Research Objectives
Al-zayyatand Al?Gamal (2014) is of the opinion that stress, anxiety and depression interfere with the overall learning process of the academic students which affects their academic performance while impairing their overall clinical practice during the training sessions. However, the majority of the studies which were conducted over stress coping strategies over the international students were either using mixed methods or quantitative approaches. Till now there is no research works undertaken in order to analyse the factors causing stress among the international nursing students and the associated coping strategies adapted from the perspective of the nursing students. Analysing the perspective of the international nursing students can be effectively done via conducting an interview with qualitative analysis approach. According to Henderson et al. (2012), stressor elements among the international nursing students are high in comparison to the national students. This is because international nursing students also suffer from additional stress factors other than work pressure like social anxiety, communication problem and indifference in the religious and spiritual thoughts. Though national nursing students also pass through anxiety and stress but the overall impact of over the international nursing students is high and this magnifies the overall stress in an exponential manner. The purpose of this study was to get a better understanding of international nursing students’ experience regarding stress and coping.
The following chapter aims to outline the methodology that utilised in order to conduct a detailed analysis of the coping strategies used by the international nursing students in order to cope up with stress. The chapter begins with stating aims and objectives of the research followed by the detailed study design, the nature of the participants who included in the interview, interview settings, data collection procedure, Data analysis, rigour and trustworthiness of the undertaken methodological approach. The main study design that used in this study includes qualitative descriptive method.
The aim of this research was to explore the experiences of stress among the international nursing students and the strategies they employ in order to cope up with stress.
The main research objectives that can be derived from research aim were:
- To identify the main stressors experienced by the international nursing students during their academic life
- To explore how this stress hampers their “work-life balance”
- To explore the coping strategies that international nursing students think are best suited to cope up with stress during their academic life
According to Bernard (2011), the research design mainly constitutes the methodologies which will be used in conducting the research. The selection of the appropriate methods is mainly based on the research aims and objectives. Proper selection of the research methodology will help the researcher to conclude the research findings (Bernard ,2011)
Methodology
In this research work, the researcher has selected qualitative data collection method. According to Miles, Huberman & Saldana (2013) qualitative research encompasses any form of study that does not employ the use of the statistical methods or quantify the results. Qualitative researchers carry forward their research work under a natural setting with an attempt to understand or interpret the phenomenon in terms of the inherent meanings which the people bring to it (Sandelowski 2000). According to Cresswell (2013) qualitative research is an approach to explore and understand an issue encountered in a group of people or individual. Previous studies have utilized quantitative methods to assess stress and coping strategies of the nursing students.
Cresswell (2013) stated that qualitative research mainly aims to generate in-depth accounts from the groups or individuals via interacting with them and watching the behaviours and subsequently analysing the artefacts. It also involves taking into account of the different contexts in which they are based. Thus the qualitative study conducted over the international nursing students will help in the proper understanding of the reason of the anxiety generation from their own perspectives. In doing so, the qualitative research will also help to understand why the nursing students execute certain stressed or hyperactive mannerism under particular stressed conditions. All helped to explore the coping strategies adopted by the international nursing students.
This study utilized qualitative descriptive design to explore the stress coping strategies of international nursing students. A descriptive design was suitable for use in this study to describe the phenomenon of stress as experienced by the international nursing students (Polit& Beck, 2012). A qualitative descriptive style research design enables the researcher to describe a current concern in depth from the perspective of the stakeholders involved in the process (Marshall &Rossman, 2011).In qualitative descriptive approach researcher gets an opportunity to develop a close relationship with the participants of the study. This close relationship further helps in analysing their exact though process or the underlying emotional connect behind a particular behaviour. (Sandelowski, 2000).
According to Bergh and Ketchen (2011) there are different types of research philosophies including positivism, interpretivism and realism. This research falls within interpretivism paradigm. According to Bergh &Ketchen, interpretivism research philosophy is best suited for qualitative approach. Interpretivism research philosophies helps in the in-depth analysis of the small samples and is best suited from the qualitative research.
According to Sullivan- Bolyai et al (2005) the main element of qualitative descriptive study in nursing research is learning from the participants and their descriptions. So this method best suited to this study which focused to gain rich descriptions from the international nursing students regarding their experience on stress and coping. The researcher here utilised inductive research approach. According to Crowther and Lancaster (2012) the main difference between the deductive and inductive research approaches is that deductive research approach is aimed and testing theory while inductive research approach deals with the generation of new theory from the emerging information. The reason for the selection of the inductive research approach was, inductive research approach is associated with the qualitative research and this kind of approach is used to narrow down the scope of the study.Thereby making it more specific. According to Crowther &Lancaster (2012), this approach necessitates the researcher to begin in a completely fresh mind without any preconceived ideas of what will be elucidated in the later stages of research. It is best suited for this research because a qualitative study regarding stress and coping strategies among the international nursing students has not been explored previously.
