The purpose of this assignment is to critically discuss the ethical issues of the paper called ‘Does building resilience in undergraduate nursing students happen through clinical placements? A qualitative study. The author chose this paper as the research method used in the paper is one that may be seen in the studies that will be included in one’s systematic review. The author will discuss the ethical issues associated with this paper and hopes to critically discuss the ethical issues inherent in this research study along with a discussion of how ethical issues are acknowledged within this paper.
To summarise the study in the paper, a qualitative approach using focus group interviews was used on undergraduate nursing students in a Bachelor of Nursing programme in a local university in Singapore. The objective of the paper is to ascertain the undergraduate nursing student’s perceptions and experiences clinical practice and to determine what helped them build resilience. The background to the study is that there is a shortage of nurses which is an international problem and to highlight ways to decrease the rate of nurses leaving the profession. It has been highlighted that resilience was an important factor that encouraged nurses to stay in this highly stressful profession.
There were two elements to this study. Phase one was a quantitative survey using validated questionnaires on 126 nursing students who took part in the survey on their thoughts on resilience on clinical practice. Participants from this study were consulted so as seek voluntary participation in the focus group interviews in the second phase of the study. Of the 126 students who completed the survey, 19 students volunteered and consented to be contacted to participate in the focus group interviews. Ethics approval was sought from the University’s ethics committee. Signed consent forms were gathered following an explanation of the study to be carried out.
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Four focus group interviews were carried out with 9 two groups of undergraduate nursing students. The participants chose the venue and time of the audio-taped interviews which were transcribed verbatim and reviewed and validated by another researcher on the team to enhance trustworthiness. ‘’The time and location of the interview was convenient for the participants and it should also be ensured that the place is interference free’’ (Dilshad & Latif, 2013).
Ethics is about being aware of right from wrong. It is ‘’fundamental to good research’’ (Doody and Noonan, 2016). In conducting a study, from planning to publication the study should be ethically sound, as researchers face ethical challenges in all stages of the study. (Sanjari et al. 2014) The Nursing and Midwifery Board of Ireland (NMBI) (2015) identify core ethical principles when applying ethics to research which are autonomy, beneficence, non-maleficence, justice, veracity, fidelity and confidentiality. ‘’These core principles protect participants through voluntary consent, freedom from coercion, appropriate risk-benefit ratio, respect for autonomy, justice and fair selection.’’ (Doody and Noonan, 2016) In this study, the researchers obtained Ethical committee approval from the university Institutional Board. ‘’Before a study is carried out, ethical approval is required from the ethics committee in order to protect the rights, safety and wellbeing of participants.’’ (Doody and Noonan, 2016) The Ethics Committee looks at the risks and the benefits of the research study, thus, the principles of beneficence and non- maleficence related to the study. This is done in order to safeguard the participants of the study and the safety of the researcher.
They will want to ensure ethical standards are met. The study should contribute to the existing knowledge base of the area being studied. If there is no benefit, then it is considered unethical and the study should be ceased. In the study, the ethical standards were mostly upheld as the ethics committee approved the research study. ‘’Full autonomy requires participants to understand fully what is being asked of them and the effect participation will have on them; to be afforded the opportunity to ask questions before/during/after the study; and to comprehend that it is their choice to participate’’ (Doody and Noonan, 2016). They will also require that safety nets are in place should there be potential effects of the study. The researchers do not report that there any safety nets in this study. ‘’Ensuring that support mechanisms (e.g. counselling, employee assistance programme) are in place for participants who become distressed during or after data collection is important, especially when there is potential to highlight sensitive information, past experiences, or when it is difficult to anticipate the direction of data to be collected’’ (Doody and Noonan, 2016). There could be potential for this to happen in this study, as the students were in stressful situations and this could bring up emotions that cause harm to them psychologically.
