Diseño de retos, fases y niveles

The delay imposed by NEAS to the start of my fieldwork persuades me against a pilot study. Although desirable in order to eliminate confusion, disinterest and empty data (Bryman, 2004) I did not want to challenge the hospitality of NEAS by having to extend my fieldwork into the winter. Observing two shifts with thirty-six participants at a rate of two a week I reasoned would take five months. However, this soon proves unrealistic partly due to the paramedic rota and partly due to a lack of personal stamina

exacerbated by bereavement. As NEAS stipulate I can only observe over day shifts for reasons of safety there are only seven shifts in each paramedics’ standard six week rota when they are available. Added to which I find completing two twelve-hour shifts with anything up to two hours of travelling time either side exhausting and need to factor in recovery time.

NEAS are very accommodating of my needs and allow me to extend my timeframe not once but twice as I have to take a complete break from my fieldwork following

bereavement. As a consequence it takes practically a whole year to collect the data from all thirty-six of my participants, as I illustrate in my fieldwork diary in Appendix 3.16. I send each participant the two self-reports for completion four weeks prior to my arrival on station and collect these either on arrival or subsequently but no later than two weeks after my field trip. Data collection of both the qualitative and quantitative datasets from each paramedic therefore spans a maximum period of six weeks.

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3.9.1 Qualitative Methods

From the qualitative paradigm I utilise participant observation, semi-structured interviews and document analysis to collect data with respect to all eight of my subsidiary research questions.

3.9.1.1 Participant Observation

Participant observation is defined by Bogdan (1972: 3) as “research characterised by a prolonged period of intense social interaction between the researcher and the subjects, in the milieu of the latter, during which time data, in the form of field notes, are unobtrusively and systematically collected”. It aims to “generate practical and theoretical truths about human life grounded in the realities of daily existence” (Jorgensen 1989: 14). Although time consuming and therefore costly it allows the researcher to identify and gather data on the who, what, where, when, why and how of interest rather than having to piece together clues from interviews in which verbalised behaviours may not mirror reality (Bogdewic, 1992).

Although I had doubts about employing this method as previously discussed, I quickly engage with the intimacy it offers that Douglas (1985) considers emotional researchers need to foster, in order to encourage their participants to behave naturally. As I become attuned to cultural terms and colloquialisms I use these to make my researcher status less threatening and to promote a conversational tone to encourage responses (ibid). As a result of making my participants aware I am a certified first-aider I am able to sway along the participation continuum (Bogdewic, 1992) depending on circumstances. On a few occasions e.g., accompanying a participant into a management meeting I adopt the role of the complete observer that anchors one pole of the continuum and is

characterised by no interaction. However, I do not adopt the role of complete participant at the other pole, as this is characterised by concealed identity.

The majority of my fieldwork lies between those two extremes with my role either an observer-participant as demanded of the majority of clinical situations or a participant- observer when exceptionally an extra pair of hands is required to help ready a patient for transport, apply pressure/dressings to a wound or administer CPR. I am generally comfortable with either role although I am on occasion challenged in respect to the first

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by the unpredictability of mentally ill patients. On one particular run where the patient being attended exhibits signs of mental distress I am told to stand behind my participant and on another to stay out of sight in the ambulance whilst my participant attends to them in their home. As I am not able on either occasion to run from my anxiety but have to face up to it I realise this is exactly what the paramedics themselves have to do but on a regular rather than exceptional basis.

With respect to the second role I am challenged by the brutality of CPR. If I am asked to assist I willingly do so as I am trained and comfortable in using those techniques. But I feel distress over how elderly people in poor health are exposed to strenuous

resuscitation techniques rather than being allowed to pass away peacefully. Although in discussion my participants generally agree with this sentiment they make it clear to me they have no choice but to initiate CPR if there is no DNR order. I respond by raising a DNR for my mother who was very poorly in a nursing home at that time as I did not want her to be exposed to the indignities associated with CPR as I knew they would be futile and more importantly, contrary to her wishes had she been able to voice them. Not an easy thing to do but my fieldwork makes me face the reality of her situation rather than continue to deny it.

The most significant challenge to my role as participant-observer occurs in the enormity of a critical incident in which my status as an ‘ambulance’ responder is assumed. This arises partly from how I wear a standard NEAS jacket emblazoned on the back simply with the word ‘Ambulance’ as previously mentioned which had been given to me to wear by my first participant and partly from being accepted by my current participant as someone they could count on for help. Although I am able to perform the basic first-aid they ask of me under their supervision I do feel anxious I might be judged by others at the scene as less than competent. I am conscious of how there is no time to explain my presence particularly to the air ambulance crew who subsequently attend the incident and engage everyone in stabilising the patient and organising their evacuation. Although I am able to follow any instruction I am given my anxiety remains until the helicopter takes off when it is replaced by a euphoria that remains with me for several days. I give more details of this incident I label T1 in the next chapter but this brief abstract signals how participant observation is not a method to be chosen lightly but in full knowledge of the responsibilities that accompany it.

