3.8.1 Population and Sample
Sampling is necessary in social research to reduce the cost and also reduce the time for the researcher to collect that data (Hedt and Pagano, 2011). The target population that forms the focus of this research study was all HSWs working and employed through commissioning arrangements by the HSE in all primary care areas in Ireland involved in direct patient care. Resources and time available to the researcher often determine the selection of both the setting and subjects (Kwong et al, 2011). Therefore, it is necessary to apply a sampling technique to assist the researcher to select a subset of the target population. The challenge remained for the researcher especially when undertaking a research study as part of an academic qualification, with limited financial, human and time resources. Therefore, with the goal of conserving these resources the researcher employed a non-probability sampling method known as convenience sampling. The convenience sample for this study are HSWs meeting the inclusion criterion and locally accessible to the researcher. Furthermore, due to the repeated measure design method employed, this convenience sample enabled the researcher to collate the data with minimum financial implications.
The writer is aware that this sampling method can introduce bias due to systematic differences and lead to under representation of the target population (Kandola et al, 2014). Within the literature Kallman and Sureuds (2009) employed a cross-sectional survey design to investigate knowledge among HSWs. This research study randomly selected the location and also randomly selected the study subjects. Population surveys provide more representative samples employing and decreasing the likelihood of selection bias (Hedt and Pagano, 2011). However, limitations were recognized in testing people’s knowledge by self-administered questionnaire with no guarantee that that HSWs did not confer with each other or consult media or literature. Therefore, the benefits of gaining insights and testing HSWs ability to detect early pressure ulcer damage and decreasing the likelihood of conferring and provide more representative results was a difficult task. Furthermore, this design not only measured the efficacy of an educational intervention but measured the
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sustainability of knowledge gained and rendered this selection of sample choice paramount.
This study was a preliminary study, convenience sampling was employed due to resources and costs to employ an alternate sampling technique such as random sampling was not achievable. Moreover, visual skin assessment is the only technique in the community to detect skin changes and HSWs are the most likely to complete this comprehensive assessment. The researcher was aware of the probability of selection bias by selecting a convenience sampling technique. Nonetheless the researcher believed it was fundamental to undertake the study to strengthen rather than weaken our knowledge about this vital group of healthcare workers. The researcher could have conducted a cross-sectional, multi-site, self- administered questionnaire in a random sample of multiple primary care teams. However, the risk of conferring and looking at media could not be excluded.
3.8.2 Negotiation of Access
Ethical approvals were sought and granted from the Clinical Research Ethics Committee of the HSE Dublin North-East and the Clinical Research Ethics Committee of the Royal College of Surgeons in Ireland Ethics Committee (See Appendix 1 & Appendix 2). The study setting selected for this research proposal was in a large primary care setting, comprising of both urban and rural populations. This setting is currently subdivided into 12 primary care teams made up of multidisciplinary team members. The Home Support Department is co-located autonomously in the primary care setting. Permission to access the participants was obtained from the Home Support Manager in the primary care setting. A copy of the access letter provided by the Home Support Manager at the study site is provided (see Appendix 3). Access to the population was through a gatekeeper appointed by the Home Support Manager. The gatekeeper invited the selected study population to attend a staff meeting where the study details and consent process were conveyed to the study population in its entirety. Historically, the vast geographical areas encompassing primary care have been an influencing factor prohibiting HSWs to attend training or meetings (Cavendish, 2013). Therefore, four staff meetings were arranged in total by the gatekeeper to ensure full attendance of potential study subjects. Hancock et al (2005), stated that ambiguous information regarding
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proposed training is a detrimental factor in how HSWs’ reach an informed decision of whether or not to participate in training. The gatekeeper expressed concerns regarding her proficiency to give clear information in regards to the details of the research study. Therefore, the researcher provided the information regarding the study details and the consent process.
A total of 150 packages including the inclusion/exclusion criterion leaflet, invitation letter, information leaflet and consent from (see Appendix 4 and and Appendix 5) were given to all study subjects that attended the meeting. All HSWs were asked to take all the relevant information home, and to deliberate with friends and family if participation in the study was the right choice. The HSWs were informed that if they decided to take part in the research study to complete the consent form and return to the home support department in a sealed enveloped provided for attention of the researcher within 48hrs. Of the 150 potential study subjects 39 replied with written consent.
3.8.3 Intervention
The educational intervention of choice was the PUCLAS e-learning tool. It was developed following the EPUAP position statement on pressure ulcer classification and IAD differentiation. PUCLAS provides an overview of causative factors (Defloor et al, 2005). This tool aims to further support clinical teaching and learning about pressure ulcer classification and IAD differentiation (Beeckman and Schoohoven, 2015). It has been developed as a solution for the on-going major difficulties experienced by healthcare professionals when classifying pressure ulcers and in making a distinction between pressure ulcers and skin lesions caused by urinary and fecal incontinence. This tool comprises four separate modules, each made up of specific learning outcomes and assessment tools (Appendix 6). An updated version of pressure ulcers classification which concurs with the latest international guidelines is included within the e-learning tool. Additionally, the most recent terminology for IAD is provided, with high quality graphic images developed by the PUCLAS Workgroup of the EPUAP (Beeckman and Schoohoven 2015).
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Permission to use the PUCLAS e-learning tool was granted by Professor Dimitri Beeckman. The flow of study intervention from obtaining consent to the final post- test is illustrated. (See, Appendix 7).