Lugar: Colegio Emilio Valenzuela, Audiovisuales

Ethics was first submitted and obtained from the university Human Research Ethics Committee (HREC) of original doctoral enrolment and then extended after transfer of study by the HREC of the current university (Appendix A). Following ethics approval contact began with the chosen health care facilities ethics department to explore the potential of this research occurring in their facility. Health care HREC committee representatives suggested that support be gained from department managers, the Director of Nursing and the Director of Hospital Research. This was a requirement at all three sites and accompanied all submissions for approval to the relevant HREC committees.

Participants that expressed interest in the research were required to read the plain language information statement (Appendix B) and sign the consent form (Appendix C) prior to interviews occurring. All participants were provided with a copy of both the plain language statement and the consent form for their own records and were also given the opportunity to have any questions answered before interviews proceeded. In addition, participants were verbally reminded that they were able to withdraw their consent at any time, without any negative repercussions. No one withdrew.

4.3.5 Data collection

The interviews conducted in this research were influenced by Kvale and Brinkmann’s (2009), and the methodological influences of critical ethnography and theoretical perspective of critical social constructionism. Thus, the words shared in interviews were considered for their subcultural and cultural connotations as well as their literal meaning (Atkinson et al., 2007; Fetterman, 1998). The researcher draws from experiences and perceptions as they are portrayed by the participant to construct meaning. This new understanding and meaning is a co-construction, unable to be created by the researcher alone and dependent on the disclosed beliefs and views of participant’s (Atkinson et al., 2007; Koro-Ljungberg, 2008; Kvale, 2014; Kvale & Brinkmann, 2009).

Influenced by social constructionism, interviews are a tool that can facilitate the formation of social meaning. By focusing the interviews upon the CPD activities

of participants the underpinning influences of social processes and contexts can be unveiled (Koro-Ljungberg, 2008). Therefore the interviews sought to extract from participants what they know, in the way that they know it, inclusive of social contexts (Atkinson et al., 2007).

The success of interviews as an effective research method is dependent on the interviewer’s ability to listen and convey to the participant that they have been heard (Kvale & Brinkmann, 2009). Guided by this approach the researcher would regularly reframe what the participant had said, in the newly co-constructed meaning. This created opportunities for the participant to realise how they were heard and also contributed to accuracy in perceiving the constructed meaning of each participant. Probing and further questioning by the researcher elicited greater depth in the newly co-constructed meaning.

Equally important to the success of the interview is rapport between the participant and interviewer. A strong rapport facilitates depth and a genuine exchange with openness. Comfort levels of participants with the researcher define the depth of knowledge and experiences shared (Atkinson et al., 2007). The researcher drew on her personal experiences as an intensive care nurse, sharing experiences where appropriate and demonstrating shared common ground, and this was effective in facilitating trust. When participants exposed sensitive cultural patterns of behaviour, such as negative workplace behaviours, the researcher also provided reassurance about confidentiality of the participant and the field site. This included highlighting that each interview was a part of a collective case study approach, not a single individual case or field site.

Kvale and Brinkmann (2009) explain that an interviewer can take many approaches but is influenced by his/her predilections of how knowledge is acquired. Using the example of a ‘miner’ and a ‘traveller’ Kvale and Brinkmann (2009) suggest two epistemological conceptions of interviewing as a process to collect knowledge (i.e. a miner), or a process to construct knowledge (i.e. a traveller). Drawing from their work, this research was conducted using the epistemological position of a traveller. As a traveller, the researcher embarked on a journey to identify CCN’s approaches to CPD using the conversations with participants along the way to construct knowledge. The travelling route was

planned but participants created unexpected twists and turns along the way in the content they shared, and the knowledge and understanding constructed (Kvale, 2014; Kvale & Brinkmann, 2009).

In this research, semi-structured interviews were well suited to the traveller’s journey. A semi-structured interview offers the guidance and ability to explore a broad range of topics in which the researcher is interested (Minichiello, Aroni, & Hays, 2008). Using this approach, the questions for the interview are designed around topics, but did not require exact phrasing or fixation of words or order of questions across interviews. Minichiello et al. (2008) explains that this interview approach allows scope to be created, facilitating the exploration of participants’ perceptions and consequently a more detailed construction of participants’ reality.

The use of open-ended questions requires care, as Kvale and Brinkmann (2009) caution the researcher to be sure to not give specific opinions on a topic and risk biasing the participant. Guided by this, as the researcher, time was taken to become aware of the researcher’s own beliefs about the topic to be sure to limit influencing the participants.

