Ethical considerations

Ethical issues are ever present in phenomenological research because this methodology involves a personal engagement with the lived experiences of individuals (Usher and Holmes 1997). The researcher must consider the in-depth nature of the engagement and the rights and welfare of the participants. With this methodology there is potential that personal traits and experiences are revealed which may not be in the best interests of the individual. Throughout this study the four key ethical principles of beneficence, non-maleficence, autonomy, and justice (Beauchamp and Childress 2009) were maintained and the rights of individuals protected.

Beneficence refers to an obligation to contribute to the welfare and benefit of others and assist them with their legitimate concerns (Beauchamp and Childress 2009) and is a fundamental principle of ethical research (Polit and Beck 2004). It was not evident that any benefit would accrue to the individual midwives interviewed and they shared their stories and experiences without any expectation of reward or benefit. It was reassuring that the midwives so freely gave me their time and also appeared to enjoy the opportunity to talk about their practice. Many spent time chatting once the interview was complete and the recorder switched off.

Ethical research must balance beneficence with non-maleficence which asserts an obligation not to intentionally inflict harm (Dickenson et al. 2001). It was not anticipated that the interviews would cause distress. Apart from one midwife who withdrew her consent following the interview, other midwives commented that they enjoyed the experience and valued the opportunity to reflect and discuss their work. The interviews did not cause any obvious distress and when the recorder was turned off opportunities were provided to the midwives to discuss the interview and their feelings about it.

A third key ethical principle is autonomy. The participant must be facilitated to act or respond freely and choose to participate at a level where they are comfortable. Autonomy can also be considered in relation to the capacity of the individual to act intentionally and with understanding (Beauchamp and Childress 2009). This principle was considered in preparing the information sheet (Appendix 5) and

consent form (Appendix 6). Information provided on these forms was unambiguous and reflected the focus of the interview. All midwives who participated in the study were voluntary and were aware they could participate or withdraw at any stage. Once the information about the research was provided, it was the midwife’s decision to contact me. This was usually when I next met them on the unit though a few did contact me by phone or text message. Signed consent forms were obtained.

A particular consideration prior to undertaking the interviews was that participants would potentially be known to me and that this may influence both their decision to be involved and the information that they would provide. Though I have worked in midwifery education for several years, I had not taught the management of women in labour for many years, thus my involvement with labour ward staff was restricted to occasionally visiting midwifery students. Nevertheless, participants may have agreed to be involved because I was a familiar figure within the maternity hospital. At the time of doing the interviews this did not seem to be an issue and I had many volunteers willing to participate. The midwives spoke freely and conversations were relaxed. The midwives’ conversations were spontaneous and required little additional input once a question was asked. I was somewhat concerned that the everyday nature of the data was, in terms of Heidegger, ‘inauthentic’. Midwives described what they did and why, but it was not was always clear what their feelings were about their activities. As will be seen, the data from this phase of the study resonated with the findings of the metasynthesis and further probing for greater depth did not reveal different issues. It occurred to me that health professionals are required to manage their emotions in their work, particularly in their communication with others. This may have impacted on the midwives’ ability to express their feelings about their experiences and practices. It was interesting that in the second stage of data collection, the feelings of the midwives were more apparent from their dialogue. This will be explored in the findings.

Justice involves fairness to participants. At a minimum this requires that individuals are treated equally without favour or bias (Beauchamp and Childress 2009). This also involves a fair selection of participants, the requirement to protect the identities and also the confidentiality of any data (Usher and Holmes 1997).

All midwives were provided with the same information about the study. While sampling was purposive, I was not selective in the midwives I approached other than to ensure that I met midwives with the diversity of experiences I required. I valued all the contributions made, particularly from those midwives who gave up their personal time to be interviewed. As there was no personal benefit to participants it was reassuring that many of them related that it was a positive experience. They were informed of the purpose of the study and how the findings would be disseminated. Transcripts were available to them to review.

I gave a commitment that anonymity and confidentiality would be maintained. To comply with this, the privacy of the midwives was maintained during my visits to the unit and to ensure that identifying information would not be retained, participants selected pseudonyms which were used in transcribing the data. All electronic recordings and transcriptions were password protected and paper copies of transcripts kept to a minimum. These were available only to my supervisors.

The hospitals where the study took place are also not identified. However, it must be acknowledged that those familiar with the Irish maternity services are likely to identify the new maternity hospital as it opened with considerable publicity and as a consequence the first hospital may also become apparent to some.