Nurse Researcher
Ethics and originality in doctoral research in the UK Cite this article as: Snowden A (2014) Ethics and originality in doctoral research in the UK. Nurse Researcher. 21, 6, 12-15. Date of submission: April 13 2013. Date of acceptance: July 8 2013. Correspondence Austyn Snowden [email protected] Austyn Snowden PhD, BA(Hons), BSc(Hons), RMN is professor in mental health at the University of the West of Scotland, Paisley, UK Peer review This article has been subject to double-blind review and has been checked using antiplagiarism software Author guidelines rcnpublishing.com/ r/nr-author-guidelines
Abstract Aim To show that the ethics governance process in the UK is not necessarily conducive to innovative investigation by doctoral students. Background Doctoral students need to demonstrate an original contribution to knowledge. This paper critically evaluates the concept of knowledge in relation to the concept of research paradigms. The purpose of this is to situate different claims to originality and show that original knowledge in nursing is always ethical knowledge of nursing. Data sources Academic databases, local and national policy documents.
be detrimental to the construction of original knowledge in nursing. This is because original research in nursing necessarily affects the ethics of care, but the gatekeeping function of risk-averse ethics committees tends to prevent students attempting ethically complex studies. This means less important research gets carried out. Conclusion To mitigate these issues, doctoral students need to develop a solid understanding of the ethics governance process. They need to build relationships with relevant ethics committees. University ethics committees are ideally placed to help with this process.
Review methods Ethics governance procedures in nurse research in the UK are summarised. These are contrasted with ethical issues embedded in day-to-day nursing practice.
Implications for research/practice Without original research practice will remain reactive. Originality entails risk on the part of both researcher and ethics committee. Positive risk taking is more feasible in the context of collaboration and mutual understanding. Nurses should become more active in research governance.
Discussion The author’s argument is that current methods of ethics governance for doctoral research in the UK can
Keywords Doctoral study, ethics, ontology, originality, PhD, research governance, supervisor
Introduction DOCTORAL STUDENTS, like all nurse researchers in the UK, need to demonstrate and defend an original contribution to knowledge (Holligan 2005, Snowden 2006, Scottish Credit and Qualifications Framework 2012). For them to claim originality, the nature of knowledge needs to be understood (Snowden 2006). This is not straightforward, as there is no agreed definition of knowledge. Instead, there is broad agreement that it consists of cognitive processes including belief, perception, association and reasoning (Cavell 2002). This position is most easily summarised as the ‘paradigm view’ (Denzin and Lincoln 2005), which situates knowledge as a component in an internally valid structure 12 July 2014 | Volume 21 | Number 6
that includes the relationship of knowledge to ontological and methodological assumptions (Table 1). For example, if it is someone’s view (belief) that the world is socially constructed, then his or her knowledge of that world must be logically coherent with that view. The problem with this is that, by selecting a particular paradigm, researchers are embedding their own assumptions about the world (ontology) into their research. While paradigms offer a robust, internally logical method of developing knowledge based on those assumptions (Paley 2011), they do nothing to externally verify them. Paradigms therefore eliminate externally valid claims about what is true (Snowden and Atkinson 2012). © RCN PUBLISHING / NURSE RESEARCHER
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Innovation
Ethics as process Ethics are enacted by considering a balance of agreed values. Ideally, an action would do good, do no harm and respect an individual’s autonomy, within the spirit of agreed principles of justice (Beauchamp and Childress 2009). These values often compete, which is the origin of most ethical dilemmas (Figure 1), but the basic principles are consistent. For example, ethical frameworks used in the judgement of safe research align with the ethical principles underpinning human rights legislation and the code of practice in nursing (Nursing and Midwifery Council 2008). The ethics governance process in UK research applies these principles to come to a judgement on the safety and quality of a research proposal. All student research has to be approved by university ethics committees. All research involving users of NHS services needs to go through the Integrated Research Application System (IRAS) for ethics approval. Permission is also required from local research and development departments. These processes can be daunting for novice researchers (Hunter 2011, Greaney et al 2012). The IRAS form consists of 80 different sections about the basic protocol information and then requires further site-specific details. Ethics committees scrutinise an application alongside the paperwork proposed for use in the study, including consent forms, participant information sheets, detailed protocol, Gantt charts and timelines. Gaining ethical approval is therefore extremely useful for researchers in clarifying exactly what they want to do and to whom, as well as where, how, when and why. Shaw (2011) went as far as to suggest that ethics committees should be © RCN PUBLISHING / NURSE RESEARCHER
Table 1
Summary view of two paradigms
Paradigm
Positivist
Constructivist
Ontology
There is a true version of events
The world is co-created by its participants
Facts and numbers
Stories and texts
Experiment
Interpretation
Statistical demonstration of correlation and causality
Complex and disputed, but includes ethics, parsimony
Epistemology Method Quality beacon
considered co-authors because of their role in this process. By the time ethical approval has been received, researchers can be confident they have workable projects. However, the prime purpose of the ethics committee is the protection of patients: ‘In medical research involving human subjects, the wellbeing of the individual research subject must take precedence over all other interests’ (World Medical Association 2008). This generates three related problems. The first is that, while the ethics process provides approval to proceed, it may not help to determine the best way of answering the research question, particularly if the ethics committee is unfamiliar with the proposed methodology. To pass ethical scrutiny, the researcher has to ‘stand firm’ on ethics committees (Carey 2010). This may be difficult for novices and the researcher may be tempted to choose an easier method, to the detriment of originality. For example, the onus to obtain informed consent is on the researcher (Iacono 2006) and, where this is difficult, such as Figure 1 Four ethical principles in tension
Beneficence
Autonomy
Justice
Non-maleficence
Adapted with permission from Nurse Education Today
Although this is an extreme position, it is important because students need to understand any limits to their claims to originality. These issues are rarely discussed in articles about paradigms, such as Houghton et al (2012). While it is necessary to understand the importance of coherence between assumptions and evidence (Kramer-Kile 2012), it is unnecessary to show that one set of assumptions is superior to another. Rorty’s (1981) pragmatism is important because it bypasses the issue, suggesting the best research has a social function; his priority was the ethics of research, not its ontology. This essentially political perspective is pertinent to nursing research (Malachowski 2010), where the focus is fundamentally moral. To be original, a nursing PhD always has to address the issue of the right thing to do (Snowden 2011).
