Nurses’ perceptions of pain assessment and management for elderly patients in the acute care setting in Saudi Arabia: A qualitative study

Nurses’ perceptions of pain assessment and management for elderly patients in the acute care setting in Saudi Arabia: A qualitative study

Data collection method-

Data collection in qualitative interview can occur in two methods either through direct one to one interview, or in a focused group. The time consuming nature of the data collection method limits the number of samples taken for the study. The advantage of qualitative interview is its richness in exploration of the topic. In the present topic, the nurse interview will be conducted through a qualitative approach as proposed in the study. Out of the four types of data collection methods available, in the present study individual interviews will be conducted. The interview to be conducted for nurses will be semi-structured in nature. The reason behind this methodology for data collection is a focused phenomenon can be explored as well as proper structure can also be maintained. In case of conducting unstructured interview that is in depth, the orientation will be affected. Since perception towards elder care might vary and factors influencing perception can differ, therefore semi structured interviews can provide us proper tool for assessment of the data. Therefore semi structured interview involved broad range questions on perception of care and guiding interview subjects. Another reason behind conducting semi structured interview is to find out any interesting factor that can provide a brief insight into factors influencing perception or themes from the perception. This structure will help the researcher to focus on two to three areas in context of elder care and help in addressing the research objectives too.  The interview should be scheduled in such a way that the participants don’t feel stressed rather it must look like a discussion.  The interview will be initiated with simple questions like what do you think of elderly care? What is your perception towards aged care with different co-morbidities and in this process it can be narrowed down to specific questions like – what is your perception towards medication management in elderly patient? How autonomy factor influence medication factors and what is your perception towards autonomy. The nurses were asked to evaluate their practice with real time evidence about perception and how it affects their practice. The interview lasted for 30-40 minutes with a mean of 32 minutes. The interview was conducted in the clinical setting according to the time given by the participant. Similarly, the interview was recorded and transcribed verbatim by a senior research assistant having no knowledge on the research conducted and the topic. This was done in order to reduce the bias (Ung et al, 2016, pp 23).

Reflection on mindfulness before designing questionnaires-

In my experience designing questionnaire for an interview data collection is difficult and must involve clear state of mind before designing any questionnaires. Designing an interview questions involves quite more than just to chose what questions has to be asked.  There are several factors that can influence the success and failure of the interview session with the participants. Following are the data collection to do list must be maintained-

·         Data collection mode- The actions and words at the time of in person interview have a major impact on the final result to be obtained. The design of question must be targeted and to the point and must not take too much time unnecessarily. The benefit of putting forward the body language will not be there and phrasing the questions will play a major role in how the participant interprets the questions and hence the final data will be influenced.

·         Impact of fatigue in survey- There are types of questions in which there are heavy burden of the respondents and this increases the mental fatigue at the time of interview. So the questions must be designed in such a way that it must not cause fatigue in both the interviewer and interviewee mind. Further it is not required to write the questions that are convoluted to the memory of the elderly people. If the questions are poorly designed then there are high chances that the elderly people may feel hesitant in replying to the questions.

·         Impact of question wordings on interview- One of the most difficult task while setting the questionnaires for interview is selection of right words. The questions asked must not be complicated and must be understood by the elderly people and collection of data actually doesn’t allow you much time to change the question phrase or add additional information to the question. If the language used in framing the question is esoteric with high technical jargons and inaccurate terminologies, it will not allow the interviewee to answer freely to the questions. Furthermore, clear instruction must be provided before starting the questionnaires session.

·         Make proper order of the question- There must be a logical flow to the question asked in the interview. If the interviewer starts jumping around the topic then it may create confusion on the mind of respondent which can causes complete abandon to the survey question. Make sure that the survey must be carefully tested in order to find out the inconsistencies during the experiences taken in survey (Alasad et al, 2015, pp 563).

Data Analysis-

The analysis of qualitative data consists of coding, identification, pattern of categorization and the themes found in the data. The applicability and the clarity of the findings must be heavily dependent on the ability of analysis of the researcher. This sort of dependence in the abilities of an analyst can be of greater strength and weaknesses of a qualitative research or interview. It is sparingly important that the researchers documents and reports analytic processes must be reported truly so that other can easily evaluate the findings of the researchers. The usage of the literature plays a vital role in the qualitative analysis of the collected data and may vary on the basis of analysis. Such as in thematic analysis it can be extensive before the commencement of data and also it can be contraindicated. Several literature suggest that it is generally very difficult to generate one’s own concepts without the addition of burden of the getting a proper literature that can make sense to the data.  One of the analysis methods apart from the software based analysis includes thematic content analysis. It is one of the common methodology used in terms of qualitative research and it mainly aims to find the common pattern across the data set and generally used with the following steps-

·         Familiarizing with the data which involve reading and rereading.

