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CHAPTER 3 RESEARCH DESIGN AND METHOD
Research is what I’m doing when I don’t know what I’m doing.
(Wernher von Braun)
INTRODUCTION
Research design was the overall plan that was employed in this study to address the grand tour question for the individual interviews and the semi structured questions for the focus group interviews which included specifications for enhancing the integrity of the study (Polit & Beck 2012:741).It provided answers to questions such as-who or what will be studied, what strategies of enquiry were to be used, what methods were to be utilised to collect and analyse data (Denzin & Lincoln 2011:243). Research methods referred to techniques used by the researcher to systematically collect and analyse data that was relevant to the research questions (Polit & Beck 2012:12and741). The research objectives of this study were:
- To explore and describe the nurses’ ontological experience of contracting and doing performance reviews.
- To identify challenges related to PDMS particularly contracting and doing performance reviews
- Develop guidelines suitable for the nursing context to improve participation of nurses in the PMDS strategy for better performance and quality patient care outcomes
This chapter covered the setting chosen to conduct the study and the reason there of, the research design and method used. It described the method as the population, sample and sampling technique, data collection and analysis, measures to ensure trustworthiness and ethical considerations that were ensured.
RESEARCH SETTING
Research setting is a specific place where data are collected. Choice of a setting in this study depended on the nature of the research question, objectives and the information required to address them (Brink, Van der Walt & Van Rensburg 2012:59). Setting is defined by Polit and Beck (2012:743) as the physical location and conditions in which data collection in a study takes place. A naturalistic setting is defined in Polit and Beck (2012:735), as a setting that is natural to those being studied for example places of work or home. OR Tambo district municipality was chosen for piloting the National Health Insurance and that put pressure on health institutions to improve the quality of services provided. This district is required to identify and bridge the gap between the quality of services which are provided in private and those that are provided in public health centers. The public hospital chosen as a study context is one of the hospitals in which PMDS was introduced and is being implemented for improvement of quality health care delivery.
The study took place in a naturalistic setting which was the hospital where participants work and experience study the phenomenon. It was conducted in a 469 bedded remote public hospital (exhibited in Figure 3.1) which was bordered by the forest on the north eastern side, the gravel road that cuts across the location. The road passes just next to the entrance on the northern side. The distance from the road to the gate is about 10 meters. This is an old institution that was built in 1958 and officially opened in 1961.Next to the institution on the northern side is a post office, two hard ware and furniture shops, three shops selling dry goods and cooked food as take away for both patients and staff. On the south eastern side are a Dutch mission building and Church that staff and patients go to for spiritual upliftment when needed.
The area of interest is situated in OR Tambo District Municipality about 30 kilometres from the sea and 26 kilometres from the tarred road.
OR Tambo district municipality has been chosen for piloting the National Health Insurance and that puts pressure on health institutions to improve the quality of services provided. This district is required to identify and bridge the gap between the quality of services which are provided in private and those that are provided in public health centres. The public hospital chosen as a study context is one of the hospitals in which PMDS was introduced for piloting the system and is being implemented for improvement of quality health care delivery.
The researcher’s selection of the setting was based on the premise that the researcher interacted face-to-face with research participants. Qualitative researchers collect data by actually talking to people and seeing them act and behave within their context or real world (Creswell 2013:45).The selection of the uncontrolled environment was also in line with (Brink et al 2012:59)’s stipulation that studies can take place in natural settings such as homes or workplaces. The rationale behind the selection of a natural setting was the researcher’s interest in the context of peoples ‘lives and real world experiences’ (Polit & Beck 2006:32). This was in line with Creswell (2013:45)’s statement that qualitative researchers often collect data in a field where participants experience the challenge understudy. The public hospital where the research was conducted caters for patients with varied sicknesses, illnesses, diseases and injuries. Medical, surgical, family planning, mental health, chronic care, acute care, mother and child care out patients and casualty services are provided.
The institution operates with the staff categories as exhibited in Tables 1.1. and 1.2. Student nurses and doctors are often allocated from the local university and nursing colleges to be mentored and accompanied by experienced nurses and doctors in clinical practice.
Nurses’ day shift extends from 07H00 to 16H00 and 19H00.Night shift extends from 19H00 to 7H00. The time of arrival is 15minutes earlier to allow handing over report. Nurses in gateway clinic start their work day at 08H00 and ends at 16H00; they do not work during weekends and during public holidays.
RESEARCH DESIGN
A research project requires an action plan that is referred to as a research design. A research design as applied in this study (Creswell 2013:49), is a plan that was followed to conduct this study. Research designs are forms of enquiry within qualitative, quantitative, and mixed method approaches which provide specific direction for procedures in a research study (Creswell 2014:247). The research design for this study is a generic qualitative, explorative, descriptive and contextual design based on the tenets of the phenomenological philosophical tradition that was used to interpret the meaning that nurses attach to their experience of contracting and doing performance reviews. Phenomenological design was the most appropriate philosophy because it enabled the researcher to identify the essence of nurses’ experiences about the phenomenon under investigation as described by them (Polit & Beck 2012:245).
