Infraestructuras de trasporte.

The relationship between the researcher an interviewee group presented a seniority difference in reverse to the researcher and nursing focus group. The Senior Nurse was the immediate senior nurse to the researcher, while the Senior Medical Officers were both in more senior positions than the researcher. A well-established professional relationship and rapport existed between the researcher and her seniors and facilitated a smooth interview process.

Interviews were one method of data collection widely used for case study research. Darke et al. (1998, p. 283) have defined them as the “primary data source” for interpretative case study research. From the interviews, valid, contextual and historical information contributed to the study an understanding of the present and the events leading to the present. The advantages of interviewing are the revelation and verbalization of deeply held beliefs and nuances which may be unlikely to emerge when employing a quantitative methodology (Park, 2010). Therefore the inclusion of interviews as a data source was an appropriate choice for the study.

There are disadvantages to interviews. Participants have a potential to deviate from the topic (Fontana & Frey, 2000). As recommended by Patton (2002), an interview guide was used to avoid deviation from the topic and to provide structure to facilitate the exploration of issues. The risks of interviewer effect, where participants consciously or subconsciously modify their responses, were minimal in this study as the interviewees are senior to the researcher and were co-operative and keen to share their knowledge. Major costs associated with interviews are time, organizing the interview, the actual interview, transcription, verification of data and analysis. Lack of anonymity for participants and opportunity for interviewer bias are further

37 disadvantages to interviews. However, despite these disadvantages, the interviews undertaken for this study provided rich meaningful data that would have been inaccessible by other means.

Participants were invited for interview through purposive sampling which is a sampling method whereby participants with knowledge of the phenomenon are invited to participate in the study. The expectation is that the participants will have an understanding of the research question (Polit & Beck, 2008). For this study the researcher invited participation from a Senior Nurse and two Senior Medical Officers. For the purposes of this study these are the titles chosen for participants, Clinical Director ICU, ICU Consultant, and Clinical Nurse Specialist (CNS). Inviting participants who were influential figures in the implementation of CCOT provided extensive data.

Semi–structured interviews were conducted to assist the exploration of the topic through the use of open-ended questions (Appendix 6). Questions were generated to explore the research question and promote participant interpretation of the subject. To enable the exploration of the research question and adherence to case study research constructs, questions were organised using Fullan’s theory which underpins the study. Embedded within the questions were the propositions for the study which provoked participants to consider the propositions and either refute or endorse them. For example, embedded within this question is the proposition that CCOT deskills wards nurses: “Explain to me if having senior critical care nurses through the CCOT coming on your wards has changed things for ward nurses”. The biases explicit in this proposition were that the practice of CCOT nurses “coming on your wards” assessing “your” physiologically unstable patients deskilled ward nurses, as CCOT nurses “took over” the patient and transferred them to ICU/HDU, whereas previously the patient was cared for on the ward by the nurses without any such intervention.

When conducting interviews several issues are important. It is important the participant is relaxed and comfortable. The interviewer must be fully conversant with the topic and possess excellent listening skills (Polit & Beck, 2008). Before the interviews I familiarised myself with the content of as many documents as possible. A total of three interviews was completed. Aside from some logistical issues to do with busy schedules, the interviews went as planned.

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Focus groups

Purposive sampling was also the chosen method of recruitment for the nursing focus group. It ensured participants were knowledgeable about the key constructs and were experienced nurses. The sampling method was enacted by restricting participants to those nurses who met the strict eligibility criteria for participation in the study. To participate in the study nurses had to have been employed on the acute wards of the hospital before the introduction of CCOT and still be employed on an acute ward. Seven experienced nurses met the criteria and participated in the group.

Recruitment of nursing focus group participants was achieved in several steps. Firstly, an email invitation (Appendix 7) was sent to all CNMs of adult acute wards in the hospital four weeks prior to the date of the focus group. The time for the group discussion was decided upon after a suitable time was discussed. Secondly, colleagues in the CCOT were asked to ensure the initial invitation had been distributed to the ward nurses and drawn to their attention. Thirdly, a further reminder was sent three days before the focus group date. At this time I also replied to any enquiries from potential participants and hand delivered the Information Sheets to wards.

A week before the focus group meeting was to take place the research assistant was supplied with a copy of the Information Sheet, Consent Form and literature review included in this work. After she had familiarised herself with the literature, time was spent ensuring that she had an understanding of the study question and what was being asked of the nursing focus group participants. A trial using the recorder also took place. The booking for the interview room was checked and the consent forms and the principles of informed consent were discussed as the research assistant would be gaining consent from the group members. The focus group

participants on the day were anonymous to me. It was unknown how many or who would attend the group. Afternoon tea was provided. A total of seven nurses participated in the focus group.

Convening the nursing focus group had the disadvantage of being-time consuming and logistically challenging in a hospital where invited participants work rotational shift rosters. However, this method had the advantage of ensuring that participants had experience and understanding of the subject under study. Focus groups may stimulate conversation which results in emerging themes after analysis of discussion (Bradbury-Jones, Sambrook, & Irvine,

39 2009). The focus group of nurses yielded sufficient data for analysis. In contrast to other

exclusively qualitative methods, the findings from case study research are merged with results from all sources of data collection in the study when data is triangulated with theory (Bergen & While, 2000). The nursing focus group contributed data pivotal to validating, interpreting and elucidating data from interviews and documents. The study would be incomplete without data from the nursing focus group.