An interview guide, as suggested by Jamshed (2014), was used across all interviews. The interview guide created a form of consistency in the phrasing of questions across participants. This was also found helpful, as a deeper meaning was constructed across participant interviews and in the process of analysing the findings.

Due to the duration of data collection, four months, an interview guide facilitated consistency in the researcher’s approach to the interviews across a considerable period of time. From each interview the researcher began to construct new knowledge and understandings of the topic. It was important to reflect upon these new insights but also remain consistent in interview questions. Failure to do so would have meant omission of the participant’s valuable insights.

The interviews for this research were conducted at a time and place that was chosen by the participant. This decision, to allow the participant to select the time and place of interview, was in response to the researcher wishing to acknowledge

the importance and value of the participant’s time and contribution. The interviews were conducted in a range of different locations including private offices, public spaces such as coffee shops, parks and participants’ homes. The interviews commenced with the participants sharing information about their professional life, such as age, past nursing experiences, qualifications and current workplace and distance of home from current employer. After gaining insight into the participant and their level of experience questions moved on to CPD. The first questions in this area allowed participants to explain what CPD meant to them, how they defined it, and their views on and engagement with CPD. This included asking about the factors that influenced their choices around CPD. Only after these areas were addressed did questions about their response to the NMBA mandate of CPD enter the interviews. This structure was important, as it allowed participants to gain comfort and develop a rapport with the researcher. This then created an opportunity for the researcher to obtain insights into the participant’s perceptions of CPD prior to addressing professional expectations.

4.3.6 Rigour

Qualitative research is commonly undertaken embracing some degree of acceptance of relativism. Accepting multiple views does not allow qualitative research to be judged using the same criteria and approach as quantitative research (Ryan-Nicholls & Will, 2009). Assessing rigour in qualitative research must include consideration of the methodological and theoretical perspective to approach the area of inquiry in the research that has been undertaken (Cho & Trent, 2014). Rigour in qualitative research draws from the four areas of credibility, transferability, dependability and confirmability (Lincoln & Guba, 1986). These areas have been embraced as a framework to achieve rigour in this thesis.

Credibility

The truth of the topic is found within the human experience determined by lived experience and perceptions of the participants. In ethnography the truth is assessed in terms of the researcher’s reflection on the research process (Ryan-

Nicholls & Will, 2009). The determination of truth lies within the plausibility of the claim. No knowledge can be countered as certain, but knowledge can be assessed based upon the “likely truth” (Hammersley, 1992, p. 69). Credibility is the ability to recognise participant experiences within the study in the findings and interpretations (Cho & Trent, 2014). Credibility can be achieved with triangulation, peer debriefing, and member checking, all which were used in this research (Lincoln & Guba, 1986).

Triangulation of data is an integral element of achieving rigour and validity in findings (Taylor, Kermode, & Roberts, 2006). Houghton, Casey, Shaw, and Murphy (2013) explain triangulation as a means to achieve completeness of data and confirming data. In this research, triangulation occurred by obtaining data from more than one field site and from different roles within the nursing profession. This diversity in nurses’ roles, within the ICU, and geographical locations opened the research findings to multiple perspectives and assisted in achieving depth of data, which is key to rigour. The participant pool was also sheltered from one another with no pre-existing interactions. This allowed the findings from the three independent locations to be compared and combined. This added depth to the collective case study and assisted in identifying data saturation during the data analysis with observation of recurrent themes and experiences across participants and field sites.

Peer debriefing was embraced by the researcher throughout the doctoral study. Engaging in conversations with supervisors contributed to maintaining an openness to the data, and remaining congruent to the theoretical and methodological positioning of the research. Lincoln and Guba (1986) espoused that through exposing thoughts, views and actions, as the researcher, to professional peers the inquirer is “kept honest” (p.77). The experience of supervisors brought different perspectives to the research and facilitated an opening of my mind to further possibilities and occurrences.

Embracing the opportunity for feedback from peers and supervisors meant two pilot interviews were conducted. These occurred prior to the interviews with research participants and involved two CCN colleagues who volunteered their time and support. With their consent the interviews were shared with supervisors

for honest and constructive feedback. This experience contributed to the development of interview skills and was an integral part of achieving rigour in the research (Kim, 2010).

The pilot interviews generated exposure for the researcher to the role of asking questions for conducting investigative research. Furthermore, it offered an opportunity to test the questions and contribute to establishing rigour. During the pilot interview questions were tested, modified and confirmed as appropriate for use with participants. Pilot participants provided feedback around the research topic and the questions posed during the interview. They confirmed that the questions were clear and lacked ambiguity, creating an opportunity to provide their personal perspectives.

