RATIONALE FOR THE DEVELOPMENT OF GUIDELINES FOR THE GNP

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CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY

INTRODUCTION

The literature review conducted for the study was discussed in chapter 2. This chapter describes the research design and methodology used to achieve the objectives of the study and answer the research questions.

PURPOSE AND OBJECTIVES OF THE STUDY

The purpose of the study was to develop guidelines for the GNP regarding content, context, actors and process. In order to achieve the purpose, the objectives were to
determine the content of the GNP for Zimbabwe
explore the context in which the GNP is developed for Zimbabwe
determine the actors involved in the development of the GNP
develop guidelines for the GNP
Therefore, the study wished to answer the following questions:
What is the content of the GNP for Zimbabwe?
In what context will the GNP be developed for Zimbabwe?
Who is involved in the development of the GNP for Zimbabwe?
What guidelines should be developed for the GNP for Zimbabwe?

RESEARCH DESIGN

A research design is the set of logical steps taken by the researcher to answer the research questions (Brink et al 2006:217; Saunders, Lewis & Thornhill 2015:136). A research design is an overall plan for obtaining answers to research questions (Polit & Beck 2010:66). Burns and Grove (2009:195) refer to a research design as a blueprint for conducting a study with maximum control over factors that may interfere with the validity of the findings. A research design, then, is a logical plan that shows how a study is to be conducted. The researcher adopted a non-experimental, qualitative, explorative, descriptive and contextual approach and selected a qualitative research design for the study.
Qualitative
Qualitative research is a means of exploring and understanding the meaning individuals and groups ascribe to social problems (Creswell 2013:246). According to Burns and Grove (2009:196), qualitative research is a systematic subjective approach used to describe life experiences and situations to give them meaning. Qualitative research focuses on the experiences, opinions, feelings and uniqueness of individuals thereby producing subjective data (Parahoo 2006:57).
Qualitative studies examine participants’ knowledge and practices and take into account their perceptions and practices in the field. Participants are viewed differently because of their different subjective perspectives and social background (Flick 2009:38). The researcher selected a qualitative design based on a constructivist paradigm to collect and corroborate data and enhance the credibility of the study.
The researcher used a qualitative, explorative case study for the study. According to Yin (2013:4), a single case study strategy is justifiable when the case serves a revelatory purpose. The researcher considered this strategy appropriate for the study with its focus on contemporary rather than historical events. The research questions focused mainly on the “what” of examining and developing guidelines for the GNP. Some types of “what” questions are exploratory and are a justifiable rationale for conducting an exploratory study (Yin 2013:4-5). An explorative case study is used to explore situations in which the intervention being evaluated has no clear set of outcomes (Yin 2013:5). The single holistic case study involved nurse education stakeholders’ perceptions of the development of guidelines for the GNP in the context of the Zimbabwe nursing education system.
The rationale for adopting a qualitative research approach was to explore and describe the participants’ views on guidelines for the development of the GNP in Zimbabwe. A qualitative case study approach was suitable because it allowed the researcher to pursue perceptions and ideas about the development of guidelines for the GNP (Baxter & Jack 2008:544).
Time, availability and type of participants made it feasible to conduct a non-experimental study (Polit-O’Hara, Hungler, Polit & Beck 2001:178). Qualitative studies do not interfere with the natural behaviour of participants being studied. In the study the topic is new and has not been addressed with a certain sample or group of people and existing theories do not apply (Creswell 2013:45). Although the findings cannot be generalized beyond the study, gaining rich data took precedence over eliciting data that could be generalized to other geographic areas or populations (Johnson & Onwuegbuzie 2004:19). The data provided the participants’ personal experiences, and emic or insider’s perceptions, which described the phenomenon under study in rich detail as it was situated and embedded. Moreover, the study provided primary context bound data and enabled the researcher to immerse himself in the participants’ natural setting and develop a relationship with them. This provided thick descriptions and simultaneous data collection and analysis (Fick 2009:12). The focus of the study was to develop guidelines for the GNP based on the participants’ views.

