The purpose of the semi-structured interviews

The purpose of the interviews was to explore current practice from the nurses’ perspective in a flexible, informal manner.

2.3.3.3 Research Method

The research method included the data collection, population, sample and data analysis.

Data Collection

Data collection from a qualitative perspective entailed planning the interviews, selecting participants and conducting the interviews according to de Vos, et al., (2005: 83). Each of the steps is discussed below.

Planning the structured interviews

Planning the structured interviews entailed describing how, where and when the nurses would be selected to participate in the interviews (de Vos, et al, 2005:83). Permission to conduct the interviews was first sought from the hospital’s research committee (Appendix C), consent was obtained (Appendix D), from the Head of the Trauma (Appendix E) and Head of the Burns unit (Appendix F). Individual letters were sent to the Nursing Service Manager (Appendix G), who subsequently gave permission to contact the participants in the burns unit. Each nurse was then invited to participate in the study and information letter (Appendix H) and consent form for the interview and tape recording was given to the nurses (Appendix I).

86 Participants were given a broad outline of the purpose and format of the interview, ensured that the interview was confidential and that no names or identifying characteristics would be mentioned as well as the process of the interview would be explained. The researcher arranged for an empty room in the unit that ensured privacy and comfort to facilitate free flow of conversation. The venue was prepared beforehand for all the interviews to commence and proceeded well (de Vos, et al., 2005:84).

Selecting the participants

The Population

The population for the semi-structured interviews was the same population as for the structured observation. Refer to Table 2.4 for details on population.

Sample size and sampling method will now be discussed.

The Sample

Purposive sampling was done to include all the nurses working in the unit. Various authors (Parahoo, 1998: 232; Holloway & Wheeler, 1996:74), describe purposive sampling as sampling where chosen individuals have special knowledge of the topic. These individuals can be referred to as useful informants (Streubert & Carpenter, 2011).

This type of sampling was chosen because this tier of the study is qualitative and an unbiased sample was more suitable than random sampling that might not have been as reflective as total population sample. As the purpose was to explore current practice by nurses and the total population was forty one (n=41), the researcher decided to include all nurses to get a better understanding of current practice. All participants, at the time of this study, were working as full time nurses in the burns unit. Interviews were conducted whilst the structured observation was in progress in the burns unit. The selecting of this period was because the structured observation and interviews were complimentary in the data collection process. All the interviews were conducted in the natural setting.

87

Planning the interview questions

As the study design was exploratory in nature, the questions were conversational and resulted in trouble- free exchanges (de Vos, et al., 2005: 297). Questions were formulated in a logical sequence (de Vos, et al., 2005: 297), based on the nursing process to cover all aspects of wound management in accordance with the integrative review and structured observation.

The first question was on the dressing preparation and was asked as an introductory question on choices made during the planning phase for dressing procedure. The main purpose of this question was to allow the participants to shift their thinking from general to specifics (de Vos, et. al., 2005: 308). The second question was on assessment and diagnosis. This was a structural question to determine the terminology used by the nurses to describe key concepts during assessment and diagnosis of wounds. The third question was on the actual execution of the dressing procedure, with the purpose of validating the observations made (de Vos, et al., 2005: 298). The last question was on outcome and evaluation of the dressing procedure. The purpose of this question, in line with the nursing process and legal requirements of nursing, was to explore how nurses evaluated their own actions.

The first three questions were planned to allow the participants to interpret the questions according to their understanding. The questions were developed with the intention of providing participants with the open opportunity to describe their interpretation of wound management and the activities they include in practice as part of wound management.

The participants were asked the following questions:

 I would like to know from you what sort of preparation you do in preparing for a

dressing?

 Please describe what you look for when assessing a wound?

 Kindly describe how you would go about doing a dressing on a patient in the following

scenarios:

o on admission of new patient,

o routine dressing-change in the ward, o Post discharge in out –patients,

88 Subsequent probing questions were planned and guided by the discussion. The semi-structured interview, therefore, not only gives interviewers some choice in the wording of each question but also in the use of probes (Barriball & While, 1994: 331).

