This study was limited by a number of factors, including
small groups and sample size and issues inherent in focus
group data collection (e.g., self selection). Although divergent
responses by sex, study phase, study unit and years
of critical care experience were not observed in this study,
judicious comparisons are constrained by the small sample.
Sample size also limits extrapolation of study findings to ICU
nurses in other settings. Likewise, the voluntary nature of
focus group and SPEACS study participation increases the
likelihood that participants differed in important ways from
those who chose not to take part in the groups or study. For
example, those that participated in the focus groups may
have had more extreme views of the intervention, and those
who chose to take part in the study at all may have been
more amenable to practise changes than the general ICU
nursing population. Finally, though focus groups