Verification process

Verification is the process of checking, confirming, making sure, and being certain. In qualitative research, verification refers to the mechanisms used during the process of research to incrementally contribute to ensuring reliability and validity and, thus, the rigor of a study (Morse, Barrett, Mayan, et al., 2002). In this study verification was done by seeking consensus on the findings from Phases One and Two.

Consensus knowledge building is defined as an outcomes design that requires critique and synthesis of an extensive international search of the literature on the topic of concern (Burns & Grove, 2007: 5350). Consensus knowledge building brings experts face to face to gain either further understanding or consensus in a particular field; they are often multidisciplinary and may be composed of professionals, healthcare users or both and panels are used to develop guidelines (Moule & Goodman, 2009: 234; Burns & Grove, 2007: 298-299). According to Moule & Goodman (2009: 235), the consensus technique can be useful in cases where there is a lack of knowledge or understanding on a particular health issue.

97 It enables healthcare professionals to access the views of experts on aspects of practice, education and research priorities and can be used in developing clinical guidelines and in identifying agreements on health and research priorities. Consensus knowledge building was applied in this study to critique the findings from the integrative review (Chapter Four) in order to deliver evidence-informed guidelines for the management of burn wounds as no such guidelines or standards are available in South Africa. The three consensus methods identified in the literature are: Focus Group Discussions, Delphi and Nominal Group Techniques (NGT). A brief explanation of each of the three methods follows.

Focus group

An interview with a group of individuals assembled to answer questions on a given topic (Jayasekara, 2012: 411; Polit & Beck, 2012: 728; Burns & Grove, 2007: 540).

Focus groups are used to study qualitative issues, analyse policy, assess consumer satisfaction, evaluate quality of care, examine the effectiveness of public health programs, make professional decisions, develop instruments, explore patient care problems, develop interventions and education programs, study various patient populations and gather participatory research projects (Burns & Grove, 2007:379). The key feature of focus groups is the active interaction among participants to explore their views and opinions. This is particularly useful when current knowledge about a phenomenon is inadequate and expansion is important (Jayasekara, 2012: 414).

A critique on the focus group is that it is usually more difficult to arrange, and bringing participants together requires energy, time, and money (Jayasekara, 2012: 414).

Delphi technique/ survey

A technique for obtaining judgements from an expert panel about an issue of concern (Polit & Beck, 2012: 725; 537; LoBiondo-Wood & Haber, 2010:577; Burns & Grove, 2007: 537; Hasson, Keeney & McKenna, 2000: 1009).

The Delphi technique is an iterative multistage process, designed to transform opinion into group consensus without requiring face- to- face discussion (Polit & Beck, 2012:267; Hasson, et al., 2000: 1010). Experts are questioned individually in several rounds, with a summary of the panel’s views circulated between rounds, to achieve consensus (Polit & Beck, 2012: 725; LoBiondo-Wood & Haber, 2010:577; Burns & Grove, 2007: 537; Hasson, et al., 2000: 1010).

98 A critique on the Delphi technique is that it is time consuming (Goodman, 1987), and panel members’ cooperation may wane in later rounds (therefore attrition bias is a potential problem). Another concern is how to define consensus (in other words how many participants have to agree before researchers can conclude that consensus has been reached with recommendations ranging between a liberal fifty one percent to a more cautious seventy percent) (Polit & Beck, 2012:267-268).

Nominal Group Technique (NGT)

A structured procedure for gathering information from groups of people who have insight into a particular area of interest (Varga-Atkins, Bunyan, McIsaac, et al., 2011: 4; Carney, McIntosh & Worth, 1996: 1026; Gallagher, Hares, Spencer, et al., 1993: 76).

The term “nominal” group signals that the group is only “in name” a group, in reality, it requires

individual input from its members (Varga-Atkins, et al., 2011:4). The purpose of the NGT is to generate

information in response to an issue that can then be prioritised to achieve consensus and action planning through group discussion (Potter, Gordon, & Hamer, 2004: 126).