Member checking is encouraged to retain credibility of research, providing an opportunity for participants to confirm or refute co-constructions formed during interviews (Lincoln & Guba, 1986). The opportunity to refute a constructed understanding of the researcher was integral to this research, attaining true and accurate insights and descriptions. Throughout the interview process participants were provided with co-constructions of the discussion and asked to confirm or correct the accuracy or inaccuracy in the understanding that the researcher had formed about their views. This was important to me as a researcher, as I wanted to remain true to the participants’ views.

Transferability

Qualitative research acknowledges that generalisations are rarely the goal. The inquiry emphasises the phenomena in the natural environment with less control over conditions found in quantitative research (Ryan-Nicholls & Will, 2009). Thick descriptions in the findings are used to provide transparency and detailed contextual information allowing the information to be compared to the work done by others (Cho & Trent, 2014). To build rigour and enable transferability, if appropriate, or replication dense descriptions are threaded throughout the thesis. These are provided to allow others to see the path that has been taken in this research with explanations as to why this path was chosen over another.

As a researcher I make no claims that the findings of this research are reflective of Critical Care Registered Nurses (CCRNs) other than those that participated in this research. The findings provide a window and a foundation on which other research can be based and wider exploration and development of knowledge surrounding nurses and CPD can occur.

Dependability

Using transparency of decisions throughout the thesis, from chapter one where my position as a nurse was concerned with policy of mandated CPD to the methodology and methods where I have outlined my theoretical perspective. In doing this I have created a window to view my approach to the research and allowed the reader to be a travelling companion along with me on my research journey. My positionality on CPD, critical social constructionism, critical ethnography and the realism/relativism continuum has been transparent for the reader. In doing this I invite the reader and possible critics to discover this research from my perspective. I acknowledge other paths could have been taken, but they would not have aligned with my views and beliefs of the world. I am not infallible, but in embracing the credibility of research rigour I have worked towards a robust thesis. Rationales for decisions are offered throughout my work. This allows those that do not share my views or opinions to see the way that I have come to such positions and decisions (Houghton et al., 2013) and travel with me. Reflexivity using personal contributions is threaded throughout the thesis. These contributions are important as they acknowledge that the researcher was part of the research (Houghton et al., 2013). Influenced by theoretical positioning of critical social constructionism the findings of the research as a co-construction were made with participants. The interpretations and discussion chapters use these co-constructions to shed light on the experiences of CCNs with CPD. The reader of the findings views them through my analytical lens. This included having supervisor feedback on the data analysis (Cho & Trent, 2014). This guidance continued to open my mind and assisted in revealing knowledge and insights. These have been presented in the findings and discussion chapters as co-constructions between the participants and me.

Confirmability

Sandelowski (1986) suggests that "confirmability be the criterion of neutrality in qualitative research” (p.33). This is only achieved when auditability, truth, value and applicability are established. Embracing subjectivity qualitative inquiry embraces the complexity of the researcher being involved with the subjects but requires a process of reflection. Reflection refers to the act of rigorously examining how researcher involvement effects the data collection, analysis and consequent dissemination of information. This deep reflection prevents the researcher from becoming too enmeshed or too disillusioned and cynical. Awareness of positionality prevents results from becoming romanticised or demonised and instead allows a true reflection of the reality provided by the participants (Thomas, 1993).

Seeking to expand knowledge and understanding the researcher embraced all nurses’ views. To achieve deeper and more comprehensive understandings participants were asked to clarify their view and provide more detail. This use of reflective research promoted a larger view with interpretations that produce new insights. This approach also builds trust and credibility in the findings (Thomas & Magilvy, 2011) which is important for the rigour of the research.

Potential Researcher Bias

Using a self-critical lens the researcher must look at their own preconceptions and how these affect the research (Cho & Trent, 2014). This approach has been embraced throughout the research. The researcher is aware and has disclosed, from the beginning, that as a CCN great concerns are held toward the model of CPD implemented by the NMBA. These concerns are compounded by the approach many RNs take to completing their CPD requirements. It was these concerns that were the catalyst for this research. Within this acknowledgement of my views is the belief that this does not apply to all nurses. It also accepts that not all nurses will share this view, nor do they have to. In fact, the researcher welcomed nurses’ views that were in stark contrast to her own. This broadening of knowledge and understanding is important as it allows me to grow as a human and to understand my research question more fully. The researcher has

endeavoured to make it clear when her opinions are offered to ensure that the reader is able to make their own determination as to what influence they may or may not have had on the interpretation of the data.