Nurse Researcher
A student’s perspective of managing data collection in a complex qualitative study Cite this article as: Dowse EM, van der Riet P, Keatinge DR (2014) A student’s perspective of managing data collection in a complex qualitative study. Nurse Researcher. 22, 2, 34-39. Date of submission: January 11 2014. Date of acceptance: March 24 2014. Correspondence [email protected] Eileen Mary Dowse MN, GDipHIthSc, DipCFHN is a midwifery lecturer at the School of Nursing and Midwifery Pamela van der Riet PhD, Med, BA, DipEd, ICU/CCu C is deputy head of school at the School of Nursing and Midwifery Diana Rosemary Keatinge PhD, MAdmin, GCert TESOL, RN, RSCN is professor of child, youth and family health nursing at the School of Nursing and Midwifery All at the University of Newcastle, Callaghan, New South Wales, Australia Peer review This article has been subject to double-blind review and checked using antiplagiarism software Author guidelines rcnpublishing.com/r/ nr-author-guidelines
Abstract Aim To highlight from a doctoral student’s perspective some of the unexpected and challenging issues that may arise when collecting data in a complex, qualitative study. Background Using a qualitative approach to undertaking a PhD requires commitment to the research topic, the acquisition of a variety of research skills and the development of expertise in writing. Despite close research supervision and guidance, the first author of this paper experienced unexpected hurdles when collecting data. This article highlights these hurdles and compares them with similar and dissimilar challenges raised by a social researcher with 30 years’ experience (White 2012). Data sources The first author’s experience of field research during her PhD candidature. Review methods Informed by a critical theoretical perspective, a snowballing technique was used to examine issues related to data collection by a doctoral student in a qualitative research study. Discussion The first author found the logistics of qualitative data collection, concerns about transparency, role confusion and power differentials with participants, and the effective use of video recording technology, unexpectedly challenging. Many of these issues are highlighted in the literature
Introduction The aim of this paper is to describe some of the issues that arose for me (EMD) as a doctoral student when collecting data during 34 November 2014 | Volume 22 | Number 2
and/or during research supervision. However, the student researcher remains a novice when entering the field. It is often only on reflection after encountering the hurdle that the student recognises future pre-emptive or alternative methods of data collection. Conclusion The challenges faced as a doctoral student managing the data collection phase of the study concurred with White’s discussion of some of the ‘real life challenges that novice researchers might face’ (2012). Specific guidance and prudence are needed by research students to know when enough data have been collected for manageable analysis within the limits of candidature. Use of reflexivity and mindfulness practised by the student during this phase assisted the ability to reflect, respond and learn from issues as they arose and aim for a harmonious work, study and life balance. Implications for practice/research This paper highlights these issues and offers suggestions for other research higher degree students facing similar challenges when collecting data in a complex qualitative study. Keywords Child and family health nurse, critical ethnography, doctoral student, family partnership model, research challenges, video recording, reflexivity, mindfulness, qualitative study, data collection a complex qualitative study. Despite careful planning and supervision, there were logistical issues, time pressures, competing demands for study participants and unexpected © RCN PUBLISHING / NURSE RESEARCHER
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Challenges in data collection factors that arose that warrant closer examination and consideration. The issues I faced while collecting data resemble those recently shared by White (2012) in his astute reflections, gained from a research career spanning 30 years, on the challenges that can occur for new and experienced researchers. White defined and discussed ten ‘real life challenges’: funding, permissions, logistics, random events, recruitment, confidentiality, roles and boundaries, complaints, dissemination and translation of research findings into practice (White 2012). While this guidance came too late for me, since I finished collecting data in 2011, it is reassuring to know that these issues occur for novice and experienced researchers (White 2012). This paper will first describe the background to the study and then focus on some of the unexpected issues I encountered. These were similar to and dissimilar from the ‘real-life challenges’ suggested by White (2012), and involved permissions, logistics, recruitment, roles and boundaries, as well as the use of video recording technology. This paper builds on the work of White (2012) and adds to what is known by describing my use of mindfulness practice as a doctoral student to aid reflexivity and personal learning and to respond with equanimity rather than react to the predicaments experienced.
Background to the study In New South Wales (NSW), Australia, the Child and Family Health Nursing Service (CFHNS) is a community-based specialty that provides free primary health care to parents and children aged 0-5 years. The staff in this service have a similar role and function to health visitors in the UK, public health nurses in the US, Plunkett nurses in New Zealand (Kruske and Grant 2012), and child health nurses in Sweden (Massoudi et al 2007). A principle tenet of NSW child and family health nursing practice is the Family Partnership Model (FPM), which ‘provides maternal, child and family health nurses and parents with a clear and structured method to navigate and make sense of the process of helping’ (Day 2013). However, some authors have questioned whether nurses are able to truly work in partnership with parents (Wilson 2001, 2003, Andrews 2006, Coyne and Cowley 2006). The aims of this study were to: Identify child and family health nurses’ and managers’ views of the factors that may influence the ability of the child and family health nurse (CFHN) to work in partnership with © RCN PUBLISHING / NURSE RESEARCHER
parents and investigate how these factors may affect this ability. Identify parents’ experiences of the relationship and interaction with the CFHN. Enable CFHNs and managers to reflect critically on existing and developing work practices, education processes, and the context and scope of practice in relation to the factors that influence and affect their ability to work in partnership with parents. Critical ethnography was the selected study design (Thomas 1993, Madison 2012). The goal of critical ethnography is to study the hidden power relations and factors influencing a phenomenon, using field methods consistent with ethnographic modes of enquiry (Allen et al 2008). Methods of collecting data used in this study were typical of ethnographic studies – audio-recorded semi-structured interviews, participant observation and field notes (Allen et al 2008). Participant observation in this study was enhanced through the use of a digital video recorder.