Qualitative Methodology
A sample is a subset of a population selected to partake in a study (Polit& Beck 2010) which will be a source of information (Clifford & Clark 2004).For this particular research, the researcher used convenient purposeful sampling. Purposeful sampling is a common sampling method use in qualitative research for selecting information-rich cases from limited number of people (Patton, 2002).This technique enables the researcher to select samples that are specifically experienced with a phenomenon of interest(Cresswell& Clark, 2011).
A purposeful sample of 8-10 international students undertaking the BSc Nursing Studies program at University College Cork (UCC) was selected as the main participants of the research.
Selection criteria, which were taken into consideration during selecting the main participants of the individual interview include:
- International nursing students enrolled undertaking the of “Bachelor of Science (B.Sc.) Nursing studies” which a full-time programme taken over one academic year.
- Students above 18 years of age
Exclusion criteria considered for selection of the participants include:
- Students who are studying in their parent country.
- International students studying courses other than nursing.
After getting approval from the School of Nursing and Midwifery local ethics committee to access the students in the School of Nursing and Midwifery, an official letter was sent to the coordinator of the B.Sc. Nursing Studies for International students at University College Cork (UCC), seeking permission to contact the potential international nursing participants. The coordinator of the entire program had been then asked to inform the participants about the research. The contact details of the researcher was included at the end of the email so that the prospective participants can ask any questions to the researcher about the study process directly and thereby clearing any gaps in understanding the topic and the requirement of the research. Interested participants were then be asked to contact the researcher directly in order sign the consent form stating that whether they are willing to participate in the study or not. Before the initiation of the interview, the researcher had conversed with each of the students individually and further explained the purpose of the study before obtaining the written consent from the participants. This was important because it helped face-to-face conversation and direct interactions helped in clearing further confusion that might have remained within the mind of the participants. Clearing all their doubts about the importance of the research helped the participants to participate in the interview process in a spontaneous manner with no pre-conceived apprehension. In addition to this a detailed information leaflet regarding the overall interview process had been provided to the participants and after going through that leaflet, if they were satisfied with the entire process, they were asked to sign the consent form. Moreover, if the participants were unsure regarding participation in the interview after having a conversation with the researcher, as well as reading the information leaflet, he or she would be given complete liberty to leave the interview set-up without citing any reasons behind the sudden withdrawal (Scott and Garner 2013).
Sample Selection
Qualitative researchers immerse themselves into the real world of the participants and observe, question, and listen to them in these real settings (Holloway & Wheeler, 2010). The current interview had been undertaken in a small private room of the university building of UCC. The room chosen was quiet or free from noises so that the participants can concentrate on the interview process will less disruption. The time of interview had been chosen as per the convenience of the students. Here convenience of the students signified that the time of the interview would not coincide with their classes. According to Neuman (2013), the interview timing of a qualitative research must be selected as per the consent of the participants so that they do not feel forced or compelled to participate in the interview.
Data collection is an integral part of the research. According to Silverman (2015), there are numerous ways of gathering the data in qualitative research in order to capture multiple realities and thereby gaining a deep analysis of the human experience. Some of the important mode of data collection procedure for qualitative research includes interviews, focus groups and observations.
For this research, the researcher followed semi-structured interviews directed towards 10 international nursing students studying in Ireland. According to Galletta (2013), the semi-structured interview is a common method used in social science research. Semi-structured interviewed are quite different from structured interviewed. Structured interviewed provide a rigorous set of questions which prevents the respondents from diverting from the interview and are thus mostly based on a set of closed-ended questions. On the other hand, semi-structured interview is based mainly on an open-ended questionnaire which provides avenues for generation of new ideas during the interview sessions (Galletta,2013). The interviewer in a semi-structured interview mainly has a framework of distinct questions that is required to be explored. Galletta (2013) further opined that the semi-structured interviews enables the respondents the complete freedom to express their own views in their own terms and provides reliable and comparable data to the interviewer. Thus conduction of the semi-structured interview via open ended questionnaire helped the research to explore the experience of the international nursing students while passing through stress and the subsequent coping strategies which they found to be helpful in negating this stress factor.
