Los Esenios

Data collection

Participant observation was undertaken to identify themes which emerged from health care professional and patient interactions to gain an appreciation of the caring relationship.

On days when observation of care was planned, the researcher sought out those health care professionals who had indicated their basic willingness to participate, to see if they would agree to observation. They were given one to four hours to consider this. Observation did not take place in an area on the wards where an individual patient or member of staff who had decided not to participate in the study might be based. The researcher worked a number of shifts in order to gather data on caring interactions across all multi-professional groups. Observation was carried out on 8 occasions, between 2 and 3 hours on any occasion.

Data management and analysis

The focus of observation, ‘observation of care and caring’, included activities such as team handover report, nurse-patient, doctor-patient, therapy-patient ‘care’ interactions, behaviours and communication. The data collected involved caring actions and commentary during routine patient-professional interactions. Any discrepancy between action and commentary was noted as well as tensions and conflicts between form and content of the caring interaction. Coded field notes were taken and ‘memoing’ formed (Glaser and Strauss, 1999), (appendix 10), this was then analyzed for shared characteristics of perspective (Becker and Geer, 1960; Bernard, 2011). The participant observation element of the study was undertaken using a staged approach adopted by Bernard (1994). Although not all stages were experienced by the researcher they are highlighted as (a) initial contact, (b) shock, (c) discovering the obvious, (d) the break, (e) focusing, (f) exhaustion and (g) leaving. By understanding and using this staged approach

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the participant observer was prepared for many of the pitfalls in undertaking this fieldwork.

Establishing the empirical approach to participant observation Zelditch (1962) outlined three elements (a) emmeration of frequencies in relation to the number of categories of observed behaviour, (b) informant interviewing in order to establish the social rules, statuses and sanctions to transgressions of regulated social interaction and (c) participation of the detail of illustrative incidents that may be related to the conceptualisations under examination.

Data management was undertaken employing the systematic fieldwork methods by Werner and Schoepfle (1987) who outline four types of data (a) the ethnographer’s journal, (b) verbatim transcriptions of native texts, (c) documents from official sources and (d) materials classified as falling between (a) and (b). Fieldnotes were taken using journals, logs, and verbatim accounts.

Acknowledgment to participants

All participants who took part in the second and third stages of the study were thanked verbally after each episode of data collection for their willingness to participate for their time and readiness to share their experiences and perceptions of the care they received. 4.8.8. Stage Three, Semi-structured interviews

Areas of inquiry varied between patient interviews and health care professional interviews. A written interview guide was developed to help provide some structure and direction to the interviews.

Patient interviews included questions designed to elicit responses to provide a picture about each patients stay in hospital and their perceptions of care and caring during this time (Appendix 11). Health care professional interviews included questions designed to elicit responses about reasons for working in a caring profession and perceptions of caring (Appendix 12).

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Following the informed consent process described earlier the researcher began the interviews with questions which elicited demographic information such as age, gender and employment. This proved to be an effective way to begin the interview and seemed to help put the participant at ease.

This initial questioning and data collection facilitated an easy exchange of questions and answers. The format for the interviews was semi-structured and a list of questions was developed to act as a guide in order to focus the participants on perceptions of caring in the orthopaedic ward environment. During the interviews further questions were used to clarify participant responses and elicit further responses. Participant answers were often restated and summarized to validate and clarify meanings.

The interviews lasted between 50 minutes and 82 minutes in length during which time questions were asked in order to elicit responses relating to care and caring experienced. Each participant was given the opportunity to answer an open ended question at the end of the study thereby providing opportunity to add any additional information relating to their personal experiences and perceptions. All interviewees were identified by a study code and each interview tape recorded with the permission of the participant and then transcribed. Specific references to individuals, wards or places were deleted to ensure anonymity. Following transcription, all tape recordings were deleted.

The audiotapes were transcribed verbatim and coded after each interview. The researcher transcribed each interview using a micro-cassette transcriber. This practice allowed the researcher the advantage of seeking out nuances and thoroughly reviewing the interview before coding began. According to Merriam (1998), the interviewer’s verbatim transcription of recorded interviews provides the best database for analysis. Unlike grounded theory where data is collected until saturation occurs, analysis was not performed until the final participant had been interviewed. This was done so that on- going interviews were not influenced in any way and the richness of the perceptions and experiences could be gathered without bias.

After coding, the transcripts were copied and kept in a separate, secure location in order to protect the data in case the original set was lost. The transcripts contained only the

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interview number originally assigned to the participants and any thoughts or speculations the researcher formed during the process of reviewing the transcriptions. All interview text was transcribed into MS Excel format. Categories to utilise the data were produced in the first instance from the themes isolated in the literature and those identified by the text (Strauss and Corbin, 1998). Occasionally the same text related to different codes, and so the copy and paste function was used to repeat the differently coded text.

The main codes where identified and labeled from Watson’s (2001) 10 transpersonal caring clinical caritas then a definition, description and example were given for each.

Table 4.12: Example of codes for semi-structured interview analysis Code 1

Label Practice loving kindness and equanimity within the context of caring consciousness

Definition Altruistic loving kindness Carative Assurance of human presence

Description Humanism – health care professional views patient as complete individual, shows interest in person as more than just a health problem. Accepts patient without prejudice and shows respect, is humane and warm towards patient

Example “I tell my patients that I am here to help them you know …. Get their trust, yeh, I want them to know that they can trust me always ….. I do care about them …. Care what happens to them”

Table illustrates examples of coding for the caring carative assurance of human presence

This process is demonstrated in (Table 4.12), the label represents a caring behavior which is defined and categorized according to Watson’s caring caritas. Finally the behavior exhibited is described and an example from the interviews given.

A combination of observational notes and interview data were used to create a full and detailed analysis of health care professionals’ and patients’ perceptions of caring.

Analysis was mainly a manual exercise which allows the researcher to become submerged and develop a thorough understanding of the textual data of the field notes

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and interviews (Braun and Clarke, 2006). Each data set was read and re-read and interview recordings listened to. This is an important introduction to the analysis process and allowed the researcher to become familiar with the data and understand the main contents (Sandelowski, 1995).

All text was examined line by line and annotations which reflected the thoughts of the researcher were made in the margins for each interview and field note. Extensive code notes were generated for each interview and included questions formulated by the researcher and a story line for each data set. The researcher frequently moved between interview and field note data to build code notes and story lines (appendix 10).