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Communication Between Staff + Parents in Neonatal Units - AS 2 - Coggle…

- - - - methods used must relate specifically to question - not cause unnecessary harm by getting info not needed - https://www.enago.com/academy/what-are-the-ethical-considerations-in-research-design/
        
        Quantitative component - need to make sure health lit test and demographic survey only get info directly relevant and needed, otherwise getting unnecessary info and potential for bias w/data analysis if researchers know more info than necessary and make judgments based on this
        
        Health lit test is based on a few previously tested tools specific for parents of newborns to limit unnecessary data gathering and make sure tool tests what it says it will
        
        Demographic surveys based on previous studies' questions asked - to provide background and establish diversity of sample only
  - - - Informed consent before being recruited - parents know what they share remains confidential + anonymous except if disclose anything that may cause harm or distress to them or anyone else
      - No coercion
        
        If recruiting where researcher works, parents may feel pressured to do study to help them out OR conversely may feel more comfortable doing it as they have a preexisting relationship with researcher
        
        Different person recruiting parents/HPs??
    - - Size
      - Population
      - Methods
        
        safety of participants
        
        Offer support - plan in place to offer counselling or at least numbers of helplines etc. if participants disclose trauma or distressing info
        
        Have safety plan if they disclose something like family violence or an unsafe home environment - have a point of contact on the unit (e.g. charge nurse) and a plan for escalation
        
        Ensure participants know that their info is anonymous and confidential in terms of study, but if they disclose anything that poses a risk to them or baby - will be passed on to relevant people to get them help
        
        Researcher may have issues in these cases drawing the line between researcher and nursing role - will need to set clear boundaries as a researcher and have good pre-established plan to avoid role confusion
        
        Have 'safety script' for cases like these (Al Tajir, 2018)
        
        Family violence increases during pregnancy and neonatal units frequently get disclosures from women, especially closer to discharge - have researchers VIP trained and know how to ask questions to assess imminent risk (will be trained if researchers are nurses)
    - - Semi-structured Interviews
        
        If currently admitted - may be less likely to be honest as baby still being cared for by health professionals they are talking about
        
        need to ensure complete confidentiality + privacy of info shared ?unless harm to person - or at least be able to refer on to support either within or outside of hospital (eg. offer counselling support if disclose poor mental health or traumatic experiences during interviews)
        
        Researcher will only interview at unit she does not currently work at (Waitakere) and only parents and HPs she has not worked with - someone else will interview at the unit she works in (North shore)
        
        Eliminate bias/potential for skewed results or limited disclosure as not interviewed by someone that knows them
        
        Researchers/interviewers will be HPs working in neonates so will know the area and have an understanding of the issues faced by parents AND HPs
      - Initial health literacy test and/or demographic survey
        
        Collected first but results not known to interviewer prior to interview to prevent bias
        
        Confidentiality - if collect demographic data, more likely to be able to identify patient so less anonymous
      - Integrity
        
        Potential conflict of interest as work for DHB that two sites for recruitment fall under - work at one of the hospitals
        
        To ensure this doesn't influence results, will get another researcher to do interviews at the hospital I work for and I will only interview participants from the other site who I don't already know/haven't been involved in their care
        
        This is common for neonatal research - better access if study is conducted at the site you work at, usually rectified by only interviewing families you haven't cared for
    - - Data Interpretation
        
        Multiple researchers independently coding to eliminate bias in analysis - regularly checking in to discuss results
        
        Constant comparative analysis - to ensure themes derived are reflective of participants views
      - Data Representation
        
        Purposive sampling - aiming for breadth and diversity of sample, may not be possible due to time constraints (need to collect/recruit over several months for max diversity of participants) + not wanting to pressure people into participating
        
        Triangulation - time (pre and post discharge) and person (parents and staff) to validate data - ensure dependable and reliable - trustworthy (reflects participants perspectives)
        
        Needs to reflect participants experiences and views or may do more harm than good - beneficence and non-maleficence
      - Data Validation
        
        member checking to ensure this - send codes/themes to participants before finishing to ensure they are reflective of their views (one person from each group to review)
  - - - careful not to claim knowledge of 'truth' or objectivity, not to adopt a paternalistic approach and go into interviews with this knowledge potentially altering questioning/forming prejudice based on their results
        
        Will only use health lit. tests in the data analysis section, interviewer will not see results of test prior to interview
- - - - Potential to value positivist paradigm/HP's perspectives over parents if put too much weight on health literacy tool results
        
        Needs to be adjunct, helping to inform main results only - data collection timing + analysis will need to be conducted in a way that reflects this
        
        Health literacy test collected first but results not known to interviewer, only data analysts
  - - - Awareness of impact of ethnicity, culture, potential immigrant status + vulnerability of participants (especially if currently admitted) when recruiting
        
        Communicate about study in a way that connects with parents culturally - be explicit about how info will be used, and the aims of the research/who will benefit and see the information
    - - Participants
        
        Purposive sampling - aiming for breadth and diversity of sample, may not be possible due to time constraints (need to collect/recruit over several months for max diversity of participants) + not wanting to pressure people into participating
        
        Have to balance need for diverse sample with time constraints and who is actually present to participate - need to avoid coercion so sample may not be as diverse as some cultural groups may be less inclined to participate due to past experience, ethnic background influencing their perception of research or sharing opinions etc.
        
        Diversity of sample ensures breadth of population covered - get perspectives of potentially most vulnerable, issues in grounded theory/qualitative approach if not able to do this effectively
        
        Risk to benefit ratio - including vulnerable groups
      - Inclusion criteria
        
        Medical staff currently working on neonatal unit + involved in d/c planning/education
        
        Any parents with babies currently admitted for 1 week or more (admission shorter than this, baby may be d/c from maternity, so not relevant)
        
        Any parents of baby's discharged within last 6 months from neonatal unit who are the primary caregivers of the baby
      - Exclusion criteria
        
        Parents who will not be going home with their baby (eg. OT cases or whāngai)
        
        Discharge education less relevant for these parents
        
        Primary caregivers who are not the biological parents of the baby (too difficult to sample in unit as not always there/will have had different and varying levels of involvement than biological parents as not involved from delivery of child)
    - - Semi-structured interviews
      - Initial health literacy test and/or demographic survey
      - positionality of researcher
        
        Potential for bias as researcher is an HP working in the area with an interest in the results/their implications for practice chang
        
        Researcher not a parent, so eliminates that bias, but will bring own culture of nursing and medicine into every interview - needs awareness of this and the power imbalances this brings in terms of knowledge and status to ensure interviewees feel comfortable and results are not analysed through the health professional lense
- - - - With HP perspectives also - more likely to have an intervention or tool/policy change that i actually practical (time, cost etc.) to implement
        
        Need HP buy-in for any policy change, not just parents, as they are the ones implementing the change/carrying out the intervention
    - - Provides a better picture, not just of what parents want but at what level they need the info/what they need to know based on their health lit. scores
      - In terms of discharge education - HPs see wider picture from a public health perspective, based on their research and experience - what parents need to learn pre-discharge
        
        Parents know what is actually helpful to them once home (post-discharge sample) + how they want communication/education delivered to them/what methods they respond to in their current situation (parents currently admitted)
    - - Quality+integrity of results
      - Proper distribution of research - including to participants
      - Clear aims for research with appropriate methodology