RESEARCH METHODOLOGY
3.7 SAMPLING PROCEDURE AND SAMPLE DESCRIPTION
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66 In this study, theoretical sampling was not based on the number of participants, but rather on the theoretical concepts that emerged from the repeated sessions with the same participants over time at the respective research settings. This was premised on Strauss and Corbin’s (1990) assertion that in grounded theory studies wherein the phenomenon of interest is developmental or evolving in nature, the researcher follows the same group of persons over time as opposed to theoretically sampling individuals or persons (Strauss and Corbin, 1990: 179). Since the conceptual category of interest was the process of development in terms of the participants’ skills of critical reflection and the establishment of CoPs, the researcher elected to purposively sample a group of 8-10 HIV nurse practitioners from each of the two district level hospitals. Guided by this inclusion criterion, a group of ten nurses from each of the sampled hospitals were sampled.
However due to attrition of two nurses during the introductory sessions of the reflective discourses, from the rual hospital; the total sample comprised of eight (8) willing nurses, purposefully selected from the rural hospital and a group of ten (10) from the urban hospital.
According to Morse and Field (1995) and Merriam (1998), a purposive sample allows the researcher to choose study characteristics or attributes that will allow enable the researcher to understand discover and gain insight on the phenomenon that is known to exist and add value to the research phenomenon. The inclusion criteria for selecting the nurse practitioners from the target population stipulated that the participant be:
(i) A professional registered nurse. This criterion was used to ensure that the participants’
experience would wholly capture the experiences of HIV nursing care. As per the South African Nursing Council, Nursing Act 33 of 2003 (SANC, 2005), a professional nurse is a nurse that is registered as a general nursing and midwifery. Further to this, this category of nurse has a wider scope of practice than the enrolled nurse or nursing assistant. In light
67 of this definition, it was necessary that participants were professional nurse practitioners so as to ascertain a fuller scope of their duties and assess the impact, if any, of the research phenomenon (i.e. critical reflection skills and shared learning in the CoP structure) on these duties, such as initiation and monitoring of ARVs within the PMTCT programme;
(ii) Currently working in a unit wherein a PMTCT programme is offered. This could be a hospital ward, such as the labour and delivery unit, or a hospital outpatient department, such as the antenatal clinic, or in a PHC clinic that is attached to the hospital.
(iii) Working for more than 1 year in the unit or ward where HIV nursing care was being provided. This criterion was used to get a wider scope of experiences in terms of the participants’ challenges of working with HIV care. Experience of more than one year in the respective units wherein HIV care is provided, either through direct patient care or within the PMTCT programme, would allow the participants to draw from experience with the critical reflection capacity building aspect of this study.
(iv) willing to be part of the study over a period of time. Given the nature of the study in terms of being process orientated, the participants’ willingness to be part of the study over a sustained period of time was important to the success of establishing a CoP and exploring the process of development, if any in terms of critical reflection.
3.7.1 Theoretical sampling of group sessions
Glaser and Strauss (1967) explain that all grounded theory procedures are directed towards identifying, developing and relating concept, which are the basis of analysis. According to to
68 Strauss and Corbin (1990), theoretical sampling is focused on sampling concepts that have theoretical relevance to the emergent theory. These authors further note that guided with the aim of theoretical sampling, the researcher samples events or incidents that are aligned to the categories, properties and dimensions and can be related conceptually to one another.
Guided by Strauss and Corbin’s (1990) description of theoretical sampling, the researcher used the incidents and events that occurred within the developing CoP in terms of learning to reflect, the process of critical reflective skills enhancement and the group dynamics as the concepts and categories that emerged in the process of theoretical sampling. At the end of each focus group discussion (FGD), which served as a group discussion and a forum where critical reflective skills were facilitated, the concepts of group dynamics and the elements of the developing CoPs were captured for differences and similarities between the two groups. For example, the process of learning to reflect in the urban group was verified as being similar or different to the process of learning to reflect in the rural group. This process of constant comparison of the theoretical concepts occurred until saturation of the concepts occurred among the participants of each group, and the concepts of both study groups were compared to asses for unique contextual dimensions of the emergent theoretical categories.
Theoretical sampling and saturation of theoretically relevant concepts which added to the emergent theory of the process of the establishment of CoPs of critically reflective HIV practitioners occurred in the following manner.
(i) Concepts that were related to a process of learning to reflect, defining group norms, group engagement, identifying barriers in group and experiential learning emerged within
69 both groups in the first two to three session The saturation of these concepts resulted in changes in the evolving nature of the participants, these led to the emergence of,
(ii) Concepts regarding critical reflection practice among the participants, greater critical thinking, clinical reasoning, group cohesion and group autonomy began to emerge after the initial three sessions and extended for a further three to four sessions in both the groups. Greater confidence was a marked characteristic in the evolving nature of the participants and this was noted.
(iii) Lastly, concepts related to increased use of critical reflection and raised consciousness on the nurse practitioners’ practices emerged after the sixth or seventh session and extended to the tenth or eleventh session at both the study settings. Conceptual categories such as sustainability, ownership and a changed identity became evident among the participants, highlighting the evolving nature of this research.