Once ethical approval had been granted by UKZN (Annexure D) this was communicated to the nursing manager of the study hospital. The research project was explained and permission was given to the researcher to conduct the study (Annexure E). Permission was also granted for the researcher to meet with the ICU unit manager in order to approach prospective nursing participants who met the inclusion criteria. A letter, including the consent form (Annexure C), was given to each of the prospective participants, both nursing and non- nursing. This contained the information sheet and the contact details of the researcher, the researcher’s supervisor, and those of the Biomedical Research Ethics Committee (Annexure B). The purpose of the study was explained in the information sheet which included the conditions under which the study would be conducted in order to maintain privacy and confidentiality requirements. Participants were told that the interviews would be
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approximately 30 minutes long and would be conducted in a private room which was to be made available for this purpose. Consent was obtained from 16 health professionals and interviews were booked to be conducted over a 3 week period. One prospective nursing participant declined to give consent and was thanked for taking time to consider being part of the study. Another shift leader volunteered to participate and was welcomed into the study. A prospective non-nursing participant who had given consent to be interviewed, was unfortunately unable to meet with the researcher during arranged interview appointments. No further non-nursing participants were asked to make up this place as by the end of the interview process it was clear to the researcher that data saturation had been reached (Fusch and Ness, 2015).
3.7.1 DATA COLLECTION INSTRUMENT
In order to assist in answering the study question of how the role of the ICU nurse in antimicrobial stewardship was perceived by the members of the antimicrobial stewardship team, several core questions (Annexure A) were used in a semi-structured interview to cover the objectives stated earlier in the study and to facilitate discussion around this topic. These predetermined open-ended questions provided an initial focus of attention for both the researcher and the participants, and issues raised by the participants in the interviews allowed the researcher to explore a wide range of topics, further developing them in following interviews (Graneheim and Lundman, 2004; DiCicco-Bloom and Crabtree, 2006; Knox and Burkard, 2009; Doody and Noonan, 2013). Study objectives, based on role socialisation as seen in symbolic interactionism, were to explore the perceptions of the various members of the interdisciplinary team with regards to the role that the intensive care nurse plays in the antimicrobial stewardship programme in this ICU, the role that the intensive care nurse plays in collaboration within this team and how the role of the intensive care nurse can be supported and developed to ensure successful antimicrobial stewardship. Participants were encouraged to speak freely and this allowed the researcher to identify and explore perceptions that were identified by the participants as being relevant to the topic under discussion. The individual interview process allowed participants the opportunity to speak freely. This may not have been possible in a focus group interview in view of the multidisciplinary backgrounds of the participants which may have affected the comfort of some of the participants. However a more experienced researcher might have the skills to anticipate and facilitate the dynamics that might arise from a multidisciplinary focus group interview process.
24 3.7.2 INTERVIEW PROCESS
Interviews were conducted over a period of three weeks in August 2014. All participants interviewed were from the multidisciplinary team of private health professionals who jointly care for patients in this general ICU. Fifteen participants, eight nursing and seven non- nursing participants, were interviewed in private rooms. Fourteen of the interviews were held in the study hospital and one participant requested to be interviewed in an office in another hospital. Nursing participants requested that interviews be conducted during break times and were interviewed in a private room that was made available by the hospital management.
Appointments were made with the office staff of non-nursing participants and arrangements were made for interviews to be conducted in these offices in between patient consultations.
At the start of the interviews an opportunity was made for participants to ask questions about the nature of the study. Participants were reassured regarding the confidentiality of their participation and contribution to the study. Permission to record the interview was obtained from each participant. An Olympus digital recorder VN-7600 was used successfully and recorded both the researcher’s and the participants’ voices clearly. One interview was over 40 minutes long but most interviews were between 20 and 30 minutes in length. All participants were greeted and confirmation made that consent had been given and that the participants were aware of their right to withdraw this consent at any stage of the study (Annexure C).
Most participants chose to use pseudonyms to protect their identity when requested to do so.
Those who did not were noted by the participant number assigned chronologically to them.
All participants appeared comfortable and this may have been due to the fact that the researcher is part of the greater multidisciplinary team in this ICU and was known to the participants.
3.7.3 TRANSCRIPTION OF RECORDED MATERIAL
Interview recordings were transcribed verbatim into print. Following completion of each interview the recording was listened to by the researcher as soon as possible. This assisted in
‘remembering’ and allowed the researcher to start the transcription process. Data analysis and interpretation commenced as soon as transcription had taken place. This occurs simultaneously with data collection in qualitative research rather than in a linear fashion as in quantitative research (Burns and Grove, 2009:507). The transcriptions were made by the researcher reading the interview into a Phillips LFHO625 voice tracer device. The transcription software had been trained prior to the interviews to recognise the researcher’s
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voice. The printed transcript was then corrected by listening to the interview and correcting word errors and punctuation.
3.7.4 DATA ANALYSIS
Several ‘listening, reading and correcting’ periods facilitated familiarisation with the data.
Reading continued until levels of data became understood. This is part of the process referred to as ‘immersion’ (Brysiewicz, 2013). Reading was repeated until it was clear that all data was placed into categories and sub categories in order to describe the phenomenon under study (Hsieh and Shannon, 2005; Elo and Kynga, 2008). A process of abstraction followed in order to emphasize interpretation of the data (Graneheim and Lundman, 2004).
TABLE 3.1 DATA ANALYSIS
Meaning unit Condensation Categorization Abstraction
Participant contribution is taken from the transcripts and described verbatim
Participant contribution is paraphrased by researcher
Data is placed in categories, sub- categories and sub-sub categories
This is a process of interpretation by the researcher
“Very important role... I mean the intensive care nurse is there, you know, all the time.
They are monitoring the trends... they can pick up the little subtle things that happen in change of condition. We’re there twice a day for a short period of time.
The ICU nurse is vital in the care of the patient... it's a massive responsibility...”
Non-nursing participant – Hospital management
example from transcripts
The doctor feels that the ICU nurse has a large responsibility
Clinical skills Monitoring Advocacy Communication Collaboration
The ICU nurse is in attendance at the bedside of the critically ill patient for 24 hours a day
There is continuous monitoring of patient and trends by the ICU nurse in attendance
In private healthcare, doctors visit the ICU twice a day to see their patients In private healthcare, doctors are not in the ICU unless called to attend to their patient by the ICU nurse
In private healthcare, ICU nurses are responsible for the identification, assessment and communication of changes in the condition of the critically ill patient.
In private healthcare, ICU nurses have a
“massive responsibility”
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