The experts’ responses to the conceptual framework was the final set of data emanating from this research. During the period of time the participants in the modified Delphi Technique provided information guided by the conceptual framework design, the information obtained was categorised and rated under the established criteria (concept, design, relevance, applicability, validity and reliability). Also the experts had the opportunity to indicate if they believe any other pivotal theory should be considered as part of the conceptual framework.
Thematic analysis was again used, if other comments were forthcoming from an open- ended question section that was provided (Harvard University, 2008). Key words and phrases were highlighted, and distilled to themes with commentary. If any pertinent data emerged, this collective feedback was considered along with the feedback from the established set of criteria - in informing and guiding the final developmental and moderation stages of the conceptual framework.
Data retrieval, maintenance and storage
Questionnaire data was focused on concept, design, relevance, applicability, validity and reliability. Data collection was primarily electronic via email and stored in word format. Data was primarily qualitative however there was numerical quantitative data provided that was collated and reported on. Data was collected via a private computer with appropriate and current firewall and virus protection. All final data published was de-identified with the use of either sequential numbering or pseudonyms to protect respondents. All identified, de- identified and analysis data is stored in compliance with current ethics rules.
Ethics
The application to undertake this research project was accepted and deemed to meet the requirements of the National Health and Medical Research Council (NHMRC) 'National Statement on Ethical Conduct in Human Research (2007) by the Victoria University Human Research Ethics Committee. Approval for the Application ID: HRE14-060 was granted for two (2) years from the approval date of 29/04/2014 (Appendix H).
Participants in the research were provided with precise, non-technical information and clear common language explanations regarding the research proposal (Appendix C; Appendix D; Appendix E). This was to ensure participants will be able to provide informed consent, participants will be offered confidentiality, and, participants will be offered an opportunity to review outcomes of the research.
It needs to be reported here that there were no overt demographic data requested or provided. While I could identify the name of the respondents on their consent forms before de-identifying the responses, I was completely blinded to quantitative information regarding factors such as age, experience, expertise and exposure to simulation, education preparation and role. These data were deemed not essential to the focus of the questionnaire as they would not provide any further insight into the research.
Real or potential risk
Risk-benefit
Given the nature of the research activity it was believed there was negligible or no real or potential risks to the participants of this study. Nevertheless all care was undertaken when explanations were provided and informed consent sought. All participants had the option of withdrawing from the project if they believed they were becoming compromised in any manner (Appendix D, Appendix E).
The potential benefits to the participants and / or contributions to the general body of knowledge significantly outweigh any potential or real risk. From a benefit perspective it was hoped that the feedback from the participants would be of a calibre that will enable the conceptual framework be developed to a quality that it will contribute to the knowledge about simulation as a teaching and learning method.
The ethical benefit is that future simulation education development will be of an educational standard that will generate improvements in healthcare practice outcomes. There are no identified legal issues or legal risks associated with any aspect of the research that require specific consideration including those related to participation in the research, the aims and nature of the research, research methodology and procedures, and/or the outcomes of the research.
Research trustworthiness
Given the mainly qualitative nature of the research, trustworthiness is an important concept because it provides the researcher the opportunity to describe the research evidence not so much in the quantitative concepts of generalizability, internal validity, reliability, and objectivity but in the alternate qualitative terms of transferability, credibility, dependability, and confirmability (Fenton & Mazulewicz, 2008; Lincoln & Guba, 1985; Loh, 2013). An audit trail is a transparent description of the research steps taken from the start of a research project to the development and reporting of findings. These are the records that are stored and can be retrieved and reviewed as to what was done in the research project (Fenton & Mazulewicz, 2008; Lincoln & Guba, 1985; Loh, 2013). To ensure that there was rigour in the study the concepts of research trustworthiness and the audit or decision trail were addressed. That is, the initial trustworthiness of collecting qualitative data from the experts and the initial quantitative validity and reliability of the model itself.
From a trustworthiness perspective credibility is provided in various ways. The questionnaires, subsequent to peer review, were reviewed by the university ethics committee and seen to be credible; the structure and boundaries of the research activity with a clear and unambiguous focus on what the project was aiming for is another. Furthermore, the extensive information able to be gathered from the expansive information technology resources now available (computers, smart phones, internet, websites, databases, electronic journals, email, skype) on a 24 hour x 7 day cycle, with almost instant response rates allowing the rapid gathering of and ongoing interpretation of both background information and research data – provides credibility around data gathering (Fenton & Mazulewicz, 2008; Lincoln & Guba, 1985; Loh, 2013).
