Migración

The quantitative phase of the study requires site sampling. Polit and Beck (2008:339) defines sampling as the process of selecting a portion of a population that represent the entire population in order to make inferences from such a population. Botma, Greeff, Mulaudzi & Wright (2010:124) defined a sample as a subset of the accessible population for the research study while sampling refers to the procedure of selecting the subset. The essential element of sampling is the representatively of the elements in the sample. In this study, the inclusion of the facilities of all the regions that meets the research criteria allowed representatively the sample. As the purpose of the study was explanatory, the use of probability sampling method was mandatory (Botma et al. 2010:125); the next sections of the study describe the process of site sampling from the site population to the site sampled.

The site population refers to the entire institutions as aggregated by the researcher (Polit & Beck, 2008:337). In this study site population referred to the entire Tshwane district PHC facilities. The PHC facilities are provincial and municipal facilities. The

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provincial (P) facilities report directly to the Gauteng provincial authority based in Johannesburg, while the local municipality (LM) facilities report directly to the Major of City of Tshwane. Due to these categories, nurses working in these facilities are operating under different conditions of employment.

Tshwane district consists of 64 PHC facilities of which 43 (67%) are provincial clinics while 21 (32%) are local municipality facilities. Provincial facilities consist of 12 Community Health Care centres (CHC) and 31 PHC clinics while local municipality consists of 21 clinics and no CHC. Table 4.1 illustrates the facilities in region 1 to 7.

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Table 4.1 PHC facilities of Tshwane district according to the regions. (Sample frame)

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7

Boekenhout Adelaide Tambo Bophelong (20) Laudium clinic Refilwe Eersterus CHC (31)

Zithobeni

Boikhutsong Dilopje Laudium CHC

(44)

Lyttelton clinic Rayton Holani Dark City

CHC GA Rankuwa Kameeldrift Skinner (30) Olivenhoutbosch

clinic Stanza Bopape II Stanza Bopape CHC (61) Ekangala Pretoria north (20)

Kekana Gardens Atteridgeville clinic

Rooihuiskraal clinic East Lynne clinic

Nellmapius clinic Kanana

K.T. Motubatse clinic (23)

Kekanastad CHC Danville clinic Phahameng clinic Rethabiseng

Kgabo CHC Mandisa Shiceka (20) FF Ribeiro clinic Pretorius park clinic Sokhulumi Maria Rantho CHC (25)

Eersterus Hercules clinic Silverton clinic Bronkhorspruit

Phedisong 1 CHC Ramotse Phomolong clinic

Mamelodi west clinic

Phedisong 4 CHC (25)

Refentse CHC Folang clinic

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Key: c Municipality clinics, which were excluded from the study C Provincial facilities, which gave provisional permission () Number of professional nurses in those facilities

Sedilega Themba CHC (25) Soshanguve 2 Soshanguve J (20) Soshanguve TT Soshanguve x Soshanguve CHC (63) Tlamelong Winterveld Karenpark clinic Rosslyn clinic Total: 455

The site target population in the quantitative phase of the study refers to the institutions that the researcher intends to aggregate for the generalisation of findings (Polit & Beck, 2008:338). In quantitative phase, the target population was homogeneous in the sense that, facilities included in this study are having a similar set of conditions of service and the salary packages which are sometimes critically in affecting the relationships of employees and customers (patients) in the working environment (ICN, 2010:1)

The target population was 43 provincial PHC facilities and the CHC because they render more that 80% of the PHC service package that predisposes the nurses who are working in those facilities to more similar working conditions. The local municipality facilities do not operate under the same conditions of service with the provincial facilities. The homogeneity of the population in this study reduced the external factors that may influence the behaviour of nurses towards their patient (such as job satisfaction levels).

The study was a multistage (Creswell, 2009:218), thus required the clustering of the facilities in preparation for sampling at different stages of the study. The same site target population was utilised throughout the three phases of the study. The list of all the PHC facilities has been accessed from the Tshwane district health information department, which was updated on April 2011 following the merger of Tshwane and Metsweding as one district. All (43) provincial PHC facilities were accessible in terms of the geographical layout (within the 50km radius) and because they are also managed from the same district authority thus the process of requesting permission was the same and thus being cost effective for the researcher. The accessibility of the sites were also possible as the managers of the facilities were directly involved in the process of accepting the accountability of allowing the researcher to utilise the facilities.

