4.6.1 Process of gathering data
Capturing the interaction pattern between the residents, family caregivers and professional caregivers is the central concern of the study. Grounded in the early work of Glaser and Strauss, Charmaz (2006) presented an overview of the philosophical foundations and new paradigms of grounded theory, and explained that grounded theory gives priority to the studied process, rather than to a pure description of the setting. From the beginning of the fieldwork, I studied what was happening in the triad by making a conceptual rendering of the observed actions. I then examined the seven different triads, and wrote about what they were like. Concentrating on a basic social process helped me to gain a more complete picture of the triad. Connection was
made between events in the triad to study the observed actions. It also increased my involvement in the study, dispelling the notion of the researcher as passive observer in other observational studies (Hertzberg, Ekman & Axelsson, 2001; Lotzkar & Bottorff, 2001). Later in this chapter, I discuss the nature of my social positioning in this study. In addition, I compared the data from the beginning of the research – not after all data had been collected – with emerging concepts and categories. This allowed me to maintain an open-ended approach and conduct checks on both data collection and analysis, going back to the data and forward to the analysis. I also returned to the field to gather further data and refined the emerging theoretical categories (Charmaz, 2006).
4.6.2 Research setting and negotiating access
Spradley (1980) suggested five criteria for selecting a social situation for doing field work and interview: “simplicity, accessibility, unobtrusiveness, permissibility and frequently recurring activities” (p. 52). This study was conducted in a long-term residential facility, hereafter referred to by the invented name “Parkview”, for 294 elderly residents with varying levels of dependency in Hong Kong. Data collection was carried out between December 2008 and August 2009 (see Table 1). A detailed description of Parkview to set the context for the analysis of the care triad is provided in Chapter Five.
Table 1: Overview of data collection
Type of data Purposive sample Theoretical sample
Field Work (hours) 188 30
Interviews
Administrators 2 NA
Residents 5 2
Family 5 2
Staff 4 3
In March 2008, I began looking for facilities to serve as sites for the study. Over the past years, I have been working as a volunteer on weekends and also have conducted several research projects in a number of long-term residential facilities. Because of this background, I was known to many of the staff working in long-term residential facilities. However, I found that gaining access was difficult through formal channels, such as the operational directors of residential care facilities at community-based social service organisations. Also, at some of the initial facilities that I approached staff expressed concerns that the aim of the study and the study methods would make
them feel as though they were being evaluated. When I was unable to secure a long- term residential care facility as research site by the summer of 2008, I began using my personal connections from the time of doing voluntary work, which proved to be much more fruitful. When I sent out an email request to a group of directors and superintendents of facilities, I immediately received one positive response, and so I began discussions with this respondent and it ultimately became the study site.
4.6.3 Negotiating entry
Negotiating entry and becoming one of the participants in the day-to-day milieu is a key to successfully engaging in data collection in field work. I spent the first month at the site introducing the study. Management was my contact and I was granted permission to attend a management committee meeting to request assistance with gaining access to likely participants. An overview of the research objectives, protocol and role of the prospective participants was presented by me at the meeting. The Director of the community organisation which runs Parkview expressed interest in the study was provided with a letter explaining the study and the criteria for participation. Subsequently, approval was obtained from the administration and the residents, their families and the staff of Parkview.
Before commencing fieldwork, I, in consultation with management, explained the project at meetings of staff, relatives and residents and answered any questions. A notice (Appendix 1) was pinned up at the reception desk and the nurse‟s station, informing all residents, families and health care professionals of the research taking place and how they could obtain more detail.
Participant Information sheets (Appendix 1), a Consent Form (Appendix 2) and Request Not to Participate forms (Appendix 3) were also made available. It was emphasised that participation was entirely voluntary and that anyone who did not wish to be observed (or have their relative observed) could complete a Request Not to Participate form. No information about non-participants was recorded. An explanation of and invitation to participate in a private interview was also given at this time. With the permission of Parkview, the researcher placed a locked “post box” at a convenient location for the return of completed forms. Potential staff participants were asked to indicate (via the Consent Form) if they were willing to be approached by the researcher at a later date to arrange an interview. I was conscious of potential cultural
and practical limitations to such a recruitment strategy. Residents and relatives were to be recruited indirectly. Staff who were willing to do so were asked to approach residents and family members who had not submitted a Request Not to Participate form if they were willing to participate as it was assumed that residents and their family caregivers would feel more able to refuse the request if it did not come directly from the researcher. I then approached the residents, answered any questions and if the residents and their informal caregivers were in agreement, provided them with a Consent Form to sign. Whenever possible these explanations were made in advance of every visit. As it turned out, no one in Parkview had any negative feeling about this study or was unwilling to be involved.
4.6.4 Participants
Residents had to have had a minimum stay of one year in Parkview and be cognitively competent to participate in an individual interview and to give their informed consent. Relatives who visited at least once a week were also invited to participate. A sample of seven care triads (21 persons) were recruited and these were considered sufficient to achieve what Lincoln and Guba (1985) refer to as the “qualitative informational isomorph”, that is, data collection ceases when “saturation” (informational redundancy) has been achieved. Informants‟ demographics are presented in Appendix 4.
4.6.5 Sample
The sample used in this study was a purposive one. In purposive sampling, individuals are recruited based on their ability to provide rich data (Coyne, 1997; Morse, 1986; Streubert & Carpenter, 1995). Suggested by the literature on research methods and prior experience of my supervisor, a small purposeful sample of five care triads (15 persons) was initially recruited to inform the researchers of their real- world experiences of the care triad. Analysis of the categories emergent from their experiences guided subsequent theoretical sampling for data collection to develop and refine emergent theory in keeping with grounded theory methods. This sampling method recognises that the composition and desired number of research participants can not be confirmed in advance and is, instead, determined during the course of the study (Glaser, 1978).
To arrive at the initial purposeful sample, participants compromising the care triad of approximately five residents were sampled. Initially five family members constituted a convenience sample of those involved in primary care. Similarly, the staff involved were those associated with selected residents. A total of 218 hours of participant observation was conducted. As conceptual categories emerged, theoretical sampling directed the sample process in order to elaborate and validate emerging concepts. Staff were asked to refer me to other residents and their families who manifested behaviour found in the emerging concepts. I tried to recruit two residents and their families for participant observation and interviews to achieve data saturation of the categories (Glaser & Strauss, 1967) to understand the social interaction processes in the care triad. Ultimately, the sample for this study was comprised of seven residents, seven family members and seven staff: one superintendent, three registered nurses, one social worker and two nursing aides. I spent 218 hours engaged in field work which included many conversations that were recorded in my field notes. A total of 31 interviews with administrators, family members, residents and staff were used to augment and expand upon the emergent themes.