Permissions I recruited outside my health district to avoid the potential ethical implications that could have arisen because of my dual roles of student researcher and senior CFHN. It was also envisaged that recruitment in a health district that had nurses working in regional and metropolitan areas might provide a greater diversity of client families. However, it is not easy in practice to know whom to contact for permission to conduct a clinical study. Knowing whom to approach, getting an appointment, attending meetings and responding to queries are part of gaining entry to the field, and are critical first steps before data collection can begin. I started at the top of the nursing corporate tree by seeking approval in writing from the health district director of nursing. This approval was obtained, as well as the contact details of the relevant CFHN managers. The managers approved the study with the provisos that I be flexible with interview times as the nurses’ clinical work had to take precedence and that I take responsibility for recruiting. Obtaining ethical approval from the health district Human Research Ethics Committee (HREC) was also straightforward, taking just two HREC meetings one month apart. However, despite the health district approving this study’s ethics submission, a further hurdle arose in obtaining ethical approval and registration with my university’s HREC. This separate committee requested numerous additional changes to information and consent November 2014 | Volume 22 | Number 2 35
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Art & science | acute care Nurse Researcher forms before granting approval, causing a significant delay in start time. This delay and complexity in obtaining ethical approval was unexpected. This is not limited to the Australian context and criticism of this protracted process has also been noted by White (2012). The total time to obtain HREC clearance from both facilities following my initial contact with the nurse managers was approximately nine months. This is a long delay in a PhD candidature.
Logistics and recruitment issues The CFHNS selected for data collection comprised four discrete teams demarcated by geographical boundaries. Each team had a nurse manager and approximately 25 CFHN staff. Data were to be collected from each of these teams in three settings: the parents’ homes, the nurses’ child and family health centres, and the nurse manager’s office. One nurse manager and nine CFHNs were recruited and first interviews conducted with them. I arranged to attend an early parenting group as soon as possible after these interviews to recruit a parent to link with each nurse. The rationale for linking a parent with a child attending a centre with a participating nurse was to ensure that this nurse conducted the child’s health check that I was to record. I attended 12 parenting group sessions overall. The logistics of recruitment and scheduling each of these interviews and field study sessions were complicated by travel difficulties – it took two to three hours of driving in heavy traffic each way. Another factor that affected the recruitment of parents was that I needed to be present for the whole two-hour parenting group session. Not wishing to disrupt group dynamics during the first two group sessions, I gave a short ten-minute presentation to the parents, distributed information packs and left. As no parents volunteered following these sessions, I surmised that they might need longer to get to know me and to gain the trust and confidence to participate (Borbasi et al 2005, McGarry 2007). Rather than being just a visitor, I found I needed to ‘join’ them by explaining my background as a CFHN and role as student researcher, sometimes participate in the discussion and occasionally help by holding a baby. This requirement of the parents to develop a rapport and begin to trust me before volunteering to join the study parallels the stage of relationship building of the helping process and the development of the nurse-parent relationship when it is based on the FPM (Davis 2009). In the 36 November 2014 | Volume 22 | Number 2
FPM, the helping process refers to the direct interaction between parents and practitioners and is a series of eight interrelated tasks that applies to any intervention regardless of its nature or timescale (Davis et al 2010). This parallel also differentiated my experience from White’s (2012) writing on this topic, as I was deliberately modelling the relationship-building approach to recruitment and interaction with participants that is a key element of the partnership model and the focus of study. This was important as I was exploring the factors that influence and the nature of their effects on the nurses’ ability to work in partnership with parents. Borbasi et al (2005) ‘acknowledge aspects of fieldwork that can be predicted’, such as the need to develop trusting relationships by spending time and immersing oneself in the field. However, as a novice researcher I experienced the challenge of finding the right balance of engagement and participation that avoided intrusiveness while gaining a rapport with participants. This was despite having insider knowledge of parenting groups and the extant literature on issues related to entering the field. As a novice researcher conducting a study based on the FPM, I had not foreseen this important link with the principles of the family partnership approach in relation to recruitment of parents. I also found I needed to stay for the entire group session and had to obtain the nurse managers’ permission to do this. Ultimately, I recruited nine parents (all mothers) with babies aged five to eight weeks old. I therefore had one to two weeks in which to attend their babies’ next scheduled child health checks: the six-eight week screening and surveillance health check of infants. These are provided by the CFHN as part of the free, community child health universal surveillance and screening service offered at key development milestones of the child from birth to five years of age (NSW Kids and Families 2013). I needed to attend this health check to observe and record the nurse-mother consultation because, unless they were concerned about their babies’ or their own health, the mothers may not have returned to the centre until the next scheduled check, which occurs at six months of age. Follow-up interviews were arranged with each nurse within one to two weeks of the consultation so they could review the footage. These were also arranged with each of the mothers to discuss her perceptions of the health checks, either immediately after her consultation or in the following week. This short timeframe for © RCN PUBLISHING / NURSE RESEARCHER
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Challenges in data collection post-observation interviews has been recommended (Thomson 2013) to promote accurate reflections and responses by participants, and one could argue that this is especially important for mothers with very small infants who possibly have disrupted sleep and are experiencing the physiological and psychosocial changes of the puerperium (Pairman et al 2010). White (2012) prudently highlighted that logistical issues should be factored in when planning access to participants and negotiated flexible work hours enabled me to do this. However, it proved to be a significant challenge to balance full-time work, study, relationships and personal commitments. Prospective doctoral students should exercise caution regarding life balance at this stage of candidature and be cognisant of the logistical feasibility of conducting studies without research assistance.