Phenomenological philosophical base
Phenomenology is a philosophy that seeks to understand the meaning of individuals ’lived experience as described by them which means that in order to understand the meaning of an experience one has to ask those who live it (Holloway & Wheeler 2010:341). Husserl and Heidegger developed a philosophic tradition that is concerned with lived experience of humans termed phenomenology. The phenomenologists’ belief is that a phenomenon can best describe by the persons who live it not those who observe it being experienced (Polit & Beck 2010:72). Understanding peoples’ everyday life experiences and the meaning they have to individuals who experience them is the goal of phenomenology. The phenomenologist views people as physically tied to their world and are conscious of their existence (Polit & Beck 2010:267). A person is the integral part of a phenomenon as it occurs only where there is a person who experiences it. It therefore cannot be studied in isolation but with assistance of people who describe it and its meaning to them. Each person experiences the phenomenon differently from one another. Diverse descriptions facilitate understanding of a phenomenon. The goal of phenomenological studies is truth about the phenomenon, although no absolute truth cannot be obtained but the belief is that those who experience the phenomenon know it better than any other person does. Nurses who are experienced in PMDS processes can provide the researcher with the required information. Phenomenology aims at finding truth from individuals’ different life experiences of the phenomenon (Burns & Grove 2009:54-55).
According to Van de Lagemaat (2005:451), truth is unattainable but if many people share the knowledge that the earth is round for example that is closer to truth than saying it is flat. Phenomenologists explore human phenomena to understand and make sense of the world .Phenomenologists make use of individuals in order to draw conclusions about phenomena. In this study the researcher made use of nurses’ descriptions to understand their experience. Interviewing and observing what people do is the source of knowledge and understanding of lived experiences. Phenomenology is the best approach through which different individual experiences can be studied. To make things easy for researchers, participants must be knowledgeable about the experience understudy for example understanding how it is like to undergo a caesarean section can best be described by women who have given birth through caesarean section (O’Leary 2004:122-123).Therefore in this study, experienced nurses exposed to PMDS for two years and above are the sources of knowledge regarding the phenomenon being studied.
Types of phenomenological research
Descriptive phenomenology
Descriptive and interpretive phenomenology is the types of phenomenological research that are conducted so that human experiences can be carefully described for the purpose of their understanding. Descriptive phenomenological research as described by Polit and Beck (2012:268) include steps such as bracketing, intuiting, analysing and describing.
Bracketing
Bracketing was identified as striving to hold in abeyance any preconceived beliefs and opinions about the phenomenon understudy so that they would not interfere with data collection and analysis (Polit & Beck 2012:228). According to Brink et al (2012:122), bracketing means that what the researcher expects to discover is identified and intentionally put aside in order to consider every available perspective. The researcher is the deputy director of the hospital for the past ten years but ensured that her beliefs, opinions and experiences about the phenomenon under investigation did not interfere with data collection and analysis through use of bracketing. Total bracketing can never be achieved however the researcher strived to bracket out her own world and any presupposition to promote objectivity.
The reflexivity process was used together with bracketing. According to Polit and Beck (2006:44), reflexivity is the process of critically reflecting on the self, analysing and making note of personal values that could affect data collection and interpretation. Reflexivity promotes bracketing in that the enquirer reflects about how own,background, culture and experiences hold potential for shaping interpretation and the meanings they ascribe to the data (Creswell 2014:186). Over and above applying the bracketing principle, a reflective journal was kept and used to record the researcher’s own feelings, experiences, opinions, insights or biases on the study construct for self-reflection.
The use of reflexive journal promoted some level of objectivity during data collection and analysis. Reflexive journal also ensure that the researcher’s personal background, culture and experiences with PMDS do not shape the direction of the study (Creswell 2012:186). It also ensured that the researcher interpreted the phenomenon as participants experienced it without contamination (Burns & Grove 2009:545).
Intuiting
Intuiting was the researcher’s effort or attempt to develop an awareness of the lived experience (Brink et al 2012:122).Intuiting occurred when the researcher remained open to the meanings attributed to the phenomenon by those who experience it (Polit & Beck 2012:731).The experience of contracting and reviewing can better be described by nurses who live it. Intuiting required the researcher to become totally immersed in the phenomenon of interest. It involved the researcher as an instrument or tool for data collection through listening to individuals describing their experience during the interview process. It was during this step that the researcher began to know and understand the phenomenon as described by participants (Streubert-Speziale & Carpenter 2007:85). Remaining open during interviewing assisted the researcher to better understand the experience for the purpose of exploring it through probes and its description.
Analysing
This was an effort to identify common themes that emerged from participants’ description of their experience. The researcher dwelled with the data through spending as much time or prolonged engagement as possible with participants and listening attentively to their descriptions of the phenomenon (Streubert Speziale & Carpenter 2007:85-86).Conducting interviews when the researcher and participants are off duty or during lunch breaks ensured that much time was spent by the two parties together.
Describing
Describing signified providing details of how data was collected captured and analysed (Brink et al 2012:122).
