Ethical considerations in relation to sampling

The next step involved obtaining ethical and access approval from the relevant institutions to conduct the study. Ethical approval was sought and obtained from the University Research and Teaching Ethics Committee and approval to carry out the study was given by each educational institution. Ethical approval was sought and granted by the relevant hospitals’ research ethics committees. This also involved both ethical approval from each hospital and educational institution and access approval to six hospitals in the Dublin/North East Region associated with general nurse education. The process for ethical and access approval differed slightly for some hospitals. Directors of Nursing and General Managers gave access approval in the hospitals. This was evidenced in writing in a site-specific assessment form. In the process of seeking approval a letter accompanied by a copy of the research proposal was submitted to the Director of Nursing and General Manager from each hospital site. Communication by phone and/or in person provided opportunity to explain any queries and a contact number and email address was available for contact where

explained verbally beforehand and supported the request for approval with a letter detailing the aims and methods employed in the research. In other hospitals ethical and access approval was also granted with communication through the ethics committee directly.

The duration for the application process for ethical approval took approximately nine months (see appendix D). This time depended on the dates for review in the respective hospitals. Some terms of agreement differed in the hospitals with a slight variation in the procedure for accessing the population. The means of distribution of questionnaires were governed by slightly different conditions for different hospitals and at all times these conditions were met. In some hospitals, the sample was accessed by meeting the Clinical Nurse Manager on each ward and requesting that they distribute the questionnaires to the respective participants who fulfilled the inclusion criteria. Each clinical nurse manager in this hospital received a short description of the research and was asked to distribute the questionnaires to those on their ward who fulfilled the inclusion criteria. In other hospitals the questionnaires were distributed through a designated employee or by post in agreement with the ethics committees. This complied with the rules outlined by the Medical Research Ethics Committees.

An enclosed stamped addressed envelope accompanied the questionnaire, which was addressed to the researcher’s home. In accordance with the terms of ethical and access approval, names of participants or locations of employment were deliberately excluded to ensure total anonymity. The results of the study made no reference to the individual hospitals involved in the study and were not named except to be part of the

Dublin/North East group of hospitals. Demographic profile questions were also excluded to ensure absolute anonymity. This decision was made in collaboration with some ethics committees as the number of males in both cohorts was proportionately low and therefore, there was a greater possibility of identifying them. All correspondence from the relevant hospitals, directors of nursing, hospital managers and ethics committees were deliberately excluded from the appendix to ensure anonymity.

3.10 Ethical considerations

‘The conduct of nursing research requires not only expertise and diligence but also honesty and integrity’ (Burns and Grove, 2005 p. 207)

In the performance of nursing research one must be cognisant of the inextricable link between ethics, research and clinical practice (Smith and Hunt, 1997). In the performance of a research study, the protection of the participant is paramount (Mulhern et al, 2004). Furthermore ‘the participant must be protected from the possible consequences of difference in power between the researcher and the participant’ (Mulhern et al, 2004 p.14/7). Beneficence can be demonstrated in the contribution of the findings to the overall good of the client and indeed the profession (Brockopp and Hastings-Tolsma, 2003).

The World Medical Association has compiled a Declaration of Helsinki (1964). This declaration has been amended six times and provides guidance on the performance of research. This guidance provides the cornerstone for the purpose, existence and

function of the ethics committees with whom the researcher had the opportunity to work with prior to the performance of the study.

The basic rights of fair treatment, anonymity or confidentiality, self-determination, privacy, dignity and safety must be adhered to (LoBiondo-Wood and Haber, 2002). These underpin the three ethical principles of respect for persons, beneficence and justice (Levine, 1986). In respect for the person the researcher ensured that information was adequate, understandable and did not place any undue pressure on participants to become involved in the research. Newly qualified nurses and student nurses are considered to be relatively vulnerable groups of individuals (Gerrish and Lacey, 2006). This is because these cohorts may feel dependent on colleagues for employment and appraisal and may be reluctant to refuse to participate in a study in case of any reprisal. With this in mind the researcher was at all times cognisant of the possible difference in power between the researcher and the participants and at no time was this power exploited for the benefit of the research. The researcher had no supervisory relationship with the participants at the time of the study.