In this research process, the interview was guided in an indicative schedule through five open-ended questions, and the overall duration of the interview was 45 to 60 minutes. Before the initiation of the interview, detailed written information about the study with the topic of the research had provided to the participants. The answers to each question by the respondents were recorded via using audio recording devices and the participants were fully informed about this interview set-up. Along with recording to the responses of the interviewer had also taken notes on verbal communications (Kallio et al., 2016). Taking notes during the conduction of the interview helped the researcher to note down important phrases or quotes of the interview which can later be used to generate themes for qualitative analysis. The audio recordings were transcribed after the interview by a professional transcriptionist. After the professional transcript was successfully generated, the transcriptions were rigorously checked for accuracy via comparing =them with the audio files recorded during the interview (Kallio et al. 2016). Moreover, before the professional transcriptionist initiated the process he or she was asked to sign a consent form stating the confidentiality of the respondents and other identity related information will be kept private and will not be disclosed to any third party people who are not associated with the study.
Participating Criteria
This study usedthematic data analysis. According to Clarke and Braun (2014), the strategy of thematic analysis is commonly employed approach for all qualitative research. Clarke and Braun (2014) further argued that the importance of thematic analysis is it helps to reduce the information into emerging themes and subsequent conclusion. Castleberry and Nolen (2018) have opined that thematic data analysis is a method of identifying the prevalent themes underlying the statement recorded by the respondents, followed by analyzing and subsequent reporting of patterns (themes) within the collected data. Thematic analysis is frequently employed due its flexibility in accommodating a vast variety of research questions and research topics in a distinctive manner (Howitt & Cramer,2008). Thematic data analysis of open ended responses from survey polls or transcribed interviews helps in exploring the underlying emotional or conceptual mindset in depth which is absent in the quantitative data analysis. (Castleberry & Nolen, 2018). Moreover, thematic data analysis enables interpretation and flexibility while analyzing the data. However, it should be taken into account that the entire process was conducted under special care and fine attention towards maintaining the transparency of the methods in order to strengthen the trustworthiness of the entire findings (Castleberry & Nolen, 2018).
The main steps used for thematic data analysis in this research was adapted from thematic analysis developed by Braunand Clarke (2006) which includes compiling, disassembling, reassembling, interpreting and finally, concluding. Compiling means transcribing the data and mostly involves accumulation of data in a written format (transcript) from the recorded audio file. After compiling and organizing the data, that data was separated based on different information coming from different sections of data; this is known as disassembling. It mainly involved taking the data apart and then creating meaningful groupings. This process involved coding the text. According to Braun and Clarke (2006), thematic coding mainly involves recording or identifying the important passages of the text or relevant images, which are linked via a general theme or an idea. Braun and Clarke (2006) are of the opinion that in order to decode important information from the interview transcript, it is the duty of the researcher to ask questions about the data/text. Such questions may include: what is going on within the study, why is the person behaving in this particular manner and what action statements are taken. After disassembling, there comes reassembling. This similar concepts are then mapped together in order to generate common themes and this is known as reassembling. In this research, each and every line of the sentences were read and re-read and then only a particular theme is generate. In this critical stage of the research, the researcher made analytical conclusions from the presented data as codes and then as themes. This is known as data interpretation (Castleberry & Nolen, 2018). It helped to extract the meaningful theme hidden inside the codes of their answers.The last portion of the data analysis is concluding and this includes generation of thematic maps from the codes and codes from themes (Castleberry & Nolen, 2018).
Exclusion Criteria
The main practical application of thematic analysis was it helped to gain insight and knowledge about the gathered information. According to Castleberry and Nolen (2018) this method helps the researcher to generate deeper appreciation for the groups of respondents or the overall situation they are researching. Via employing thematic analysis, researchers create broad patterns that enable them to conduct further research and analysis. Castleberry and Nolen (2018) have highlighted themes emerge from the information that is gathered and nor never imposed or pre-determined by the researcher.
Rigor and Trustworthiness include credibility, transferability dependability and confirmability (Moule&Hek, 2011). These principles will be discussed in the following paragraphs.
Credibility and Authenticity
Credibility is very much related to reliability and validity, which are important aspects of research (Golafshani, 2003).These are the key ideas which help to produce credible and believable results (Neuman, 2013). According to Neuman (2013), credibility is the very fast aspect or criterion for a research for establishing trustworthiness. Credibility essentially conveys the researcher to clearly link the study findings of the research to reality in order to demonstrate the truth of the findings. Credibility in the qualitative research is obtained via triangulation. Triangulation mainly involves proper use of the data sources or themes in order to gain a comprehensive understanding of the phenomenon that is being studied. It is used to make sure that the findings of the research are robust, comprehensive and well-developed (Golafshani, 2003). In this research, the researcher used analyst triangulation. Analyst triangulation mainly involves the use of more than one analyst to review the findings or the research. This is helpful in eliminating the blind spots in the analysis process. In this research, the researcher took help of research supervisors in the process of the identification of the themes via thorough review of the interview transcript. This will help to prevent the generation of biased themes.
