Engaging use of social media as a research tool to capture the daily life experiences of young people with chronic pain.

EBN engages readers through a range of online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.

A protocol to measure the impact of intentional changes to nurse staffing and skill-mix in medical and surgical wards.

AIM: The aim of this research is to measure the impact that planned changes to nurse staffing and skill-mix have on patient, nurse, and organizational outcomes. BACKGROUND: It has been highlighted that there are several design limitations in studies that explore the relationship between nurse staffing and patient, nurse and organizational outcomes; not least that the vast majority of research in this area emanates from studies that are predominantly observational in design. There are limited studies that measure nurse, patient, organizational, and economic outcomes using a longitudinal design following a planned change in nurse staffing. DESIGN: The research will employ a longitudinal, multimethod approach to evaluate the impact that planned changes in nurse staffing and skill-mix have on wards in three pilot hospitals. METHODS: Administrative data collection will take place on a shift-by-shift basis prospectively over a three-year period including the measurement of nursing sensitive outcomes: cross-sectional patient experience data and nurse outcomes (nursing work, job satisfaction, burnout, missed care) will be collected at intervals prior to, during and after the implementation of planned changes in nurse staffing and skill-mix. Data will be analysed using interrupted time-series models, adjusted for key hospital, ward and patient-level factors. An economic costing of the changes will further investigate the resources required for the intervention that can then be aggregated to a national level for future roll-out plans. DISCUSSION: The study aims to provide evidence on the impact of planned changes to nurse staffing and skill-mix based on a systematic approach using a longitudinal design and to determine the extent to which the approach can be implemented at a national level.

Ethical considerations when conducting joint interviews with close relatives or family: an integrative review.

BACKGROUND: Researchers are obligated to do no harm to participants of research. Conflicts in relationships can cause negative well-being; therefore, insight is needed into the particular ethical considerations that arise when conducting joint interviews with close relatives or family members simultaneously in the healthcare setting. AIM: To collect and share knowledge related to ethical considerations conducting joint interviews. DESIGN AND METHODS: A literature review inspired by the integrative review method was performed. Data were retrieved through a structured search in PubMed, CINAHL and the Philosopher's Index and Academic Search Premier for articles published in English from 1980 to 2016 and included 18 articles, of a possible 2153. Article content was assessed line-by-line, and ethical considerations were extracted and organized in three subgroups regarding: Planning joint interviews; Conduction joint interviews and Reporting on joint interviews Findings: Participants should be offered the best terms for a constructive, on-going relationship after the joint interview has ended. This obligates the researcher to ensure a safe environment during the joint interview and create a delicate balance between the needs of the participants, using nonconfrontational techniques that foster equal and neutral but dedicated attention to all parties, before, during and after the joint interviews. CONCLUSION: Specific ethical considerations should be taken into account before, during and after joint interviewing. Further research is needed before a final conclusion can be drawn.

Sensitive Interviewing in Qualitative Research.

In this paper we focus on important considerations when planning and conducting qualitative interviews on sensitive topics. Drawing on experiences of conducting interviews with dementia caregivers, a framework of essential elements in qualitative interviewing was developed to emphasize study participants' needs while also providing guidance for researchers. Starting with a definition of sensitive research, the framework includes preparing for interviews, interacting with gatekeepers of vulnerable groups, planning for interview timing, and location, building relationships and conducting therapeutic interactions, protecting ethically vulnerable participants, and planning for disengagement. This framework has the potential to improve the effectiveness of sensitive interviewing with vulnerable groups. © 2016 Wiley Periodicals, Inc.

Conducting qualitative research in the context of pre-existing peer and collegial relationships.

