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).