Metodología utilizada

An initial discussion, by focus group was held at the end of the participants’ five- week theory block, during which time they were exposed to teaching and learning within the simulated ward environment. Because participants were recruited from two cohorts of students, one focus group was undertaken with each cohort (cohort 1 n=4; cohort 2 n=8). See Table 4.2 above for schedule.

A focus group was utilised for two reasons. First of all, as a means of addressing one of the research questions related to how simulation facilitated preparation for practice. Secondly, I felt the participants who were all student nurses and to whom I was a stranger, would find comfort and support in the group culture. Thirdly, that coming together to discuss a shared experience would help to stimulate discussion of their feelings and experiences, whereby data produced could be directly linked to the interaction between the group participants (Gibbs 1997).

Subsequent one – to – one interviews shifted the focus onto individual perspectives of the phenomenon under study. Individual students were free to talk only about their own experiences (Holloway and Wheeler 2010).

In preparing for the focus groups, the same format was followed for each, to ensure consistency. Students were contacted to arrange a mutually agreeable time. Focus groups occurred at the end of an academic day and as students were already in college they did not accrue additional travel costs.

A classroom was booked for the interview and I arrived an hour before the scheduled start time in order to prepare the venue. The literature offered sound advice regarding necessary preparations (Gray 1994; Dearnley 2005; Casey 2006). The room was arranged so that all the students and myself were seated around one table, which was positioned away from the window to avoid draughts; refreshments were available. Although a digital recorder was used for the one – to – one interviews, at the time of the focus groups I only had access to an audiocassette recorder (ACR). Undertaking a sound check ensured that whilst it was unobtrusively located, near to hand, normal conversation was clearly audible. I took the opportunity to recheck all functions of the ACR and ensured that I had additional audiotapes. Finally, for privacy a ‘Do not disturb’ notice was posted to the outside of the door.

Each cohort was greeted with preliminary introductions, some informal ‘chit chat’ to put them at ease and the offer of refreshments. The rationale for the study was recalled and students were given opportunity to ask any questions. They were reminded of their rights to withdraw and ground rules were set, including that all discussion which took place should be treated as confidential and not disclosed outside the room (RCN 2009). Students then signed two copies of a consent form, one for my records and one for them. I also took demographic details such as name and address, age range and contact details.

Each focus group commenced with an initial general question; used to generate discussion. A topic guide was used, which acted as an aide memoir and as a relatively inexperienced researcher I found this to be a useful strategy. It helped to keep the discussions focused on the research topic (Polit and Beck 2008).

Focus groups were initially designed to enable researcher’s to ask particular questions about a specific topic and having grown in popularity since the 1950’s, are now widely used within social research (Denzin and Lincoln 2003; Curtis and Redmond 2007; Neale 2009). The premise is that participants with a shared common experience are brought together to recall events and to explore views, feelings and experiences about the event (Denzin and Lincoln 2003; Kvale 2006). According to focus group theory we are all products of our environment and as such are influenced by those with whom we interact. One of the key characteristics of the focus group is that data produced is directly linked to the interaction between the group participants (Kitzinger 1995; Polit and Beck 2008).

The dynamic nature of the focus group is useful for eliciting insight into phenomena and if well moderated can produce rich descriptions of shared experiences that are cumulative and complex because they allow participants to discuss, clarify, differ and share attitudes and experiences (Curtis and Redmond 2007; Neale 2009). They are relatively inexpensive and are highly adaptable (Denzin and Lincoln 2003). Focus groups are useful in the initial stages of research to evaluate particular issues, such as in the case of this study to explore student’s perceptions or equally at the end to evaluate or generate further research. They can also be used as the sole mode of data collection or used in partnership with other methods, again as in this study (Kitzinger 1995; Neale 2009).

There are disadvantages cited and these centre round group dynamics and culture, which can interfere with individuals’ free expression. Dominant personalities can override other participant contributions. There is also the danger of ‘group think’. Focus groups are not appropriate where there are issues of hierarchy among the participants, for example nurse managers and junior nurses or where sensitive issues are to be discussed (Happel 2007). Neither was applicable in this case.

Group dynamics and management within the focus groups was relatively problem free. Cohort one consisted of four students and my field notes revealed that the atmosphere was relaxed and there was a good flow of discussion. Students interacted well and had a good relationship. Although two students were slightly more vocal, no one overtly dominated the conversation, which was peppered with good humour. I made a point of asking each student about specific aspects if they had not contributed. I had anticipated that it might prove challenging to keep the conversation going with four but this was not the case. In the literature, between six and ten participants was considered optimum (Polit and Beck 2008; Streubert and Carpenter 2011), although Holloway and Wheeler (2010) cited examples where six was too large and three just right. They suggested this was influenced by both the topic and the characteristics of the participants.