AIM: To highlight issues and challenges faced in recruitment and interviewing during a study that sought to explore the transition of nurses into academic life and the associated ethical implications. BACKGROUND: This paper explores the challenges faced in conducting research where the potential participants are peers and workplace colleagues. There are advantages when conducting research with those among whom a pre-existing relationship is shared. However, difficulties can also arise. REVIEW METHODS: A methodological review was undertaken. Key database searches included CINAHL, MEDLINE, PubMed, Scopus and Google Scholar using the keywords as search terms. Studies were included if they described in detail issues surrounding qualitative interviewing of peers and colleagues. DISCUSSION: Management of the issues involved is discussed, with emphasis on boundaries, trust and rapport, the use of self-disclosure and maintaining confidentiality. CONCLUSION: Research involving peers and colleagues has received relatively little consideration in the literature. There are difficulties associated with interviewing participants with whom the researcher has a pre-existing and ongoing relationship in the same organisation. To ensure ethical conduct, strategies can be used to mitigate negative situations such as issues surrounding dual roles, practising reflexivity, trust and rapport, self-disclosure and confidentiality. IMPLICATIONS FOR RESEARCH/PRACTICE: It is imperative that dual roles are declared and acknowledged. Researchers need to be mindful of the difficulties that may occur and prioritise participants' confidentiality and privacy.

Methodological and ethical issues related to qualitative telephone interviews on sensitive topics.

AIM: To explore the methodological and ethical issues of conducting qualitative telephone interviews about personal or professional trauma with critical care nurses. BACKGROUND: The most common method for conducting interviews is face-to-face. However, there is evidence to support telephone interviewing on a variety of sensitive topics including post-traumatic stress disorder (PTSD). Qualitative telephone interviews can limit emotional distress because of the comfort experienced through virtual communication. Critical care nurses are at increased risk of developing PTSD due to the cumulative exposure to work-related stress in the intensive care unit. We explored the methodological and ethical issues of conducting qualitative telephone interviews, drawing on our experiences communicating with a group of critical care nurses. DATA SOURCES: Qualitative research interviews with 27 critical care nurses. Fourteen of the nurses met the diagnostic criteria for PTSD; 13 did not and had scores consistent with high levels of resilience. REVIEW METHODS: This is a methodology paper on the authors' experiences of interviewing critical care nurses on sensitive topics via the telephone. DISCUSSION: The authors found that establishing rapport and connections with the participants and the therapeutic use of non-verbal communication were essential, and fostered trust and compassion. The ethical issues of this mode of communication include protecting the privacy and confidentiality associated with the disclosure of sensitive information, and minimising the risk of psychological harm to the researcher and participants. CONCLUSION: Qualitative telephone interviews are a valuable method of collecting information on sensitive topics. IMPLICATIONS FOR RESEARCH/PRACTICE: This paper explores a method of interviewing in the workplace. It will help inform interventions to promote healthy adaptation following trauma exposure in the intensive care unit.

'To be honest, I haven't even thought about it' - recruitment in small-scale, qualitative research in primary care.

AIM: To review strategies for successful recruitment in small-scale, qualitative research in primary care by exploring those used in a variety of settings and providing a reflective analysis of the strategies used in one such study. BACKGROUND: Recruitment of participants in small-scale, qualitative research in primary care is problematic. Researchers need to be more aware of the issues involved, but there is little practical guidance available to help them devise efficient strategies for maximising recruitment. DATA SOURCES: This paper draws on a study conducted in the Highlands of Scotland examining the emotional wellbeing of pregnant and non-pregnant women. This was a qualitative study using diaries and interviews over a period of nine months. Ten women were recruited over a period of more than two years. REVIEW METHODS: The author reviews the strategies for successful recruitment based on both a review of the available literature as well as the experience of one study. DISCUSSION: Recruitment of subjects to a study is one of the major elements of a research proposal and requires significant effort, yet there is little to guide researchers through this difficult process. The challenge of recruitment is seldom debated and studies rarely report problems encountered or outline approaches that proved particularly successful. The importance of successful recruitment is discussed and the arguably typical recruitment difficulties encountered by researchers conducting a study in the Highlands of Scotland are outlined. The elements that comprised successful recruitment in this and other studies are appraised. CONCLUSION: Although focused specifically on recruitment in small-scale, qualitative studies in primary care, this paper raises broader issues about the recruitment of participants in all types of research. Recruitment has implications for the trustworthiness and dependability of the data and hence the findings of research. Despite this, there remains a lack of evidence about what enhances research recruitment, leaving researchers to rely on guesswork and anecdotes. In a climate of evidence-based practice, researchers should be encouraged to include a formal evaluation of recruitment strategies in their studies and to report their findings. IMPLICATIONS FOR PRACTICE/RESEARCH: As recruitment has implications for the trustworthiness and dependability of research, researchers need to consider a wide range of recruitment strategies and include a formal evaluation of their recruitment strategies when reporting on their research.