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By accompanying each participant over two consecutive twelve hour day shifts I should have accrued 836 hours of observations over the five-months spanning April through to August 2008. However, I only accrue 660 hours from April through to the end of March 2009, Appendix 3.16 refers. In July 2008 I take, albeit with some reluctance, the

decision to reduce the number of shifts I observe with my seventeen remaining respondents from two to one. I do this in order to maintain progress whilst having to increase the care I give to my seriously ill mother. This undoubtedly compromises my data collection, as time to build a rapport and ease the respondents into an emotional dialogue is shortened and the data has to be captured over half the time.

In November 2008 I have to take an enforced twelve week break when my mother passes away. However, I do observe over a total of 276 runs. I use both an audio-

recorder and a series of A5 notebooks to collect field notes into which I also incorporate my personal feelings to allow my account to be strengthened by a reflexive emotional engagement and drive for further understanding that this encourages (Fielding, 1993). I record in particular details of my relationship with each participant and the depth of rapport I achieve and what factors influence this to allow any bias in my collection and subsequent analysis to be determined and exposed.

3.9.1.2 Interviews

Interviewing is “an art that cannot be achieved by following rules or particular methods” (Liamputtong and Ezzy, 2005: 60). It requires, according to Taylor and Bogdan (1998: 99) “an ability to relate to others on their own terms.” As emotional experience “is not readily or fully disclosed through superficial interview exchanges” (Gubrium and Holstein, 1997: 65) patience and tenacity are both required. Douglas (1985) advocates the sharing of anecdotal experiences to soften an interview into a less threatening conversation. Fortunately, I have my past experience of working in a hospital that I share which not only softens interactions but strengthens my credibility and acceptance. As I decide against a pilot, I rely on my extensive experience of

designing and conducting interviews during a previous employment in Human Resource Management, in order to get them right first time.

I hold the first interviews with managers [Group Two] at HQ during March 2008. The interview guide reflecting the organisational aspects of my contextualised theoretical

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framework is prepared as part of the NHS submission for ethical approval, Appendix 3.13 refers. From this I create a mind map on one page of my notebook to avoid

distraction from turning pages and to provide a jotter for additional questions as advised by Liamputtong and Ezzy (2005) who act as my mentor. I follow their advice in setting up a database in order to keep track of all activities from the initial approach to the final claim for travel expenses and debriefing with someone familiar after each interview so residual emotion does not impede the next one. My NEAS liaison officer willingly undertakes this role for which I remain most grateful. Each interview is recorded and as soon as practicable afterwards I secure a private space to ensure no malfunction has occurred and there are no passages presenting difficulty in interpretation. As I sometimes have difficulty with accents I carry out this check whilst details of the interview are still fresh so that if the interviewee has to be contacted to confirm and/or fill gaps as appropriate, it is still fresh in their minds also (ibid).

The second set of interviews takes place with my paramedic cohort. However, a one hour uninterrupted semi-structured interview I deem a first-rate collection is to prove the exception rather than the norm it had been with the managerial group. I admit to being naive but I envisaged my interviews being conducted in the relative comfort, quiet and privacy of the ambulance station even if they were segmented between runs. This expectation, as I am to discover on my very first shift, is unrealistic. The demand on the service is frantic that day and there is no time to do more than break the ice with my participant. To compensate they offer to stay for thirty minutes at the end of that shift. As they are keen to do so I accept and we talk in a corner of the station yard as the shift changeover inside is hectic and noisy. The emergency service is even busier on the second shift next day with the second meal break suspended until 18:15pm just forty- five minutes before the end of the shift. My participant offers me that time as it is too late for them to eat before going home and we talk in the back of an ambulance this time as it is cold outside. We have to beat a hasty retreat when the relieving crew who come in early have a run but in those two thirty minute slots I manage to secure my data.

Although this baptism is less than ideal it proves to be one of my better experiences as my interviews with my other participants who are one half of a crew more often than not comprise a series of short snatches of focused conversation between runs. I rank those which take place within the relative quiet and comfort of the ambulance station a second-class collection and those which take place in the ambulance cab on route to or

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from an incident which makes audio recording and note taking difficult a third class. Interviews whilst on standby vary as solo responders are often stationary for longer periods than ambulance crew as ambulances are more in demand. However, irrespective of which vehicle I am in the threat of a run hangs in the air. This creates a tension which I acknowledge may have impaired the attention given to my questions and limited the paramedics’ responses.

