Extracción del ADN

Research Question Four: Which, if any, observational data collection activities of paediatric RNs during the admission procedure can feasibly be used to collect valid and reliable information with which to answer whether the identified quality behaviours are being practised during the admission procedure?

Using video observation enables both visual and audio data to be captured in detail (Borbasi et al., 2008). Subtle and concurrent behaviours can be recorded (Paterson, Bottorff, & Hewatt, 2003). In addition, video recorded data is more accurate and credible than relying on the opinion or the memory of an observer (Paterson et al., 2003). Previous research using video observation has been able to monitor nurses‘ behaviour and their communication skills during patient interactions successfully (Andersen & Adamsen, 2001; Lotzkar & Bottorff, 2001;

Uitterhoeve et al., 2008). For example, Andersen and Adamsen (2001) documented interactions between nurses and patients who were undergoing radiation therapy for cancer, concluding that video ―... can document accurately interactions and behaviour ...‖ (p. 257) between nurses and patients.

A significant problem in using video observation is the potential anxiety aroused by being in front of a camera (Nilsen & Baerheim, 2005; Paul, Dawson, Lanphear, & Cheema, 1998). Indeed, during the recruitment stage of this research, several nurses expressed concern about the camera being in the room. These nurses articulated their feelings of self-consciousness due to the video camera‘s presence. However, ways to address research subjects‘ concerns include thoroughly describing the research process and emphasising to participants the purpose of the research as this should ―... decrease apprehension ...‖ (Nilsen & Baerheim, 2005, p.5). The research process was presented to the nurses at site-level team meetings. The video camera

82 was shown to them and a brief explanation given about the QM development. At no stage were they told what the QMs were as this could have created a proclivity in the RNs to ensure that the QMs were met. During the meetings, it was emphasised that the RNs should try to conduct the admission procedure in their usual manner. Nilsen and Baerheim (2005) also advocate that each participant is treated as an individual so that the personal style of the participant can be expressed. The RNs were reassured that this was not a review of their work practices and that no one other than the research team would have any access to the videos.

Another issue which seemed to have helped relieve some of the anxieties expressed by the RNs was by informing the participants that they would be filmed during more than one

admission. This was demonstrated in the Paul et al. (1998) study of medical students‘ feedback where more than one episode of filming helped reduce anxiety. Also, during the site level meetings, the Hawthorne Effect was explained and given as the reason as to why more than one admission being video recorded.

Observation research can be overt, meaning the sample is aware they are being observed, or it can be covert meaning the observer is concealed with the participants being unaware they are being observed. The benefit of covert research is participants are more likely to behave

naturally if they are unaware of being observed. But there are ethical problems of this type of data collection (Centres for Disease Control and Prevention ([CDCP] p.1 2008). Covert or concealed research means that people involved in the research cannot give their informed consent and this not respectful to the sample (National Health and Medical Research Council, 2007).

Observational research can also be direct or indirect. Direct observational research means the interactions or behaviours are being watched as they occur whilst indirect observational

research refers to the time of a researcher‘s observation of the results of the interaction (CDCP, 2008). An example of this would be observing children‘s/ families‘ behaviour after the admission procedure to see if they demonstrated less anxiety if all of the QMs were met. However, this was not the purpose of this research. The purpose was to develop and test the QMs to determine if specialist education in paediatric nursing affected the quality of the admission, as determined by the literature and the Delphi Panel. Hence, the style of observational research used in this study was direct and overt, meaning the nurses were aware their actions and behaviour were being recorded during the admission procedure they had consented to be part

83 of the process and their agreement to be included anonymously in the data collection and its evaluation purposes for this dissertation.

Observational data collection is a lengthy process (Borbasi, et al., 2008). To gain cooperation of the sample, researchers generally have to be accepted by the group being studied, unless the observation is covert (Bell, 2005). Bell goes on to say that it is advantageous to do the same job as those being studied. Prior to this study, the researcher had worked at both research sites and was well known in each; therefore, acceptance was not a threat to the research process.

Other methods to capture the behaviours include taking of field notes but these rely upon the researcher‘s interpretation and memory of the events (Mulhall, 2003). Also, Emerson, Fretz and Shaw (1995) argued that if the notes are recorded during the event, then there is a risk that some behaviour may be missed due to the researcher concentrating on writing the observed events. The procedure could have been tape recorded but audio cannot capture any non-verbal behaviour (Paterson et al., 2003). The RNs could have been interviewed as to what they deem as high quality care during the admission procedure but this would not have enabled the researcher to observe behaviours and this was a central to this research: to observe if SPNs behave differently to NSPNs in terms of how they interact with children and their families during the admission procedure. Therefore, video observation research was considered the most suitable method for this research. Video observation enabled the capture of nurses‘ behaviour and interactions with children and their families and enabled the researcher to observe the quality of the interaction.

The foremost consideration when deciding to use this method is whether or not it is possible to observe the phenomenon of interest, that is, could video capture whether the QMs were being achieved or not? Video is more efficient than field notes due to the researcher not influencing the event and behaviours are not missed when taking notes. By analysing the videos, it was possible to see if nurses met the QMs.

Although attitudes cannot be observed, behaviour can be and inferences can be made about attitudes through the observed behaviour (QuickMBA, 2010; Sahney, n.d.). Using video observation enables both visual and audio data to be captured in detail (Borbasi et al., 2008). For example, facial expressions could be recorded as this may have indicated how comfortable the caregiver[s] was with the admission procedure.

84 The observation method in this research was looking to see if particular behaviours were

present i.e. whether or not the nurses met the QMs. It was possible to see if the behaviours were present and it was possible to score if the QMs were met or not. Another principle benefit of using video observation for this research is the video enabled the independent reviewer to validate the findings, thereby enhancing validity (Caldwell & Atwal, 2005; Macnee & McCabe, 2008). In addition, Caldwell and Atwal (2005) affirm that using video ensures reliability because if this method was repeated, it would be possible to replicate the findings.

Finally, the observational method enabled the researcher to collect other in-depth qualitative data during the procedures. This was behaviour which was not included as outcomes of the QMs but many of the RNs were observed exhibiting these behaviours during the review of the videos. These additional observed behaviours may also have an impact upon quality care and included children and families being left on their own by the RNs for long periods. What was also observed during several admissions was the completion of the admission form before assessing or examining the child. Another example noted was the RNs standing over the child and family during the procedure. All of the additional observed behaviours are listed in Chapter Five, Section 5.6.

Prior to describing the recruitment of the sample, ethics approval was granted and this is described below.