Case study

The researcher used a qualitative case study to facilitate the development of guidelines for the GNP within its context. A case study is a detailed examination of an event or series of related events which the researcher believes exhibits the operation of some identified general theoretical principles (Rhee 2004:1). According to Yin (2013:16), a case study is an empirical inquiry that investigates a contemporary phenomenon in its natural context especially when the boundaries between phenomenon and context are not clearly defined and relies on multiple sources of evidence. According to McMillan and Schumacher (2010:34), a case study examines a bounded system or a case over time in detail, employing multiple sources of data found in the setting. In this study, the case applies to the case study of the GNP within the subsections of content, context, actors and process.
There are three types of case studies, namely intrinsic, instrumental and collective (Yin 2013:10). Intrinsic case studies wish to understand a particular case. Instrumental case studies wish to gain insight into research questions. Collective case studies extend instrumental ones to several cases. Case studies may be exploratory, descriptive or explanatory. If the research is mainly focused on “what” questions, it may call for an exploratory case study. An explanatory case study is used when there are “how” or “why” questions. A descriptive case study focuses on background information and an accurate description of a case in question (Yin 2013:10). The researcher selected an exploratory case study to determine what the content of the GNP was, what its context was and what guidelines should be developed for it.
A criticism of case studies is that their results cannot be generalized (Yin 2003:76). Case studies are only generalizable to theoretical propositions and not populations or universes. The purpose of case studies is analytical generalization to expand theory and not statistical generalization. Case studies make naturalistic generalisations which are different from deductive generalizations based on statistical analysis. Donmoyer (2000:46) points out that human beings act toward things that are meaningful to them and because meanings are generated by social interaction rather than external causes. However, Gomm, Hammersley and Foster (2000:111), maintain that generalization of results of a case study should not be dismissed. Instead, the boundaries of a case or cases should be carefully clarified in order to make appropriate generalizations and cases should be carefully selected. The findings of this study were not intended for generalization to a larger population. The findings were only used to make analytical generalizations to expand theory (Yin 2013:11).
A case study can be embedded (multiple units of analysis), holistic (single unit analysis), single case design and multiple case design (Yin 2013:11). The researcher conducted a single case study.

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RESEARCH METHODOLOGY

Research methodology is the process or plan for how the study will be conducted and includes the population, sample and sampling, data-collection instrument, and data collection and analysis (Burns & Grove 2009:264). Research methods are the techniques used to structure a study and to collect and analyse information relevant to the research questions (Polit & Beck 2012:741).

Population

A population is “the total number of units from which data can potentially be collected’’ (Parahoo 2006:256). A research population refers to the entire set of elements, individuals or objects having some common characteristics in which a researcher is interested (Polit & Beck 2010:337; Fawcett & Garity 2009:135). Polit and Beck (2012:273) distinguish between the target and the accessible population. The target population is the aggregate of cases about which the researcher would like to generalise. The accessible population is the aggregate of cases that meet the inclusion criteria and are accessible as participants for a study. In this study, the population comprised all nurse education stakeholders in Zimbabwe and international nurse education experts.

Sampling

Sampling is the process of selecting a part of the population to represent the total population (Polit & Beck 2012:290). Burns, Grove and Gray (2012:134) describe sampling as a process of selecting events, people or other typical elements to conduct a study. There are four types of sampling, namely quota, snowball, judgmental and purposive (Polit & Beck 2012:291; Babbie 2010:193). Purposive or non-probability sampling is used in qualitative research to select study participants because they understand the research problem and phenomenon under study (Creswell 2013:225). In purposive or non-probability sampling, the researcher selects participants based on personal judgement about which ones will be the most informative provide extensive information about the experience being studied (Polit & Beck 2012:291; Burns et al 2012:137; Patton 2015:264-265).
Purposive sampling is the selection of participants or sources of data to be used in a study, based on their anticipated richness and relevance of information in relation to the study’s questions (Yin 2011:311).
In this study, the researcher used purposive sampling to select nurse educators working in the nursing directorate, Zimbabwe Nurses Council directorate, Zimbabwe Nurses Council nurse education committee members, senior nurses working with student nurses in the clinical area at Parirenyatwa Hospital and lecturers in the Department of Nursing Science of the University of Zimbabwe, and post-basic community health, midwifery and mental health students, and international nurse education experts.
The participants for the interviews, the two focus groups and the Delphi technique were selected because of their suitability for the study. The Delphi technique focuses on eliciting expert opinion therefore the selection depended on the areas of expertise required for the development of the GNP. The participants included in the Delphi technique needed to have sufficient time to participate and be nurse education experts (Aigbavboa & Thwala 2012:155). Accordingly, the participants included top management in nurse education in Zimbabwe, South Africa, Lesotho, Botswana, Malawi, Saudi Arabia, the USA, the UK, the WHO and the International Council for Nurses (ICN) whose judgements were sought (Hsu & Sandford 2007:3).

