Thomas had heard the same devastating story before. He knew what to expect or so he thought. He had seen the shattered lives, lost youth and the trail of broken dreams that had divided families and friends. Often it was the innocent bystanders most affected by such behaviour. The collateral damage was often so costly. But it was Thomas who would end up as Daniel’s target that day.
All researchers have different beliefs and ways of viewing and interacting within their surroundings. As a result, the way in which research studies are conducted vary. However, there are certain standards and rules that guide a researcher’s actions and beliefs. Such standards or principles can be referred to as a paradigm. To gain a better understanding of why and how the researcher chose the methodological approach in this study, an initial discussion will be completed about the paradigm that best fits the focus of this study.
Following a discussion about the research paradigm, the aim of this chapter is to discuss the research design and methodology utilised in this study. In order to describe the variety of research activities undertaken during this study, the data collection activities and associated analysis methods will be systematically discussed under four phases. For ease of discussion, the study activities will be described in the order in which the researcher completed them. The order of the study activities have been outlined in Figure 3.
According to Taylor, Kermode, and Roberts (2007, p. 5), a paradigm is “a broad view or perspective of something”. Additionally, Weaver and Olson’s (2006, p. 460) definition of paradigm reveals how research could be affected and guided by a certain paradigm by stating, “paradigms are patterns of beliefs and practices that regulate inquiry within a discipline by providing lenses, frames and processes through which investigation is accomplished”.
Therefore, to clarify the researcher’s structure of inquiry and methodological choices, an exploration of the paradigm adopted for this study will be discussed prior to any discussion about the specific methodologies utilized in this study.
This study utilised a triangulation approach to explore and guide the development and evaluation of a clinical forensic nursing educational package. The use of both the qualitative and quantitative methodologies was necessary to encompass the different aspects of forensic science and nursing’s holistic approach to patient care. According to Lynch (2006), providing forensic patient care requires objectivity and neutrality while attending to the various human dimensions of health and well-being. To address the diversity and complexity of such nursing and forensic issues, a mixed methodology was necessary.
According to Weaver and Olson (2006), the paradigms most commonly utilised in nursing research are positivist, postpositivist, interpretive, and critical social theory. The quantitative methodology shares its philosophical foundation with the positivist paradigm (Weaver and Olson). The positivist paradigm arose from the philosophy identified as logical positivism and is based on rigid rules of logic and measurement, truth, absolute principles and prediction (Halcomb and Andrew, 2005; Cole, 2006; Weaver and Olson). The positivist philosophy argues that there is one objective reality. Therefore, as a consequence, valid research is demonstrated only by the degree of proof that can be corresponded to the phenomena that study results stand for (Hope and Waterman, 2003).
In this study, such rigid principles lend themselves more to the scientific forensic aspects such as scientific knowledge, logic and measurement incorporated into this study (Weaver and Olson, 2006; Lynch, 2006). However, such inflexible beliefs did not have the capacity to accommodate the investigatory aspects of this study that dealt with the social and human experiences. As a result, qualitative methodologies were also incorporated into the research design (see Table 3.1). The qualitative methodology shares its philosophical foundation with the interpretive paradigm which supports the view that there are many truths and multiple realities. This type of paradigm focuses the holistic perspective of the person and environment which is more congruent with the nursing discipline (Weaver and Olson, 2006). Additionally, the interpretive paradigm is associated more with methodological approaches that provide an opportunity for the voice, concerns and practices of research participants to be heard (Cole, 2006; Weaver and Olson). Cole further argues that qualitative researchers are “more concerned about uncovering knowledge about how people feel and think in the circumstances in which they find themselves, than making judgements about whether those thoughts and feelings are valid” (p. 26).
Due to the complex nature of the research study, there was no single paradigm that could satisfactorily deal with all of the required methodological aspects. Therefore, the researcher found it necessary to combine the quantitative/positivist paradigm with the qualitative/interpretive paradigm.
The blending of both paradigms provided the researcher with the ability to statistically analyse the scientific data whilst also recognizing the complex psychosocial and emotional factors that influence patient care issues. The discussion that follows will further elaborate and describe in detail how each paradigm and methodological approach was implemented in this study.
In this descriptive study, qualitative and quantitative data collection techniques were used including; semi-structured interviews, chart audits, pre and post-test questionnaires, focus group interviews, and the researcher’s field notes of personal observations and conversations. Additionally, to provide a more complete and multidimensional understanding of the issues, a triangulation methodology design was employed (Taylor, Kermode, and Roberts, 2007). In the section below, the discussion will be divided into two main headings; that of descriptive research and triangulation.
In order for the researcher to gain different perspectives and draw attention to different factors that affect forensic practice in Western Australia, descriptive research methods were employed in this study. According to Polit, Beck, and Hungler (2001, p. 180), descriptive methods are used when the researcher seeks to “describe, observe, and document a naturally occurring phenomenon which cannot readily be ascribed an objective value”. In other words, descriptive research deals with questions that look to explain what things are like and describe relationships but do not predict relationships between variables or the direction of the relationship. Depending on what is to be described, descriptive research can be very concrete or more abstract (DeVaus, 2002). At a concrete level, data collected is often strongly quantitative in nature (Polit, Beck, and Hungler, 2001).