Roles and boundaries Having previously worked as a CFHN clinical consultant, I perceived conflict within my role, as I was an ‘insider’ but acting as ‘outsider’ as a student researcher in this specialty. At times, it was challenging for me to remain within the boundaries of the researcher role and the CFHN participants may have also misunderstood my role with them as a student researcher: despite not knowing the nurses personally, a number asked for my opinion on their interactions with parents during their follow-up interviews. This ambiguity (White 2012) occurred despite my recruiting outside my health district and clarifying my role as student researcher. The blurring of role boundaries that may arise when one is an ‘insider’ ethnographer has been explored by Simmons (2007) and Cudmore and Sondermeyer (2007). Similar to my experience, Simmons found that: ‘Although I took care to be clear with participants when I was acting as researcher, they still viewed me as a manager during fieldwork…’ (Simmons 2007). Transparency was needed with participants regarding my role as a student researcher and what would happen with their data, particularly the video recordings of the nurse-parent consultations. After each of these consultations, I reconfirmed with participants their consent to the use of this data. Some nurses expressed anxiety about the potential use of their images in recordings presented at conferences but did not withdraw consent. Likewise, one mother felt she had disclosed too much about her spousal relationship and chose to limit the use of her recording to the research and © RCN PUBLISHING / NURSE RESEARCHER
withdrew consent for its use in photos or conference presentations. The nurse linked with this mother similarly chose to limit her consent to ensure the mother’s wishes were upheld. Conflict occurred for me when collecting data, regarding the need to place a critical ‘lens’ on the data as is required with a critical ethnography (Thomas 1993, Madison 2012). The conflict was between my role as a student researcher and honouring the nurses’ trust in me as someone they had come to know over the weeks and months of the research. Simmons (2007) and Cudmore and Sondermeyer (2007) described similar dilemmas related to role and loyalty conflict. Cudmore commented that she felt ‘like a traitor’ and this sense of betrayal was linked to ‘not wanting to portray her colleagues in a “bad light” in the outcomes of the research’ as well as an awareness of the ‘power this position gave me over participants’ (Cudmore and Sondermeyer 2007). That this tension and conflict occurs for experienced Australian nurse clinicians who are also nurse researchers is unsurprising: the fundamental ethical principles of beneficence and non-maleficence are implied or stated in nursing practice and research (National Health and Medical Research Council 2007, Nursing and Midwifery Board of Australia (NMBA) 2013) Madison (2012) argued that critical ethnography must move beyond politics alone to the ‘politics of positionality by including self-reflection’. I needed to take greater heed of my positionality and its ‘power, privilege and biases’ (Madison 2012). However, Cudmore and Sondermeyer (2007) stated that a critique of practice can also be well received by participants and this was my experience. Nurse participants in particular exhorted me to complete my research because they were interested in finding out more about the factors that influenced their ability to work in partnership with the parents. These predicaments related to roles and boundaries, which signalled a need for me to develop greater capacity for mindfulness (White 2014) and reflexivity (Davies and Cannon 2006), and acknowledge my position and respond appropriately. Mindfulness and reflexivity are similar but interdependent concepts (Tusaie and Edds 2009, Warin 2011); they both involve self-awareness but mindfulness also requires attention to the present moment and being non-judgemental (Tusaie and Edds 2009). White (2014) stated that: ‘The concept of mindfulness encompasses intricately connected attributes: it is a transformative process, where one develops an increasing ability November 2014 | Volume 22 | Number 2 37
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Art & science | acute care Nurse Researcher to experience being present with awareness, acceptance and attention.’ During my candidature, I enrolled in a mindfulness-based stress-reduction course to cultivate a mindfulness practice and stance concurrent with my research studies (Kabat-Zinn 2013). Reflexivity, while having numerous definitions (Davies et al 2006, Jootun et al 2009, Parahoo 2006) in this instance encompasses recognition of the researcher’s integral part of the social world being studied (Ersser 1996). Practising mindfulness as a strategy for reflexivity was crucial to my interviews and observations related to the FPM. During consultations and interviews, I adopted a position of knowledgeable insider and strived to remain present and aware. Yet at the same time, I maintained an awareness of my role as a researcher as ‘a detached witness’ (O’Haver Day and Horton-Deutsch 2004). This is one of the challenges of critical ethnography in balancing the role of insider and outsider. In addition, regular research supervision sessions and use of a fieldwork journal during observation of the consultations assisted in keeping track of my responses and reflections. I also asked participants at follow-up interviews for their views and experiences of my presence and of the video camera during the consultation. Tools to aid reflexivity are necessary requirements for all qualitative researchers to build methodological rigour and understanding of their role (Jootun et al 2009). It also improved the quality of my data and my personal learning during my doctoral studies.