Although the conversational tone softens the formality of my discussions which are as a consequence less threatening their segmented nature makes it more difficult to maintain threads. I compensate for this by making a careful note of where I am with my questions and the last response given by my participant in my notebook so I can quickly recap when we resume. Sometimes I am able to pick up each thread and develop these without interference but at other times, I have to cut them off prematurely if

circumstances such as an intervening bad run, has wiped the paramedics’ thoughts. Opportunities for me to enlarge some areas of interest are inevitably curtailed as a consequence of not having longer, uninterrupted sessions.

Data collection becomes particularly fraught when the time available in which to collect it shrinks due either to operational requirements or participant comfort and I find myself constantly reining in the freedom I afford my participants to chat and reviewing whether each question I want to ask has been saturated by previous participants. I do not apply any hard and fast rule to this which crops up only after I have reduced my observations to one shift but simply omit questions which have generated a uniform response in favour of those that show less typicality. I acknowledge my decision to be selective in this way may have obscured exceptions but I decide securing a breadth of data is important in order to expose all of the nuances to paramedic emotional labour.

The questions I pose touch on each quadrant of my contextualised framework for which I use those I submitted to the REC for their approval as a partial rather than absolute list as I have previously explained. I draw a mind map of areas to cover but as these

interviews focus on the subjective elements of emotional control I endeavour to create the intimacy recommended by Douglas (1985) by making a mental image so I can chat without diverting my attention. Alongside this, I keep in mind a list of probes whose purpose is to minimise sidetracks, encourage detail, clarify uncertainty, check experience against hearsay, determine evidence/bias and most importantly, convey

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attention (Rubin and Rubin, 1995). These take the form of a brief comment e.g., ‘Go on’ or a gesture e.g., Nod of the head. Knowing when to use these is an important skill, Seidman (1991: 67) comments “laughter is often a good cue for a probe or further exploration” as it is often used as a cover for uncertainty that needs to be explored rather than ignored. I check my data at the end of each shift to avoid later queries although on occasion I am too tired and resort to following up the occasional query through email.

3.9.1.3 Document Analysis

To extend the breadth of my knowledge and add meaning to my data analysis I access both public and private documents. A number of documents reside in the public domain. From the DOH I scrutinise key publications with respect to the ambulance service e.g., ‘Improving Working Lives for Ambulance Staff’ (DOH, 2004b) and ‘Taking Healthcare to the Patient’ (DOH, 2005a). Assimilating this later report referred to colloquially as Bradley after the author proves particularly fortuitous as it is subject to a number of scathing comments by my participants who always ask me if I have read it and being able to answer ‘Yes’ emphatically and discuss it critically enhances my credibility. I also peruse various publications from the NHS including ‘Meeting the Challenge: A Strategy for the Allied Health Professions’ (NHS, 2000).

The Healthcare Commission who subsequently rebrand themselves the Care Quality Commission [CQC] provide performance ratings for each NHS trust and the results from annual NHS staff surveys (CQC, 2009). As the latter are broken down by trust they are particularly useful as I can allude to their sections on stress and job satisfaction in my discussions as a means of introducing those topics. Historic information is

however context specific and needs to be treated with caution (Habermas, 1984) so I do not attempt to validate the content but use it as a springboard to ascertain the views of each of my participants. From the private domain of the research site, documents pertaining to local policies on discipline, diversity, flexible working, absence and recruitment are made available to me via my liaison officer. These policies represent those most likely, in my opinion, to crop up in discussion and I consider it would be useful to have prior knowledge to both prevent distortion of responses and increase the pertinence of my questions.

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3.9.2 Quantitative Methods

Only a small number of studies (Mann, 1999; Brotheridge and Lee, 2003; Glomb and Tews, 2004; Chu and Murrmann, 2006) have sought to devise measurement scales for emotional labour even though the advantages of being able to do so are widely

articulated due to the implications of the concept for wellbeing (Brotheridge and Lee, 2003). I consider a resurgence of interest in the field of organisational emotionality that has led to the development of multiple strands of inquiry (Ashkanasy, Zerbe and Hartel, 2002) has diverted attention particularly the seductive lens of EI (Fineman, 2003) whose charm has attracted a number of researchers investigating emotional labour (Grandey, 2000; Cote, Miners and Moon, 2006; Mikolajczak, Menil and Luminet, 2007; Austin, Dore and O’Donovan, 2008; Cheung and Tang, 2009; Joseph and Newman, 2010). As each study has developed its own conceptual measure none carry a universal endorsement. Similarly, I find none of the measures have been castigated on the

grounds of either reliability or validity. As Fineman (2005: 7) points out, they all benefit from being “buttressed by reputational gatekeepers, such as editors of key journals, where measurement is taken as an unquestioned gateway to scientific truth.” This, in my