Trustworthiness

In order to enhance trustworthiness within this study, the researcher used several methods that contributed to credibility, transferability, dependability, and confirmability of study findings (Lincoln & Guba, 1985).

2.4.4.1 Credibility. Strategies to support credibility are aimed at promoting confidence that the researcher has accurately captured the phenomenon being studied (Lincoln & Guba, 1985). Throughout the data collection and analysis phase, the researcher improved credibility of research findings using several different methods. First, data collection in the prospective study occurred over a 15-month period (prolonged engagement; Lincoln & Guba, 1985) in which the researcher spent approximately two days every three weeks in each home (data collection alternated between the two LTC homes). Over this time period, the researcher was able to become familiar with the setting and culture of the two LTC homes, as well as learned to

overcome preconceived notions that the researcher had about how staff provide care and interact with residents. For example, the researcher believed that the staff would always be in a rush

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when interacting with residents at all times and that ancillary staff would have few meaningful interactions with residents who lived in the homes. This was not the case with all of the staff, all of the time. These pre-conceived notions were overcome as the researcher observed staff over time and witnessed that many staff treated the residents as if they were a member of their own family. The pre-conceived notions were written in the field notes, reflexive journal, and discussed with the researcher’s supervisor as they arose. Prolonged engagement allowed the researcher to build trust with the participants so that they felt comfortable around the researcher, particularly during the interviews and observation periods.

Second, in addition to prolonged engagement (Lincoln & Guba, 1985), the researcher also was able to spend over 24 hours in each home observing and 15 hours shadowing the staff to learn about the culture and routines of the staff in the prospective study. Persistent observation (Lincoln & Guba, 1985) helped the researcher ascertain which factors were the most important and applicable in the research setting and which ones were not. For example, in the prospective study homes, the researcher discovered that the roles, characteristics, and attributes of the formal leader played a significant role in whether or not staff use GPA skills in their day to day clinical practice. Prolonged engagement and persistent observation (Lincoln & Guba, 1985) enabled the researcher to witness the impact that the formal leader had on staff. The relationship between sustainability and leadership may not have emerged as strongly if data collection had included only interviews and document reviews.

Third, according to Lincoln and Guba (1985) triangulation of data is another way in which a researcher is able to enhance credibility of study findings. Data triangulation support the development of “converging lines of inquiry” and therefore more convincing and accurate conclusions (Yin, 2014, p. 120). The researcher used two types of triangulation: source and method (Lincoln & Guba, 1985). For both studies, the researcher interviewed, observed, and shadowed various participants from different departments (source triangulation). For example, in the retrospective study, the DOCs/managers/administrators, GPA Coaches, RNs, and NAs were interviewed. In the prospective study, the researcher observed maintenance and the kitchen staff interacting with residents, and interviewed NAs, GPA Coaches, formal leadership, CNL, etc. For method triangulation (Lincoln & Guba, 1985), the researcher analyzed the data from all of the interviews, focus groups, observations, shadowing, and document review on their own for each home. Then, the results of each data collection method were compared against each other within

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and across each home for both studies (e.g., interviews against observations, observations against focus groups, interviews against focus groups). Fourth, peer debriefing was used to strengthen credibility by allowing a fellow researcher to examine the findings for bias, honesty, and the testing of emerging relationships in the data (Lincoln & Guba, 1985). To accomplish this, the researcher’s doctoral supervisor reviewed the field journal and all of the data collected on a bi- weekly basis.

2.4.4.2 Transferability. After a researcher has completed their final report, it is

important for readers to make a decision on whether or not the conclusions can be transferred to other contexts, settings, situations, times, or people. Transferability (Lincoln & Guba, 1985) is supported when the researcher provides enough detail or “proper thick description” (Lincoln & Guba, 1985, p. 316) for the reader to make the decision on whether or not the conclusions can be transferred. Thick description occurs when the researcher collects data about the context that is rich and detailed (Stake, 2006). In the current study the researcher described all of the

observations and interactions that occurred during shadowing in detail in the field journal. In addition, the researcher elicited comprehensive answers from participants during the formal and informal interviews. Throughout the document reviews, the writer recorded poignant and emotional chart entries by staff who were working with residents with extreme responsive behaviours.

2.4.4.3 Dependability. To achieve dependability, it is important for the researcher to have a fellow researcher conduct an inquiry audit (Lincoln & Guba, 1985). An auditor is brought in by the researcher to review the process that was undertaken during the data collection and analysis phase as well as to examine the final product. A researcher from the doctoral committee reviewed the data gained through the semi-structured, shadowing, document review, focus groups and observations in both studies after data collection was completed. The author also met with the committee member, in conjunction with her doctoral supervisor, once per month to review how the data were analyzed and to assess the results of the retrospective and prospective studies.

2.4.4.4 Confirmability. The author also established an audit trail so that future researchers could review the steps taken from the beginning of the project to the final report (Lincoln & Guba, 1985). The writer kept all of the raw data (e.g., field journal, voice recording, transcriptions of interviews and focus groups, documentation review information) in encoded

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files on a password-protected computer. All of the coded documents and data reduction charts as well as all jottings and field notes were kept in a locked filing cabinet. A field journal was used and memos were completed to “map activities in support of maintaining the audit trail” (Birks & Mills, 2015, p. 50). The field journal and memos were reviewed by the researcher’s doctoral supervisor every two weeks throughout the data collection phase of both studies. Finally, a reflexive journal (Lincoln & Guba, 1985) was also kept throughout this research project so the researcher could record her thoughts and feelings about what she had learned about herself during the research process, and why certain methodological decisions were made. Entries were completed whenever the researcher was in the field or when changes to the methods occurred. 2.4.5 Consent and Data Storage

Participation in this research project was voluntary. Operational approval was sought at the individual and organizational levels within the care homes as well as from the health region research office, and the University of Saskatchewan Behavioral Research Ethics Board. Ethics approval was received for this study on October 11, 2011 (Beh # 11-244). Managers/DOCs/ administrators were asked to have their care home participate in this research study. They were asked if the researcher could shadow staff and grant the researcher access to written

documentation. Staff/residents/families were able to opt out of the observation that occurred in the “public” areas of the LTC homes by asking the researcher not to observe them or their family member. This message was conveyed to staff and families at the beginning of the data collection by the managers/administrators/DOCs through verbal and written communication. Focus groups and semi-structured interviews occurred after the staff member had given written consent (or verbal consent if they had difficulty with English as a second language; See Appendix C). All stakeholders who agreed to participate in this study remained anonymous. Aside from the first author’s supervisor and the researcher who did the audit, only the researcher had access to the interview and focus group data. The initial audio recordings of the semi-structured interviews and focus groups, as well as all other data sources, were saved encoded on the researcher’s computer. Data were stored in a locked cabinet under the supervision of the researcher’s doctoral supervisor at the University of Saskatchewan for five years after completion of the study.

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CHAPTER 3.0: THE IMPACT OF LEADERSHIP AND ORGANIZATIONAL