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It has been estimated that interviews have been used as a data-gathering tool in 90% of social science studies (Holstein and Gubrium, 1995). One-to-one, in-depth interviewing has an established position as a critical and fundamental tool for the

acquisition of data within the sphere of qualitative research within health and social care (Bray, 2008). Lawton (2003) suggested that qualitative methodologies and in-depth interviewing have led the way in providing an important and previously unheard voice for patients and have influenced their positioning to being placed at the centre of

researchers attention. Nevertheless, it was evident from the literature review discussed in the previous chapter that the patient’s voice is conspicuous by its absence within the medically framed survival literature.

When considering her work that involved interviewing women, Oakley (1981) challenged the objective, positivist paradigm that was dominant within sociological research at that time when she regarded that traditional approach to interviewing as a sterile, one-directional method that attempted to extract data without feeling, social interaction or consequence. Oakley, citing publications that admonished the social skills of interviewers, rejected this premise and embraced an array of human behaviours that she regarded as integral to promoting the quality of interview data. Not only did Oakley (1981) recognise the importance of human sociability factors that enhanced the rapport between the interviewer and the participant, she made the crucial point in

acknowledging that the creation of an open, transparent and trusting demeanour in the interview, with a flattened hierarchy is likely to yield deeper, richer data. This important realisation was echoed by Johnson (2001), who described in-depth interviewing as a social form that involved a particular type of interaction between people, based on a developing intimacy between the interviewer and the interviewee. He went on to define

an in-depth interview as usually being conducted one-to-one, with face-to-face

interaction and of relatively long-duration. In a post-modernist context, Fontana (2001) stated that with a breakdown in the former patriarchal relationships, the roles between the interviewer and the researched have become more ambiguous and previously unheralded opinions have become important, consequently interviewing is now seen as an interactive, dynamic process shared between the researcher and the researched (Bryman and Cassell, 2006).

In keeping with my methodological rationale outlined in section above, I had settled upon an unstructured, grounded approach to conduct the interviews. This was akin to the epistemological stance taken by Strauss (1987), being one of an

acknowledged active, participatory approach taken by the interviewer to facilitate and encourage the development of new and perhaps unpredictable themes and discussion items that are consequential to the interview without conflicting with the core questions previously identified for the purposes of the in-depth inquiry, a strategy previously described by Bolam, Gleeson and Murphy (2003). Furthermore, having taken a symbolic interactionist / constructivist position it was important to adopt a

methodologically approach that incorporated open, unstructured interviews which placed the patient at the centre of the inquiry. In the interests of methodological rigour and as a reflexive researcher it was also important that the opinions, views and biases of me as the researcher would be kept to a minimum whilst intending to be transparent in the acknowledgement of my participation and influence as a the researcher in the derivation of the data.

In the context of unearthing truths about the world, some argue that qualitative research, by necessity, requires a reflexive approach in order to explain the constructed nature of the interview and the uniqueness of the relationship that develops during the interview between the researcher and their subject (Power, 2004). In support of this approach Jootun, McGhee and Marland (2009) suggested that such a reflexive strategy is highly appropriate. Furthermore, Kezar (2003) cited the importance of reflexivity, within the context of conducting qualitative research, where the interviewer considers and acknowledges their own contribution and influence upon the entire research

process, critically, the acquisition of the data. Kezar (2003) also linked reflexivity and the awareness of the researchers part in the process, whereby the balance of power and

the direction of the interview is shared between the interviewer and their subject, as first described by Oakley (1981).

A further important consideration is to regard the interaction between the

researcher and the researched, which was highlighted by Richards and Emslie (2000) who argued that in addition to gender, age and ethnicity, the professional background of the researcher is important to the nature of the data obtained during the interviews. Richards and Emslie (2000) found that the status of the researcher is perceived

differently to the extent that it may significantly influence the responses of their interview subjects. Mindful of this evidence, and given that all of the interviews took place in a clinical setting, I opted to wear my usual work clothing (formal shirt and a suit) along with my NHS identification card and name badge, but I remained aware of the visual significance of how my appearance may underpin and / or influence the perceptions that potential recruits may formulate when regarding my (dual) role as a researcher and a clinician. However, I believe that it would have been more explicit had I worn a uniform.

