Research methods unit III Scholarly Activity

4 NURSERESEARCHER 2010, 18, 1

commentary

The three themed papers in this edition identify particular issues in the ethi-

cal conduct of qualitative research. Some concerns are common to all three

papers and other concerns raise queries related to the conduct of the authors’

own research. This commentary will focus on three of these issues: gaining

access and recruitment, informed consent and the relationship between the

researcher and participant.

Ethical challenges in the conduct of qualitative research Desley Hegney and Tuck Wai Chan highlight the issues of particular relevance to qualitative studies

NURSERESEARCHER 2010, 18, 1 5

Accessing the research site and recruiting participants raise many ethical

questions that researchers need to take into consideration before starting

their research. Although the focus of the research might differ, the issues are

much the same for research by qualitative researchers as they are for those

involved in quantitative research. Houghton et al (2010) and Walls et al

(2010) describe how they required assistance from clinical staff to distribute

information about their research as part of their recruitment processes. Three

distinct steps are suggested:

Clinical staff can ask patients if they are interested in participating in research,

and if they are they are given written information. If, after reading this informa-

tion, the patients are still interested in participating in the research they contact

someone from the research team. Potential participants can then choose to opt

in or opt out and are also able to withdraw at any time.

Removing the researcher from the consent process until the potential par-

ticipant is willing to meet them helps to ensure that individuals do not feel

coerced into taking part in the research. In some instances, however, it is not

possible to use this process to recruit participants. For example, Houghton et al’s

(2010) research involved the observation of students who were providing care

to patients and, therefore, involved healthcare staff, patients and visitors to the

research area. The authors discuss their process for obtaining informed consent

to collect data in a public space. They note that visitors to the clinical area can

also become part of the research and that there can be difficulty in ‘deciding

from whom to obtain informed consent and by what means’. The strategy used

to overcome this was to place posters in public spaces to inform visitors and to

provide information sheets for the ward staff. What the authors do not consider

is what might happen if a visitor does not consent to participate in the research.

Does this mean they are unable to visit their relative or does it mean that the

research must be suspended?

A controversial alternative might be for research participants to opt out rather

than to opt in to some forms of research. That is, if people do not indicate their

desire not to be involved in the research then they are considered to have con-

sented to be in the research. How participants had received sufficient informa-

tion would, of course, need to be demonstrated to and then approved by the

relevant research ethics committee (REC). Houghton et al (2010) consider how

6 NURSERESEARCHER 2010, 18, 1

commentary

a ‘potentially exploitative relationship’ can arise between the researcher and the

research participant and link this to the ethical principles of ‘autonomy, benefi-

cence and justice’. In the conduct of their research, and in all human research, the

principle of justice is the most important. Are the students being treated as mere

objects of the researcher or as a resource with little or no consideration of their

wellbeing? A similar question could be asked when conducting sensitive research

as described by McGarry (2010). Given the sensitive nature of the research, are

the participants the right ones to be recruited or are they simply a group that is

easy to access?

Houghton et al (2010) also discuss the principles of beneficence and non-

maleficence, noting that the researchers have to ‘calculate the risk-benefit

ratio’. They state that the ‘benefit of the interview does not outweigh the

harm of distress’. This statement acknowledges that all research carries the

risk of some harm; it is just the degree of harm that has to be balanced. They

note that if the interviewee becomes distressed then the researcher ‘may

(our emphasis) refer participants to appropriate professional intervention’. It

could, however, be argued that researchers have an obligation to take action.

Consideration should also be given to the fact that the distress constitutes an

adverse event which must be reported to the REC. In any research protocol,

harm should be anticipated and processes put in place to manage it.

Houghton et al (2010) also highlight the complex ‘dual role of the clinician

and researcher’. They use the example of a ‘potentially dangerous’ situation

where the researcher observes poor care. They argue that here the researcher,

as a nurse, should intervene. There are arguments in some research disci-

plines that interfering in this way might not be appropriate, but when the

researcher is a nurse, with a professional obligation that takes precedence

over their role as a researcher, they have no choice but to always consider the

care of the patient first. Houghton et al (2010) demonstrate the complexity

of this relationship by describing research in which a nurse researcher was

observing a nursing student delivering care to a patient. They say that if

researchers observe harm they are obliged to intervene. It could be argued

that the obligation not to cause harm in this situation rests with the student.

Further, the nurse-researcher has no obligation beyond reporting the situation

to another member of staff. Researchers need to be aware of which role they

NURSERESEARCHER 2010, 18, 1 7

are working in and that they have multiple roles (nurse, teacher, researcher)

and must consider how these roles might clash with or affect their research.

These three papers have examined some interesting ethical considerations

but they also suggest that the ethical conduct of qualitative research (in the

social behavioural research ethics paradigm) is somehow different to that of

quantitative research. While many RECs may believe that there is a greater

risk of harm from poorly designed social science research, this is not neces-

sarily so. Ethical principles should equally apply to all research regardless of

the paradigm being used. Many of the issues considered apply as equally to

quantitative research as they do to qualitative research n

Desley Hegney is director of research, Alice Lee Centre for Nursing Studies,

National University of Singapore and Faculty of Health Sciences, the

University of Queensland

Tuck Wai Chan is associate director, Institutional Review Board,

National University of Singapore

Houghton CE, Casey D, Shaw D, Murphy K (2010) Ethical challenges in qualitative research: examples from practice. Nurse Researcher. 18, 1, 15-25.

McGarry J (2010) Exploring the effect of conducting sensitive research. Nurse Researcher. 18, 1, 8-14.

Walls P, Parahoo K, Fleming P, McCaughan E (2010) Issues and considerations when researching sensitive issues with men: examples from a study of men and sexual health. Nurse Researcher. 18, 1, 26-34.

references

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.