Stake (1995) and Yin (2003) concur that multiple sources of information within the real life context generates data that is comprehensive and rich. Yin (2003) identifies six sources of evidence: documentation, archival records, interviews, direct observations, participant observation and physical artifacts. This is logical because the weakness in one method can be compensated for by another at least partially.
This study is based on 4 data sets:
1. Interviews and focus group with ONPs and analysis of relevant historical data pertaining to the evolution of the ONP role.
2. Interviews with health policy makers.
3. Interviews with accident and emergency nurses.
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In addition to policy analysis, this qualitative research employed three data collection methods, a) focus group, b) individual interviews and c) reviewing and analyzing historical and official documents.
The combination of multiple qualitative methods (triangulation) is advocated to provide better exploration and understanding of a particular phenomenon (Lambert and Loiselle, 2008; 2000; Yin, 2003). The rationale for triangulation in this study is to provide
comprehensive account and understanding of the development of the role of ONPs. This is termed by Lambert and Loiselle (2007) as an integrated approach that aims to ensure completeness and confirmation of data collected. When the researcher is interested in completeness of data, it is believed that each method of data collection provides a different perspective of the phenomenon and therefore the each method complements the other (Lambert and Loiselle, 2007).
The use of the focus group technique helped to explore the views, opinions and beliefs that informants had about the role (ONP and APN) whereas interviews helped to explore personal experiences of informants (ONPs and accident and emergency nurses) and other key stakeholders with APN role development. Focus group is often criticized as it offers superficial insight into a particular phenomenon (Talbot, 1995). Complementing focus group with in-depth individual interviews helped to provide better understanding of ONP/APN roles as a phenomenon. The use of focus group technique assisted the
researcher to decide on pertinent questions that could have been followed up and explored further during individual interviews. In both data collection methods, the researcher used open-ended and semi structured questions which gave informants the opportunity to
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express their views and experiences freely (Lawal, 2009). It is believed that people may need to listen to others’ opinions to help them formulate their own and thus the focus group provided a less threatening environment that presented during one to one interviews (Marshall and Rossman, 2006).
To summarize, holding a focus group sessions with ONPs followed by in-depth individual interviews with informants (ONPs, and accident and emergency nurses)
provided data to answer research questions related to environmental factors that facilitated or hindered role development. In addition, this allowed the exploration of informants’ views about the impact of the role on the care of patients and the organization.
Interviewing the former Nursing Director aimed to explore rationale for role
development in addition to influential environmental factors that may have influenced such a role development. This included exploring rationale for role development, possible role transfer, facilitating and hindering factors and impact of the role.
Interviewing two key policy makers helped to explore their views about ONPs role development and possible transfer of the role to other subspecialties within the Palestinian health care system. This included the exploration of needed resources for such role
development in addition to exploring key policy makers’ knowledge of and interest in APN roles.
Reviewing official documents included ONP curriculum, assessment documents, and minutes of meetings and clinical protocols pertinent to the development and regulation
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of the ONP roles. This helped to uncover data and knowledge pertinent to the ONP role development and environmental factors that have influenced such role development.
3.5.6.1 Focus group
Focus group is defined as a one-off meeting between participants to discuss a particular subject chosen by the researcher (Hopkins, 2007). Focus groups are used to explore opinions and beliefs of groups of interest (Halcomb et al, 2007). It aims to listen to and learn from stakeholders with regards to a particular phenomenon (Halcomb et al, 2007). This data collection method was also adopted to provide an interactive account of the phenomenon where informants listen to each other’s views and experiences which may help them form their own views and opinions (appendix one provides the focus group protocol). A focus group comprising 6 ONPs was used to explore the collective and interactive views of all informants in the group. The session took place in a classroom in the school of nursing at a time convenient for all participants, and lasted for 54 minutes. This also allowed the exploration of differences and similarities in opinions and how these were reasoned about and worked out. This added depth to the study of a phenomenon and revealed aspects that may otherwise be inaccessible (Lambert and Loiselle, 2008).
Generated data revealed similarities and contradictions in opinions and beliefs pertinent to a particular experience and or phenomenon (Hancock and Algozzine, 2006 ). One of the main critical issues that a researcher needed to manage was power dynamics amongst the group where some participants were less dominant than others (Poat et al, 2007).
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As suggested by Vaughn et al (1996) the following elements were included in the focus group session: introduction; warm up; simple questions; more complex questions; wrap up; member check and conclusion. Such a structure assisted in collecting pertinent and
relevant data.
Tape recording was used to capture data during the focus group session. Halcomb et al (2007) favor the use of note keeping in addition to tape recording during a focus group session. This strategy helps to capture nonverbal communication during group interaction. In this project, this strategy was difficult to employ as the only researcher was engaged in facilitating the focus group session and ensuring that discussions were
pertinent to the to the research aim. As advised, data generated from focus group sessions was transcribed after completion of the session in order to enhance accuracy of data (Del Rio-Robers, 2011). In focus group, the group of informants as a whole was the unit of analysis (Halcomb et al (2007). In this study, data generated from the focus group was categorized to inform the individual interviews.
3.5.6.2 Individual interviews
Individual interviews are the most widely used method of data collection in qualitative research (Lambert and Loiselle, 2008). This data collection strategy helped to explore detailed personal accounts and experiences of individual informants with regard to a particular phenomenon. It is believed that when informants are asked the correct
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questions they are able to express their views that account for their experiences (Lambert and Loiselle, 2008).
The researcher used a broad “grand tour questions” (Polite and Hungler, 2007: p 255) which was followed by a more focused questions based on the responses from the initial questions, please refer to appendices 2 and 3. Semi structured individual interview was used to explore personal experiences of stakeholders (four Ophthalmic Nurse
Practitioners, eight accident and emergency nurses, one former Nursing Director who was instrumental in the evolution of the role and two key governmental nursing policy
makers). Individual interviews were conducted at times convenient to the informants and lasted between 35-58 minutes. All interviews took place in private venues to ensure confidentiality and promote interaction with informants.
An interview with the former Nursing Director (lasted 51 minutes) helped to explore issues related to the rationale for role development, dynamics of such evolution and role impact. Interviewing key nursing policy makers at the ministry of health was essential to explore their views regarding the professional and legal implication of such a role development. In addition, these interviews help to explore health officials’ views about possible role
transfer to other sub specialties within the Palestinian health care system.
3.5.6.3 Reviewing and analyzing historical and official documents
As one of the main objectives of this study is to explore the historical environment in which the role of ONPs developed, reviewing and analyzing historical and official
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documents was necessary. Minutes of meetings, educational curricula, policies and procedures, job descriptions, directives and communications pertaining to the role
development and management were reviewed and analyzed. These documents are held in the Nursing Directors’ office, human resources office and the school of nursing as well as certain clinical settings. The researcher was granted a written permission from the
Hospital Ethics Committee to access such documents. Pertinent historical documents were retrieved from the year 2000 (when the role was first introduced) until end of 2014. Documents were reviewed with regard to the main research questions to ensure that only meaningful data was collected.
One of the strengths of analyzing the content of such documents was that it was unobtrusive (Marshall and Rossman, 2006) as it was employed without disrupting the environment in which it was conducted. However, such review and analysis of such documents may be subjected to interpretation of the researcher (Poat, et al, 2007). This method was particularly useful for triangulation and supplementing other data collection methods as it provided another perspective on the phenomenon.