·         Labeling or coding of the whole text recorded during the interview

·         Searching for the theme in accordance with broader pattern of meaning

·         Review of the theme in order to ensure that they fit to the data collected

·         The name of the theme will be defined

·         Finally preparation of coherent write up which includes quotes that are being said at the time of interview buy the interviewee (Alsharani et al, 2014, pp 400).

Ethical Considerations-

There are several ethical considerations has to be kept in mind before starting of the interview. There are personal as well as conversational interview version in which such situation is developed where possibility of causing ethical issues are usual. Such issues are-

·         Confidentiality- As the respondent might be sharing their very personal information, it is sparingly important to assess the confidentiality clauses and up till where the interviewer can promise to keep the confidentiality. There are kind of disclosure such as threats to the safety and child abuse must be reported as the interviewee must be knowing all this information from the very beginning. Also it must be considered very thoroughly regarding the preserving of confidentiality when the analysis and the reporting of data will be done. The person must have access to the data who actually owns the same (Alqahtani, 2014).

·         Informed consent- Most of the studies which includes evaluation of program are covered by some sort of human subjects in the process of review. This actually demands the sign of the respondent in a particular sheet where it will be providing the permission that the respondent is participating the interview and he or she is already informed regarding the benefits and potential risk during the session.

·         Assessment of Risk- It is very important to assess and consider all the potential risk involved and must include all the risk associated with the consent documents. Although just talking may seem harmless but there are instances where elderly people participating in the open ended interview may get stressed, political and legal repercussion or ostracism by the staffs who believes that the participants are using unflattering views about them.

·         Reciprocity and promises- The major issue in this is that what are the rewards the participants gets after the interview by sharing their insight as well as time with the interviewee. It has to be ensured to them that is the community benefitted in some or the other way as a result of the study or if any promises are made towards monetary payment after the interview and such promises must be fulfilled.

·         Mental health of the interviewer- The process of interview can be quite intensive and also can be an interpersonal issue. Being as the participant can experience several stress by disclosing more than what is intended to be disclosed and can sometimes becomes painful experiences as well. Sometimes the process of the interview can be of quite sensitive nature of what has been observed or heard. The interviewer must have the capability to control the emotional situation and stay practical as much as they can in order to get the data collection properly done (Albaqawi et al, 2016, pp 191).

Implementation of research plan-

The major objective of developing a research proposal is to implement it as quickly as possible in order to achieve the desired objectives. This basically involves the process of collection and processing of the information. The collection of data can be carried out by the analysis and processing of the information collected. The collection of the data can be done through interview process of the elderly individual by the research staff or even by outsourcing the job to the outside firms. The implementation stage of the proposal is the most expensive phase of the research and if the implementation is not done properly then there are chances of getting an error while execution of the research. It is the duty of the researcher to closely watch and ensure that the plan has been implemented properly. The major duty of the researcher is to keep a watch towards the problems and must be able to tackle the respondent in case they refuse to cooperate at the time of interview process and provides biased answer or takes shortcuts in reply to the answers. The researchers must also analyze and process the data collected to isolate the information as well as findings. They also required checking the completeness and accuracy of the analysis and finally computing and tabulating the results obtained from the data that is collected through interview. The major changes requires while implementation of the research within me is my patience level and my attitude towards conducting the research. There are instances where people will refuse to participate in such interview process but I need to keep clam and convince them to become the part of the research to make them aware of the benefits of this research in the future process (Almutairi et al, 2016, pp 31).

Journal-

I would like to publish my data obtained through this research in the American journal of nursing. It is because this journal is one of the oldest running journal related to nursing in the world with distinction. Their several publications in the year 1900 has been widely cited and gain recognition across the world. Further this caught my interest because this journal basically focuses on the evidence based article publishing and also provides clinical information on timely basis. This will help in high citation of my work in the future (Cruz et al, 2016).