In terms of Gowin's Vee@Cite(NovakJD84a), data analysis involves the generation of data from the events or objects under investigation, the collection and maintenance of that data in records, and the transformation of the data into useful information. In this research, the events studied were the process and outcomes of online discussions, responses to questionnaires that included comments, and responses to interview questions. The records are the transcripts of the online discussions, response sheets from the questionnaires, transcripts of the taped interviews, as well as written and taped comments. One of the two questionnaires was administered "pre-task" to generate data on the age, education, and computer-related experience of the subjects. The other was administered "post-task" to generate data on the subjective impressions of the participants. The interview also helped elicit impressions of the communication task in general.

The transformation to useful information involved multiple methods and triangulation@Cite(TrenholmS86a ", p. 249"). The content of the online communications was analyzed qualitatively for evidence of cognitive activity and cooperation. The outcomes (nursing diagnoses and nursing care planning) were rated on items that reflect the orientation and expectations for nursing student performance at the institution where the study was conducted. These, along with responses to scaled items on the questionnaires, were transformed through descriptive statistical procedures. Also, with due consideration for the limitations and threats to validity caused by the sampling and coding procedures, routine inferential statistical analyses were employed to further enhance the descriptive power of the information.

To help illustrate the sources from which content elements were sorted, categorized, counted, and analyzed, excerpts from the transcripts are presented in subsequent sections of this report. Similarly, a selection of comments are presented to highlight a variety of subjective impressions expressed by the participants.

3.4.1 Preparation for Coding and Rating

Prior to coding, the asynchronous transcripts were extracted from the CSILE database and the synchronous transcripts were collected from the log files. At the same time, the taped interviews were transcribed to files on electronic media. As such, all data, except the questionnaire response sheets, were accessible to electronic data-processing and text-processing tools.

Presently, there are a variety of these tools available to assist qualitative and quantitative researchers in text-analysis. Unfortunately, most of them are either too complex, or too dedicated to a particular analysis modality, to be of use in this project. For ease of code insertion in transcript files, a coding program was written. Content-Coder¹⁴ provides a simple yet flexible interface permitting the user to quickly insert codes in the text, which appears in the upper window, while maintaining a list of codes on the screen in the lower window (see Figure @Ref(figcod1)).

Figure 3-2: Content-Coder - text in top window, codes in bottom window.

Content-Coder also allows the user to review the criteria for each code through its help function (see Figure @Ref(figcod2)).

Figure 3-3: Content-Coder - text in top window, criteria in bottom window. Content-Coder - text in top window, codes in bottom window.

Coding Criteria for Cognitive and Cooperative Activity

Categories and criteria for the coding of verbal elements representing cognitive activity were adapted from Powell (1986). @CiteMark(PowellJP86a) Whereas numerous categorization systems for the analysis of interpersonal or group communication exist, most are oriented to interactions, relations, and other social factors@Cite(BalesRF50a, DanzigerK76a, HirokawaRY80a, RogersLE75a). Although the social-relations aspects of group problem-solving are considered in some of these reports, few deal specifically with the cognitive activity of the participants. Powell (1986), on the other hand, developed categories for, "... the cognitive content of the verbal interaction" (p. 26) in his studies of tutored versus leaderless discussion groups.

For the coding of cooperative activity, Powell's minimal attention to group processes, compared to other analysts, left his scheme with only one category for all such activity whether negative or positive. This is much too narrow in light of the enormous work done in social psychology concerning the effects of interaction. Hirokawa (1980), for example, demonstrates that, "... group @CiteMark(HirokawaRY80a) interaction plays an important role in decision-making effectiveness" (p. 312) and that, "... members in effective groups produce more procedural statements than members of ineffective groups" (p. 321). Similarly, Beckwith (1987) recognizes the importance of "debilitative" and "facilitative" interaction as determinants of success in group problem-solving (pp. 101-104). To take account of such interaction, these components of Beckwith's model were used for the coding of verbal elements representing cooperative activity. The codes and criteria for both cognitive and cooperative verbal elements are shown in Table @Ref(tabconcod1). Also, Appendix @Ref(appsmplcodes) provides samples of the coded transcripts.