The non-probability stratified sampling techniques are used in the selection of the site sample in order to allow enough participants for the three phases of the researcher study without necessarily using the same participants (questionnaire, observation and focus group) which increased the generalizability of the research findings in the setting of the study. In this study, the facilities were stratified according to the regions (1; 2; 3; 4; 5; 6&7). Region 4 & 5 were excluded from the study, as they did not have any provincial health facilities. All the CHC‟s in Tshwane were legible to be included in the study as they are large facilities with a staff complement of more than 20 professional nurses. Eligibility is defined as the specific characteristics of the site (Polit & Beck,

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2008:338). The clinics with the staff complement of >20 professional nurses were also being included in the study thus allowing at least eight professional nurses (40%) to participate in the study from a facility. If eight nurses participated, in the study then a minimum of two completed the questionnaire, to participate in participative observation and the other four participated in the focus group discussions.

The researcher then randomly selected the sites. The process of systematic random selection of the sites included the alphabetical arrangement of the facilities according to the different regions from the sample size. The researcher chose every second legible facility and then telephonically requested the provisional permission to undertake the study from the facility manager (Annex 1),

Kelly (2010:1302) explains that the sample size needs to be planned based on the purpose of the research and the number of research parameters. As in this research, the purpose is not to test the hypothesis, the accuracy in parameter estimation (approach) was utilised to estimate the sample site. The interest was to obtain the sufficient narrow confidence interval for the research parameters for the quantitative phase of the study. Polit Beck (2008:349-351) explains that even though there is not a precise formula to determine the accuracy of the sample size, but representatively the sample is important in the quantitative component of the study.

Polit & Beck (2008:602) recommends power analysis as one of the procedures used to determine the sample size of the study in advance to reduce the risk of errors. In reference to the sample frame (Table 4.1), 14 PHC facilities participated in the study (7 CHCs and 7 clinics) in the quantitative phase of the study.

In this study, the research population included all professional nurses working in the primary health care facilities in Tshwane district. According to the Department of health human resource statistics (2009:1) 987 professional nurses were practising at Tshwane district (both local municipality and provincial facilities) (Annex 2).The target population included all professional nurses working at the provincial PHC facilities. According to the 2009 statistics (Department of Health, 2009:1), 884 professional nurses were permanently employed in Tshwane provincial PHC facilities (excluding local municipality professional nurses).

116 The inclusion criteria were:

 Professional nurse registered with the South African Nursing Council

 Professional nurses with additional qualification in Clinical assessment, treatment and care diploma.

 Professional nurses who have practiced in the PHC setting for more than a year, which allows adequate exposure to the system to allow confidence and improve competency levels of staff.

 Category of professional nurses who are I possession of the qualification that allows them to diagnose, prescribe treatment and dispense medication thus having complete responsibility of the management of chronic pain patients visiting the PHC facilities.

The exclusion criteria were:

 Professional nurses with less than one year of exposure to PHC services

 The local municipalities PHC facility nurses are not included in the study as they operate under different scope and working conditions as the provincial nurses.

Botma, Greeff, Mulaudzi & Wright (2010:124) explain accessible population as persons who meet the sampling criteria and are accessible to participate in the study. In this study, all professional nurses who were working at the sampled sites were included in the accessible population of the study.The stratified, convenient sampling technique enabled the researcher to represent the population as closely as possible (Polit and Beck, 2008:262; Cornwell, 2009:148). From each stratum (region) and sampled facilities, professional nurses who met the inclusion criteria were personally invited to participate in the study following the brief presentation of the study to them. All the legible respondents completed the questionnaire voluntarily. A convenience sampling technique was utilised, as the researcher would request the nurses who are available on the day of the visit to the facility to participate voluntarily in the study. Due to the quota requirement of the study, to achieve the required sample, the researcher revisited the facility.

According to the 2009 statistics, 455 nurses were working in the facilities that were legible to participate in the study at the time of data collection.

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In order to minimise the biasness error the formula was used to calculate the sample size as indicated below (Naing, Winn and Rusli 2006:9):

n = Z2P (1-P) d2

(1.96) 2(0.2) (1-0.2) (0.05) 2 = 246

Where n = sample size,

Z = Z statistic for a level of confidence, P = expected prevalence or proportion (In proportion of one; if 20%, P = 0.2), and d = precision

(In proportion of one; if 5%, d = 0.05).

In this case, because the total population is small the finite population correction was applied according to this formula (Bernard, 2011:141):

n‟ = _____n____ 1 + (n – 1/ N

_____ 246___ 1 + (245/455)

= 160

Hundred and sixty was then adopted, as the sample size of the study, further division of the sample to cover the different phases of the study will be discussed in each of the phases of the study

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As this survey is the sequential explanatory strategy, the first process included the quantitative aspect of data collection (Creswell, 2009:211). In this stage, several processes were included in the development of this stage as summarised in the diagram below.

Figure 4.3 Processes of quantitative data collection