‘’It is the responsibility of the researcher to demonstrate that they have taken the necessary steps to guarantee that the participant whose consent is being sought has been given the necessary information in an understandable manner’’ (Doody and Noonan, 2016). It is noted in the study that signed consent was obtained. Thus, participants would have expected to participate voluntary, free from coercion and without undue influence. They should be aware that they can withdraw at any stage without consequence. ‘’Though the participants ability to withdraw may not always be possible, such as after analysis and publication, or if they responded to an anonymous questionnaire’’ (Doody and Noonan, 2016). In the focus group the researcher should go through the consent procedure within the group and record any objections on tape.
In this study, the researcher claims that the purpose and nature of the study was explained. The participants should be given a detailed information leaflet. The participant needs to understand how data will be stored, analysed and used, including any details relating to how they will be identified. Also, how data will be used in the future. Permission should be sought if this is the case. The data collected should be treated in respect to the Data protection act 2018, local policies, and the ethics committee. The participant should be informed of these details as part of the consent process. Consent may need to be affirmed at different times to ascertain if they are willing to continue with the study. To prevent breaches of confidentiality, consent forms with personal identifiable information should be stored in a locked cabinet away from other information about the study.
Assurances of confidentiality was not mentioned in this study. This was probably done verbally and in writing or could have being done through an information sheet. Though it is not clear if it was made available to the participants in this research study. Participants should be aware that when they are disclosing information that they are aware of the professional’s obligation to report certain activities (e.g. self-harm) (NMBI, 2015)
In this study, focus group interviews were conducted with student nurses, as they are directly related to the issue being studied. ‘’Focus group interviews are an effective means of research through convenience sampling, as the researcher finds the information needed to produce the data results’’ (Dilshad & Latif, 2013). It is a common qualitative research technique. Some ethical issues that can arise from the use of focus group interviews are the risk of harm, consent, confidentiality and anonymity. In the study, the researcher only discusses consent and information giving. The risk of harm, confidentiality and anonymity is not touched upon. The disadvantages of focus group interviews are that participants may not express an honest opinion about the topic of discussion, or they may be influenced or intimidated by other participants in the group. ‘’Some participants may conform to the responses of other participants, even though they may not agree’’ (Dilshad & Latif, 2013). ‘’A few vocal participants may dominate other members in the course of group discussion’’ (Dilshad & Latif, 2013)
Regarding, consent and information, the detail of the focus group interview may be hard to predict. Topics may arise in discussion that are of a sensitive nature which maybe communicated outside the group. ‘’Interviews can pose some difficulties, as the direction of questions cannot always be anticipated, and probing questions are used to obtain meaningful information about the phenomenon under investigation’’ (Richards and Schwartz, 2002; Parahoo, 2014) as cited by (Doody and Noonan, 2016). The participants in the interview may have well known peers also in the interview.
Quotes from this study could be easily identifiable by others in the group outside the focus group interviews and they were students at a local hospital so they could be easily identifiable. It is hard to know beforehand about what discussions may arise, to protect the participants and make them fully informed about same. ‘’Anonymity can be hard to achieve especially through interviews’’ (Saunders et al. 2015). It is important that this is made aware to the participants that anonymity would be limited in the focus groups. ‘’The rules of confidentiality must be emphasized in the interviews and that the participants are given the opportunity to ask any questions they may have’’ (Dilshad & Latif, 2013). Overall, it appears that the researcher has no clear ethical standards protocol which could be used to ensure that the ethical standards are met.
To conclude, researchers face ethical challenges in all stages of a study. It is useful to apply ethical principles to research studies. The ethical principles which should be applied are autonomy, beneficence, non-maleficence, justice, veracity, fidelity & confidentiality. It is also essential to get ethical committee approval in order to protect the rights, safety and the wellbeing of participants. This was demonstrated in the study as the researchers got ethical committee approval from the institutional board and obtaining voluntary consent for phase two of the study, getting signed consent forms and explaining the nature and purpose of the study. Focus group interviews were used in this study. There are many advantages and disadvantages to this qualitative method of research. There are also many ethical issues that can arise with focus group interviews.