Use of video recording technology Video recording of consultations aided my participant observation and reflection through being able to subsequently review in detail the nurse-parent-child interactions scene-by-scene. The conversations of the nurse and parent were also digitally audio-recorded and transcribed. This process, in addition to reflexivity, assisted in making ‘the familiar appear unfamiliar’ (Edvardsson and Street 2007). However, the use of video recording technology was more complex than had been foreseen. The complexities resulted from the lack of a clear, upfront plan regarding the collection and analysis of video recordings. Issues ensued related to analysis of the large amount of footage and technical issues. For example, planning which aspects of interaction and behaviour between the nurse and mothers in each consultation to record and for what time period could have avoided having an extensive amount of footage to analyse. Audability of the 38 November 2014 | Volume 22 | Number 2
recorded conversations was also poor at times if the infant was crying. In hindsight, I realise that to ensure methodological cohesion, the study design and method should determine how to collect and analyse video recordings. It is critical to know before entering the field how and what is to be recorded, how to analyse the recordings (Luff and Heath 2012) and how the interactions between your participants and you as videographer (Knoblauch 2012) will be managed. It would have been prudent to place greater limits and parameters on the inclusion of video recordings for analysis. Each of the nine videotaped consultations was between 30 and 60 minutes long, resulting in an extensive amount of footage for a doctoral researcher to analyse alongside 29 audio-recorded interviews (30-75 minutes) and copious field notes. Likewise, a clearer plan would have helped determine how best to video record the nurse-mother/baby consultations. Luff and Heath (2012), which was published after I had collected my data, provided a detailed discussion of the technological challenges in analysing video recordings in relation to the choices made regarding their use at each stage of research, such as which behaviours, actions and interactions to be observed. Luff and Heath discussed the benefits and limitations of using a single camera rather than multiple cameras to record social situations; whether the camera(s) should be fixed or roving; the positioning of the camera(s) and the consequent effect on audibility and ability to capture detail; the choice of a wide versus a narrow angle of view; details of what is not recordable, including temperature and odour; and how much content should be video-recorded (Luff and Heath 2012).
Conclusion This paper highlights some of the challenges I faced as a doctoral student in managing the collection of data in a complex qualitative study. These concur with White’s discussion of some of the ‘real life challenges that [novice] researchers might face’ (White 2012) and may well be central to difficulties that other student researchers face in collecting data in qualitative research, especially when taking a critical ethnographic approach, which requires thick descriptive data. A clear gauge is needed for these students in collecting sufficient qualitative data to understand the phenomena they are investigating, while avoiding having so much data that a research assistant or team is needed to manage the analysis and produce a thesis within the limits of candidature. © RCN PUBLISHING / NURSE RESEARCHER
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Challenges in data collection Furthermore, it is crucial to use reflexivity during this phase to assist with issues pertaining to entering the field, positionality, roles and boundaries and to aid personal learning. Mindfulness practice complemented my ability to reflect, respond and learn from issues as they arose. Specific guidance is recommended for research students planning to use video
recordings to collect data. Have clear parameters established before entering the field on how and what is to be recorded and how analysis will be managed. Finally, doctoral students should practise the same level of due care themselves as they do for their participants during their research candidature and aim for a harmonious work-study-life balance.
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Conflict of interest None declared
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Edvardsson D, Street A (2007) Sense or no-sense: the nurse as embodied ethnographer. International Journal of Nursing Practice. 13, 1, 24-32.
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McGarry J (2007) Nursing relationships in ethnographic research: what of rapport? Nurse Researcher. 14, 3, 7-14.
Thomson G (2013) Digging over that old ground: an Australian perspective of women’s experience of psychosocial assessment and depression screening in pregnancy and following birth. BMC Women’s Healtha. www.biomedcentral.com/1472-6874/13/18
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Tusaie K, Edds K (2009) Understanding and integrating mindfulness into psychiatric mental health nursing practice. Archives of Psychiatric Nursing. 23, 5, 359-365.
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Warin J (2011) Ethical mindfulness and reflexivity: managing a research relationship with children and young people in a 14-year qualitative longitudinal research (QLR) study. Qualitative Inquiry. 17, 9, 805-814.
Borbasi S, Jackson D, Wilkes L (2005) Fieldwork in nursing research: positionality, practicalities and predicaments. Journal of Advanced Nursing. 51, 5, 493-501. Coyne I, Cowley S (2007) Challenging the philosophy of partnership with parents: a grounded theory study. International Journal of Nursing Studies. 44, 6, 893-904. Cudmore H, Sondermeyer J (2007) Through the looking glass: being a critical ethnographer in a familiar nursing context. Nurse Researcher. 14, 3, 25-35. Davies B, Cannon S (Eds) (2006) Doing Collective Biography. Open University Press, Maidenhead. Davis H (2009) The Helping Relationship: Understanding Partnerships. www. teamaroundthechild.com/issue/issuenumber-6/172-the-helping-relations hip-understanding-partnerships.html (Last accessed: September 16 2014.) Davis H, Day C (2010) Working in Partnership: The Family Partnership Model. Pearson Education, London.