In this study, data will be collected in the form of participant demographics, chart audit data, monitoring of implementation tools, and data collected from the pre and post-test questionnaires. In addition, more abstract descriptive research, in the form of stakeholder interviews, was also included. According to Morse and Richards (2002), qualitative descriptive approaches are extremely helpful because evidence of experience and knowledge can be easily missed when quantitative methods are used.
In this study, semi-structured interviews were incorporated into the study design because the researcher believed that open ended questions would be the most efficient way to collect data from stakeholder participants. Open ended questions are thought to allow an individual time and scope to discuss their perception and knowledge (Morse and Richards, 2002). DeVaus (2002) believes that descriptive research can play a key role in highlighting the existence and extent of problems which can stimulate interventions and actions that lead to policy change. The intent of stakeholder interviews was to investigate and describe current forensic practices occurring in Western Australia.
According to Taylor, Kerrmode and Roberts (2007), qualitative interviews attempt to “make meanings” from individual accounts and experiences. Forensic patients are usually treated in partnership by medical and legal professionals (Lynch, 2006). Therefore forensic and healthcare stakeholders who work in the field have the best ability to contribute, enhance links and increase the successful integration of services (Haddow, O’Donnell, and Heaney, 2007). The incorporation of stakeholders in this study was to enhance the understanding of the current issues and experiences confronting forensic and healthcare professionals working with and providing care to forensic patients.
Multiple triangulation methods were utilised in this descriptive study. Triangulation involves the application and combination of several research methodologies in one study (Schneider, Elliott, Lo-Biondo-Wood, and Haber, 2003; Taylor, Kermode, and Roberts, 2007). There are four common types of triangulation discussed within the literature including: data triangulation that involves time, space, and persons; investigator triangulation which uses multiple observers; theory triangulation that uses more than one theoretical perspective to interpret the study phenomenon; and methodological triangulation that involves using more than one methodological strategy during data collection. According to Halcomb and Andrew (2005), the use of multiple data sources and methods to cross-check and validate findings increase the depth and quality of the results and also provides valuable guidance to nursing practice.
Triangulation provides in-depth data, increases the confidence in the research results as well as enables different dimensions of the problem to be considered (Barbour, 2001; Jones and Bugge, 2006). A combination of methods is thought by some to improve the consistency and accuracy of data by providing a more complete picture of the phenomenon (Roberts and Taylor, 2002; Halcomb and Andrew, 2005; Williams, Rittman, Boylstein, Faircloth, and Haijing, 2005; Jones and Bugge, 2006). Morse (1991) cited in Minichiello, Sullivan, Greenwood, and Axford, (1999, p. 258) believes that triangulation is a means by which the researcher is able to “capture a more complete and holistic portrait of the phenomena under study”.
In this study, the researcher employed methodological, data, and unit of analysis triangulation. Each of these aspects of triangulation will be discussed individually below and study examples provided to help illustrate the concepts. Firstly, methodological triangulation will be explored which can be sub-divided into within and across-method triangulation (Schneider, et al., 2003; Halcomb and Andrew, 2005).
Methodological triangulation, according to Taylor, Kermode, and Roberts (2007), involves using two or more research methods in one study at the level of data collection or design. Across-method triangulation involves combining research strategies usually qualitative and quantitative methods. Such an approach is common in nursing studies (Jones and Bugge, 2006; Halcomb and Andrew, 2005). In this study, for example, data from stakeholders interviews were utilised to reinforce and complement the data from quantitative chart audits because concepts mentioned by the stakeholders were checked during the chart audits. Complementary findings in a study make a more valid contribution to theory and knowledge development, enhance diversity, and enrich the understanding surrounding the study’s objectives and goals (Schneider, et al., 2003; Macnee and McCabe, 2008).
Data triangulation can be described as the use of multiple sources of data to obtain differing views about a situation in a single study (Roberts and Taylor, 2002). For example, in this study, data was collected from various interviews, pre and post-test questionnaires and by reviewing nurse participant’s documentation within patient medical records. Multiple data sources help validate the findings by exploring different views of the situation under investigation (Taylor, Kermode, and Roberts, 2007). Data triangulation can be divided into categories of time, space, and person (Roberts and Taylor).
Time triangulation involves researchers collecting data at different points in time such as time of day; at different days of the week, or at different months of the year (Rinaldi, Carpenter, and Speziale, 2006). In this study, however, the goal was not to compare participant knowledge between shifts or from one month to the next. 46
Instead, the researcher was interested in evaluating an educational intervention over time. Therefore, for this study, only two types of data triangulation were utilised: space and person. Space triangulation involves the collection of data from multiple sites (Roberts and Taylor, 2002). In this study, for example, data was collected from two hospitals emergency departments. Analysis from both sites helped evaluate the effectiveness of Phase III activities of this research and also increased the validity and strengthened the study (Begley, 1996; Halcomb and Andrew, 2005). Person triangulation implies that data was collected from more than one category of person (Roberts and Taylor, 2002; Taylor, Kermode, and Roberts, 2007).
For example, in this study, participants included ED nurses as well as key forensic and healthcare stakeholders. The use of various legal and healthcare professionals provided greater insight into a variety of issues including: hospital administration, staffing, costing concerns; medical practices; Western Australian legal requirements and governmental policies; current evidentiary processes; as well as existing investigatory practices. Such data was utilised to support, supplement, and validate the information gained from published forensic material as well as the research data.