According to Barriball & While (1994: 331), probing can be an invaluable tool for ensuring reliability of the data as it allows for the clarification of interesting and relevant issues raised by the respondents; it provides opportunities to explore sensitive issues that can elicit valuable and complete information and it enables the interviewer to explore and clarify inconsistencies within respondents’ accounts. Probing can help respondents recall information for questions involving memory and probing and it maximises the potential for interactive opportunities between the respondent and interviewer which helps to establish a sense of rapport and reduce the risk of socially desirable answers (Barriball & While, 1994: 331).

Probing questions included:

 Can you please tell me how one decides which dressing is appropriate for which wound?  I would like to know more about how you would describe the different depths of the burns?  Please explain how do you know if the wound is not getting better?

See Appendix T for interview guide. This session was ended with a summary and an expression of gratitude for participation.

Conducting the interview

The interview commenced with the researcher reminding the participants of the goal of the interview and projected length of the interview and the topics for discussion. The participants were informed that they were being invited to participate, as they were representative of a group of nurses involved in the management of burn wounds and were assured that their statements would be kept confidential at all times. All the interviews were conducted in the burns unit in an empty office or a boardroom, depending on availability.

The researcher collected field notes, which included what participants said and observations on nuances of mannerisms, facial expressions and attitudes displayed when statements were made (Thompson, 2007:3; Frankel & Devers, 2000:253). Observations were made to collect information that could not be captured on the tape recorder relating to who, when, what and how of all activity (Kvale, 1996:130).

89 Pauses were denoted with dashes and prolonged pauses or silences were denoted with three dots. Exclamations, laughter, crying or sighs were indicated in the transcript.

The transcripts were typed in single-spacing and a line was left blank between speakers. A generous margin was left on the right hand-side of the transcription for the researcher to add comments. These gestures were reflective of feelings and emotions that accompanied statements and denoted meaning.

As the guiding question for this study is to understand meaning/s, the researcher listened attentively to descriptions and underlying meaning/s provided by the participants.

Words used, content and explanations given were explored through guiding, probing, questioning and encouraging the discussion in a non-directive manner (Rosenthal & Rosnow, 2008:170), to describe and understand the participants’ particular situations, experiences and meaning (Saleem, 2010:5; Frankel & Devers, 2000:258).

The average time spent for each interview was 45 to 60 minutes; the average recommended duration of a semi structured interview is 60 to 90 minutes (Walker, 2011:24; Laforest, 2009:3). A reasonable time for the interview ensures participants’ concentration and data quality. All the interviews were recorded and transcribed verbatim for preservation. As Rosenthal & Rosnow (2008:169), and Marshall & Rossman (1995: 112), point out the process of preserving the transcribed data increases data efficiency in preparation for data analysis.

After exhausting the broad guidelines of the interview no new content emerged in the discussion. The participants were asked if they wished to say anything further before closure.

The researcher as a data collection instrument

The researcher was the main data collection instrument during the semi-structured interviews. The interviews were recorded and the researcher extracted data from the material after the interview was complete.

The researcher’s role was to encourage participants to speak freely about all the topics on the interview schedule and to relay stories in their own words.

90 Techniques the researcher implemented to allow the interview to progress effortlessly were as per Fox (2009: 25-26): Firstly, establishing rapport. Before commencing the interview, the researcher took the time to explain the reason for the interview, including the aim of the research project and what will happen to the interview data. The researcher checked whether the interviewee had any questions before the interview commenced. Questions were asked in a relaxed informal manner so that the interview appeared more like a discussion or conversation. The researcher was aware of the effect of body language in indicating interest, encouraging the interviewee to talk and maintained a non-threatening atmosphere. Secondly, each interview, emulated a conversation. The researcher attempted to make the interview seem, as much as possible, like a normal conversational situation in which people disclose information to others. Thirdly, listening to the participants. The researcher listened attentively to the participants so as not to miss the nuances of what was being said. Fourthly, being non-judgmental. The researcher attempted to ensure the participants felt secure and are not judged for their responses. Fifthly, the researcher let participants talk. Open-ended questions were intended to get respondents to enter into a ‘stream of consciousness’, in which few cues from the researcher were required to keep participants talking. Lastly, the researcher was attuned to words and gestures from participants and both verbal and non-verbal clues were observed and recorded. Non-verbal behaviour can often be revealing of lies or distortions and were used to reduce the possibility that a respondent was misleading the researcher consciously or unconsciously.