Under the Code of Professional Conduct (2000c), the nurse as a researcher has an obligation to ascertain that the appropriate bodies, namely the Ethics Committee, the relevant hospitals and the colleges of nursing, sanction the research. This ensures that the rights of the participants are protected at all times (An Bord Altranais, 2000c, 2007b). In order to carry out the study, the researcher obtained permission to pursue the study from the Director of Nursing where the author was employed. Permission was granted and funding was provided from The Nursing and Midwifery Planning and Development Unit.

The Data Protection Act (Department of Justice, Equality and Law Reform, 2003) has protected the participants from intrusion in relation to their own personal data. The principle of this act in relation to personal health information obliges the person processing the data to ensure that it is obtained fairly and that the purpose of the collection of this information is explained clearly. The information must be relevant and not excessive. It should not be held longer than necessary and must be purpose specific and held securely. This Act is relevant to researchers. While this Act has great merit, the consequences for nursing research have been significant as the process for gaining ethical approval and access approval is lengthened and randomisation is more difficult to obtain. This deters possible researchers from using such methods where names of participants are required, as they cannot be disclosed to the researcher and therefore places a dependence on a designated hospital employee to facilitate accessibility to the participant.

Absolute anonymity was assured and demonstrated in the deliberate exclusion of the signed consent form and demographic data. This is crucial when dealing with personal information such as stress (Murphy-Black, 2000). This was requested at the outset in gaining approval to carry out the study. The exclusion of demographic data took into account the low number of male potential participants in each cohort. Therefore identification of oneself as male almost identified the person. This was in accordance with the Code of Professional Conduct (An Bord Altranais, 2000c) and ‘The Data Protection Act’ (Department of Justice, Equality and Law Reform, 1988 and 2003). Respective institutions were therefore not identified in the data collection process. There was no means of identifying the participant who responded except to identify as student or newly qualified nurse. In order to comply with the Data Protection Act

(1998, 2003) at no time did the writer have access to the participants’ names. This may have posed difficulty in facilitating a good response rate as the letters were impersonal addressed to “Newly Qualified Nurse’ and ‘Fourth–Year Student Nurse’. Addresses were not required, as the questionnaires were posted to their place of employment with an enclosed stamped addressed envelope to the researcher’s home address. The completed questionnaire did not contain any identifying features other than identifying as student nurse or newly qualified nurse.

Voluntary participation is mandatory in research of this nature (De Raeme, 1997). This was respected at all times. Each participant must be willing to participate in a voluntary capacity with the of participant’s welfare paramount (Gerrish and Lacey, 2006). Unconditional respect was demonstrated and explicit assurance that they could decline from participation in the study without any consequence asserting their own autonomy in their freedom to determine one’s own actions (Treacy and Hyde, 1999). Information about the study was provided in an understandable way so that the participants can make an informed decision about consent and participation ensuring voluntary commitment. As detailed in the information for participant letter, return of the questionnaire will indicate consent. ‘By filling out this survey, you are indicating that you have read this statement and have agreed to voluntarily participate’ (see appendix A). A tick box was placed on the questionnaire where the participants could give a sign of consent without disclosing their place of employment or own name. This was explained in the information letter for the participants alerting them to the fact that return of the questionnaire would indicate consent.

The professional integrity of the researcher compels the adherence to ethical principles of safety (Gerrish and Lacey, 2006). The greatest care was undertaken to ensure safety of the participants as it is well known that the end does not always justify the means (Mulhern et al, 2004). The principle of nonmaleficence which is rooted in the maxim ‘first do not harm’ (Treacy and Hyde, 1999) was adhered to in the unconditional respect for the respondents. Moreover access was provided to a counsellor should the need arise, as the provision of professional advice from the researcher is not recommended (Mulhern et al, 2004). If any individual would experience any discomfort following the completion of the questionnaire phone numbers of the counselling services were provided in the participant’s information letter (see appendix A). Participants are advised to contact a counselling service attached to their hospital as stated in the participant’s information letter. The counselling services were contacted in advance of the research outlining the details of the research.

All institutions and participants received the same information and were treated fairly at all times in keeping with the principle of justice for all (Treacy and Hyde, 1999). Findings of this study may not directly benefit the participants, though indirectly through the establishment of structures to support the transition of the newly qualified nurse. Findings may also reveal key issues that cause stress for student nurses and thus may potentially contribute towards strategies to reduce student attrition rate.