Four principles guide the considerations of ethics in health care research. These are autonomy, non-maleficence, justice and beneficence (Beachamp and Childress 2001; Grove et al 2014). Autonomy is understood as respect for choice; this ‘allows’ the individual to withdraw from the research at any time and a consent form which points this out was sent to every student in the study (see appendix 7). Given that I was the teacher as well as researcher of the students in the study means that a decision to withdraw could be more difficult than would normally be the case. I therefore pointed out at every available opportunity that I was aware of this potential dilemma and reassured participating students that there would be no repercussions if they made this decision. The second principle of non-maleficence means no harm should occur to the participants. This condition was met by engaging in a person-centred
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manner, building trust, and respecting the right of the participants to answer the questions in any way they wished. It also meant being aware and responding appropriately to any sensitive issues that may arise. Providing details of the research methods and the rationale in the form of an information leaflet to would-be participants addressed this principle. It was also made clear that the information collected would not be used in any detrimental manner. This principle extends to the collection, storage and access to data. Issues such as the anonymity, confidentiality and dissemination of data have to be considered including awareness of legal protections such as the Data Protection Act, 1998 (Moule and Goodman, 2014). The names given in this thesis to both the students and the staff are pseudonyms in order that confidentiality and anonymity can be maintained. Access to the data is password protected and stored on my own personal laptop. The third principle is an obligation on the part of the researcher to ensure that the research is directed towards the benefit of others. This would mean ensuring that the findings are widely disseminated. This would entail sharing them with my colleagues and attending conferences to share them with others, and then seeking out relevant nursing and educational journals in order to publish these same findings. One of the reasons for undertaking this research was the hope that it would shed some light on helping to improve the student experiences of learning by enabling them to learn SMI consistent skills. The fourth principle, justice, is conceptualised as ensuring that equal access and opportunity is given to all who would wish to participate in the research irrespective of race, religion, age, sex or class. This principle enshrines the idea of fairness and this was achieved throughout the
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research by making sure that the sampling procedure was transparent and inclusive. It also meant that the interests of participants take precedence over any other issues. This principle also applies to issues regarding data, in which all views must be represented. If ethical issues or perhaps more accurately ethical tensions do arise during a research study then being mindful that informed consent is not a single event but an ongoing process is essential. This meant that the original advice, information on the consent form and any other aspects of the study were raised as a topic for discussion at regular intervals during the study.
A second aspect of conducting this research is to adopt a reflexive approach towards my own actions. I was mindful at all times of the key ethical principles to do no harm, to convey respect to the individuals in the study and to issues concerning storage of information gleaned about the participants. To behave in an ethical manner is enshrined not only in my own professional code of conduct (NMC 2015) but also through the advice and guidelines issued by the Health Research Authority, both universities and by the Royal College of Nursing. The principle of doing no harm and being respectful to the individuals I interviewed is to acknowledge the collaborative nature of the person-centred interviews. These are understood to mean using the skills of open questioning, making affirmations, reflecting, summarising, clarifying and on occasions probing, whilst at the same time making sure that the autonomy and dignity of the participant was maintained. All of the interviews were conducted in this style but there is a real possibility that my novice status as a researcher left some worries and concerns that were not acknowledged and left unexplored by myself. I had no awareness of any ethical tensions arising
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during the study but the power imbalance present in interviews does little to increase awareness of this process.
I acknowledged and tried to interpret nonverbal signs to give me indications if what I was saying was causing some stress for the interviewee. Sometimes it became necessary because of this to change the wording and timing of the questions because of feelings that some difficulties were arising in the interview. For example, it was clear that one student was becoming distressed when asked to describe her experiences of undertaking the SM module since she had difficulties with another member of the cohort who she felt was regularly discounting what she said. I judged that this student needed some reassurance and some attempt at validating her experiences, after which she appeared to regain her composure. I decided to go straight to the question about what a lecturer could do to help with the process of learning rather than focus on examining her beliefs and attitudes (see appendix 4). To do no harm could be interpreted as making sure that the participants did not feel that what they said was ignored, disregarded or misinterpreted during the study. I may also have inadvertently brought up issues that the participants may have preferred not to discuss; although I did not feel that this occurred there is no way of knowing that this was entirely true.
Power issues are ever present when a researcher conducts an interview but greater complex arises when existing unequal relationships such as those between teacher and student (Donalek 2005) are involved. Students may feel that they are obliged to give the answer that they think the lecturer wants to hear. Inequality in the distribution of power between researcher and participants needs to be acknowledged by and strategies
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put into effect to minimise its impact. Establishing relationships in which the interviewees feel safe to tell their stories is the key to managing issues in which student don’t feel able to share how they really feel (Murray 2003). One way to help to reduce this influence is by implementing practices that ensure that students are protected from harm. Stating that you are available to discuss the data and any implications at mutually agreed times can be reassuring to participants. In addition, giving written information about how the data is collected, stored and eventually disseminated can also help empower those interviewed. Informing all of the interviewees that the information gathered was available at any time for them to check for accuracy and interpretation was also an important step in aiming to reduce these power imbalances.