Chapter 2
Research design
2.1 INTRODUCTION
The purpose of the research is to explore and describe the experiences of student
nurses during their placement in the clinical learning environment. In order to achieve
this, an appropriate research design needs to be chosen. In this chapter, the research
process and design which include the data collection method and instrument, data
analysis, target population and sample, pilot interview and methods to ensure
trustworthiness, are discussed. According to Botes (1995:17), these are collectively
referred to as research design. Justification is also given for the particular methods or
strategies employed in this study.
2.2 RESEARCH METHODOLOGY
Research methodology is defined as the total strategy, from the identification of the
problem, to the final plans for data gathering and analysis (Burns & Grove 2001:223).
2.2.1 Research design
Research design is defined as the clearly defined structures within which the study is
implemented (Burns & Grove 2001:223). A qualitative, exploratory, descriptive and
contextual design was followed using the phenomenological method to explore the lived
experiences of student nurses during clinical practice (Streubert & Carpenter 1999:18).
The richness and depth of the description gained from a qualitative approach, provides
a unique appreciation of the reality of the experience (Munhall 2001:106).
Qualitative research emphasises the dynamic, holistic and individual aspects of the
human experience, and attempts to capture those experiences in their entirety, within
the context of those experiencing them (Polit & Beck 2004:16; Streubert & Carpenter
1999:15). The researcher chose to follow a qualitative research process to explore the
experiences of student nurses during their placement in a clinical learning environment.
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Through this approach, it was possible for the researcher to deeply engage and interact
with student nurses through phenomenological interviews, and rich data was generated
on the experiences of the student nurses during their placement in clinical learning
facilities.
During the interviews the interviewer used bracketing (which refers to putting
preconceived ideas aside) and intuiting (focusing on the lived experiences of
respondents during their clinical placement).Field notes were taken by the interviewer
based on the observations made during the interviews. Interviews were conducted until
the data saturated as revealed by repeating themes and not by the amount of interviews
conducted. A colleague (who is a registered nurse) assisted the interviewer by
operating the audio tape recorder through out the interviewing process. Coding was
done by the researcher with the assistance of the researcher’s promoter and co-
promoter who both also controlled the coding.
Exploratory research is defined by Burns and Groove (2001:374) as research
conducted to gain new insights, discover new ideas, and for increasing knowledge of
the phenomenon. The study attempts to explore the experiences of student nurses
during their placement in clinical facilities in one of the districts of the Limpopo Province
in South Africa.
Descriptive research involves direct exploration, analysis and description of the
particular phenomena, as free as possible from unexplained presuppositions, aiming at
maximum intuitive presentation (Streubert & Carpenter 1999:49). Descriptive studies
are used to document the phenomenon of interest in the real situation (Marshall &
Rossman 1995:41). The experiences of student nurses during their placement in
clinical practice are described and recommendations for the improvement of the clinical
learning environment are proposed.
Botes (1995:16) describe contextual research as findings valid within the time space
and value context in which the study is being done. This study therefore focused on the
clinical practica experiences of student nurses on one of the nursing campuses of the
Limpopo College of Nursing and its clinical facilities. Thus, the study is restricted to one
nursing campus and its clinical facilities in one district of the Limpopo Province. The
researcher also attempted to capture the context in which clinical learning took place, in
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order to obtain a holistic picture of student nurses experiences. The approach allowed
the researcher to explore the insider’s view, with utmost respect for the individual
student nurse’s perspective and his or her space (Streubert & Carpenter 1999:17).
The phenomenological method was chosen in order to describe the lived clinical
learning experiences of student nurses during clinical practice. Phenomenology
emphasises the individual’s constitution of his or her life world, in other words, how the
person experiences his or her world. The phenomenological research method was used
to conduct this study, as it provides the opportunity for the student nurses to share their
lived experiences with the researcher, without imposing views of the researcher.
Phenomenology emphasises descriptions of the phenomena as consciously
experienced, without theories about their causal explanation and as free as possible
from unexplained preconceptions and presuppositions (Streubert & Carpenter 1999:44).