Table 3-1: Transcript Content Codes

Rating Criteria for Nursing Diagnoses and Care Planning

The criteria for rating of the nursing diagnoses and nursing care planning were developed from several sources. The primary source was the course materials, and the guidelines and principles used in the curriculum at the Faculty of Nursing where the subjects studied nursing theory. Two texts, and one educational computer program, were used to teach nursing diagnosis and its relation to nursing care planning. The texts were:

Griffith-Kenney and Christensen, (1986), Nursing process:
  Application of theories, frameworks, and models.

Iyer, Taptich, and Bernocchi-Losey, (1986), Nursing process
  and nursing diagnosis.

Yoder, (1984), Introduction to nursing diagnosis
  [Computer program]

Townsend, (1988), Nursing diagnoses in psychiatric nursing.

From these resources, and through discussions with nursing instructors at the study site, it was decided that evaluation of the nursing diagnoses and related care planning had to embrace two main components in the understanding of this content: first, the form in which nursing diagnoses were stated, and second, the correctness of the statements relative to the information provided in the nursing case study.

Since the students who participated in this research were from the first and second years of the nursing program, it was not expected that they would have a broad and sound understanding of the many health care factors that must be considered in psychiatric nursing diagnosis or the practice of nursing in general. Therefore, the correctness of their nursing diagnoses and care planning was not as important as the manner in which they tried to develop it and state it. At that point in their nursing education, their understanding of such statements was expected to reflect the basic structure, components, and form they had been taught. The nursing diagnosis statements, in particular, were to follow the basic Problem-Etiology-Symptom (P-E-S) structure described in Section @Ref(ssnurpro). The data and factors contained in their diagnoses were to be sufficient to allow them to prioritize the diagnoses as requested in the task assignment.

With these considerations in mind, the nursing diagnosis, nursing care planning and related outcomes of the online discussions were rated on the following eight items (the rating scale was 1 to 5):

NDF1	-form of the nursing diagnosis designated priority #1
NDC1	-correctness of the nursing diagnosis designated priority #1
NDF2	-form of the nursing diagnosis designated priority #2
NDC2	-correctness of the nursing diagnosis designated priority #2
NCPF	-form of nursing care planning
NCPC	-correctness of nursing care planning
APC	-attention to principles and criteria
ICA	-individual contribution to adherence

The criteria used in evaluating these items were drawn from the previously mentioned texts and are presented in Table @Ref(tagndcrit).

Table 3-2: Criteria for Assessment of Nursing Diagnosis and Nursing Care Planning Outcomes

1. Elements of form:

Nursing Diagnosis...

        - use of Problem-Etiology-Symptom model
                (see Section 2.5)
        - proper connecting phrases
        - proper order of components

Nursing Care Plan...

        - includes expected patient outcomes
        - timeframe stated
        - includes nursing orders/actions
        - rationales stated

2. Elements of correctness [related to patient data]:

Nursing Diagnosis...

        - uses nursing criteria not medical criteria
        - signs/symptoms not stated as the health problem
        - patient's problem, not the nurse's problem
        - basic human needs are not stated as health problems
              (unless they are unmet needs)
        - unclear concept labels (eg: stress) not used
        - statement is not legally inadvisable
        - problem and etiology are not saying same thing
        - environmental factors part of etiology not
              the problem component
        - health problem is amenable to nursing intervention
        - stated in terms of altered or potentially altered
              response, rather than as a need
        - only one problem and one etiology per diagnosis
        - the nursing diagnosis is stated concisely
        - problems suggest EPOs, and etiologies suggest
          nursing orders

Nursing Care Plan...