Jootun D, McGhee G, Marland GR (2009) Reflexivity: promoting rigour in qualitative research. Nursing Standard. 23, 23, 42-46. Kabat-Zinn J (2013) Full Catastrophe Living: Using the Wisdom of Your Body to Face Stress, Pain and Illness. Bantam Books, New York NY. Knoblauch H (2012) Introduction to the special issue of qualitative research: video-analysis and videography. Qualitative Research. 12, 3, 251-254. Kruske S, Grant J (2012) Educational preparation for maternal, child and family health nurses in Australia. International Nursing Review. 59, 2, 200-207. Luff P, Heath C (2012) Some ‘technical challenges’ of video analysis: Social actions, objects, material realities and the problems of perspective. Qualitative Research. 12, 3, 255-279.
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Simmons M (2007) Insider ethnography: tinker, tailor, researcher or spy? Nurse Researcher. 14, 4, 7-17.
Nursing and Midwifery Board of Australia (2013) Codes and Guidelines. www. nursingmidwiferyboard.gov.au/CodesGuidelines-Statements/Codes-Guidelines.aspx (Last accessed: December 13 2013.) O’Haver Day P, Horton-Deutsch S (2004) Using mindfulness-based therapeutic interventions in psychiatric nursing practicec-Part I: description and empirical support for mindfulness-based interventions. Archives of Psychiatric Nursing. 18, 5, 164-169. Pairman S, Tracy S, Thorogood C et al (2010) Midwifery: Preparation for Practice. Second edition. Churchill Livingstone Elsevier, Chatswood, Australia.
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A student’s perspective of managing data collection in a complex qualitative study Cite this article as: Dowse EM, van der Riet P, Keatinge DR (2014) A student’s perspective of managing data collection in a complex qualitative study. Nurse Researcher. 22, 2, 34-39. Date of submission: January 11 2014. Date of acceptance: March 24 2014. Correspondence [email protected] Eileen Mary Dowse MN, GDipHIthSc, DipCFHN is a midwifery lecturer at the School of Nursing and Midwifery Pamela van der Riet PhD, Med, BA, DipEd, ICU/CCu C is deputy head of school at the School of Nursing and Midwifery Diana Rosemary Keatinge PhD, MAdmin, GCert TESOL, RN, RSCN is professor of child, youth and family health nursing at the School of Nursing and Midwifery All at the University of Newcastle, Callaghan, New South Wales, Australia Peer review This article has been subject to double-blind review and checked using antiplagiarism software Author guidelines rcnpublishing.com/r/ nr-author-guidelines
Abstract Aim To highlight from a doctoral student’s perspective some of the unexpected and challenging issues that may arise when collecting data in a complex, qualitative study. Background Using a qualitative approach to undertaking a PhD requires commitment to the research topic, the acquisition of a variety of research skills and the development of expertise in writing. Despite close research supervision and guidance, the first author of this paper experienced unexpected hurdles when collecting data. This article highlights these hurdles and compares them with similar and dissimilar challenges raised by a social researcher with 30 years’ experience (White 2012). Data sources The first author’s experience of field research during her PhD candidature. Review methods Informed by a critical theoretical perspective, a snowballing technique was used to examine issues related to data collection by a doctoral student in a qualitative research study. Discussion The first author found the logistics of qualitative data collection, concerns about transparency, role confusion and power differentials with participants, and the effective use of video recording technology, unexpectedly challenging. Many of these issues are highlighted in the literature
Introduction The aim of this paper is to describe some of the issues that arose for me (EMD) as a doctoral student when collecting data during 34 November 2014 | Volume 22 | Number 2
and/or during research supervision. However, the student researcher remains a novice when entering the field. It is often only on reflection after encountering the hurdle that the student recognises future pre-emptive or alternative methods of data collection. Conclusion The challenges faced as a doctoral student managing the data collection phase of the study concurred with White’s discussion of some of the ‘real life challenges that novice researchers might face’ (2012). Specific guidance and prudence are needed by research students to know when enough data have been collected for manageable analysis within the limits of candidature. Use of reflexivity and mindfulness practised by the student during this phase assisted the ability to reflect, respond and learn from issues as they arose and aim for a harmonious work, study and life balance. Implications for practice/research This paper highlights these issues and offers suggestions for other research higher degree students facing similar challenges when collecting data in a complex qualitative study. Keywords Child and family health nurse, critical ethnography, doctoral student, family partnership model, research challenges, video recording, reflexivity, mindfulness, qualitative study, data collection a complex qualitative study. Despite careful planning and supervision, there were logistical issues, time pressures, competing demands for study participants and unexpected © RCN PUBLISHING / NURSE RESEARCHER
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Challenges in data collection factors that arose that warrant closer examination and consideration. The issues I faced while collecting data resemble those recently shared by White (2012) in his astute reflections, gained from a research career spanning 30 years, on the challenges that can occur for new and experienced researchers. White defined and discussed ten ‘real life challenges’: funding, permissions, logistics, random events, recruitment, confidentiality, roles and boundaries, complaints, dissemination and translation of research findings into practice (White 2012). While this guidance came too late for me, since I finished collecting data in 2011, it is reassuring to know that these issues occur for novice and experienced researchers (White 2012). This paper will first describe the background to the study and then focus on some of the unexpected issues I encountered. These were similar to and dissimilar from the ‘real-life challenges’ suggested by White (2012), and involved permissions, logistics, recruitment, roles and boundaries, as well as the use of video recording technology. This paper builds on the work of White (2012) and adds to what is known by describing my use of mindfulness practice as a doctoral student to aid reflexivity and personal learning and to respond with equanimity rather than react to the predicaments experienced.