Sample

A sample is a subset of a population (individuals, elements or objects) or a group selected to act as representatives of the population as a whole and who meet specific inclusion criteria (Polit & Beck 2012:275; Babbie 2010:199).
To be included in the study, the participants had to
be expert in nursing education; that is be informed individuals in nursing education
have knowledge of and experience in nurse education
be willing to participate voluntarily in the study (Aigbavboa & Thwala 2012:155)
The researcher selected a sample of 49 participants for the study (see table 3.2). Semi-structured interviews were conducted with 20 participants; 19 participants participated in the two focus group discussions (focus group 1 had 9 and focus group 2 had 10 participants). With regard to the Delphi technique, a less complex phenomenon and a more homogenous group call for a smaller number of experts (Hsu & Sandford 2007:3). In this study, 10 experts participated in the Delphi technique, representing a broad background. Table 3.1 lists the number of participants in the three data-collection methods.

Data collection

Data collection is the precise, systematic gathering of information relevant to the research purpose or objectives of the study (Burns & Grove 2009:266; Polit & Beck 2012:60). In qualitative research, data collection is flexible due to the continuous evolution in the already collected data (Burns & Grove 2011:507). Qualitative data collection uses various forms such as interviews, observations, documents and records (Creswell 2014:291).
Data was collected using semi-structured interviews, two focus group discussions and the Delphi technique. The Delphi technique used a questionnaire with open-ended questions, which was administered by electronic mail. A combination of semi-structured interviews, focus group discussions and the Delphi technique was used in order to increase the quality of the data collected and ensure authenticity (Polit & Beck 2012:532). The use of multiple data-collection methods assisted data triangulation to enhance the validity of the findings.

Semi-structured interviews

An interview is a face-to-face interaction in which the researcher seeks spoken answers from participants (Bryman 2008:192). Qualitative interviewing is a deliberate strategy of discovering how people feel and think about their world including their experience of their world. Specific areas are explored during these interviews (Creswell 2013:173).
The researcher obtained permission from the participants to audio-record the semi-structured interviews (Charmaz 2006:26; Creswell 2013:168).
The researcher developed an interview guide for the interviews (Johnson & Christensen 2008:208). The questions were open ended and based on the literature review. Interviews provide information, clarify vague statements, permit exploration of topics and yield experiential data from participants (Denzin & Lincoln 2005:697-698). The researcher did not always follow the exact order of the interview guide. For example, participants sometimes answered a question while narrating their experience before it could be asked. In addition, on occasion the researcher asked questions not included in the interview guide in order to clarify relevant and important aspects mentioned by participants (Bowling 2009:285; Creswell 2013:163). For example, “Please explain what you mean by your selling of medication in remand because of hunger.” The researcher audio-recorded the interviews and took notes during the interviews (Turner 2010:756). The interviews were conducted in the participants’ offices.

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Focus group discussions

A focus group discussion is an interaction between one or more researchers and more than one participant for the purpose of collecting data (Parahoo 2006:13). Kumar (1987:3) describes a focus group discussion as a rapid assessment, semi-structured data-collection method in which a purposively selected set of participants gathers to discuss issues and concerns based on a list of key themes drawn up by the researcher or facilitator.
The researcher conducted two focus group discussions. Focus group 1 consisted of nine
(9) three-year generic diploma mental health nursing students. Focus group 2 consisted of five (5) post-basic community health nursing students and five post basic midwifery nursing students. The focus group discussions were conducted in addition to the interviews and the Delphi technique in order to minimize bias, enrich the findings, confirm the results and overcome disadvantages of a Delphi technique (Patrick 2009:1).

