“Grounded theory methods specify analytic strategies, not data collection methods” (Charmaz, 2006). In order to obtain both depth and breadth of understanding of the subtle nuances of interaction among members in the triad-rich data, the research “used a kaleidoscope to look at different view of people‟s behaviour” (Silverman, 2005, p. 58). An extensive amount of data with thick description has been drawn from two sources, i.e., participant observation and interview. Five intact triads, comprised of a resident, family and staff, were interviewed individually and observed in action to gain insight into their shared enactment of caregiving in the triad. The main data collection technique for the study was observation. Participant observation allowed the detailing of what the key informants “do and say” in their everyday environment. Observations involving my unobtrusive (non-participant) presence for purposes of documenting in detail the full range of interactions that occur between residents, staff and visiting family members were made in the first six months. No observations were made of intimate activities, e.g., showering, engaging in personal care, etc.; I
respected any request for privacy by leaving the room. My “participation” was limited to innocuous activities such as helping with meals, arranging furniture, etc., and lasted on average 5–6 hours most mornings or afternoons. An initial six-month time frame was sufficient to provide opportunity to observe a wide variety of events, activities and participants in various context. There were opportunities for periods of my personal reflection away from the field to develop themes, while repeated visits offered an opportunity to discuss and confirm ideas and thoughts with the participants.
Participant observation
During the preliminary work, observation produced rich data about the activity patterns and interrelationships among the members of the triad. Gathering places such as day-room, lounge, television room, activity room and dining room were initial observation sites. As more data were collected, additional key field studies were identified. These included family–staff meetings, cooking classes, family fun days, festive celebrations and meal times. Field studies lasted a minimum of five to six hours per visit, twice a week. Data were collected until informational redundancy was obtained.
Participant observation allowed me to make observations from within a triad, for example of assumptions, roles and other aspects of the everyday life of the participants (Bogdewic, 1999). In this social construction version of grounded theory, participant observation was a constructive and reflexive act, with me, as a researcher, engaging with and reflecting on my participation in the study site (Tedlock, 2005). From the outset, I had to situate myself within the field. Because I am a nurse and had worked in Parkview as a volunteer previously, I had to explain my current role as researcher to participants. I explained that I was able to do similar tasks as a volunteer, but that I could not perform any nursing work as that was not my purpose of being on- site. Tasks I assisted with included delivering food or drinks to residents in the dining room as directed by staff, and retrieving items in the wards, such as clothing from the wardrobe or face towels, as directed by staff or residents. On three occasions, however, I was present when a resident had a fall. On one of those occasions, I was able to ensure that the resident was safe and then got a nurse as I did not know the resident‟s medical and mobility history and did not want to put him at risk by moving him. On the other two occasions, staff were present and gave me directions on how to
assist them with supporting the residents back to bed. On one of these occasions, a nursing aide wanted me to assess the resident rather than getting the nurse on duty; however, I asked her to get a nurse so that she could do the assessment and document the fall. Overall, I found that when I explained my role to participants they were respectful of the limits to my activities in day-to-day routines.
At Parkview, I spent some time doing informal observations of the general milieu or participating in group activities. I would sit in the common areas, such as the TV room, the multi-use recreation room or the day lounge, so I would often sit among the residents to pass the time. When the residents or visitors would inquire about what I was doing, I would remind them about the study and explain. I also attended staff meetings, family–staff meetings and resident–staff meetings, which gave me an opportunity to observe their interactions and communication. I attended resident activities such as the Chinese Opera singing group and the cooking class.
I also spent one-on-one time with staff, following them during their daily routines. I did this mainly with nurses, nursing aides and activity staff. These sessions lasted between one to three hours at a time. Throughout the session, I jotted down notes to myself, which I later expanded into full field notes. I tried to have a flexible observation schedule in order to avoid bias that may be introduced by restricting myself to a limited portion of daily life in Parkview. So, for example, I conducted observations on different days of the week and varied the time between day time and early evening. I did not do observations during the evening and night shifts between 8 p.m. to 7 a.m., a time when residents are for the most part sleeping or staying in their own rooms, and there are no visitors and only a small number of staff. Rather, I spent time at Parkview most mornings or afternoons, my visits lasting on average 5–6 hours when there were residents, family and staff interacting with each other in order to capture the interaction pattern in this dynamic process.
In addition to these observations of daily routines, I also attended several formal meetings to observe how individuals interact with each other in a more formal setting. I attended meetings that were just between staff, such as staff meetings, committee meetings, and resident–family–staff meetings. I also attended in-service or staff education sessions, involving a guest speaker and staff, for example, on infection control. Lastly, I attended care conferences, which are weekly meetings between the
director, staff, residents and family members where an individual resident‟s plan of care is reviewed.