Background to the study In New South Wales (NSW), Australia, the Child and Family Health Nursing Service (CFHNS) is a community-based specialty that provides free primary health care to parents and children aged 0-5 years. The staff in this service have a similar role and function to health visitors in the UK, public health nurses in the US, Plunkett nurses in New Zealand (Kruske and Grant 2012), and child health nurses in Sweden (Massoudi et al 2007). A principle tenet of NSW child and family health nursing practice is the Family Partnership Model (FPM), which ‘provides maternal, child and family health nurses and parents with a clear and structured method to navigate and make sense of the process of helping’ (Day 2013). However, some authors have questioned whether nurses are able to truly work in partnership with parents (Wilson 2001, 2003, Andrews 2006, Coyne and Cowley 2006). The aims of this study were to: Identify child and family health nurses’ and managers’ views of the factors that may influence the ability of the child and family health nurse (CFHN) to work in partnership with © RCN PUBLISHING / NURSE RESEARCHER
parents and investigate how these factors may affect this ability. Identify parents’ experiences of the relationship and interaction with the CFHN. Enable CFHNs and managers to reflect critically on existing and developing work practices, education processes, and the context and scope of practice in relation to the factors that influence and affect their ability to work in partnership with parents. Critical ethnography was the selected study design (Thomas 1993, Madison 2012). The goal of critical ethnography is to study the hidden power relations and factors influencing a phenomenon, using field methods consistent with ethnographic modes of enquiry (Allen et al 2008). Methods of collecting data used in this study were typical of ethnographic studies – audio-recorded semi-structured interviews, participant observation and field notes (Allen et al 2008). Participant observation in this study was enhanced through the use of a digital video recorder.
Permissions I recruited outside my health district to avoid the potential ethical implications that could have arisen because of my dual roles of student researcher and senior CFHN. It was also envisaged that recruitment in a health district that had nurses working in regional and metropolitan areas might provide a greater diversity of client families. However, it is not easy in practice to know whom to contact for permission to conduct a clinical study. Knowing whom to approach, getting an appointment, attending meetings and responding to queries are part of gaining entry to the field, and are critical first steps before data collection can begin. I started at the top of the nursing corporate tree by seeking approval in writing from the health district director of nursing. This approval was obtained, as well as the contact details of the relevant CFHN managers. The managers approved the study with the provisos that I be flexible with interview times as the nurses’ clinical work had to take precedence and that I take responsibility for recruiting. Obtaining ethical approval from the health district Human Research Ethics Committee (HREC) was also straightforward, taking just two HREC meetings one month apart. However, despite the health district approving this study’s ethics submission, a further hurdle arose in obtaining ethical approval and registration with my university’s HREC. This separate committee requested numerous additional changes to information and consent November 2014 | Volume 22 | Number 2 35
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Art & science | acute care Nurse Researcher forms before granting approval, causing a significant delay in start time. This delay and complexity in obtaining ethical approval was unexpected. This is not limited to the Australian context and criticism of this protracted process has also been noted by White (2012). The total time to obtain HREC clearance from both facilities following my initial contact with the nurse managers was approximately nine months. This is a long delay in a PhD candidature.