Transferability refers to the the ability of the findings to be recognised as applicable in other settings (Liamputtong, 2013).Transferability was established via providing detailed evidence of the study findings of the research which could be applicable to other situations, contexts, times and population groups (Serry&Liamputtong, 2013). In this research, the researcher promoted transferability via thick description of the phenomenon. According to Serry and Liamputtong (2013), thick description of the phenomenon is defined as a process in which the research provides a robust yet detailed account of their experience during the process of data collection. This mainly signifies that about providing a detailed description of where the interview will be conducted and the characteristics of the focus group of the interview. All this information will help the reader to construct the particular scene that surrounds the research study. This allows outside researchers as well as the readers to make the transferability judgements by themselves.
Data Collection Procedure
Dependability and confirmability
The background of the researcher affect their though process of what they choose to investigate (Polit and Beck ,2012) It also affects the angle of overall investigation, the findings considered to be most appropriate, and the framing and communication of conclusions. This is known as reflectivity of the qualitative research. As the researcher is also an international student the researcher might formulate own ideas and experience during the data collection and analysis(Liamputtong, 2013). In order to reduce this bias researcher was discussing own insights and perceptions to the supervisors in the data analysis phase. The reflectivity of the qualitative research increases the chance of bias results (Polit& Beck, 2012). Dependability emphasizes the consistency and reliability of data and the study findings (Polit&Beck , 2012). According to Parahoo (2006) it ensures that the study is free from the researcher’s bias and preconceptions. The proposed research study was evaluated by two external reviewers to affirm confirmability and dependability of the study. If there is consistency between the interpretations of the data among both the external reviewers, the conformability and the dependability of the research could be established.
This study had been reviewed and approved by Social Research ethics Committee, University College, Cork on as per the ethical committee requirements. All the ethical requirements such as consent forms, information sheets and interview guide had been truly verified and approved by the Social research ethics committee.
According to Clarke and Braun (2014), in order to increase the trust-worthiness of the research, the researcher will abide by all the ethical principles of a qualitative research study. In order to generate the informed consent, an information leaflet had been distributed among the potential participants via email before initiation of the interview. They also got an opportunity to ask any questions about their participation in the study before they sign the consent form. The participants were informed that the entire process of interview will be recorded via an audio recorder and all the data will be kept confidential and they are eligible to leave the process of interview conduction at any point of time before providing any prior intimation (up to two weeks of interview recording). They were also informed that if they opt not to participate in the interview process, it would have no impact on their grades and their tenure of academic discipline in UCC. After completely ensuring that the participants arecomprehensively aware about the interview process, audio recording and subsequent data-analysis, they will be asked to sign a written consent form (see appendix….).
Ethical Considerations
In order to maintain the confidentiality of the research process, the researcher made sure that no names of the interviewee appear over the final generated interview transcript. The researcher used pseudo names in order discriminate between the respondents. The written records of the interview were locked securely in a separate cabinet situated inside the principal supervisor’s office. The materials will be kept secured for 10 years. Moreover, all the audio recordings along with the transcript were encrypted in the student laptop and the same were destroyed following the transcription (Sandelowski 2000).
Though, the study was not likely to cause any psychological distress to the participants, the researcher was ensure to minimize the distress during the study. If, the participants were encountered with emotional stress, the interview would be discontinued and they can contact to the UCC student counselling and development centre or UCCNiteline service if they required. The contact details of the both counselling centres had been provided prior to the interview process.( See appendix)
Conclusion
Thus from the above discussion it can be concluded that the study here employs the instrument of semi-structured interview with open ended questions that has been specifically developed by the research after doing a rigorous review of literature. Thus overall it can be said that qualitative descriptive design is best suited for this research topic because it helps to analyse along with proper understanding of the complex phenomenon via using thematic analysis. It employed inductive approach in order to provide the succinct answers to the research questions. Another important aspect of the qualitative research, which has made itsuitable for this particular research was the research initiates via observation and simultaneous collection of the non-numerical rich data and thus attempting to identify a specific pattern in data (via themes) and thereby generating significant results in regards to present information. (Leedy&Ormrod, 2012).
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