Research quality

In qualitative research, the research quality is described as enhancing the trustworthiness of the study’s data (Lincoln & Guba, 1985; Polit & Beck, 2012). Several dimensions are used to achieve trustworthiness, such as credibility, dependability, confirmability and transferability.

3.9.1 Credibility

Credibility refers to the extent that the research methods create confidence in the truth and in the interpretation of the data (Polit & Beck, 2012). To achieve credibility in this project, the quality of the literature review, the observations, interviews and the interprofessional simulations should be examined. Having two researchers to decide inclusion or exclusion of the studies in the literature review using a flow diagram contributes to gain credibility. In the observation study, moments like staying in the ED in two different hospitals for a longer period has strengthened the credibility of the results in the study. Short conversations with healthcare professionals (ambulance workers, nurses, doctors) were held right after the observations were completed to catch the professionals’ view concerning quality of the specific transition.

The observations were conducted and completed before the interviews started, which contributed to a better understanding of the healthcare professionals’

explanations during the interviews. To ensure credibility during the observation study in the ED and at the hospital wards, the characteristics, such as common functions and routines performed during hospital admission and discharge, were identified and described. The choice of different participants’

qualifications such as observing ambulance workers, nurses and doctors with different roles and views of patient participation aimed to strengthen credibility in the observations and individual interviews. Another important moment here is that participants also had different work experiences, as well as variation in age, profession and work experience in general. During the observation period, my supervisor observed for a few hours in the ED in order to validate the descriptions of the context, which was useful in the analysis of the data collected. She also was apparent, taking notes and observing one of the patient situations in hospital admission. Hence, together with the qualifications and the clinical experience of both researchers (in hospital admission and discharge), the credibility of this research is strengthened. To obtain credibility for the results of the data from the interprofessional simulations, notes were taken both by each supervisor at each group, the participants in each group and one researcher who was responsible for notes from the plenary discussion. For the follow-up meetings, one researcher took notes and in addition to a recorder that was used, to secure that all moments were captured. The data were transcribed verbatim into text material by one of the researchers in the research team.

3.9.2 Dependability

Dependability refers to consistent and stable evidence (Lincoln & Guba, 1985).

Consistency in this study might, in the literature review, be the stability of the research process, using the same search terms in all databases to achieve a more stable evidence. Concerning the observations and interviews, one researcher was collecting all empirical data in hospital admission; another researcher was conducting all observations during hospital discharge. Hence, there is not consistency between the participants in hospital admission and discharge, as we never managed to observe the same patients from admission to discharge.

However, we collaborated in developing the observation guide and also the interview guide, to find the right questions to figure out what we were looking for. Consistency was obtained by informal and formal meetings to discuss observations, as well as co-existence in timing of the observations. The three interprofessional simulations were carried out using the same program and the same researchers with an educational part and a discussion part, to achieve consistency. In the same way, the follow-up meetings were conducted to obtain dependability.

3.9.3 Confirmability

Confirmability concerns objectivity; the degree to which study results are derived from characteristics of participants and the study context (Lincoln &

Guba, 1985). To secure confirmability in this thesis, several approaches have been used (Polit & Beck, 2012). The methods used to collect data in this thesis include participant observations, individual interviews, discussions (seminars) with study participants and watching participants’ behavior. This might also involve the way different healthcare professionals were included in the study, such as ambulance workers, nurses and doctors, to explore and understand the complexity of the admission and discharge situations. Efforts were done to be structured in the data collection (getting all questions answered), as well as in the analysis process, using Malterud’s (2012) stages with systematic text condensation. In addition, as a member of a larger research project, there was collaboration with the members of the research team and with an expert advisory group. Preliminary findings have been presented for some of the

participating wards at the hospital and the municipality, when showing the film based on the observations in the interprofessional simulations.

3.9.4 Transferability

Transferability is another aspect of trustworthiness and refers to the extent to which qualitative findings can be transferred to other settings, contexts or groups (Lincoln & Guba, 1985). To promote transferability, rich descriptions of the research context are important, so that others can make inferences about contextual similarities. This thesis’ findings might be transferred to other settings, due to the purposive sampling with relatively detailed described context and professionals involved, owing similarity to other hospital admission and discharge settings. The analysis process for all the data gathered is thoroughly described with extractions of tables, showing each stage of the analysis and will ease the understanding of the categories emerged. Findings, both empirical and in the literature review, are also in accordance with findings in other research studies, which will strengthen the results.