Ethical Considerations

This section shows how ethical thoughtfulness informed key stages of the research process although ethical considerations arose at every stage from the decision to explore incivility to the decision as to what to include in the findings and what to leave out.

Approval to proceed was granted by the University’s Ethics Committee in 2015 (Appendix I) and again in 2016 (Appendix J) when a request to extend the numbers of participants was

submitted. As described previously, permission to undertake the research in the various settings was obtained through the relevant personnel (Appendix G).

The consideration of the rights of individuals and other ethical issues are an important dimension of all well-conducted research. This requires that researchers should act with honesty and avoid deception or misrepresentation throughout the research process (Denscombe 2007:141). One aspect of this is ensuring that the participants know the truth

90 about the research they are being asked to participate in and their role within it. This was

achieved through the provision of written information (Appendices K, L, M) which was given out at the invitation stage, providing the basis for obtaining informed consent in a one-to-one discussion which took place before the interview.

Consent, confidentiality, and consequences are described by Cohen et al., (2011:442-443) as the three main ethical issues relating specifically to interviewing. Consent is the formal stage of ensuring that participants know exactly what the research is about and what their involvement entails (Denscombe, 2007:145). The signing of a consent form not only ensures that the participant’s willingness to participate is recorded; it also protects the researcher from any accusation of impropriety relating to the recruitment process (Denscombe, 2007:145). Long (2007:53) described how even with informed consent, external pressure (coercion) can prevent free choice, and how this may be brought to bear unintentionally in the selection of participants. One aspect of this is where there is a perceived power differential, i.e. where one person is in an apparent or actual position of seniority or influence over another. This was an important consideration for somebody working in a senior position in the research setting, particularly in relation to the nurse tutors and the students. It was less of an issue with the mentors because they had relatively little contact with the institution and none with the

researcher directly. The potential power differential was managed by taking care to separate out the researcher and academic roles. For example, the researcher’s name/title badge was

removed before interviewing and interviews were conducted in meeting rooms rather than in the researcher’s everyday work office.

Given the potential of the interviews to identify people and places in a negative light, the principles of confidentiality and anonymity (Long, 2007:56-57), were given particular attention. Participants were asked to avoid revealing the names of people and places during the interview and where mention of these or any other potential identifier was made, it was removed during transcription; the completed transcripts were then sent back to the participants to be double checked for any missed breaches. The wording on one of the transcripts had to be changed as a result of this because a participant had referred to having a husband during the interview and she felt this this may have identified her. Confidentiality and anonymity were further preserved by using pseudonyms in the writing up of the findings.

Breaches of confidentiality have the potential to lead to embarrassment, financial loss and even legal action (Denscombe, 2007:143). All research-related data were therefore secured on a

91 password-protected laptop backed-up on an encrypted memory stick kept in a locked drawer in the researcher’s home office. Furthermore, all interview data were handled by the researcher, so the risk of data loss or misdirection was minimised.

The third of Cohen et al.’s three main ethical issues is consequences, by which it is meant that participants have the right not to be harmed as a consequence of their involvement in research. Harm is often thought of in terms of trauma caused by physical intervention but consideration of psychological harm is just as important (Denscombe, 2007:143). Some interview topics can be emotive and even those subjects that are not overtly sensitive can elicit a degree of upset (Williamson, 2007:14). As discussion about incivility has the potential to surface a wide range of emotions, referral routes to support personnel were identified so that participants could be referred onward if needed. Johnson (2007:40) suggested that this kind of strategy illustrates a risk-benefits approach rather than a rights-based one because it moves away from the notion of protecting the participant at all costs and introduces the idea of weighing up the risks and benefits of various actions and taking the least harmful, most beneficial course of action. Another area of potential harm was in knowing the individuals being referred to at interview, or of knowing the interviewees themselves. In this respect, the potential for harm lay in responding negatively to a situation or decision because of something that had been heard at interview. As this information could not be ‘un-known’ once heard, it was important to maintain a high level of awareness about the interview content, not just at the point of interview but in everyday working practice as well (Chapter 6).

One further aspect of potential harm did not become fully apparent until the later stages of the research. This was in relation to the findings, some of which may reflect negatively on the research setting (both the institution and its NHS partners), for example the incidents of bullying and racism. In this situation, a decision had to be made about how the findings could be shared with the wider nursing community whilst still protecting the identity of the setting. The alternative would be to not share the findings at all which would be unethical in itself given the participants commitment to sharing their stories for the improvement of the nursing profession. To fail to act on the findings would therefore be to knowingly allow poor practices to continue unimpeded. Other issues of an ethical nature included ensuring the right of participants to withdraw from the research at any time with no negative consequence (Williamson 2007:347). This was

particularly relevant given the researcher’s seniority in relation to the nurse tutors (albeit with no line management responsibility) and in relation to the students who might have wondered whether their grades could be negatively influenced if they withdrew. It was also recognised that

92 participants might need to withdraw for practical reasons such as assignment pressures or clinical commitments. The freedom to withdraw without consequence was explained to participants during recruitment and at the interview outset. In addition, they were emailed two days before the interview to check if it was still convenient to proceed; this ensured they had opportunity to delay or cancel the interview if needed.

Once in the interview, there were experiences that were shared that raised concerns from an ethical perspective such as hearing about substandard patient care and bullying behaviours. In these cases the interviewer’s responses were guided by the profession’s code of conduct (Nursing and Midwifery Council, 2018b) and the British Educational Research Association guidelines for ethical research (BERA, 2011).

Further ethical considerations including the right not to be over-researched and conversely, the right to be researched, were upheld through the recruitment process and the relatively short data collection period. The research was theoretically open to any student, nurse tutor, or mentor with relevant experience to share and there was no pressure to participate or otherwise. The participants involvement of approximately one hour in an interview was not onerous in terms of time commitment or physical demand, both factors to take into account when protecting participants from being overly burdened (Williamson, 2007:11).

Finally, incentivising through payment was considered for the mentor participants due to the difficulty of recruiting them; however, it was decided against because of the potential impact on the quality of the data collected. As described by Head (2009), payment could result in

participants volunteering just for the payment and not because they had anything of relevance to share. As the value of the phenomenological interview lies in the depth and detail shared by the interviewee, there would have been no gain in interviewing people with little of relevance to say. The recruitment ‘adverts’ therefore appealed instead to participants’ interest in the

development of civil learning and working environments for the benefit of all.