Delphi technique

The Delphi technique was developed and designed as a group communication process aimed at conducting detailed examinations and discussions of a specific issue for the purpose of goal setting, policy investigation or predicting the occurrence of future events (Hsu & Sandford 2007:1). It is a widely used and accepted method for collecting data from respondents within their domain of expertise. The Delphi technique is well suited as a method for consensus-building by using a series of questionnaires and multiple iterations to collect data from a panel of selected subjects (Hsu & Sandford 2007:1). The technique is used to obtain the most reliable consensus of opinion of a group of experts by a series of intensive questionnaires interspersed with controlled feedback. The purpose is to achieve consensus on a certain issue where no agreement previously existed (Keeney, Hasson & McKenna 2011:4).
Using the Delphi technique provides anonymity to respondents, a controlled feedback process, and the suitability of a variety of statistical analysis techniques to interpret the data (Aigbavboa & Thwala 2012:155). Theoretically, the Delphi process can be continuously iterated until consensus is determined to have been achieved (Keeney et al 2011:4). The number of Delphi iterations depends largely on the degree of consensus sought by the researcher and can vary from three to five (Keeney et al 2011:4). In this study, three iterations were used to achieve consensus on guidelines for the development of the GNP from the participants.
The Delphi technique consists of four steps: planning, setting up the expert panel, administering the questionnaires, and interpreting the findings for decision-making.
Planning involved:
Identifying and engaging experts.
Determining the specific purpose, focus and scope of the Delphi technique.
Developing time lines for the Delphi technique, which included intended deadlines, setting up the expert panel, sending out questionnaires, receiving responses from each questionnaire, analysing and interpreting the final results.
Determining how consensus from the responses would be defined.
Creating the first questionnaire for the Delphi study and pilot testing the questionnaire.
The researcher selected the participants for this stage of the study with the assistance of prominent nurse education experts whom he knew. The selected participants were specialists in different areas of nurse education. To be included in the study, the participants had to have technical knowledge and professional experience in nurse education
be willing and able to participate in the study
be neutral in their assessment and maintain confidentiality
agree to participate
Ten experts were purposively selected for the Delphi technique. The participants comprised one nurse education expert each from Zimbabwe, South Africa, Lesotho, Botswana, Malawi, the USA, the UK, Saudi Arabia, the WHO and the International Council of Nurses (ICN). The researcher selected the expert from the UK because the nurse education system for Zimbabwe follows the UK model of nurse education. Table 3.2 lists the distribution of the participants for the Delphi technique.

TABLE OF CONTENTS
CHAPTER 1 ORIENTATION TO THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND TO THE RESEARCH PROBLEM
1.3 STATEMENT OF THE PROBLEM
1.4 PURPOSE OF THE STUDY
1.5 SIGNIFICANCE OF THE STUDY
1.6 FOUNDATION OF THE STUDY
1.7 RESEARCH DESIGN AND METHODOLOGY
1.8 RIGOR IN RESEARCH
1.9 TRUSTWORTHINESS
1.10 ETHICAL CONSIDERATIONS
1.11 DEFINITION OF KEY TERMS
1.12 OUTLINE OF THE CHAPTERS
1.13 SUMMARY
CHAPTER 2 LITERATURE REVIEW
2.1 INTRODUCTION
2.2 RATIONALE FOR THE DEVELOPMENT OF GUIDELINES FOR THE GNP
2.3 THE WORLD HEALTH ORGANIZATION’S PERSPECTIVES ON THE DEVELOPMENT OF GUIDELINES FOR NEW NURSING PROGRAMMES
2.4 NEW NURSING PROGRAMME GUIDELINES IN DEVELOPED COUNTRIES
2.5 NEW PROGRAMME GUIDELINES IN DEVELOPING COUNTRIES
2.6 ROLE OF THE NURSES COUNCIL OF ZIMBABWE IN THE REGULATION OF THE GNP
2.7 SUMMARY
CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY
3.1 INTRODUCTION
3.2 PURPOSE AND OBJECTIVES OF THE STUDY
3.3 RESEARCH DESIGN
3.4 RESEARCH METHODOLOGY
3.5 TRUSTWORTHINESS
3.6 GUIDELINES FOR THE GNP
3.7 SUMMARY
CHAPTER 4 DATA ANALYSIS AND INTERPRETATION, AND RESULTS
4.1 INTRODUCTION
4.2 PARTICIPANT CATEGORIES
4.3 DATA ANALYSIS
4.4 SEMI-STRUCTURED INTERVIEWS
4.5 FOCUS GROUP DISCUSSIONS
4.6 THE DELPHI TECHNIQUE
4.7 SUMMARY
CHAPTER 5 GUIDELINES FOR THE GNP IN ZIMBABWE
5.1 INTRODUCTION
5.2 CONTENT OF THE GNP
5.3 CONTEXT WITHIN WHICH THE GNP IS DEVELOPED
5.4 RESOURCES FOR THE GNP
5.5 ASSESSMENT AND EVALUATION
5.6 SUMMARY
CHAPTER 6 CONCLUSION, LIMITATIONS AND RECOMMENDATIONS
6.1 INTRODUCTION
6.2 SUMMARY OF THE STUDY
6.3 PROCESS OF DEVELOPING GUIDELINES FOR THE GNP
6.4 FINDINGS
6.5 SIGNIFICANCE
6.6 LIMITATIONS
6.7 RECOMMENDATIONS
6.8 CONCLUDING REMARKS
LIST OF REFERENCES
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