III. The Outcome component
3.7: Instruments for data collection
3.7.1 Semi-structured interview schedule: Two types of semi-structured interview schedules were used to collect qualitative data from the administrative staff and the elderly residents. The administrative staffs instrument contained 42 items divided into three sections: the first section dealt with demographic information of the facility; section two covered background information of each ReF; and section three was the main interview schedule covering questions on the structure, process and outcome of each ReF. The contents of the questions addressed the research objectives (see Appendix II).
3.7.2 Questionnaire: A self-administered questionnaire was used to collect quantitative data from nursing staff of each of the four ReFs. The questionnaire contained 25 items with three sections, containing both open and close ended questions (see Appendix IV).
The questions aimed to provide information on the process and outcome of each ReF, from the perspectives of those who are directly involved in caring for the elderly. The first section was designed to provide demographic information such as age, gender, marital status and level of education of the nursing staff. The second section covered care and service delivery strategies and methods, while the third section covered staffs' experiences of caring for the elderly.
The elderly residents' instrument was directed at their health outcome, including their health status, quality of life and level of satisfaction. The instrument contained 13 items , which was divided into two sections. The first section dealt with demographic information of the elderly. Section two was the main interview schedule, directed toward the outcome of the elderly (see Appendix IV).
3.7.3 Facility record review checklist: The instrument for record review was a checklist that was designed based on the literature. It contained four columns, indicating the type of record, the availability, its purpose, topics and contents. A specification of the types of documents was made in the rows, when an allowance was made to write information gained on review of the documents (Appendix VII).
3.7.4 Observational checklist was used to capture unique data in a pre-specified and objective manner as some phenomena are best studied in their natural settings (Polit &
Beck, 2004). Nursing staff members were observed while interacting with the elderly.
The care giving environment was also observed as indicated in the checklist:
1. A description of the environment (single room, dormitory, other);
2. Characteristics of environment (tidy, dirty, other);
3. Caring interactions during activities of daily living (ADL) (feeding, bathing, dressing) interaction;
4. Communicating with the elderly;
5. Other: Specify (Appendix VIII).
3.8 Reliability and validity of data collection instrument
Research studies adopting a quantitative approach are guided by two scientific principles:
reliability and validity, which are used to evaluate the instrument for data collection.
Reliability was defmed by Creswell and Miller (2000) as the consistency of a measurement, or the degree to which an instrument measures the same way each time it is used under the same condition with the same subjects, or the repeatability of a
measurement. In order to address the issue of reliability, this study's questionnaire was piloted among the nursing staff (3 RNs and three care givers). The result showed that the care givers had difficulty responding to the questions. As the result, caregivers in all the RCFs were excluded from the study. The final instrument was produced based on the result of the pilot study. The pilot study was carried out to investigate the feasibility of the study and to detect any problems with the instrument for data collection in order to enhance its reliability (Creswell & Miller, 2000). The conceptual framework also served as a useful protocol to ensure that relevant concepts were addressed in each of the cases, thus enhancing the strength of the reliability of the study.
Validity Validity is the strength of the conclusion of the study, inferences or propositions. More formally, Cook and Campbell (1979) defined the term as the best available approximation to the truth or falsity of a given inference, proposition or conclusion. It refers to whether an instrument accurately measures what it is supposed to measure, given the context in which it is applied (Bless, Rigson-Smith & Kagee, 2006). It is seen as a more complex concept that is generally concerned with the soundness of the evidence of the study, indicating, whether the fmdings are cogent, convincing, and well grounded (Cameron, Wise, & Lottridge, 2007). According to Yin (2003), the following three aspects of the quality of research design should be maximized in terms of validity:
construct validity, internal validity and external validity.
Construct validity is the extent to which scores on an instrument reflect the desired construct rather than some other construct (Cameron, Wise, & Lottridge, 2007). The methodology chosen for this study provided a platform for its construct validity to be
ensured: the mixed of qualitative and quantitative methods. Secondly, through the technique of triangulation, the researcher ensured the use of more than one method of data collection: questionnaires, semi-structured interview schedule, on site observation and document review. The purpose of triangulation is to provide a basis for convergence of the truth by using multiple methods and perspectives to ensure a study'S validity (Risjord, Moloney & Dunbar, 2001). Moreover, the researcher established a clear operational definition for each of the concept of the study in order to ensure and strengthen the consistency of the application of the concepts in each case study.
In discussing content validity, Bless, Higson-Smith and Kagee (2006) suggest that a researcher should link information and items to the theoretical components of the research topic with a view of providing some information on all its different components.
Documents were used as secondary sources to supplement the data sources, and increase the comprehensiveness and validity of the study. The research instruments (qualitative and quantitative) cover all variables in the study appropriately and addressed the structure, process and outcome of the conceptual framework.
External validity refers to the generalizability of the research findings to other settings or samples. According to Risjord et al., change (2001), if a nursing intervention under investigation is found to be successful, others will want to adopt it. However, an important question is whether the intervention will work in another setting and with different patients. There are three major threats to external validity because there are three ways the researcher could be wrong: people, places or times (Bless & Higson-
study in four ReFs, with different people (program managers, nursing managers, RNs, ENs, ENAs and the elderly), and at different times (days & nights) as well as on different days of the week: thereby ensuring the strength of the study's external validity.