POTENCIA TOTAL INSTALDASUBCUADRO SQP2

Three study measures were used to score changes in participants’ skills capability, self- efficacy and attitudes to RPMC at Point 1, Point 2 and Point 3.

3.14.1.1 Study Measures

1) General Self-efficacy Scale (Appendix 8), which has established psychometric properties, was developed by Schwarzer (1993). It is a 10-item scale designed to assess optimistic self-beliefs to cope with a variety of difficult demands in life. It measures the belief that one's actions are responsible for successful outcomes. The questionnaire is short (10 items) and takes five minutes to complete. It is recommended that not too much time is spent on each individual statement.

2) Leeds Attitude towards Concordance Scale (LATCon) (Appendix 9) (Thistlethwaite et

al., 2003) describes the psychometric properties of the LATCon, which is used to

measure attitudes of nurses towards patients and MC. However, a small adaptation was made to the LATCon scale by substituting the term ‘nurse’ for ‘doctor’ and ‘service user’ for ‘patient’ in the current study. It consists of 12 items, each scored on a four point Likert scale and thus the range of scores is 12–36. An item score of 2–3 means that the participant agrees with the principle of concordance.

Permission was obtained from the authors of the Self-efficacy and the LATCon questionnaires (Appendix 10), included in the frequency distributions in the next chapter.

3) The Skills Capability Questionnaire (Appendix 11) was designed for this study to measure the content of the RPMC course. To date, no work has taken place to measure its psychometric properties. A modified Likert scale of 1–5 was used, 1 being Strongly Disagree, 5 being Strongly Agree and 3 being Neutral. The scoring was analysed at Points 2 and 3 to find out if there had been a change in nurses’ attitudes towards MC. 3.14.1.2 Data Analysis Methods

The main analysis was to investigate changes at Point 1 and Point 3 to establish whether any change in nurses’ skills capability, self-efficacy and attitudes occurred as a result of the RPMC training.

The data were analysed using the Statistical Package for Social Sciences (SPSS). Non- parametric tests were used, in this case a two-tailed Wilcoxon Signed Rank Test (WSRT) that measures the strength, or otherwise, of ‘within-group’ changes. The WSRT was chosen because of the abnormal data distribution and the small sample size that required non-parametric testing. As this was a small sample, statistical power was not claimed as the effects are harder to detect in a small sample (Button et al., 2013). The Wilcoxon test was used for the within-group analysis because there were repeated measurements on a single sample to assess whether their population mean rank differed from Point 1, to Point 2 and Point 3. It also provided the median and range for comparisons, along with the P-value. For more details, see Appendix 12.

3.14.2 Phase 2 – Qualitative methods

In order to explore the impact of the programme and to gain further insight (Krefting, 1991) into the ‘real practice world’, the five participants in this qualitative study were volunteers and, as it happened, they came from three different services. Consequently, views obtained of the impact of RPMC in practice were broadly realistic in the thematic analysis and integration phase of this study.

When the participants had initially been recruited onto the study a specific question was posed as part of the consent procedure, asking the participants whether or not they were prepared to take part. The interval of 10 weeks was chosen, as to have

integrated this with the administration of the surveys would risk the participants being influenced by their answers.

3.14.2.1 Data Collection Methods: Qualitative Steering Groups

This group was set up to devise the questionnaire and obtain accurate information relating to the level of knowledge, attitude, personalities and beliefs, or preferences (Leung, 2001). A small advisory steering group was chaired by a nurse consultant who had been involved with the project since its inception, along with the principal research applicant, an academic, a qualified nurse, a service user and a carer. It was convened following the programme to finalise the themes for the qualitative interview guide (Appendix 13).

An interview guide was used, whereby the same questions with the same wording and in the same sequence were asked of all respondents (Corbetta, 2003). In other words, the interviewees were presented with the same context of questioning (Aboraya, 2009). The interviews of the focus group participants were conducted by two independent researchers, one to facilitate the discussion and a second to take notes regarding his or her interactions. To that effect, an interview guide was developed (Appendix 14) and finalised (Appendix 15) and training was provided to the interviewers to conduct the interviews in a systematic approach. The process was rehearsed until they felt sufficiently confident to conduct the interviews.

3.14.2.2 Data Analysis Methods

Following transcription, the transcripts were examined to extract themes using the framework set out by Braun and Clarke (2006). Thematic analysis (TA) is a method of identifying, analysing, reporting and interpreting various patterns or themes within the data (Boyatzis, 1998). The data were analysed in the following forms: interview

transcripts; field notes; and audio recordings. Themes may be directly observed from data or may be seen at an underlying level. In this way it can be seen how the

In order to ensure quality assurance, a nurse consultant educated to doctorate level helped me to examine the transcripts to derive themes. Thereafter, we met to negotiate, and finally to agree them.

Once the reflective quotes were received, I familiarised myself with them by going over them several times so that I could work out the themes emerging from the answers. As part of the TA, I devised a structure process with outcome measures leading to the persuasive theme. This structured approach included: Level 1 coded extract; Level 2 merging themes; and Level 3 naming the themes. The analytic process described the various stages from the interviews leading to the framing of the themes. This included the interpretation of themes, summaries arising from each question and the themes emerging from each summary, before naming the final or critical theme. Finally, there was a discussion and presentation leading to the persuasive theme of this thematic analysis. All aspects of the thematic analysis are presented in Chapter 4, Part 2, which in turn forms part of the data integration.