Expected Patient Outcomes [EPOs]

        - good order of priority
        - reflect the problem component of the ND
        - client centered
        - clearly and concisely stated
        - observable and measurable outcomes in terms of:
             - bodily functions and appearance
             - specific symptoms
             - client's knowledge
             - psychomotor skills
             - emotional status
        - realistic:
             - timeframe
             - client's resources
        - client is involved in the plan

Nursing Orders [planned interventions]

        - includes dependent, interdependent
             and independent nursing roles
        - consistent with ND etiology
        - based on scientific principles
        - individualized
        - provides safe, therapeutic environment
        - provides teaching/learning opportunities for client
        - reflects availability of appropriate resources
        - specifies who, what, where, when, how
             and how much

With respect to the specific nursing case study (see Appendix @Ref), the possible nursing diagnoses (in order of priority) are as presented in Table @Ref(tabnd). It is understood that the case study was used in the context of learning, as it is used in the nursing curriculum, and could not fully represent the real-world of nursing practice.

Table 3-3: Possible Nursing Diagnoses

Diagnosis	related to	as manifested by
Anxiety	- unmet needs - maturational crisis - threat to self-concept	(panic attacks) - palpitations - hyperventilation - "cold sweat" - shaking
Sleep pattern disturbance	- depressed mood - anxious mood	- client reports sleeping problems
Alteration in nutrition (less than body requirements)	- depressed mood - loss of appetite	- client reports eating problems
Potential for self-directed violence	- depressed mood - feelings of worthlessness	- client states he probably couldn't do that right either
Disturbance in self-concept (low self-esteem)	- lack of positive feedback - consistent negative feedback	- client describes himself as a loser with no friends
Hopelessness	- lack of positive feedback - numerous failures	- client states that there is nothing else left to do but go to hospital - client indicates he is uncertain about his ability to handle future work or study.

There are other possibilities for nursing diagnoses in this case, but, for various reasons, they were not as acceptable. For example, ineffective individual coping was not clearly manifested but should be considered. Also, self-care deficit is not noted in the case, but it could be a "potential" problem. Powerlessness has a similar P-E-S as hopelessness, but is not as clear, and social isolation is another potential problem that has not yet been fully demonstrated by the patient.

Finally, with regard to the assessment of nursing process outcomes in the online discussions, the possible nursing orders, (planned interventions or care planning) are presented in Table @Ref(tabnoguid) (grouped by their related nursing diagnoses). The scoring of these was based on a holistic evaluation related to the components listed in Tables @Ref(tagndcrit) and @Ref(tabnoguid).

Table 3-4: Nursing Orders to Guide Rating of Correctness in the Nursing Care Planning

- maintain calm, non-threatening manner
- reassure re: safety and security
- be there, with simple words and gentle talk
- low stimuli, quiet
- administer medications (tranquilizing)

- monitor and record sleeping patterns
- discourage sleeping during the day
- measures to promote sleep: warm drinks,
   warm bath, back rub
- relaxation exercises
- limit intake of stimulants (eg: coffee)
- administer medications (sedative)

- cooperatively with patient and dietician establish
   patient's food likes and dislikes and caloric needs
- monitor and record intake/output and calorie count
- weigh patient daily
- provide small frequent feedings and bedtime snack
- include high fiber to avoid constipation
- administer medications (vitamins and minerals)
- ask family members to bring in special foods
   that patient likes
- stay with patient during meals
- teach patient good nutritional habits

- create safe environment, remove all dangerous items
- encourage patient to interact with nurse or other
   helping person if self-harm ideas arise
- assess degree of intent and capability for self-harm
- encourage patient to agree to safe, appropriate
   behaviour for specified short periods of time
- allow patient to express feelings of fear,
   anger, and frustration

- be accepting
- be there for the patient
- help patient focus on strengths and accomplishments
- encourage participation in group activities
   where positive feedback from peers is possible
- help patient identify things he/she would like to
   change about themself
- help patient engage in tasks with simple methods of
   achievement
- teach assertiveness techniques
- teach effective communication techniques

- help patient focus on "here and now" issues
   affecting him/her directly
- help patient focus on strengths, accomplishments
   and his/her own potential
- help patient identify things he/she would like to
   change about themself or their environment

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