A six-week pilot CF resiliency (CFR) program was developed and offered to interprofessional healthcare providers and staff at a regional cancer centre in Ontario, Canada. The intervention was offered as a two-hour program after the workday in the hospital setting and based on the CF – Accelerated Recovery Program (ARP) (Gentry, Baranowsky, & Dunning, 2002; Traumatology Institute, 2012). It was evaluated using an experimental embedded mixed methods research study design (Creswell & Plano Clark, 2010) to evaluate the impact of the pilot CFR Program. The purpose of this presentation is to examine the use an experimental embedded mixed methods research study design and discuss the best ways to achieve victories and avoid research hazards when doing workplace interventional studies.
In keeping with a mixed methods design a combination of qualitative and quantitative methods was used to evaluate the CFR program. The use of a mixed methods design provided a better understanding of the complex phenomena of compassion fatigue than either approach alone (Molina-Azorin, 2016). Standardized instruments to measure CF and related concepts were administered before and after the educational program intervention. Focus groups and individual interviews were conducted at mid-intervention and at completion of the CFR program. The qualitative and quantitative data were analyzed separately and merged to produce the overall findings. Researcher triangulation was used throughout all phases and processes of the study enhancing the inferences made.
After ethical approval was granted from both the university and the healthcare system Faculty of Nursing members drove the research component separately from the educational intervention undertaking that was totally supported by the cancer care facility. Initial support from the cancer care facility extended to assistance with study packet photocopying, communication with participants interested in the educational intervention and other administrative oversight.
The mixed methods design used a phase one quantitative data collection through voluntary recruitment prior to the initiation of the CFR program. Complete study packets from clerks, managers, registered nurses, physician’s, radiation therapists and other care workers for analysis were received. The research team was available during this portion to assist with question on how to fill in the questioners. At the end of the quantitative data collection a separate form asked participants if they would consent to being contacted at the mid point of the educational intervention to participate in 3 scheduled focus groups or an individual interview to discuss their experiences as the qualitative section of the method used. Final data collection was done at the end of the last session of the educational intervention and again participants were asked if they would like to be contacted to participate in focus groups or have an individual interview.
Our Victories:
The working relationship between the cancer center staff and the faculty members was excellent. Recruitment into the educational program and initial enrolment into the study portion exceeded our expectations. It was also thrilling to have participation from so many segments of the healthcare team. Initial assistance with study packets and having a room in the hospital dedicated to the study and then to the educational intervention made it convenient for staff and for the research team. Financial support from the management team supported the endeavour and encouraged participation in the educational intervention.
Encountered Hazards:
Support from the cancer center management team was withdrawn halfway through the educational program when the main program champion changed jobs. This significantly impacted the educational sessions and planned activates. Hospital printing of the study packets for final data collection had errors that were not correctable therefore valuable data was lost. Expecting multidisciplinary groups to learn together has its own set of concerns that must be addressed prior to doing this type of education. Many participants did not complete the program nor stay for final data collection again significantly impacting the results. Focus groups were poorly attended with many participants’ preferring individual interviews, which can be costly and time consuming.
Conclusion
Mixed methods design can acquire rich data on areas that are not well researched. Use of this methodology can be complicated but truly does allow for a more complete analysis of the situation. Describing how to successfully embed qualitative and quantitative methods will assist other nursing researchers in the future use this methodology. Multiple victories and hazards were encountered when doing the research component of this program. Bringing awareness of them and the impact they had on doing this type of research is necessary to assist other nurse researchers in avoiding the same issues in future research endeavours.
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