Description of the data analysis follows.

Data Analysis

As in quantitative research, the purpose of conducting qualitative research is to produce findings according to de Vos, et al., (2005: 333). Qualitative data analysis involves reducing the volume of raw information, sifting significance from trivia, identifying significant patterns and constructing a framework for communicating the essence of what the data reveal (de Vos, et al., 2005: 333). Data analysis is a challenging and a creative process characterised by an intimate relationship of the participants and the researcher (de Vos, et al., 2005:339).

Qualitative data analysis

Qualitative data analysis needs to be conducted with rigour and care (Coffey & Atkinson, 1996: 189). When researchers prepare to attend to the data, the first task is a conceptual one: the clarification of the researcher’s own preconceptions of the phenomena under study.

91 This means suspending, as much as possible, the researcher’s meanings and interpretations and entering into the world of the participant interviewee, according to Tesch (1992: 92). The next step in the data analysis process was the transcription of the taped interviews; the researcher transcribed the tape- recordings verbatim. A generous margin was left on the right hand-side of the transcription for the researcher to add comments. Each page was numbered, with interview number and page number.

Data analysis process

Tesch’s eight-step procedure was applied for the analysis of the data (Tesch, 1990 in Creswell, 1994:155). A brief description on the procedure follows.

The researcher carefully read through all the transcriptions, making notes of ideas that came to mind. She then selected one interview and read it to try and get meaning in the information, writing down thoughts coming to mind. After going through the transcripts, the researcher arranged the similar topics in groups by forming columns labelled major topics, unique topics and leftovers. The researcher then abbreviated the topics as codes and wrote the codes next to the appropriate segment of the text. The researcher scrutinised the organisation of data to check if new categories or codes emerged. There after she found the most descriptive wording for the topics and converted them into categories.

The aim was to reduce the total list of categories by grouping topics together that relate to each other. Lines drawn between the categories indicated interrelationship of categories. A final decision was then made on the abbreviation of each category and the codes were arranged alphabetically. The data material belonging to each category was put together in one place and preliminary analysis performed. Recording of the data was done if necessary.

Description

The descriptive stage is very important in qualitative studies. It is the initial phase whereby the researcher becomes familiar with the data (Burns & Grove, 2003: 378).

The researcher used reflexivity, bracketing and intuiting to exclude preconceived ideas about the phenomenon under study. The researcher replayed the tape recordings after the interview to listen to voice, tone, pauses and responses, as well as the entire content (Burns & Grove, 2003: 380). The recorded interviews were then transcribed verbatim.

92 Following transcription the researcher read the transcripts against the audio-tape from which they were transcribed. The researcher immersed herself in the data, reading and re-reading the transcripts in order to achieve closeness to get a greater understanding of the data (Henning, 2004: 127-128). The process of proofreading allowed the researcher the opportunity to become familiar with the interviews and ‘to get a

sense of the whole’ (Tesch, 1990 in Creswell, 1994:155).

The questions on the interview schedule were informed from the literature and the identified categories were used to group the responses from the interviews. The researcher sought to determine the underlying meaning of the detail described by the participant in the interview (Tesch, 1990 in Creswell, 1994:155); reflecting various aspects of the participants experience (Leedy & Omrod, 2005: 144).

When satisfied that the text had become accessible to her, the researcher could highlight “meaning units” throughout the interview transcripts and decided which ones were relevant to the research questions posed. The researcher then went on to connect the question with the meaning unit (Tesch, 1992:91). Furthermore, the researcher made notes in the margins of the transcribed interview.

