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ward there was always a bay of seven male patients. My rationale for using a small study site was to enable depth in study data consistent with ethnographic methods within the time and resources available, reflecting other ethnographic studies in nursing (Burden 1998; Manais and Street 2001; Hill 2003; Savage and Scott 2005; Deitrick et al. 2012).

The study followed a purposive or judgement sampling method used by both Hill (2003) and Burden (1998). The participants in the study were all patients and staff on the ward that had consented to be involved with the research, therefore the study had representative participants of the study population. Rounding was observed on both wards depending on the availability of the nurse observer, the interviews took take place with a selection of patients and staff, immediately post rounding. The patients were selected for the purpose of describing the experience of rounding in which they had participated (Robson 2011). There was also a judgement by the nurse observers as to the interest of the patient to the study after the rounding observation had taken place. On all occasions where possible the staff member delivering the rounding was invited to a post round interview.

Inclusion and exclusion criteria were applied to the study sample to define the participants who took part in the study (table 15). The criteria were applied to ensure the balance of obtaining relevant knowledge and insights from staff and patients with ethical rigour (Parahoo 2014). The rationale for the inclusion criteria for the study was that the process of rounding was applicable to all patients and staff within the study site setting, therefore the study had wide inclusion criteria. However, within the wards there were also patients and staff who were excluded from the study. The rationale for the patient exclusion criteria included patients who did not give their informed consent due to the patients being too unwell to undertake the informal consent process (as determined by their consultant) asking a patient about their participation in a research study whilst unwell would go against maintaining high ethical standards. A further rationale for patient exclusion related to the fact that a large part of the data collection involved post rounding interviews and there were no resources available for interpretation, therefore patients who did not speak English were also excluded from the study as were patient with communication difficulties.

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An additional rationale for the exclusion of certain patients was that patients needed time to assimilate the information about the study prior to giving informed consent. A further priority was that patients needed time to adjust to their admission to the ward and their clinical care, hence informed consent was not immediately sought from patients who were new to the ward. Patients who had previously given their informed consent at pre admission clinics were given time to verify their decision, again this would ensure the study upheld high ethical standards.

All substantive staff within the study wards were invited to voluntarily participate in the study, because they performed rounding however the rationale for the staff exclusion criteria acknowledged and respected the rights of staff not be involved. Staff who chose not to provide their informed consent were excluded from any observations and interviews. The exclusion criteria for staff also included temporary staff and nursing students allocated to the wards the rationale for this exclusion criteria was the requirement of the study to focus on the culture of the substantive ward team in relation to rounding therefore non substantive staff were excluded.

Table 15: Study inclusion/exclusion criteria

Inclusion Exclusion

Patients

 All patients within the two study wards who provided informed consent

 Patients who were unwell and unable to

provide informed consent (determined by their Consultant)

 Patients becoming confused or unwell, as the interviews were being performed will be withdrawn and excluded

 Non-elective patients admitted to the wards who had not yet given informed consent, patients given 24 hours before being

approached about the study with further time to consider their participation prior to giving informal consent

 Elective admission patients who were given 24 hours to confirm their informed consent

 Patients unable to communicate in English

 Patients with communication difficulties not associated to a language barrier

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 All grades of staff (nurses and nursing assistants) within the two study wards who provided informed consent

 Temporary staff

 Nursing students

 Ward staff who did not give informed consent

The target population for the staff participation in the study was all of the nursing staff within the two wards, this included a nursing establishment (for both wards) of 84 registered nurses, nursing assistants with a small number of housekeepers. From this total population four staff refused to provide their consent to be involved and were, subsequently excluded from the study. However not all staff were observed rounding or interviewed during the study period, it was dependent on their presence on the ward at the times rounding was being observed and whether they were allocated to deliver rounding on the ward at that time, so staff involvement in the study was random.

The target population for patients was all patients on the two wards during the study period. The numbers of patients who consented to the study was 75 with two declining consent. None of the patient sample were excluded from the study interviews as a result of becoming unwell and unable to continue the interview. The list of target patients for the two wards was checked on a daily basis throughout the study phase by me to ensure accurate identification of patient inclusion and exclusion criteria regarding patient’s fitness, wellness and time on the wards to participate in the study plus that informed consent had been obtained.

The sample size was similar to a previous observational study on rounding (Deitrick et al. 2012) where similar numbers of observational and interview data generated findings that were considered satisfactorily trustworthy and credible to publish and thus used as a benchmark for this study.

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