Ethical Considerations

A number of ethical considerations are associated with the case study process. According to Stake (1995) the confidentiality and anonymity of participants are the main points for ethical consideration within a case study. Firstly, there is the issue of confidentiality agreements surrounding information given by Ministry officials, because if the case study is not appropriately designed, it may be possible to identify research participants, especially those in high positions and in focus groups. The research was conducted in accordance with the ethical principles published by the Royal College of Nursing (RCN, 2011). One of the most important among these principles is that for data collection and analysis: all confidential documents should be placed inside a locked cabinet and access should be allowed only to authorised persons (RCN, 2011). This ensures that documents are secured and the personal opinions of participants are not exposed or compromised. The UK Data Protection Act (1998) was applied as the framework to protect the data of this research. All participant information was coded and anonymised; only the researcher and supervision team at the UoS had access to anonymised data. However, no names or personal details were used that could identify places, individuals, or professional roles, and such data was removed from transcriptions and audio recordings. The study displays two

103 forms of data; a hard copy and an electronic copy. Hard copy data was kept in a locked cabinet accessible only to the researcher. Electronic data was secured on a password protected external hard disk and connected only to the researcher’s private laptop, the only person who had access to the saved study data. Furthermore, during the study period, all data were considered highly confidential and carefully handled with respect to participants’ anonymity and dignity to avoid breach of confidentiality. Besides that, all anonymised hard and electronic data will be kept for three years following the study, whilst publication and dissemination take place. The data will then be discarded through confidential shredding and secure deletion methods.

For the face-to-face interviews, the Code of Ethics (RCN, 2011) recommends that interviews should be performed after informed consent is given and should ensure the confidentiality of information disclosed by the participant. Furthermore, the interviewee should have the right to withdraw at any time without fear of adverse consequences (RCN, 2011). For the focus group stage, there will be special consideration of confidentiality. For example, all interview participants were assured total anonymity and ensured that they would not be mentioned by name or position in the final written report. There will be no disclosures to a third party; only anonymised discussion in my thesis and subsequent publications and presentations. To address this, coding was used to protect the anonymity of place, person and role.

For participants in this study the protection of their human rights was assured throughout the study. Participation in the research was voluntary; and this was reinforced by sending the consent form, the information sheet, and the interview questions before the interview. Data collection started after approval was obtained from the Research Ethics Panel of Salford University and the MoH in Saudi Arabia (Appendix 4.2; 4.3), thereby ensuring the protection of human subjects involved in this study. The process of obtaining permission to access the facilities of the MoH is illustrated in Appendix 4.1. Data collection included adult respondents over the age of 18 years and did not involve any vulnerable populations. It was a long process to obtain permission from the MoH to gain access to its hospitals, and make practical arrangements with the three levels of participant. Fortunately, this process was helped by the Saudi cultural attaché, who provided me with an introductory letter to the MoH to facilitate access, recruitment of participants and preparation for the data collection phase. Concurrently, there was a need to visit the MoH in Riyadh to obtain

104 ethical approval. This took around four to six weeks. In February 2015, while I was waiting for the research approval, I contacted my place of work and met the General Director of Nursing in order to explain the purpose of the study and the research process so that I would be able to gain access to valuable resources and ultimately data for the study. The General Director was supportive and provided all the facilities that I needed such as an office, computer, printer, internet access and telephone.

The research proposal was submitted to both the General Director of Nursing and the General Director of Research for review and approval at the MoH in SA. Within the MoH, such ethical approval is equivalent to that granted by any ethical committee in a UK academic setting. The policy of the University of Salford (UoS) is to obtain ethical approval from the university in the first instance, followed by approval from the area where the research is to be conducted; in this case Saudi Arabia. Evidence of the latter then needs to be passed to the former. The ethical approval was obtained from Rachel Suttleworth (University of Salford) in February, 2015 (Appendix 4.2). The Saudi ethical approval from the MoH and its hospitals was obtained in March, 2015 (Appendix 4.3).

4.10 Summary and Conclusion

This chapter has discussed the research methodology for this study, considering the philosophical perspectives of the research and discussing the most appropriate research paradigms, with a primary focus on the justification for using a qualitative case study. The macro, meso, and micro level theory/framework of Caldwell and Mays (2012) was highlighted, followed by the consideration of the study design, data collection and analysis. The three levels identified by Caldwell and Mays (2012) macro, meso and micro, within the MoH context were detailed, along with the four phases of the study design. In addition, the choice of sampling method was explained, accompanied by the sampling criteria.

Furthermore, the importance of the trustworthiness of the study has been considered; an in- depth discussion has been provided on this matter with a particular focus on reflexivity and the potential of the researcher’s influence on the research. Finally, the ethical considerations that apply to the conduct of this study were discussed, including the necessary documents obtained by both the UoS and the MoH that made the study possible.

105 The following chapter will highlight the research process and provide an in-depth analysis of the reality concerning the implications of the study, looking at the effects of the policy requiring a Bachelor’s degree education as a minimum for entry into the practice of nursing in SA. This analysis will consider the perspectives of the participants from all three levels, macro-meso-micro, within the context of the MoH.

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