The researcher approached the investigation with the intention of discovering the emic
view or the insider’s perspective.
2.2.2 Research population
Population is defined by Polit and Beck (2004:50) as the aggregate or totality of those
conforming to a set of specifications. Student nurses, who were in their fourth-year of
study on one of the three nursing campuses of the Limpopo College of Nursing, were
targeted for participation as they had already been exposed to different clinical settings,
i.e. both in hospitals, the community, and clinics. At this level, they have also covered
almost all study disciplines for the four-year integrated programme (SANC 1985). They
will therefore be able to reflect easily on those experiences deemed to be positive and
negative throughout their clinical learning.
2.2.3 Sampling
Sampling refers to the process of selecting a portion of the population that conforms to
a designated set of specifications to be studied. A sample is a subset of a population
selected to participate in the study (Polit & Beck 2004:731; Uys & Basson 1991:87). A
purposive sampling method was used, which is most common in phenomenological
inquiry.
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According to Brink (1996:141), purposive sampling requires selecting participants who
are knowledgeable about the issue in question, because of their sheer involvement in
and experience of the situation. While Creswell (2003:185) states that purposive
sampling refers to selection of sites or participants that will best help the researcher
understand the problem and the research question, they must be willing to reflect on
and share this knowledge. Student nurses in clinical practice were found to be the best
source of rich and valuable information regarding their experiences during placement in
clinical settings, as they are experts regarding their own clinical practice experiences
(Lincoln & Guba 1985:290; Talbot 1995:487-488). The participants were selected based
on their particular knowledge of the phenomenon, for the purpose of sharing their
knowledge and experiences with the researcher (Streubert & Carpenter 1999:58).
The researcher personally recruited participants. All forty-seven fourth-year student
nurses who were registered for the four-year integrated nursing programme at one of
the three campuses of the Limpopo College of Nursing, were requested to participate in
the study, of whom only fifteen were willing to participate. Limpopo College of Nursing
has three nursing campuses, one of which has been selected for the study. A total of
eleven participants were interviewed, and at that stage, data saturation appeared to
have been reached. Those interviewed were four males and seven females, with the
age range of 23-30 years. Participants were requested to give written consent for the
interviews to be audiotaped.
2.2.4 Sampling criteria
The sampling criteria are the characteristics essential to the membership of the target
population. These criteria are the characteristics that delimit the population of interest
(Burns & Grove 2001:366).
For this study the inclusion criteria were:
• The participant has to be registered for a four-year nursing diploma programme
at one of the selected nursing campuses of the Limpopo College of Nursing.
Limpopo College of Nursing has three nursing campuses, one of which has been
selected for the study.
• The participants have to be in the fouth year of study (final year)
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• The participants should have had exposure to clinics, the community, and
hospitals as clinical learning environments in all four disciplines (general,
psychiatry, community and midwifery nursing).
2.2.5 Setting
The researcher had agreed to meet with student nurses at a suitable venue and time
convenient to the student nurses. The interviews were conducted in the nurses’ hostel.
The private sitting room for the housekeeper was used, and a tag with the message:
“Do not disturb - interviews in progress“, was displayed on the door to avoid
interruptions.
2.3 ETHICAL CONSIDERATIONS
Ethics refers to the quality of research procedures, with regard to their adherence to
professional, legal, and social obligations to the research participants. It is the branch of
philosophy that deals with morality (Polit & Beck 2004:717). As this research involves
human participants, it was therefore necessary that the following ethical principles be
adhered to:
¾ Right to self-determination
According to Burns and Grove (2001:196), the right to self-determination is based on
the ethical principle of respect for a person. This means that participants must be given
adequate information regarding the research; they must be capable of comprehending
the information; and they must have the power of free choice, enabling them to consent
voluntarily to participate in research or decline participation.
The objectives of the study were explained to the participants, and their informed
consent was obtained. Participants were informed of their rights to withdraw from the
study at any time. The participants were continuously reminded and informed of their
right to review the first agreement (process-informed consent). The researcher and the
participants had discussed and clarified their understanding of the investigation. The
informants were briefed on the objectives and purpose of the research during the pre-
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interview discussion meeting, when the appointments for the interviews and written
consent were secured.