The obser-view: a method of generating data and learning.

AIM: To introduce the 'obser-view' qualitative research method and to show how obser-view can be used in research. BACKGROUND: The author developed the obser-view during a qualitative research project about nursing students' learning processes, because participants wanted to talk with the author after being observed. Conducting a non-scripted interview immediately post-observation became the obser-view. DATA SOURCES: Eleven nursing students on clinical placement in psychiatric hospital wards participated in the project. Nine participated in obser-views. REVIEW METHODS: A review o f literature resulted in two sources in which 'obserview' (not 'obser-view') was used to gain explanations of participants' actions, whereas the author sought a greater understanding of participants' actions. DISCUSSION: Whether to include a dialogue with the nursing students in the research design was a dilemma. An argument for so doing was that the method should support efforts to make the research transparent, as the obser-view would give the author an inside, an outside and an inter-subject perspective of the data and increase the internal validity of the research. CONCLUSION: During the obser-view dialogue, the researcher, as a catalyst for reflection, has the opportunity to obtain participants' views of the observed situation, and for the researcher and participants to reflect on the situation both have been part of. The obser-view offers the researcher a deeper understanding of empirical data than can be gained from observation and qualitative semi-structured interviews alone, and offers participants deeper understanding of their actions. IMPLICATIONS FOR PRACTICE/RESEARCH: There is potential to use the obser-view in research involving students or patients, including families and cares of patients, whether in psychiatric or physical nursing. Further use over time will show in what other fields the obser-view method can be used to generate data and as a learning space for research and participant.

Older people in long-term care settings as research informants: ethical challenges.

Conducting nursing research in long-term care facilities and with samples of older people requires careful attention to research ethics and the ethical conduct of the study. This review analysed the research ethics of the empirical studies that focus on older people in long-term care settings as research participants. Articles (n = 66) focussing on older people in long-term care settings as research informants were retrieved from an electronic search of MEDLINE (1990 to February 2012) using the MESH terms 'Nursing' AND 'Long-term care' (578 citations) and 'Institutionalization' and 'Nursing' (89 citations). Ethical approval procedure was reported in more than half of the studies (58%) and informed consent in two-thirds of the studies (70%). Ethical issues in data collection were described in most of the articles, but only a few reported ethics in problem statement, reporting or presenting implications. There is a need to focus on reporting research ethics and procedures in empirical research on vulnerable people.

Qualitative observation in a clinical setting: challenges at end of life.

This paper explores the methodological challenges associated with undertaking qualitative observation in the clinical setting at end of life. The authors reflect on their experiences of using non-participant observation to explore the nursing care delivered to dying patients in acute hospital wards. The challenges of observation as a method, clearly defining the participant group and involving vulnerable populations, such as the dying patients and their families, will be discussed. Consideration is also given to defining and working within the observational field, the researchers' dual roles, cost versus benefit, impact of culture, religion and ethnicity, and the determination of research limits/boundaries, with reflections from the authors' own experiences used to exemplify the issues.

Reflexivity in a study of family carers in home palliative care: a personal account.