Logistics and recruitment issues The CFHNS selected for data collection comprised four discrete teams demarcated by geographical boundaries. Each team had a nurse manager and approximately 25 CFHN staff. Data were to be collected from each of these teams in three settings: the parents’ homes, the nurses’ child and family health centres, and the nurse manager’s office. One nurse manager and nine CFHNs were recruited and first interviews conducted with them. I arranged to attend an early parenting group as soon as possible after these interviews to recruit a parent to link with each nurse. The rationale for linking a parent with a child attending a centre with a participating nurse was to ensure that this nurse conducted the child’s health check that I was to record. I attended 12 parenting group sessions overall. The logistics of recruitment and scheduling each of these interviews and field study sessions were complicated by travel difficulties – it took two to three hours of driving in heavy traffic each way. Another factor that affected the recruitment of parents was that I needed to be present for the whole two-hour parenting group session. Not wishing to disrupt group dynamics during the first two group sessions, I gave a short ten-minute presentation to the parents, distributed information packs and left. As no parents volunteered following these sessions, I surmised that they might need longer to get to know me and to gain the trust and confidence to participate (Borbasi et al 2005, McGarry 2007). Rather than being just a visitor, I found I needed to ‘join’ them by explaining my background as a CFHN and role as student researcher, sometimes participate in the discussion and occasionally help by holding a baby. This requirement of the parents to develop a rapport and begin to trust me before volunteering to join the study parallels the stage of relationship building of the helping process and the development of the nurse-parent relationship when it is based on the FPM (Davis 2009). In the 36 November 2014 | Volume 22 | Number 2
FPM, the helping process refers to the direct interaction between parents and practitioners and is a series of eight interrelated tasks that applies to any intervention regardless of its nature or timescale (Davis et al 2010). This parallel also differentiated my experience from White’s (2012) writing on this topic, as I was deliberately modelling the relationship-building approach to recruitment and interaction with participants that is a key element of the partnership model and the focus of study. This was important as I was exploring the factors that influence and the nature of their effects on the nurses’ ability to work in partnership with parents. Borbasi et al (2005) ‘acknowledge aspects of fieldwork that can be predicted’, such as the need to develop trusting relationships by spending time and immersing oneself in the field. However, as a novice researcher I experienced the challenge of finding the right balance of engagement and participation that avoided intrusiveness while gaining a rapport with participants. This was despite having insider knowledge of parenting groups and the extant literature on issues related to entering the field. As a novice researcher conducting a study based on the FPM, I had not foreseen this important link with the principles of the family partnership approach in relation to recruitment of parents. I also found I needed to stay for the entire group session and had to obtain the nurse managers’ permission to do this. Ultimately, I recruited nine parents (all mothers) with babies aged five to eight weeks old. I therefore had one to two weeks in which to attend their babies’ next scheduled child health checks: the six-eight week screening and surveillance health check of infants. These are provided by the CFHN as part of the free, community child health universal surveillance and screening service offered at key development milestones of the child from birth to five years of age (NSW Kids and Families 2013). I needed to attend this health check to observe and record the nurse-mother consultation because, unless they were concerned about their babies’ or their own health, the mothers may not have returned to the centre until the next scheduled check, which occurs at six months of age. Follow-up interviews were arranged with each nurse within one to two weeks of the consultation so they could review the footage. These were also arranged with each of the mothers to discuss her perceptions of the health checks, either immediately after her consultation or in the following week. This short timeframe for © RCN PUBLISHING / NURSE RESEARCHER
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Challenges in data collection post-observation interviews has been recommended (Thomson 2013) to promote accurate reflections and responses by participants, and one could argue that this is especially important for mothers with very small infants who possibly have disrupted sleep and are experiencing the physiological and psychosocial changes of the puerperium (Pairman et al 2010). White (2012) prudently highlighted that logistical issues should be factored in when planning access to participants and negotiated flexible work hours enabled me to do this. However, it proved to be a significant challenge to balance full-time work, study, relationships and personal commitments. Prospective doctoral students should exercise caution regarding life balance at this stage of candidature and be cognisant of the logistical feasibility of conducting studies without research assistance.
Roles and boundaries Having previously worked as a CFHN clinical consultant, I perceived conflict within my role, as I was an ‘insider’ but acting as ‘outsider’ as a student researcher in this specialty. At times, it was challenging for me to remain within the boundaries of the researcher role and the CFHN participants may have also misunderstood my role with them as a student researcher: despite not knowing the nurses personally, a number asked for my opinion on their interactions with parents during their follow-up interviews. This ambiguity (White 2012) occurred despite my recruiting outside my health district and clarifying my role as student researcher. The blurring of role boundaries that may arise when one is an ‘insider’ ethnographer has been explored by Simmons (2007) and Cudmore and Sondermeyer (2007). Similar to my experience, Simmons found that: ‘Although I took care to be clear with participants when I was acting as researcher, they still viewed me as a manager during fieldwork…’ (Simmons 2007). Transparency was needed with participants regarding my role as a student researcher and what would happen with their data, particularly the video recordings of the nurse-parent consultations. After each of these consultations, I reconfirmed with participants their consent to the use of this data. Some nurses expressed anxiety about the potential use of their images in recordings presented at conferences but did not withdraw consent. Likewise, one mother felt she had disclosed too much about her spousal relationship and chose to limit the use of her recording to the research and © RCN PUBLISHING / NURSE RESEARCHER
