2.3. Data Collection and Analysis

Recruitment of participants began after the study protocol was reviewed and approved by the University of St La Salle Graduate Program review panel and ethics committee. The participants were initially recruited using the purposive sampling method guided by the aforementioned inclusion criteria. To bolster the recruitment of the participants, the snowballing technique, in which hospital contacts recommended participants who met the research criteria and who might also be willing to participate in the study [43], was used. This method was selected specifically for its ability to reach hard-to-find populations [44]. The final sample size of 12 participants was set once saturation was reached or no new concepts or themes emerged during the interviews [41].

Potential ICU nurses assigned to different hospitals were contacted and invited through Facebook Messenger, e-mail, or mobile phones. As part of the informed consent process, all information about the study was disclosed to the participants. The study was initiated by sending a letter of request and an informed consent form which included information about the study, such as the introduction and purpose, participant selection, a clause for voluntary participation, procedures, risks and benefits, and a confidentiality agreement.

Once consent was obtained, a schedule for the interview was arranged. Participants were free to choose which method of online communication was most convenient for them (Zoom, Facebook Messenger, Google Meet, Skype). The interview was scheduled to last for 30 min to an hour. Participants were also encouraged to select a convenient time and location that would enable them to be comfortable, relaxed, and at ease during the interview. In view of the ongoing COVID-19 pandemic, the participants were initially offered the option of conducting the interview online. However, if the participant decided to conduct the interview face-to-face, precautions were taken accordingly. In total, only two participants chose to conduct the interview face-to-face, while the remaining ten chose online interviews. Prior to the interview, participants were reminded that the session would be recorded and that they may stop the interview at any time. All interviews were conducted in English. However, participants were free to use any language they wished to share their thoughts. In the later transcription of the data, non-English languages were carefully translated into English. Participants were also asked to select their preferred pseudonym to be used for the transcription. After the transcription was completed, the participants were asked to validate the accuracy of the data gathered.

A description of the ICU nurse’s experience was derived and acquired through the use of narratives or stories about their lived experience during their involvement in the caring of the dying COVID-19 patient. A guiding context was provided to encourage participants to share more about key moments in the provision of EoLC. For instance, an overarching question was asked: “What is your experience of providing EoLC to a dying COVID-19 patient?”. Second, several preset probing questions were also used to help confirm and clarify certain descriptions or statements made by the participants. Examples of probing questions were: “What are the different things you do while providing EoLC?”, “What was the patient’s response like while receiving EoLC?”, and “Is there anything else that you would like to discuss in relation to your experiences in EoLC?”. The content of the guide also enabled the determination of the profile of the participants, which included their age, gender, marital status, educational level, length of service, hospital type (whether private or public), hospital location, and the number of months being assigned to a COVID-19 critical care unit.

Data analysis followed Colaizzi’s [45] method. This approach provides a rigorous analysis through a unique seven-step process in which each step remains close to the data in order to ensure the credibility and reliability of the results, as well as exposing emerging themes and their interwoven relationships [46]. This approach depends on the rich first-person accounts of experience that may emerge from interviews conducted online or face-to-face [47]. The seven steps in Colaizzi’s [45] descriptive method include the following: (1) familiarization by reading and re-reading the ICU nurses’ narrative transcripts multiple times, (2) identifying and extracting significant statements from the participants that relate to their profound experience while providing EoLC, (3) forming meanings from the statements of the participants, (4) grouping and organizing the ICU nurses statements to form relevant and meaningful themes, (5) developing an exhaustive description of the thematic findings, (6) constructing the basic structure, and (7) seeking verification of the basic structure and to validate the results by returning them to the participants and confirming the results with their experiences [45].

Experiences and thematic statements of the participants were highlighted in order to generate a series of themes as to how ICU nurses experience EoLC on a day-to-day basis. The intuitive process was completed by establishing rapport and contact with the participants, paying particular attention to their daily activities and absorbing their lifestyle. Intuition refers to the researchers’ attempt to empathize with the situation by empathizing with a feeling or thought of the participants that they have experienced themselves. This occurs when researchers remain open to the meanings attributed to the phenomenon by those who have experienced it [48].