CONCLUSIONS AND RECOMMENDATIONS OF THE RESEARCH
1.4 Central theoretical argument
1.6.2.2 Data collection and operational context
questions were formulated based on the results of the first phase and the stories of the resilient nurses, and included the following themes:
• What does resilience mean to you?
• How does resilience manifest in the work of a nurse?
• What would you say is hindering you in maintaining resilience?
• What is your opinion on the importance of resilience in professional nurses?
• What do you think guidelines for training resilience in nurses should include?
• How do you think such guidelines on resilience for professional nurses should be used?
The focus group interviews were conducted by the researcher who has proven skills and experience in conducting interviews. Communication techniques such as clarifying, summarising and reflection, as described by Kneisl, Wilson and Trigoboff (2004) were used to facilitate the group discussions. The researcher made field notes during and after each interview containing descriptive notes, reflective notes and demographic information (Creswell, 1994). Voluntary, written consent was obtained from each participant before both phases of the study (Appendix D).
By using multiple data collection methods as in this study, data is triangulated as the topic is analysed from mUltiple angles, sources, and varieties of expression (Guba &
Lincoln, 1985; Patton, 1990). This also increased the trustworthiness of the data and the findings (Guba & Lincoln, 1985). In this qualitative phase the researcher was looking at ways to engage the participants so that the muIti-dimensionality of the human experience could be encapsulated (Goldman, 1992).
1.6.2.3 Data analysis
Data of the first phase was captured and statistically analysed by a statistical consultant using the SPSS computer program. Descriptive statistics as well as cut-off points for resilience were determined. The researcher interpreted the statistical results derived from
the data. The biographical information was also analysed and the answers to the open ended questions transformed to quantitative data regarding nurses' feelings about the profession and about their own resilience, providing a profile of the participating professional nurses.
The analysis of data in the second phase involved the examination of words with the researcher becoming immersed in the data, reflecting on possible meanings and relationships in the data (Brink, 2006). Data was analysed simultaneously with data collection, -interpretation and narrative report writing (Creswell, 1994). It also implied that the researcher filters the data through a personal lens that is situated in a specific sociopolitical and historical moment. The researcher thus systematically reflects on who she is in the inquiry and is sensitive to her personal biography and how it shapes the study. This introspection and acknowledgement of biases, values, and interests (or reflexivity) is an important part of the qualitative phase (Mertens, 2003). Data analysis took place by means of open coding (Babbie, Mouton, Vorster & Prozesky, 2004) and inductive analysis, constructing understanding and meaning from data, where prior theory could be set apart in an attempt to open new aspects of the phenomena under investigation (Gilgun 2006). Inductive analysis involves reflection on data records and discovering patterns, themes and categories (Camozzi & Marthie, 2005; Patton, 2002).
The interviews were transcribed verbatim and field notes were compiled directly after each focus group (Creswell, 1994). The raw data was reduced to themes or categories and interpreted by the researcher and an experienced co-coder working independently on the data. The co-coder was an advanced psychiatric nursing specialist and the researcher involved her from the start of the study, the hospital settings are known to her and she could emerge herself in the data. The researcher and the co-coder reached consensus on the themes for the final narrative using a protocol compiled with the help ofTesch's steps of analysing textual data (Appendix H). Several sessions were held to reach consensus on the main and sub-themes/categories. These themes or categories were reduced to
"families" of themes that consisted of a small, manageable set of themes to write the final narrative.
With completion of data collection and data analysis in the second phase, the research findings were compared or related to the existing body of knowledge of resilience in professional nurses. In a qualitative study a literature control is necessary (investigation, interpretation and integration of literature) so that the findings can be discussed within the context of what is already known about resilience in nurses (Streubert & Carpenter, 1999). The literature serve the purpose of validating the data, identifYing data that confirm findings, identifYing what is in literature but not evident in the study, or the findings that are unique in the study and not found in literature (Bums & Grove, 2005).
1.6.2.4 The role of the researcher
Written, informed consent was obtained from all the role players and the participants, as well as from the mediators. The researcher first contacted the Departments of Health and the management of the different hospitals to establish their willingness to give permission and allow staff to participate in the study, as well as to explain the objectives of the research. The researcher followed this up by personally visiting the management of the hospitals with letters to explain the study and request for the research to be conducted in the facility and again followed this up by presenting the study to the nursing personnel.
Appointments were confirmed at least a day before an appointment and again with the follow up for the second phase of the study for the interviews. The questionnaires were delivered and collected by the researcher together with the consent forms to serve as records of proof that participation was voluntary. The focus group interviews were conducted at the place of choice of the participants and care was taken to assure a peaceful and quiet setting for discussion. The researcher was the primary instrument for data collection and analysis in the second phase of the research, although a co-coder was used for analysis. The presence of the researcher during the research activities was brief but personal, as requests were made for the narratives of and focus group interviews with participants (Marshall & Rossman, 1995), (Examples of field notes, part of a transcription and written stories, Appendix I, J & K).