Selecting the Participants Prior to the recruitment of participants and the collection of data, institutional review
ethical approval was obtained from my host institution and the University nursing school where the research was conducted. As the collection of data took place in four nursing education centres that are attached to a University nursing school, an occupational health assessment and criminal records bureau check was undertaken,
117 and an NHS research passport was obtained. There were however, administrative problems22 with the new NHS research passport system (introduced in 2009) and frustratingly, the process for acquiring a passport took over a year to be completed. Pre-registered (years two and three) mental health student nurses were self-selected from four nursing education centres attached to a University nursing school in the north of England. Students from the first year (2010-2011 cohort) of the Diploma/BSc in mental health nursing were not considered for this study, as I felt that they needed time to establish themselves and gain confidence in clinical situations. The nursing educators informed me that during the first year of the Diploma/BSc mental health nursing pathway, many of their students struggled to come to terms with the basic theoretical and applied aspects of nursing. I therefore did not want to further burden these first year students by asking them to participate in the study. Clinical placements during the first year are also less intensive than in years two and three of the undergraduate mental health nursing pathway. In year one, the duration for placements is only eight weeks and involves a placement in a general nursing setting. By contrast, in years two and three of the Diploma/BSc mental health nursing pathway, the clinical practice component is more prominent, as each placement’s duration is twelve weeks and takes place in a variety of hospital, forensic and community mental health settings (Bonham, 2004). I felt that it was important that students should have at least one academic year of clinical placement experience behind them; hence my decision to focus the research on years two and three students.
In terms of facilitating access to the University nursing school, a meeting with the professor (who had overall academic responsibility) of the undergraduate mental health nursing pathway was arranged. During this meeting, the theoretical basis, methodology, selection criteria, recruitment strategies, and data collection procedures were discussed. The nature and purpose of the study was then disseminated in the form of an information sheet to the academic coordinators for the years two and three undergraduate mental health nursing pathway. I was then invited by the academic coordinators to give an oral presentation of the research to
22
At one point in the NHS research passport application process, my own personal health information was lost by Human Resources. I only discovered that my health information had gone missing when my GP reported that he had received no contact from Human Resources.
118 each of the second and third year undergraduate mental health nursing branch cohorts at the four education centres. To ensure a high level of student attendance, the oral presentations were arranged to take place at the beginning or at the end of lecture sessions. Typically, the duration of each presentation was about 15 minutes and an extra 5 minutes was allocated for any student queries. A study information sheet was given to the students at the presentations and sheets were left behind for anyone who was absent at the presentations.
Due to a low student uptake and to achieve ‘data saturation’ (Lincoln and Guba, 1985), the oral presentations had to be given to all ten student cohorts (2010-2011) across the four nursing education centres. A further study information sheet was then emailed to the students who had indicated their interest in participating in the research. It was likely that the low uptake of students in each cohort to the study was the consequence of the administrative delays in obtaining an NHS research passport. In particular, forward planning of participant recruitment was undermined by this delay, as the passport was not received until half way through the student nurses’ academic year (2010-2011). By the time I had arrived on the scene, students were already immersed in completing assignments or engaged in clinical placement. In addition to the self-selected sample of students, a purposive sample (Patton, 1990) of undergraduate second and third year mental health nursing educators was selected from the academic faculty of this University nursing school. By their depth of experience as clinical educators and as former practitioners (including their own experiences as student nurses), these educators provided important insights about mental health student nurses’ ‘multicultural clinical interactions’ in clinical placements. More specifically, it is in clinical supervision sessions23 that student nurses share with their peers and educators the kinds of ‘critical incident’ stories
23
During every twelve week clinical placement, students go back to their nursing education centre for three days of clinical supervision. Clinical supervision sessions typically last between 1 and 1.5 hours, with an additional 30 minutes set aside to talk about any issues deemed inappropriate for group discussion (Ashmore, Carver, Clibbens and Sheldon, 2012). Each session normally has between 10- 12 students and one nursing educator. Clinical supervision is defined as “a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations” (Department of Health, 1993, p. 15). The purpose of clinical supervision is to encourage students to reflect on their clinical placement experiences, to help identify solutions to problems arising from clinical practice, and increase the understanding of professional issues (Ashmore and Carver, 2000).
119 discussed in the methodology and findings chapters of this thesis. As a nursing educator explained to me during the course of an interview, “it is in the clinical
supervision sessions when you get to hear their stories and you tend to get interesting stories”. Thus, the nursing educator participants could be described as
‘key informants’ (Hudelson, 1994), who were considered as “individuals who possess special knowledge, status or communication skills, who are willing to share their knowledge and skills with the researcher, and who have access to perspectives or observations denied the researcher through other means” (Gilchrist and Williams, 1999, p. 74). Key informants are purposefully selected on “theoretical and personal considerations-for the insights and interpretations they bring to the research topic” (Hudelson, 2005, p. 312).
In accordance with the anthropologically informed research design, the aim of the recruitment strategy was to establish the range of cultural phenomena and to select information rich cases that would illuminate the research questions. Including the perspectives of nursing educators and student nurses can be seen as a form of data triangulation (Knafl and Brietmayer, 1989; Flick, 2008b). The triangulation of data sources maximises the range of data, which contributes to a more complete and nuanced understanding of study topics (Krefting, 1991a).
Participants
Thirty six transcripts of interviews with second and third year pre-registered mental health student nurses were analysed. In addition to participating in an interview, a third year student volunteered to write a critical incident narrative. The data set also included seven transcripts of interviews conducted with second and third year undergraduate mental health nursing educators. With the exception of one third year student, background information was clearly recorded for all the student participants. Just over half (n=20) of the student participants were recruited from the second year undergraduate cohort (2010-2011). Most of the participants (n=34) were enrolled on a BSc programme. The other 2 students were studying for undergraduate diplomas. Thirty three of the student nurses identified themselves as from a ‘White-British’ background, one as ‘Black Caribbean’, and one each from ‘Any Other Ethnic group’ and ‘Any Other White background’. The majority of the student participants were female, as only six of these participants were male. Just under half of the
120 participants (n=17) recorded their age as between 18-25, four as aged between 26- 30, six as aged between 31-35, three as aged between 36-40, four as aged between 41-45, one as aged between 46-50, and one participant did not record their age band. All of these participants recorded English as their first language; however, five of the participants recorded at least one second language. All of the nursing educators were female and of the lecturer grade. Three of the educators were involved in the teaching and clinical supervision of second year undergraduate mental health student nurses, with the rest of the interviewed educators (n=4) having the same responsibilities for third year cohorts.
The decision to limit the number of student participants to thirty six was based on practical reasons and a feeling that the collected data was sufficient. By the end of the data collection, I had given oral presentations of my research to all the second and third year undergraduate mental health nursing cohorts (2010-2011). Time limitations prevented the additional recruitment of second year students from the following year group (2011-2012). Given the protracted delay with obtaining an NHS research passport and the subsequent problems with recruitment planning and recruiting participants, the ethnographic interviews carried out for this study had generated a sufficient and wide range of ‘critical incidents’. I also had the experience which Colaizzi (1978, p. 70) described as “a certain empty but ‘distinct’ feeling of being satisfied” with the adequacy of the generated data. The length of the critical incidents varied from a few lines to a few pages-and in one case, an entire forty five page interview transcript. These critical incidents provided data about different kinds of placements, from community to hospital and forensic settings.