The Fieldwork Research Design

The empirical research investigates the previously mentioned dilemmas and the means by which they are resolved, asking whether this involves invoking professional codes or guidelines on ethics or good practice. Using qualitative, some quantitative, and philosophical analyses, I assess and interpret the answer to these questions, investigating how and why ethical attitudes are formed and whether there is, as feminist philosophers claim, a significant difference in those of male and female healthcare workers and users. Or is this difference a socially constructed myth, rather than an immovable social reality?

4.4.1. Context

It might be expected that, as a result of their common experiences as social actors, users’ and practitioners’ views would express not merely individual, but also shared ethical values, although variations based on personal and cultural characteristics must exist within these. As Weber (1947) says: ‘Sociology ... is a science which attempts the interpretative understanding of social action in order thereby to arrive at a causal explanation of its cause and effects ... Action is social only in so far as, by virtue of the subjective meaning attached to it by the acting individual ... it takes account of the behaviour of others and is thereby orientated in its course’ (p88). From W eber’s point of view, the interactions, ethical or otherwise, between healthcare practitioners and users would constitute ‘social actions’. These arc motivated by the meanings held by the individual and take account of others’ actions (W eber 1949, pp. 136-147). In order to understand those social actions related to ethical practice in mental health settings, it is necessary to

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not only record, but also interpret them. In the process of interpretation, given the cross-disciplinary nature of empirical ethics, after initial qualitative analysis, philosophical analysis and discussion are employed.

4.4.2. Validity, Reliability and Replicability

The criteria of validity, reliability and replicability must also be considered when deciding between methodological options. Validity of measurement requires that this genuinely does measure what it purports to. The process includes the accurate and complete documentation of the social actions in their context, for example, the exact recording of the words spoken at the interview, although:

‘There may or may not be the need ... to transcribe all of your taped materials, or indeed every paragraph or line of each interview or taped field note. The actual transcribing should be selective’ (their emphasis).

(Strauss & Corbin, 1990.p30) According to Shipman (1997), in assessing the validity of the evidence gathered it is necessary to ask: review’, the reader’s responsibility is to ‘take up the offer’ (Shipman, 1997, pviii).

Reliability refers to the methods used and demands that ‘applying the procedure in the same way will always produce the same measure’ (King et al., 1994, p25). In research such as that described here, it must be stressed that test-retest reliability will not necessarily equate to the core concept of reliability, since each human

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situation has different characteristics, a factor particularly pertinent to the study of ethics in mental health practice. It implies that ‘the results from different occasions in a series of occasions of observation should confirm one another’ (Robertson, 1998, p 133). Data collection is considered complete, this source claims, ‘when the rate at which new themes appear becomes very small’ (ibid.). Sufficient information for the reader to be able to distinguish clearly between evidence and opinion is also essential.

Shipman (1997) claims that: ‘Reliability and validity tend to be incompatible’, particularly in research based on open-ended questions and qualitative accounts.

For this reason, great care had to be taken in ensuring that the questioning In addition, in researching a sensitive subject, much thought has to be given to the interaction between interviewer and respondent. In this respect, the training in philosophical counselling proved extremely useful insofar as the techniques on this are based on listening in a friendly, yet relatively “dead-pan” fashion and asking questions which encourage the respondent to think about what s/he is saying and elaborate on this. A simple example might be as follows:

Respondent: ‘So he was a real bad ‘un.’

Interviewer: ‘What do you mean by that?’

Respondent: ‘Well, he was always playing dirty tricks on you’

Interviewer: ‘Can you give me an example of a “dirty trick”?’

Respondent: ‘Well, like he’d have you up all night playing cards and that.

Assuming that the questions asked and the responses given are understood by interviewer and respondent in the way that each of these intended, employing this type of questioning is both valid and reliable.

Having said this, ‘both intention and understanding can be affected by factors that may not even be appreciated by both parties’ (Shipman, 1997) and the importance o f awareness of the interaction between interviewer and respondent is discussed in the section on "Reflexivity” below.

The research project is interpretative and could therefore be described as constructivist, in that it makes no firm predictive claims, but instead describes generating grounded theory from observations in the field. This subsequently revealed what was irrelevant and what was central to the project, changing the focus of the research and, by creating an accurate picture of ethical policy and practice in mental health settings, revealing that values arc inseparable from these.

4.4.3. Keflexivily

Ensuring that evidence obtained in the fieldwork interviews faithfully reflects the reality under investigation is vital. In interpretative research, the awareness of the subject and his or her interaction with the researcher means that ‘the appropriate metaphor is not of actors playing parts written for them, but of actors constructing their own roles in a drama that they helped to write’ (Shipman, p39). Both researcher and researched act reflexivcly.

At this juncture, a caveat is required in the interests of investigative responsibility.

My experience as a psychiatric nurse, observing ethical practice in mental health settings at first-hand, almost certainly introduced an inescapable subjectivity in approaching the research. Fieldwork in an area as sensitive as mental health is experiential in a very significant way, insofar as it involves not only the researcher’s physical presence but also his/her emotions. Indeed, a certain awareness of becoming insidiously "attached” to the research process could be said to develop. Part of qualitative research is recognising this relationship, given that achieving a maximum of objectivity must be a central concern to all research, although that objectivity can ever be totally assured in research of this nature is questionable. Particular care was therefore taken to ensure that the study was at least as objective as possible.

Perhaps it is relevant here to posit a redefinition of objectivity - the researcher could be said to be objective in recognising his/her own subjectivity (Coffey, 1999). When research involves human beings, controversy is inevitable. Bias can, according to Shipman (1997) enter at any of the three stages of research - the conceptual stage, the technical stage and finally, at the publication stage, when the findings might prove to be ‘loaded down with views not derived from the evidence itself’ ( p i8). It has, therefore, been essential to heed the latter’s advice, attempting to go beyond merely technical issues to the assumptions behind the design of the research and the way in which the results arc presented. Using one’s own life experience in intellectual work may prove to a certain degree inevitable, for as Wright Mills says in The Sociological Imagination: ‘You arc personally involved in every intellectual product upon which you may w ork’ (1959, p!96).

My years of experience of mental health practice are undoubtedly one of the motivating forces behind this particular research project. Maintaining personal

"bctes noires” under check during the interviews and the later interpretation of the fieldwork findings was possibly the most difficult part of the research.

Although Shipman (1997) recognises that ‘...from start to finish, an open mind is impossible. All researchers have preconceptions that affect what they see and how they interpret it’ (p42). That I was at least reasonably successful at keeping an open mind is perhaps illustrated by two things. The first, the fact that the initial interview findings surprised me to the extent that it was necessary to confirm them by means of a subsequent questionnaire survey. The second, that the subject of values eventually became central to answering the research question, although until analysing the fieldwork findings it had been of little relevance. Both represented a radical rethinking of the original research design - and an increased workload. Nonetheless, ‘it is impossible to confirm objectivity ... when the research is about humans, there is always controversy.’ (Shipman, 1977, p 18). As this author says, most researchers accept that we construct our own knowledge of the world around us and realise that there is ‘no detached position for neutral observation’ (ibid).