Right to confidentiality
According to Burns and Grove (2001:201), confidentiality is the researcher’s
management of private information shared by the participants, which must not be
shared with others without the authorisation of the participants.
The researcher has ensured and guided against unauthorised access to the data, and
that the research data is only made available to the researcher and the promoter.
¾ Anonymity
Anonymity occurs when even the researcher cannot link a participant with the data of
that person (Burns & Grove 2001:201). Although anonymity cannot be completely
guaranteed in qualitative research (Streubert & Carpenter 1999:38), an attempt has
been made by the researcher to ensure that there is no unauthorised access to the
data. Data will also be kept safe by locking it in the cupboard and destroying the tapes
on completion of the study. Revealing materials, such as names of participants, were
withdrawn during the process of data collection, to ensure that there is no unnecessary
disclosure of the identity of the participant.
¾ The right to privacy
The researcher will maintain privacy in all personal matters arising from information
coming from the participants. This might be in the form of feelings, beliefs or attitudes,
and opinions. Raw data will be protected from unauthorised persons, and will not be
shared and no names will be linked to the data. Data will also be kept safe in a locked
cupboard, and tapes will be destroyed on completion of the study (Burns & Grove
2001:200).
2.4 DATA COLLECTION APPROACH AND INSTRUMENT
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Data collection is the process of selecting participants and gathering data from these
participants (Burns & Grove 2001:460).
2.4.1 The instrument
The researcher has used an unstructured interview as the tool for data collection,
because it provides participants with the opportunity to fully describe their experiences.
This method of data collection was chosen to allow the participants to share their own
stories in their own words, rather than being forced by pre-established lines of thinking
developed by the researcher. Interviews are also regarded as the best way for exploring
and gathering experiential narrative material, that may serve as a resource for
developing a richer and deeper understanding of a human phenomenon (Munhall
2001:156; Streubert & Carpenter 1999:59). Furthermore, interview methods were
accepted as valid methods for studying experiences and perceptions of student nurses,
as they had been used in many qualitative studies on student nurses, for instance,
Baille (1995:1053) and Shields (1995:16). For this study, unstructured interviews
yielded rich data, as participants were able to raise their views without the influence of
the researcher.
2.4.2 Preparation for the interview
The researcher had met with individual student nurses at the nurses’ hostel. The
purpose of this contact session was to introduce the research topic to the student
nurses, establish rapport with the student nurses, clear up any questions, obtain
consent for participation and permission to tape record the interviews. The researcher
had then agreed with those who were willing to participate, on the venue and time for
the interviews. A writing pad, pen and tape recorder were also prepared in advance.
2.4.3 Interview process
All participants were asked one comprehensive, open-ended question which was as
follows:
• Describe your clinical learning experiences during placement in a clinical learning
environment.
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The researcher used communication skills such as reflection, nodding, questioning,
clarification, and maintaining eye contact, to facilitate and encourage participants to talk,
until there were no new themes or issues emerging from the participants. Field notes
were also taken during the interviews. The interviews were tape recorded, and verbatim
transcriptions were made. A follow-up interview was done with some of the participants,
after first listening to the tapes. This was done to verify and allow the participants to
expand on inadequate descriptions, or add descriptions to the phenomenon.
2.4.4 Pilot interview
According to Brink (1996:60), a pilot study is a small-scale version, or trial run, of the
major study. The purpose of the trial run is to obtain information for improving the
project or assessing its feasibility. The same main comprehensive question that was
planned for the study was asked to one student nurses, before the actual interviews
with the participants. This was done to test the effectiveness of the instrument and any
difficulties it might impose on the participants, and was found to be effective.
2.5 DATA ANALYSIS
According to Streubert and Carpenter (1999:60), data analysis begins with listening to
participants’ verbal descriptions, and is followed by reading and re-reading the verbatim
transcriptions or written responses. Data analysis was conducted using Tesch’s method
of analysis of qualitative data, and the steps are as detailed below:
(a) The researcher had listened to audiotapes and had also read and re-read all the
transcriptions. This was done to get a sense of the whole data, and some ideas
were jotted down as they emerged.
