Team:
The analytic team consisted of the non-clinician qualitative experts
(MV, EC, SK) who conducted the interviews, two clinician-researchers
within the field of emergency medicine (JS, TMC) who provided contextual
support, and the senior author (SM) with expertise in psychology and
medical education oversaw all aspects of the study.
Analysis: Through the application of a narrative analysis, stories were analyzed
for key components, rewritten within a chronological sequence (i.e.,
ordering the key events in time), and developed within an emergent
metaphor56, 60-61. This “re-storying” process
emphasizes meaning-making from the shared stories. Through many
discussions, the multi-disciplinary team worked together to develop and
refine the characters, setting, and plot. The final version then becomes
a meta-narrative that is shaped by present context and past
retellings60. Data analysis using a narrative approach
that emphasizes chronology was important because we are most interested
in the order that events are happening so that we may further establish
temporal relationships between these occurrences. NVIVO 12 (QSR
International) and manual hand coding were used in tandem to manage the
data. The primary author (SK) coded all interviews with direct
consultation and direction from MV and SM; EC, JS, and TMC provided
ample feedback and helped to re-define and solidify the analysis.
Consistent with a narrative analysis approach, the coding emphasized an
evaluation of the actual temporal sequence of events, which may have
been different than the sequence in which the story was shared during
the interview. The analysis process included: (a) initial coding; (b)
focused coding; (c) creating the meta-narrative and accompanying
metaphor. Initial codes are the basic analytic units that capture
relevant aspects of data. By using labels to categorize each action
element and character/setting descriptions within a story, a series of
steps and characteristics began to emerge. This process was replicated
across all stories. Next, focused coding led to the development of
broader themes. This approach was used to collapse similar labels
through comparing and contrasting. Finally, these broader themes were
organized into a coherent picture to illustrate the order of key events
and the detailed descriptions of each character within a common setting.
Through detailed discussions amongst the research team members, this
trajectory was developed into a preliminary graphical representation of
the narrative data and then in parallel, formulated into a metaphor. All
authors agreed on the final version of the meta-narrative, schematic,
and metaphor.
This study received approval from the Hamilton Integrated Research
Ethics Board (HIREB) on August 16, 2017 (Project #2553).