The NGT combines aspects of the Delphi technique and focus group. A critique on the NGT is that views of individuals may influence others in the discussion phase, minority disagreement is masked, the timing of nominal group sessions can have an influence on the outcome of the research and that reporting of only the top five items may be considered to be an issue (Varga-Atkins, et al., 2011: 8). Table 2.5 depicts the comparisons between the decision making groups.

Table 2.5 Comparison of consensus decision making groups (Potter, et al., 2004: 127).

Attribute Decision making process

Delphi Focus Group NGT

Face-to-face group meeting process No Yes Yes

Generates a large number of ideas Yes Maybe Yes

Avoids focusing on a single train of thought Yes Yes Yes

Encourages equal input from all participants Yes No Yes

Highly structured process Yes Maybe Yes

Meeting time usually 1-2 hours duration No Yes Yes

Avoids ‘quick’ decision making Yes No Yes

High degree of task completion Yes Maybe Yes

Provision of immediate feedback No Maybe Yes

99 A consensus technique may also be carried out by a consensus panel. Consensus panels are groups of individuals gathered to arrive at a consensus regarding an issue such as guidelines for the management of burn wounds by nurses in this study.

There are a number of different types of consensus panels as per (Green & Thorogood, 2014:127):

Delphi groups

In this type of group the participants do not meet, but are mailed a questionnaire to garner views on a given topic. Summaries of the views of the group are then mailed back, with participants invited to change their responses in light of the views of the group. This can be repeated several times until members of the group reach consensus.

Consensus conferences

Is a generic term for workshops or discussion groups where participants come to consensus through debate and interaction in such activities as guideline development.

Consensus panel convened for an NGT

This type of group was developed to enable groups of people with an interest or expertise in an area to generate and rank ideas. Each participant privately and independently writes their comments on the group’s question. These are then listed and discussed. Finally points are awarded to the top ideas which are then ranked.

The consensus method used in this study is the NGT and therefore the advantages are highlighted as justification for this selection.

Advantages of the Nominal Group Technique

The advantages of the NGT are grouped under four subheadings: advantages for individual participants, advantages for the group dynamics and participants, advantages for the purpose/task and advantages for the facilitator. Each of these advantages will be discussed individually as per (Varga-Atkins, et al., 2011: 6-8).

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Advantages for individual participants

The stage of individual-responses precedes group discussion. This has been proposed to help maintain the autonomy of individual viewpoints and members making their own judgements, it allows equal input by each participant and encourages participants to consider all options, it generates its own issues rather than those prescribed by the researcher.

Advantages for group dynamics

The structure of the NGT helps to value every member’s input, even that of shy or reticent members. It helps reduce the influence of members with vocal voices or bias in the group and so promotes equal participation. During a nominal group session, the generated ideas and responses to the question(s) are displayed to the whole group. This visual representation of mental processes has been found to enhance the satisfaction felt by group members in the process. In the last stage, ranking the list is the product of group consensus and provides a direct reflection of the implicit views held by a group, in other words, the achieved consensus.

Advantages for the purpose/task

One of the advantages in terms of the purpose of the research or evaluation itself is that using the NGT produces a greater number of ideas than with other group methods, for example, focus groups or brainstorming groups. The technique allows members to carry out a substantial volume of work in a short time. The prioritisation stage helps decision-making by devolving it to the group.

Advantages for the facilitator

The structure of the session restricts the role of the researcher and avoids allowing the facilitator to express their own inference or interpretation on the group members’ input. If the discussion topic is controversial and is likely to end in heated discussions, the structure inherent in the session can act as a control mechanism.

For the same reason, the technique can also be useful in a research setting when participants are seen as having more power than the facilitator, the NGT groups requires little facilitator input or preparation time, although this benefit is not necessarily shared by others.

101 The purpose of verification is stated for consistency.