withdrew consent for its use in photos or conference presentations. The nurse linked with this mother similarly chose to limit her consent to ensure the mother’s wishes were upheld. Conflict occurred for me when collecting data, regarding the need to place a critical ‘lens’ on the data as is required with a critical ethnography (Thomas 1993, Madison 2012). The conflict was between my role as a student researcher and honouring the nurses’ trust in me as someone they had come to know over the weeks and months of the research. Simmons (2007) and Cudmore and Sondermeyer (2007) described similar dilemmas related to role and loyalty conflict. Cudmore commented that she felt ‘like a traitor’ and this sense of betrayal was linked to ‘not wanting to portray her colleagues in a “bad light” in the outcomes of the research’ as well as an awareness of the ‘power this position gave me over participants’ (Cudmore and Sondermeyer 2007). That this tension and conflict occurs for experienced Australian nurse clinicians who are also nurse researchers is unsurprising: the fundamental ethical principles of beneficence and non-maleficence are implied or stated in nursing practice and research (National Health and Medical Research Council 2007, Nursing and Midwifery Board of Australia (NMBA) 2013) Madison (2012) argued that critical ethnography must move beyond politics alone to the ‘politics of positionality by including self-reflection’. I needed to take greater heed of my positionality and its ‘power, privilege and biases’ (Madison 2012). However, Cudmore and Sondermeyer (2007) stated that a critique of practice can also be well received by participants and this was my experience. Nurse participants in particular exhorted me to complete my research because they were interested in finding out more about the factors that influenced their ability to work in partnership with the parents. These predicaments related to roles and boundaries, which signalled a need for me to develop greater capacity for mindfulness (White 2014) and reflexivity (Davies and Cannon 2006), and acknowledge my position and respond appropriately. Mindfulness and reflexivity are similar but interdependent concepts (Tusaie and Edds 2009, Warin 2011); they both involve self-awareness but mindfulness also requires attention to the present moment and being non-judgemental (Tusaie and Edds 2009). White (2014) stated that: ‘The concept of mindfulness encompasses intricately connected attributes: it is a transformative process, where one develops an increasing ability November 2014 | Volume 22 | Number 2 37
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Art & science | acute care Nurse Researcher to experience being present with awareness, acceptance and attention.’ During my candidature, I enrolled in a mindfulness-based stress-reduction course to cultivate a mindfulness practice and stance concurrent with my research studies (Kabat-Zinn 2013). Reflexivity, while having numerous definitions (Davies et al 2006, Jootun et al 2009, Parahoo 2006) in this instance encompasses recognition of the researcher’s integral part of the social world being studied (Ersser 1996). Practising mindfulness as a strategy for reflexivity was crucial to my interviews and observations related to the FPM. During consultations and interviews, I adopted a position of knowledgeable insider and strived to remain present and aware. Yet at the same time, I maintained an awareness of my role as a researcher as ‘a detached witness’ (O’Haver Day and Horton-Deutsch 2004). This is one of the challenges of critical ethnography in balancing the role of insider and outsider. In addition, regular research supervision sessions and use of a fieldwork journal during observation of the consultations assisted in keeping track of my responses and reflections. I also asked participants at follow-up interviews for their views and experiences of my presence and of the video camera during the consultation. Tools to aid reflexivity are necessary requirements for all qualitative researchers to build methodological rigour and understanding of their role (Jootun et al 2009). It also improved the quality of my data and my personal learning during my doctoral studies.
Use of video recording technology Video recording of consultations aided my participant observation and reflection through being able to subsequently review in detail the nurse-parent-child interactions scene-by-scene. The conversations of the nurse and parent were also digitally audio-recorded and transcribed. This process, in addition to reflexivity, assisted in making ‘the familiar appear unfamiliar’ (Edvardsson and Street 2007). However, the use of video recording technology was more complex than had been foreseen. The complexities resulted from the lack of a clear, upfront plan regarding the collection and analysis of video recordings. Issues ensued related to analysis of the large amount of footage and technical issues. For example, planning which aspects of interaction and behaviour between the nurse and mothers in each consultation to record and for what time period could have avoided having an extensive amount of footage to analyse. Audability of the 38 November 2014 | Volume 22 | Number 2
recorded conversations was also poor at times if the infant was crying. In hindsight, I realise that to ensure methodological cohesion, the study design and method should determine how to collect and analyse video recordings. It is critical to know before entering the field how and what is to be recorded, how to analyse the recordings (Luff and Heath 2012) and how the interactions between your participants and you as videographer (Knoblauch 2012) will be managed. It would have been prudent to place greater limits and parameters on the inclusion of video recordings for analysis. Each of the nine videotaped consultations was between 30 and 60 minutes long, resulting in an extensive amount of footage for a doctoral researcher to analyse alongside 29 audio-recorded interviews (30-75 minutes) and copious field notes. Likewise, a clearer plan would have helped determine how best to video record the nurse-mother/baby consultations. Luff and Heath (2012), which was published after I had collected my data, provided a detailed discussion of the technological challenges in analysing video recordings in relation to the choices made regarding their use at each stage of research, such as which behaviours, actions and interactions to be observed. Luff and Heath discussed the benefits and limitations of using a single camera rather than multiple cameras to record social situations; whether the camera(s) should be fixed or roving; the positioning of the camera(s) and the consequent effect on audibility and ability to capture detail; the choice of a wide versus a narrow angle of view; details of what is not recordable, including temperature and odour; and how much content should be video-recorded (Luff and Heath 2012).
Conclusion This paper highlights some of the challenges I faced as a doctoral student in managing the collection of data in a complex qualitative study. These concur with White’s discussion of some of the ‘real life challenges that [novice] researchers might face’ (White 2012) and may well be central to difficulties that other student researchers face in collecting data in qualitative research, especially when taking a critical ethnographic approach, which requires thick descriptive data. A clear gauge is needed for these students in collecting sufficient qualitative data to understand the phenomena they are investigating, while avoiding having so much data that a research assistant or team is needed to manage the analysis and produce a thesis within the limits of candidature. © RCN PUBLISHING / NURSE RESEARCHER
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Challenges in data collection Furthermore, it is crucial to use reflexivity during this phase to assist with issues pertaining to entering the field, positionality, roles and boundaries and to aid personal learning. Mindfulness practice complemented my ability to reflect, respond and learn from issues as they arose. Specific guidance is recommended for research students planning to use video
recordings to collect data. Have clear parameters established before entering the field on how and what is to be recorded and how analysis will be managed. Finally, doctoral students should practise the same level of due care themselves as they do for their participants during their research candidature and aim for a harmonious work-study-life balance.
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Conflict of interest None declared
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