After reading all the interviews, the researcher made a list of all the main emerging topics. Similar topics were clustered as per Tesch (1990 in Creswell, 1994:155): the emerging topics were then abbreviated as codes. Following this process the researcher went back to the transcribed interviews and proceeded with coding.

The researcher read through the transcripts and underlined the main emerging categories. The code was placed in the margin adjacent to the category in the text.

These categories were summarised as key words, written in the margin of the transcribed interview. These descriptive codes, written in the participant’s own words, described ‘what was going on and how these

things proceeded’ (Denzin & Lincoln, 1994:432).

The researcher used interpretive codes after the descriptive codes. By now the researcher was familiar with the interviews and was seeking meaning. A different colour pen was used to write the interpretative codes into the margins.

The third time the researcher reviewed the transcribed interviews was to determine the explanatory codes (Burns & Grove, 2001:599). It was here that the researcher began to link the emerging categories to theories and to identify developing patterns.

93 The explanation codes involved justifying, giving reasons, supporting or making relationship claims (Denzin & Lincoln, 1994:432). Once again a different colour pen was used to denote the explanatory codes. Descriptive codes, interpretative codes and explanatory codes were once again categorised into themes and sub-themes.

All the data belonging to each category and sub-category were assembled. The data were named according to the interview number and the page number within the interview, so that the researcher could refer back to the original transcript. In addition, the researcher consulted peers, colleagues and literature during the process of identifying the categories.

Analysis

Analysis goes beyond description because data was transformed and extended (Burns & Grove, 2003: 382). In this process there is identification of essential features and description of interrelations among them. The researcher identified categories, subcategories and patterns from the data. The use of coding was to expand, transform and re-conceptualise data, providing opportunities for more diverse analyses. Memos were also used to record insights and ideas related to notes, transcripts or codes. The researcher recorded any ideas that emerged, even if they were vague. Memos were given dates and titles (Tesch, 1992:87).

Data analysis is a mechanism for reducing and organising data to produce findings that require interpretation by the researcher (Burns & Grove, 2003:479). Interpretation focused on the usefulness of the findings for clinical practice. Refer to Chapter Six, for the results and discussion of the findings. Implementing the following strategies ensured trustworthiness of the semi-structured interviews.

Trustworthiness

Trustworthiness refers to the degree of confidence that qualitative researchers have in their data (Polit & Beck, 2012: 745). According LoBiondo- Wood & Haber (2012: 588), trustworthiness is the rigour of the research in a qualitative study. Qualitative research is therefore trustworthy when the research accurately records the experiences of the study participants.

The use of Lincoln & Guba’s (1985:290), model was to ensure the application of trustworthiness in the qualitative phase of the study. This model was chosen because it is well developed conceptually and has been extensively used by qualitative researchers, particularly nurses, for a number of years.

94 Lincoln & Guba’s (1985: 112), model identifies the following criteria for establishing trustworthiness:

Truth value strategy: credibility measure. Applicability strategy: transferability measure. Consistency strategy: dependability measure. Neutrality strategy: conformability measure.

These criteria were used according to its applicability in the context of the study. Each criterion is described below.

Truth value (Credibility)

Credibility according to Polit & Beck (2012: 585), refers to confidence in the truth of the data and the interpretations of them. According to Lincoln & Guba (1985:80), in qualitative research credibility is obtained from the discovery of human experiences as they are lived and perceived by the participants. In this study the following strategies for credibility were employed according to Lincoln & Guba (1985).

Prolonged field experience: The researcher has been involved in the care and management of burn

wounds for the past ten years, which indicates her knowledge of the field. Additionally the researcher had been working closely with the head of department (which served as the expert in the field) for seven years in the unit where the study was conducted, which allowed the researcher to get an in-depth understanding of the phenomenon. The researcher and participants had a good rapport which assisted in gathering rich data.

Referential adequacy: The researcher applied a pilot interview prior to conducting the actual interviews

to determine that the interview schedule was practical and understandable. The pilot interview was discussed with the expert.

Peer debriefing: The researcher was assisted by the head of department at the burns unit in the study, a

unit manager in a different burns unit and a private nurse practitioner, who does wound care daily, as