Observations were recorded by writing extensive, detailed field notes. Field notes provide a literal account of what happens during participant observation in the field (Bogdewic, 1999). In order to keep reflexivity central to the field work, I used subtitles in the field notes to delineate between the actual events and my reflections. I also wrote myself into the activities because I was often an active participant in what was happening. Writing field notes with this kind of texture, rather than using a neutral tone where the researcher is passive or absent, is reflective of the critical underpinnings of this study (Allen, 2004).
I wrote a field note for each observation. These field notes included data on where the observation took place, the participants‟ physical appearance and my reflections on what had occurred. The field notes also provided a place to consider how the participant‟s experience fit within some of the routines and policy that influenced their experiences. I used two steps to develop the field notes. The first step was to jot down key words and phrases to capture the essence of observation. I always had some paper and a pen in my pocket so that when there was a break in the action or I needed to take a break to capture something that seemed important, I could discreetly write down a few words. The second step was to expand these notes into detailed field notes with rich description. I was provided with a small desk in the reception office so I was able to write my complete fields notes immediately after each observation.
In-depth interview
Data were also collected through in-depth interviews with residents, family members and staff. Interviewing was the mode of inquiry with the researcher serving as the research instrument. Bertaux (1981) stated that since the subjects of inquiry in social sciences can talk and think, language is the appropriate tool. According to Seidman (1991), “at the heart of what it means to be human is the ability of people to symbolize their experience through language” (p. 4).
In grounded theory techniques (Glaser & Strauss, 1967), the interviews usually start with generalities and become more specific and focussed as basic social processes emerge through the use of the “constant comparison method”. The richness of the data
influenced the richness of the theory that was developed. According to Blumer (1978), in order to understand a group of people, the researcher must “lift the veils that obscure or hide what is going on” within the group. Semi-structured interviews that were adapted to the individual informants were conducted and focussed on answering the research questions. Interviews were conducted after at least one participant observation session and took place at a time of the key participants‟ choosing in a private room away from the clinical area. Each interview was audiotaped with the participants‟ permission.
The interview guide was constructed based on Charmaz‟s (2003) method for developing questions for grounded theory research and the researcher‟s preliminary work on observation. The interview questions were semi-structured around two broad topic areas, such as the description of an average day and what the caring and caregiving relationship looked like (Appendix 5). The first set of questions was intended to obtain data that would identify the social process associated with living in Parkview. The second set of questions was intended to yield information about the care triads. A total of 31 hours of in-depth interviews with 27 individuals representing residents, family members, staff and director were conducted. These in-depth interviews were characterised by an interpersonal dialogue between myself and the participants. As well, within the critical perspective that guided this study, interviews were characterised by their interactive nature, with myself and the participants often engaging in mutual self-disclosure (Lather, 1991). In describing these kinds of interviews, Heyl (2001) states:
… interviewing…in which researchers have established respectful, on-going relationships with their interviewees, including enough rapport for there to be a genuine exchange of views and enough time and openness in the interviews …(p. 369)
In this study, interviews were arranged at a time of the participants‟ choosing. All interviews took place at Parkview. All of the staff interviews took place during a staff participant‟s shift. These participants arranged coverage for their work so that the interviews largely went uninterrupted. Each interview started with some informal conversation about the participants, as a way of building rapport. Often I had already had several interactions with the participant before the interview began, so that it was more of a continuation of a conversation than an isolated event. This process of
building rapport is an important aspect of qualitative interviewing as it often leads to a richer dialogue between the participants and the researcher (Madison, 2005).
Interviews typically lasted an hour. Each interview was recorded and transcribed at a later time. Although I used an interview guide to provide some structure to the conversations, I generally asked the participant to tell me the story about their experience in the triad. This provided a springboard to explore further issues. Once the formal, recorded part of the interview was completed, there was often a period of “off the record” chatting that took place. Two residents who had been selected as participants perceived the study to be “too sensitive”, fearing that their loyalty to Parkview would be questioned. This was particularly noticeable with these two residents who often seemed to breathe a sigh of relief when the recorder was turned off and then told me “what they really thought”. This chatting after the interviews shed light on the participant‟s interpretation of the interviewer and the interview process (Warren et al. 2003). These comments were recorded in my notes after each interview and were used to contextualise the interview during my interpretation of the data.
Interviews were tape recorded and transcribed verbatim. In order to keep the nuances of the conversation from tape to paper, ellipses (…) were included to indicate extended pauses, and expressions such as laughter were included in brackets. I checked each transcript by listening to the recording while reading the transcript, filling in any gaps where I was able to recall what was said. If I was not able to recall, then I would leave the gaps in place. This process of ensuring the accuracy of the transcripts contributes to the overall rigor of the research process (Tilley, 2003).