Cohort two comprised eight students, so greater diligence was needed to moderate effectively. Although not so relaxed as the previous cohort, one or two students spoke confidently and freely initially. As the interview progressed others contributed to the discussion, agreeing with comments and acknowledging shared common experiences (Polit and Beck 2008). The group culture in focus groups can bolster participants and help them to explore feelings, attitudes and experiences in a supportive way that could be lacking in a one to one interview. People with shared experiences often find solace from being with others who have had similar experience (Curtis and Redmond 2007). The participants in my focus groups all had a new-shared experience in common.

My role, as moderator involved monitoring group dynamics, ensuring all students had opportunity to express their thoughts and feelings (Holloway and Wheeler 2010). Two incidents stood out with cohort two and remain fresh in my mind. One student, Sue (a pseudonym) disagreed with an aspect of what had been taught in simulation – she did not see the point of it. As an experienced clinician and a lecturer involved in the programme (albeit on another campus) I knew the rationale behind it. However, in my moderator role I opted to not comment because I wanted, as suggested by Kitzinger (1995) to use the interaction between group members to generate data.

To return to Sue’s comment – almost all of the group disagreed with her and were able to justify why they did. However, whilst this provided good data, Sue was left feeling uncomfortable. In my role as moderator I was able to use my interpersonal skills to counter any potential hostility by pointing out the value of all opinions and reiterating that all comments were welcome, valid and respected (Holloway and Wheeler 2010). This episode could have resulted in Sue disengaging from discussion, but she continued to contribute.

Another incident involved Jen (pseudonym) who sat quietly throughout the interview. I made several attempts to draw her into the discussion, asking her directly about her experiences and feelings regarding simulation. Although able to articulate when asked, she made minimal voluntary contribution. As I got to know Jen during the one –to –one interview process, which occurred later, she spoke very freely, I realised that she lacked confidence in group situations. A focus group was perhaps not the best medium for her to share experiences (Parahoo 2006; Happel 2007).

Controversy exists regarding the use of the focus group interview within a phenomenological research framework (Webb and Kevern 2001). Phenomenology is interested in the nature of the individual experience, whilst focus groups rely on group interaction to stimulate conversation and produce data based on shared perceptions (Polit and Beck 2008; Holloway and Wheeler 2010).

Webb and Kevern (2001: 780) asserted that the goal of phenomenology was discovery of the essence of the phenomenon and that to do this the participant needed to “describe their experiences in a relatively uncontaminated way”. They believed focus groups with their reliance on group interaction were in direct opposition to this and the literature advised that certain topics were unsuitable for focus group discussion (Denzin and Lincoln 2003; Happel 2007). However, Bradbury-Jones et al., (2009) counter argued that focus groups had a place within a phenomenological framework.

A number of studies within nursing and midwifery have utilised the focus group interview method of data collection within an interpretive phenomenological structure. The aims of these studies focused on perceptions of participants in order to extract understanding or meaning of what it was like to experience a specific phenomenon. Some utilised the focus group as the sole method of data collection (Darbyshire 2003; Alexis et al., 2007; Kooken et al., 2007) whilst others used it with another data collection method (Carr 2004; Howatson-Jones 2007).

As previously stated, sometimes group culture can bolster participants and help them share experiences and explore feelings and attitudes in a companionable way lacking in the one to one interview. People with shared experiences often find solace from others who share similar experience (Curtis and Redmond (2007). Kooken et al., (2007) acknowledged that focus groups were not consistent with the philosophical underpinning of phenomenology but was able to provide justification for adopting it by applying the ‘group as a whole’ theory and because it suited the research question. Similarly, Alexis et al., (2007) believed the group processes helped elicit participants’ attitudes and beliefs and Howatson-Jones (2007) used the focus group environment to draw out participants understanding and meaning. With regards to my study, the students always undertook simulation using a team approach and I had anticipated that perhaps the focus group would foster a similar ‘team’ approach.

Each focus group (one with each cohort) lasted an average of one hour, by which time the discussion drew to a natural close. The students were thanked for their valuable contribution and reminded of the need for confidentiality. Whilst a one off focus group interview was undertaken, the main method of data collection was semi-structured, one-one interview. This was preceded on one occasion by non-participant observation, used as a means of witnessing the students’ application of skills in clinical practice.