It was planned that data was to be collected using a triangulation methods approach in efforts to capture different dimensions of the same phenomenon. This triangulation process of data collection, which is the collection of data from the three data sources in the study – the literature, the simulation centre questionnaire (Appendix A) and the modified Delphi Technique questionnaire (Appendix B) - is a valid and vigorous research technique (Jick, 1979; Write.com website, 2015). Using a multiple methods approach ensures the research is rich, robust, comprehensive and well-developed, which helps facilitate greater insight, deeper understanding and generate rigorous outcomes (Jick, 1979; Write.com website, 2015).
This has allowed for very effective triangulation and constant comparison of incoming data which could be filed and stored electronically in ways that can be easily retrieved for further review. This adds level of transparency and credibility as it is both the repository of the research data and also essentially an audit resource. Finally credibility involved establishing whether the research was credible or believable from the perspective of the participants in the research (Fenton & Mazulewicz, 2008; Lincoln & Guba, 1985; Loh, 2013).
To be able to demonstrate both transferability and contextualisation in this study will be to first; utilize a data retrieval process that systematically gathers enough and appropriate data, which will in turn verify that the researcher has been accurate in their assumption(s); that the evidence gathered will corroborate that there remains a need for a conceptual framework; that the research activity is valid and genuine, and that this is confirmed through the support of the data both from the literature and from the support of the respondents feeding back meaningful data (Fenton & Mazulewicz, 2008; Lincoln & Guba, 1985; Loh, 2013). To enhance the contextualisation of the research outcomes will require the researcher to carry out a methodical analysis of the results, so as to ascertain if the research can be generalized or contextualised to other contexts or settings. (Fenton & Mazulewicz, 2008; Lincoln & Guba, 1985; Loh, 2013).
Dependability is provided by the nature and construct of the research process and by the actions of the researcher. Dependability requires that the researcher account for the dynamics and context within which research occurs. The researcher is responsible for describing any changes that may occur in the research and how these changes may affect the way the researcher both considers and manages the study. The researcher needs to ensure that there is validated rigour in the way the research is designed, developed, scrutinised, modified, carried out and evaluated, along with the audit strategies in place to maintain a standard from an ethics and quality perspective. So when a reader peruses the research there is an obvious evidentiary trail in terms of accuracy of analysis and findings, within the context of the research (Fenton & Mazulewicz, 2008; Lincoln & Guba, 1985; Loh, 2013).
Confirmability refers to the extent to which the results can be confirmed or corroborated by others. Confirmability is where the reader of the research outcomes can identify and confirm that the analyses, explanations and recommendations can be linked to the collected and collated data, via the audit trail (Fenton & Mazulewicz, 2008; Lincoln & Guba, 1985; Loh, 2013). This is inclusive of the rationale attached to the literature review, the rationale in selecting the participants in the initial questionnaire and the rationale for selecting
the experts to undertake the constructive critique in the Delphi Technique. These participants were approached based on their involvement in and expertise in the use of simulation in healthcare education. Beside the provision of a set of questions pertinent to the study they were also given opportunities to respond via a set of open-ended questions thus allowing the gathering of further data for analysis. Thus as part of the audit trail the reader is provided with a literature review (Chapter 2), a methodology (Chapter 4) interpretation of and discussion of the findings, (Chapter 5) and the concluding remarks and recommendations (Chapter 6). Summary
In this chapter the methodological approach employed has been presented including the rationale for the research. The theoretical underpinnings of the research design that provide guidance, focus, construct and boundaries to the study have been identified. The research methodology of evaluation research has been reported, including the rationale and use of a modified Delphi technique. The sampling technique and the justification of the size of the research sample have been provided, as has been the data recruitment and collection phases. Issues of bias, ethics and consent considerations, data analysis methods and risk factors are discussed. To make sure that there is rigour in the study the concepts of research trustworthiness and the audit or decision trail are addressed last in the chapter.
The following chapter comprises a report and an interpretation of the research findings. The research findings are synthesized to demonstrate evidence supportive of the research aims. This included a reiteration in report form of the outcomes of the literature search and review, interpretations of the accumulative data from the primary questionnaire and from the Delphi Technique undertaken. The collective interpretation was analysed and the information is used to guide the final chapter of the study.