I considered that it was important to attempt to overcome any sense (for the participants) that they were in a traditionally passive Parsonian sick role (Parsons, 1951). I attempted to minimise this effect through open, transparent and explanatory dialogue with each of the participants so as to firmly establish that their contribution was fundamental to the quality of the research. I also ensured that, to the best of my ability, each and every participant understood my role as a researcher and how that interfaced with my dual role as a clinical nurse. I was confident that my professional and personal life experiences enabled me to engender an appropriately respectful and convivial relationship with each participant and that this provided a solid platform upon which I conducted the interviews.

When considering the researcher participant encounter I also viewed this

engagement as a nurse patient encounter and I experienced my own internal difficulties with being in a potentially conflicting dual role. Given the acuity of illness present

amongst the occupants of the clinical areas where the interviews were being conducted there was a genuine potential for a medical emergency to arise (with the participant or other patients in the vicinity of the interview space) in an instant. Accordingly, I had cause to consider that I might be required to switch into an active clinical role at a

moments notice. As an experienced expert leader in resuscitation and critical care I was cognisant of the fact that not only was I was recognisable by colleagues and medical staff and would be expected to respond to any emergency that arose, I was also under the professional, ethical and regulatory auspices of the medical gaze (Nursing Midwifery Council, 2008). It is interesting to note this situation is not covered in the guidance offered by the Royal College of Nursing (2011) or in the Research Governance

Framework for Health and Social Care (Department of Health, 2005), a point that I will return to in the discussion chapter.

Creswell (2007) also identified that whilst being open to external influences, the qualitative researcher will bring their own opinions, views, experiences and

philosophical positioning to their interpretive framework, furthermore the researcher will be influenced in their decisions by the ontological, epistemological and methodological perspectives that they hold. Some consider that a reflexive approach is necessary in order to explain both the constructed nature of the interview and the uniqueness of the relationship that develops between the researcher and their subject (Power, 2004). In recognition of this and with particular reference to the nature of the intended subjects, caution is advised when interviewing patients who are critically ill.

Morse (2001) noted that the nature and severity of the illness may render the (ideal) sample of patients as unreliable informants as their normal biographical

competence may be suspended. Paradoxically, it has been evidenced that interviewing such patients can be a welcome distraction for them once recovery and rehabilitation has commenced, even amongst those recovering from serious illness or injury. They often have questions to ask about what happened to them and may require an

explanation as to the circumstances that led them to their current situation and it may be and it can be reassuringly therapeutic to the patient (Morse, 2001).

The patient accounts published on the Healthtalk web resource (previously Healthtalkonline) are entirely constructed from in-depth qualitative interviews and reflect individual patient’s experiences of healthcare. This resource and has provided

invaluable insights into patient’s experiences of healthcare and has added a new level of accessible knowledge to the medical fraternity and beyond. Healthtalk is well

(Healthtalkonline, 2008) and continues to expand. Furthermore, it is evident that qualitative methodology has become increasingly and more widely accommodated as an acceptable and valid methodology, the National Institute for Health Research (NIHR) research specification document (NIHR, 2009) selection process specifically requests evidence of qualitative methodologies, including in-depth interviewing.

I had envisaged that each of the interviews would be loosely framed by a fluid interview schedule (appendix 1) that I developed from a theoretically informed position that arose as a consequence of interactions and responses during a previous research study with patients recovering from cardiac arrest. This interview schedule was an aide

memoir designed to ensure that potentially important areas were not inadvertently

overlooked.

Accordingly, I concluded that the use of the one-to-one, in-depth interview represented the most appropriate methodological model to successfully address the research questions within the planned study. My previous 30-year history of talking to patients and my recent experiences of interviewing patients was also very helpful. Furthermore, the chosen approach would provide the best possible circumstances to yield high quality data, provided that sufficient preparation was made in constructing a psychologically safe environment that would be conducive to disclosure of their genuine thoughts and feelings regarding their experiences of recovery from cardiac arrest. The next sections of this chapter detail the research setting, the sampling methodology, the ethical issues and recruitment to the study.