AIM: To discuss a personal account of the role of reflexivity in a qualitative, grounded theory study with family carers in home palliative care. BACKGROUND: The study explored the experience of carers of family members dying at home using semi-structured interviews before and after the death. It focused on carers' expectations and preparedness for the dying process. The findings suggested that carers play a leading role in a drama but there are no rehearsals because they have not been in this role before. They also have no script because they find it hard to read about the dying process. Consequently they feel anxious, uncertain and unprepared. They have direction from professionals and support from paid carers, but have mixed experiences of these services. Hence the research setting was charged with emotion and presented particular ethical challenges. DISCUSSION: Reflexivity is an important component of qualitative inquiry. It involves constant attention to the researcher's perspective, background and influence on the research process and the effects this has on the researcher, which may affect the research. Reflexivity was a prominent thread throughout my study, involving epistemological and personal aspects. It focused on my performance as researcher and the role of empathy and reciprocity in the researcher-participant relationship. The potential for therapeutic change for research participants was seen as beneficial, but it could cause conflict between my roles as nurse and researcher and risk of exploiting participants. Reflexivity also involved exploration of the emotional impact of doing the research and implications of the research setting. CONCLUSION: Reflexivity was an essential and dynamic component of this study, which involved constant interplay between the author and the research.

An embodied response: ethics and the nurse researcher.

The aim of this study is to reflect on situational ethics in qualitative research and on a researcher's embodied response to ethical dilemmas. Four narratives are presented. They are excerpts from field notes taken during an observational study on Norwegian public health nursing practice. The stories capture situational ethical challenges the author experienced during her research. The author's reflections on feelings of uncertainty, discomfort and responsibility, and Levinas' philosophy help to illuminate the ethical challenges faced. The study shows that the researcher always participates, to some degree, and is never merely a spectator making solely rational choices. Ethical challenges in field research cannot always be solved, yet must be acknowledged. Feelings of vulnerability are embodied responses that remind us of the primacy of ethics. More so, it is the primacy of ethics that gives rise to feelings of vulnerability and embodied responses.

Exploring the effect of conducting sensitive research.

The term 'sensitive research' has become recognised in health and social care research literature generally. It has been used to describe a wide range of topics, undertaken across a variety of disciplines and settings, using a range of methods. Drawing on evidence from other disciplines, this article examines the particular issues and effects that arise for nurses in carrying out sensitive research as the field continues to evolve.

Ethical challenges in qualitative research: examples from practice.

This article examines the many ethical challenges that are specific to qualitative research. These challenges concern the issues of informed consent procedures, the researcher-participant relationship, risk-benefit ratio, confidentiality and the dual role of the nurse-researcher. Each challenge will be examined and practical examples of how it was dealt with, using examples from a multiple case study, will be described.

Issues and considerations when researching sensitive issues with men: examples from a study of men and sexual health.

This article highlights some ethical considerations and practicalities that arose when conducting research with men in relation to decision making and seeking help for a sexually transmitted infection (STI). The aim of the study was to explore, using a grounded theory approach, the processes involved in making the decision to seek help. The main issues that arose were in relation to seeking permission and gaining approval, obtaining informed consent and susceptibility to harm. The interview itself and the concept of the researcher as a tool of data collection also gave rise to ethical issues. These issues have implications for the conduct of sensitive research with men and highlight the need for more overt reporting of the ethical issues and practical considerations that arise when planning and conducting research.

The ethical community consultation model as preparation for nursing research: a case study.

This article describes a case study in which community consultation was used to assist in the preparation of a research project on viewing self in the mirror after mastectomy. Breast cancer survivors, nurses, and other health care professionals were consulted using a variety of interactive modalities. Over a period of three months, pre-research planning information was obtained from participants. A descriptive qualitative design was used to analyze the data. The ethical goals of community consultation provided the framework for dialogue and the synthesis of information. During this project, the potential benefits of the proposed research study were explored. Possible risks to future participants were discussed, and recommendations for participant protection suggested. Community members provided insight into the legitimacy of the study. Community consultation is a tool that researchers may consider when designing studies.

The joys and challenges of semi-structured interviewing.

Semi-structured interviewing is an important tool for gathering data in qualitative research. This paper explores some of the joys and challenges associated with research interviewing. It discusses some of the basic skills required to do interviewing well, some of the difficulties associated with interviewing on a practical and emotional level, and how to address them. Being a good interviewer in a research context means to be aware of the responsibility for the participants' wellbeing as well as one's own. Good listening skills and emotional control are among the most crucial skills to develop. This paper summarises some of the skills needed to remain or become a professional, empathetic and ethical interviewer in the context of community practice. If some basic guidelines are followed and combined with practice, the craft of interviewing can become an art.