II CONSIDERACIONES Y FUNDAMENTOS DE LA CORTE CONSTITUCIONAL.

Prior to any data collection the Research Committee of the Department of Nursing and Midwifery assessed the project for scientific merit. Full ethical approval to proceed was granted from the Human Ethics Committee of Massey University and the Regional Health Ethics Committee.

Informed Consent

Throughout the project the researcher was responsible for protecting the rights of all the participants. A full explanation of the nature and purpose of the study was given to all team members who were assured that consent to participate was ongoing. Unforeseen events and consequences are always possible. Continuing facilitation and renegotiation were essential to protect participants' human rights. If interviews were interrupted, or delayed, even though the researcher wanted to talk to people, she had to offer the option of appointment cancellation with a sincere spirit so people had genuine choices.

Potential participants have the right to feel free from pressure or undue influence of any kind (Wilson, 1985) . Every effort was made not to be over enthusiastic or to use persuasive language when inviting people to join the study. Participants were given an information sheet in advance and time to read that before the written consent was signed. Verbal consent was accepted as an initial agreement in team meetings. Participants also had the right to know the potential time commitment. Because it was impossible to advise participants when data saturation might occur, people were reminded of the right to withdraw from the study at any point. Of the forty-four participants twenty-six had one interview, four people were interviewed twice, seven people were interviewed three times and three people were interviewed four times. Total interviewing time was 80 hours.

In actively consenting to be part of the study, participants agreed to the tape recording of the interview. People were asked to pass on only that

information they felt comfortable sharing. They were assured the tapes, transcripts and computer discs would be stored safely in the researcher's home. When a transcription typist was used, participants were given the name of that person and asked if they accepted her listening to the discussion. The typist was asked not to discuss fmdings with others. Transcripts were returned to each individual for perusal.

Many participants were uncomfortable reading their transcripts although the choice to do that, or not, was individual. Some were embarrassed about their verbal expression. Others noticed they did not answer the questions. The researcher was philosophical about such issues. Everything was data. Most participants were willing to fill in gaps, to provide new leads, to explore ideas, to help the researcher understand more about team practice. Indeed, Strauss ( 1 987) has suggested that the analyst believes everything but believes nothing. Any alternative view always advances connections and the synthesis of impressions into a coherent whole.

Anonymity and Confidentiality

Throughout the study no clinical data was collected on clients receiving care from anyone in the teams. Issues about the participants' anonymity and confidentiality were discussed fully prior to interview. Care was taken to ensure participants were not linked . with specific data. Most clinical directors had high international proflles. Everyone was asked to choose a pseudonym as an interview name. · The choice of a pseudonym was significant as, in any research project, fmdings will be shared with colleagues in seminars, conferences, and international publication.

Researcher Involvement

Although research in grounded theory attempts to limit the influence of a priori knowledge of the phenomena being studied, Glaser and Strauss ( 1 967) stated that, once immersed in data collection, the researcher does not remain a passive recipient of impressions. Understanding participants

in the area of study is a complex process that also depends on the quality of the researcher-participant relationship, which, in turn, affects the rigour of the study. Once the researcher entered the field she was responsible for establishing an all-inclusive reciprocal relationship with participants.

Morse and Field ( 1 995) believe that "the amount and quality of the data and the depth of analysis depend on the ability of the researcher" (p. 1 4 1 ) . Throughout the project, the researcher was conscious of creating a sense of trustworthiness, which would enable her to gather significant information from the clinicians. Krefting ( 1 990) believes that the nature of the rapport influences the passing on of sensitive material. Similarly, any sense of trustworthiness is likely to increase when the researcher actively uses strategies that promote credibility, transferability, dependability, and confrrmability.

The researcher established her credibility with participants by spending time in the clinical areas, and by collecting data from various sources. The "prolonged field experiences" (Krefting, 1 990, p. 2 1 7) helped the researcher to check out different perspectives, and gave the participants time to become accustomed to having a stranger in their midst. During interviews the researcher was conscious of creating a communication climate which conveyed her commitment to openness, honesty, and genuineness. The researcher worked to put preconceptions to one side, to be as open as possible, to uncover the meaning behind differences, as she encouraged participants to share their ideas. The collection of significant data depended on the researcher suspending prior knowledge and assumptions, and actively listening, so that responses and explanations were not preempted.

The researcher also appreciated that the assessment of trustworthiness would be judged according to the quality of the theoretical sampling and the density of the data. Every effort was made to follow up emergent leads, and to talk to new participants from the four teams who might introduce different understandings which could be compared with the existing data.

Krefting ( 1 990) argues that the density of the descriptions supports transferability of the data. In this grounded theory study data density was achieved by the amount of data collected from participant observation and interviewing. There were eighty hours of interviewing and eighty hours of participant observation in this project.

The dependability of the data refers to the consistency of the findings (Guba, 198 1 ) . This was supported by the careful description of the research methods and the audit trail, by the constant comparative method of data collection and analysis, and by peer review of theoretical development. The process was pervaded by a deep commitment to the emerging grounded theory method, and an aversion to forcing the data in a direction that did

t not represent the reality of the participants. When the researcher became aware of questions, problems, or biases she took time to memo ideas, to reflect on her position, to talk through the issues with another grounded theory researcher, and to return to the participants to clarify emerging ideas. Peer debriefing with trusted colleagues (Lincoln & Guba, 1 985) was useful to ensure the researcher was challenged for her biases and was working to keep herself honest in her interpretations. Prolonged engagement in the field may lead to an over-involvement with participants. Reflexive analysis was critical here (Krefting, 1 990). The researcher was well aware that she was never neutral because of her involvement with the

participants, so she was forever monitoring her self, as she sought some state of balance between subjective and objective meanings, which influenced her ability to interpret content accurately.

Confirmability in a grounded theory study occurs when the participants recognise the experiences being explicated. According to Krefting ( 1990) , the interpretive process is dynamic, and its success is dependent on· searching for multiple perspectives, and fmding different slices of information, which "maximise the range of data that might contribute to complete understanding of the concept" (p. 2 1 9). Recognition and clarification of meaning was an ongoing process in this grounded theory, as

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with existing interpretations, and checked out with participants. Information emerging from one interview was checked at the next and so on, until the fmal interpretation was presented to some team members for their feedback.