Interpretive phenomenology
Interpretive phenomenology implies interpreting and understanding human experience. In-depth interviews and focus groups interviews were conducted with individuals during which phenomenology or hermeneutics connoted the art and philosophy of interpreting the meaning of the participants’ experiences as lived (Polit & Beck 2012:496).
Qualitative paradigm
According to Brink et al (2012:121), qualitative design or approach is a broad range of research designs and methods used to study phenomena that are not commonly understood. Qualitative approaches are appropriate and effective for researchers who aim to explore the meaning of phenomena in order to describe and provide an in-depth understanding especially of human experiences. Qualitative research aims at obtaining an emic perspective or insider’s view of an experience. The researcher used it to focus on the qualitative aspects of meaning, experience and understanding the nurses’ view in this regard (Brink et al 2012:120-121). Qualitative design is holistic and emergent in nature (Creswell 2013:47). The researcher used the qualitative data collection process as it occurred in the field where participants experience the phenomenon understudy being the instrument for data collection and analysis (Creswell 2014:185).
CHAPTER 1 ORIENTATION AND OVERVIEW OF THE STUDY
1.1 INTRODUCTION
1.2 PHASES OF THE STUDY
1.3 BACKGROUND AND RATIONALE ABOUT THE RESEARCH PROBLEM
1.4 AIM OF THE STUDY
1.5 SIGNIFICANCE OF THE STUDY
1.6 DEFINITIONS OF KEY CONCEPTS
1.7 FOUNDATIONS OF THE STUDY
1.8 RESEARCH DESIGN AND METHOD
1.9 SCOPE OF THE STUDY
1.10 STRUCTURE OF THE THESIS
1.11 CONCLUSION
CHAPTER 2 LITERATURE REVIEW
2.1 INTRODUCTION
2.2 PERFORMANCE MANAGEMENT AND DEVELOPMENT SYSTEM (PMDS) TOOL.
2.3 EFFECTIVE PERFORMANCE FEEDBACK: MANAGER’S ROLE
2.4 Performance outcomes and their management
2.5 Management of sub-standard performance
2.6 EMPLOYEE TRAINING AND DEVELOPMENT
2.7 BENEFITS OF PERFORMANCE MANAGEMENT AND DEVELOPMENT SYSTEM
2.8 PERFORMANCE OBSTACLES
2.9 Practice competencies of nurses
2.10 Performance Improvement Plans (PIP)
2.11 Theories and Models of motivation related to performance management
2.12 CONCLUSION
CHAPTER 3 RESEARCH DESIGN AND METHOD
3.1 INTRODUCTION
3.2 RESEARCH SETTING
3.3 RESEARCH DESIGN
3.4 RESEARCH METHOD
3.5 ENHANCING TRUSTWORTHINESS
3.6 ETHICAL CONSIDERATION
3.7 CONCLUSION
CHAPTER 4 PRESENTATION, ANALYSIS AND INTERPRETATION OF THE RESEARCH FINDINGS
4.1 INTRODUCTION
4.2 SAMPLE DEMOGRAPHIC DATA
4.3 DATA ANALYSIS PROCESS
4.4 THEMES AND SUB-THEMES THAT EMERGED
4.5 DATA PRESENTATION
4.6 THEME 1: CHALLENGES IN IMPLEMENTATION OF THE PMDS
4.7 THEME 2: LACK OF UNDERSTANDING OF THE PMDS PROCESS
4.8 THEME 3: NEGATIVE EXPERIENCES
4.9 THEME 4: POSITIVE EXPERIENCES
4.10 CONCLUSION
CHAPTER 5 DEVELOPMENT AND PRESENTATION OF GUIDELINES FOR IMPROVEMENT OF CONTRACTING AND DOING PERFORMANCE REVIEWS
5.1 INTRODUCTION
5.2 GUIDELINES
5.3 METHOD FOLLOWED TO FORMULATE THE GUIDELINES
5.4 FORMULATION OF GUIDELINES TO FACILITATE PERFOMANCE APPRAISAL COMPLIANCE IN THE NURSING CONTEXT
5.5 Concluding statements
5.6 CONCLUSION
CHAPTER 6 CONCLUSIONS, RECOMMENDATIONS AND LIMITATIONS OF THE STUDY …
6.1 INTRODUCTION
6.2 CHALLENGES RELATED TO PDMS CONTRACTING AND DOING PERFORMANCE REVIEWS
6.3 VIEWS OF PARTICIPANTS ON PDMS CONTRACTING AND DOING
6.4 RECOMMENDATIONS
6.5 LIMITATIONS
6.6 IMPLICATIONS
6.7 CONTRIBUTIONS OF THE STUDY
6.8 CONCLUSION
BIBLIOGRAPHY
ANNEXURES
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THE LIVED EXPERIENCES OF NURSES WITH PERFORMANCE REVIEWS IN A PUBLIC HOSPITAL IN THE EASTERN CAPE PROVINCE: A PHENOMENOLOGICAL APPROACH
