Ethical Considerations

Prior to undertaking research, it is imperative to consider ethical implications and ensure ethical research practice (RON, 2009a; Bradbury-Jones and Alcock, 2010). I therefore sought ethical research guidance from published literature, fellow researchers and my supervisors to ensure all ethical viewpoints had been considered before applying for research approval. The ethical approval was finalised through a formal application to and consideration by the relevant Ethics Committees at both the host University where the students were recruited and nurse teachers were working, and within the University where I was enrolled as a post-graduate student. Both Ethics Committees issued a favourable response to the applications for research approval for both the student interviews (appendix 2) and subsequently the nurse teacher interviews (appendix 3).

The role of an Ethics Committee is to protect those involved in the research, participants and researchers, from any risks inherent within the research design and ensure the proposed research has potential value so participants are not exposed to unnecessary or pointless intrusions (RCN, 2009a). For example, if a participant should become distressed during an interview, perhaps through recalling a difficult or challenging experience in practice, then the researcher would need to have plans to manage that situation in order to protect the participant. For the purposes of my study where this risk existed, I planned for managing potential student distress by immediately stopping the interview and advising the participant to seek their usual source of support, such as their Personal Tutor. I would provide any immediate comfort required but would not pursue the questioning unless the participant recovered composure and specifically requested to continue with the interview. Due to the emotional nature of nursing practice, participants may disclose experiences that bring back feelings from the time of the experience, but that is not necessarily harmful as long as ongoing management of those emotions is provided (RCN, 2009a). Therefore, included within the application for ethical approval was a detailed risk analysis to demonstrate how all potential risks to the participants and the researcher were managed (appendix 4).

The use of student nurses as participants required special consideration of ethical research practice, as they were vulnerable to coercion and due to the pressures of their programme, may already feel under duress (RCN, 2009a; Bradbury-Jones and Alcock, 2010). There needed to be careful consideration of potential role conflicts in the research relationship, particularly if the researcher was known to the students in the capacity of educator or manager, as students could feel unable to decline to take part (Steinke, 2004). These considerations required acknowledgement alongside all the usual requirements for ethical research practice.

For this study, I made a deliberate decision to recruit participants from a University distant to where I was employed as a nurse teacher or had worked as a RN. Recruiting from within my own University student nurse population as a member of their teaching staff, would have meant I would be personally known to potential participants. Despite the personal convenience that local population sampling would have provided me, as opposed to the time, travel and accommodation expenses associated with recruitment and data collection from a geographically distant area, I decided that remote recruitment was required in order to minimise the risk of participant coercion. Some researchers justify using their own students in research in that it remains true to established relationships (Roberts, 2009), however my personal feeling was that my familiarity with student nurses at the University of Surrey could not only impact upon their feeling obliged to volunteer, but it could also impact upon the truthfulness within the data collected. I believed they may be more inclined to withhold information during their interview if they felt that disclosure could leave a negative impression about themselves or other people known to me. By collecting my data a considerable distance away from where I was known, I was better able to ensure participants’ trust and honesty, and I felt I was more likely to be able to seek the truth within their socialisation experiences.

According to the ethical principles of research (Beauchamp and Childress, 1994; Moule and Hek, 2011), researchers must adhere to the principles of veracity and autonomy, fidelity and

respect, non-maleficence and beneficence, and justice. To ensure veracity and autonomy, fidelity and respect, the participants would be told the truth in terms of an honest disclosure about the research focus, it being their decision whether or not to take part, that they could leave at any time without consequence to them, and that they would be treated with respect, their privacy and well-being would be maintained, with their anonymity protected. To ensure beneficence and non-maleficence, the research was undertaken in good faith that it could provide new and valuable knowledge of importance to society, and in through using a non- judgemental and risk managed process, not cause harm to individual participants or society. The research was carried out fairly, ensuring equality and respectfulness, and thereby worthy of the principle of justice.

Each participant’s decision to take part was informed through provision of general details about the research within an information leaflet prior to volunteering to participate (appendix 5a) and agreeing to participation was recorded through signing an informed consent form (appendix 6). Participants’ consent was on-going, with opportunities provided when they could withdraw from the study, before, during and after the interview, or withdraw their transcript from the data set at the point of member-checking.

Within traditional Glaserian Grounded Theory there is no requirement for the use of consent forms as this is seen as potentially interfering with the free flowing nature of theoretical sampling and open discussion (Glaser, 1992). However, the ethical requirements of research within most organisations do require evidence of consent (Artinian et al., 2009), and so consent forms were used. I argue that being aware of this digression from Glaser’s original guidance was sufficient to ensure my theoretical sampling and interviewing retained openness alongside informed consent by participants. Glaser did acknowledge that interpretations and variation within some processes in Glaserian Grounded Theory were acceptable if rationale was provided justifying the variation, as long as the central Grounded Theory concepts were adhered to (Glaser, 1999).

Further steps to ensure the research was ethically sound were also taken, such as protecting the participants’ anonymity in the transcripts and thesis through the use of numerical pseudonyms, and keeping confidential the content of an individual’s interview; meeting the requirements of the Data Protection Act (1998). I therefore assigned the numerical pseudonyms to the consent forms that provided the participants’ names and email contact information, and these were the only identifier provided thereafter, such as on the digital recordings and transcripts, further protecting confidentiality while ensuring an audit trail (Mason, 2007).

These steps are fundamental requirements of ethical research (RCN, 2009a). The identity of the students and nurse teachers was only recorded on the consent forms which were put into secure storage, and their anonymity was further protected within the transcripts when they made specific references to personal information. Disclosures of personal information during the interview were appropriately ‘reworded’ in the transcript by the researcher to maintain the essence of what was said without the features of an individual’s identity being exposed, such as changing the participant’s use of a person’s name to ‘participant’s tutor’ or of a named practice placement to ‘a surgical ward’.

Member-checks by participants, as discussed later, further ensured this process and provided reassurance to the participants of their anonymity as well as reassurance to me that meaning was not lost in the rewording. When I emailed the transcripts to participants for member-checking, I firstly thanked them again for taking part and told them that any references that could expose their identity in their transcript had been reworded, and if they had any concerns about the content they could let me know. None of the participants responded to me with concerns about the transcript, and those that did subsequently email me did so only to thank me for the opportunity to take part.

Demographic data in relation to each participant’s age and ethnicity was not requested although words used by participants and recorded within transcripts were not disguised if

they provided this information, as long as they did not expose an individual participant identity. Glaser (1999) suggests that true understanding of phenomena comes from participants’ experiences and theoretical sampling to explore the breadth and depth of their experiences, and therefore is not dependent upon having a ‘representative sample’ from a population. For this reason, gathering demographical data and demonstrating demographic variation is only of relevance if central to data emerging and theoretical sampling (Artinian et al. 2009).

I was also aware of the ethical responsibility to make participation as enjoyable and meaningful as possible, hoping the students would learn the satisfaction of taking part in research through a positive experience of participating (RCN, 2009a). After each interview I explained that I hoped to publish my research in due course and gave all the participants an opportunity for me to send on a synopsis of my findings through an email communication route, explaining that this might be a few years away as my data collection was still on-going and my PhD studentship was part-time. Several of the participants expressed interest in knowing the final research findings but none of them requested a personal synopsis, with some saying that they did not know where they would be in a few years, and several responding that they would read about it in the nursing press when it was published. For the participants, the offer of member checks following transcription of their interview was expressed as sufficient post-interview communication.

Reflecting back on the participant recruitment, data collection and analysis, I feel all ethical considerations were undertaken seriously and successfully.