(b) One transcript of the interview was picked at a time and re-read. The underlying
meaning of the data was sought, and was written in the margin. Topics which
represented positive experiences were written in a blue colour, and those that
represented negative experiences were written in a red colour. This was done
with all transcripts.
(c) A list of topics was made, and then similar topics were clustered together.
Thereafter, columns were drawn to form major topics, unique topics and leftovers
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(i.e. those that fitted into major topics/categories and those that did not fit into
either of the categories).
(d) The compiled list was then used to compare the data, and topics were
abbreviated as codes. These codes were written next to the segments of the text,
while checking if new categories and codes were emerging. These codes were
colour-coded (i.e. red for negative experiences, and blue for positive
experiences).
(e) The most descriptive words for the topics were assigned and turned into
categories. Topics that were related to each other were grouped together, in
order to reduce the list of categories.
(f) Each category was checked and alphabetised.
(g) Data was analysed and systematically explored to generate meanings, and
existing data was recorded, participants were asked to validate analysed data,
and recoding was done where necessary (Creswell 2003:192; Tesch 1992:141).
In reporting the findings, examples from the participants’ verbatim statements have
been included, to engage the reader in consensual validation of the text (Leonard
1989:40-45).
2.6 DEMONSTRATING TRUSTWORTHINESS
Trustworthiness refers to the establishment of validity and reliability of qualitative
research. Qualitative research is trustworthy, when it accurately represents the
experience of the study participant (Streubert & Carpenter 1999:333). The method of
establishing trustworthiness was adopted from that of Lincoln and Guba (1985:294),
also cited in Krefting (1991:24) and Mouton (2001:227).
¾ Credibility
Credibility relates to the trustworthiness of findings in qualitative research studies.
Credibility is demonstrated when participants recognise the reported research findings
as their own experiences (Streubert & Carpenter 1999:330). To ensure credibility, the
researcher has employed the following measures:
• All participants were taken through the same main question
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• The researcher had conducted debriefing with informants, and any additional
information was taken into consideration when analysing (member checks).
• The researcher had interviewed the participants to the point at which there was
data saturation (prolonged engagement). No new information was raised.
• The interviews were tape-recorded and transcriptions were made of each
interview (referral adequacy).
• The researcher went back to some of the participants, to ascertain whether the
transcribed data was a truthful version of their experiences.
¾ Dependability
The dependability criterion relates to the consistency of findings. According to Lincoln
and Guba (1985:316), there can be no validity without reliability (and thus no credibility
without dependability). Therefore, a demonstration of the former is sufficient to establish
the existence of the latter. The same principle also applied in this research.
A dense description of the methodology used to conduct the study, and a dense
description of the data, was done. Data was also organised in categories and themes.
All interview materials, transcriptions, documents, findings, interpretations, and
recommendations, were kept, and any other material relevant to the study made
available and accessible to the supervisor and any other researcher, for the purpose of
conducting an audit trail.
¾ Confirmability
Confirmability refers to the objectivity or neutrality of the data, such that there will be
agreement between two or more independent people about the data’s relevance or
meaning (Krefting 1991:221; Polit & Hungler 1995:255;). The researcher did data
analysis, and the supervisor did an audit trail of the verbatim descriptions, categories
and themes.
¾ Transferability
Transferability refers to the extent to which the findings can be applied in other contexts,
or with other participants (Mouton 2001:277; Polit & Hungler 1995:255). A literature
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control was done wherein similar findings of other research studies were reported. The
researcher had provided a dense description of the research methodology, the
participants’ background, and the research context to enable someone interested in
making a transfer, to reach a conclusion about whether transfer can be possible or not.
Purposive sampling was used (Krefting 1991:214; Lincoln & Guba 1985:316; Mouton
2001:277).
2.7 CONCLUSION
The research design and method, population and sampling, ethical considerations, data
collection approach and instrument, data analysis and demonstration of trustworthiness
of the research data, were described. In the following chapter, literature reviewed will be
discussed.
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