July 2014 | Volume 21 | Number 6 13
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Nurse Researcher
Autonomous
Autonomy generation
Possible conflict
s
die
tu hs
ug
hro
yt wa
Dependent
Candidate’s status
Figure 2 Negotiation of the ‘rackety bridge’
ath lp
a Ide
Appropriate support
Benign neglect
Hands on Hands off Supervisor’s recent style (Adapted from Gurr 2001)
with vulnerable populations (Wilson and Hodgson 2012), the researcher may avoid this route and either investigate a less important question or conduct the research with a less relevant population. The second problem is that viewing ethical judgements in research as gatekeeping has the potential to minimise the originality of research over time. If researchers view ethics as a bureaucratic hurdle to successful research, instead of as an integral aspect of it, presuppositions will tend to go unchallenged (Wilson 2011). For example, worthy focuses of mental health nursing research are stigma, inequality, consent and capacity, but ethics committees may inadvertently discourage such investigations by protecting groups they consider vulnerable because of these issues. Wilson and Hodgson (2012) claimed that such procedural prioritisation devalues the perspectives of the people most likely to make accurate judgements, such as those people deemed incapable and the nurses caring for them. The issue of vulnerability and research participation is complex (Lange et al 2013), but it is rational to aim for ‘authentic’ (Kim 2011) research. Kim (2011) defines authenticity as a function of congruence between a person’s values and decisions. Because he is defining authenticity in the context of autonomy for people with cognitive problems, he sees authenticity as a moral imperative. To generalise this point, authentic research would not only do no harm, it would also do good. While ethics committees want the latter, their final judgements are focused on the former. The third problem is that ethical judgements are difficult to make, particularly when the research methodology is not entirely familiar to the committee (Carey 2010). As a consequence, there is marked inconsistency in the types of judgements 14 July 2014 | Volume 21 | Number 6
made by ethics committees (Sayers 2007). For example, one committee recently deemed without ethical scrutiny that a study in which I was involved was safe to proceed. The local research and development department disputed this because it had concerns about the potential inclusion of people with capacity issues. This department then forwarded their query to Scotland A REC, a special committee held to review complex cases such as those entailing adults with capacity issues. This committee decided that the study was instead suitable for ‘proportionate review’, a form of review entailing a subgroup of a full committee. This committee in turn decided that a full REC committee should instead review the application, bringing us round in a complete cycle. All these judgements were defensible and made by rational people, but they are difficult and inconsistent. As such, the relationship of the researcher to the committee can have a significant effect on the outcome (Larkin et al 2008). In the example above, the committees that did not know the research team made the more riskaverse judgements. Generating original knowledge through a PhD therefore needs an expert guide who understands the moral and legal implications of the proposal, the academic requirements of the PhD and the potential points of conflict between the two in the research. This is an evolving process (Figure 2). However, the structure of the research process means the issue of ethics arises early, when the student is least experienced. As a consequence, the supervisor needs to be more proactive in this discussion than would be the case if the student were more autonomous (Snowden 2013). I would also argue, after Larkin et al (2008), that ethics committees should be included in these discussions as early as possible so they will be better placed to judge the researcher’s authenticity. If the committee trusts the researcher, it is more likely to believe the project is in safe hands (Larkin et al 2008). The best way to demonstrate trustworthiness in research is to demonstrate clear thinking and communication (Sellman 2006). Universities are best placed to facilitate this in the first instance. The student’s university is responsible for formally approving all research projects, a position critiqued in the spirit of this paper by McAreavey and Muir (2011). University approval involves scrutiny of the research proposal in the same manner as approval by ethics committees. However, there is also a potential opportunity for a more informal discussion of the best way of constructing © RCN PUBLISHING / NURSE RESEARCHER
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Innovation the research project, including a detailed examination of decisions made to date. At the University of the West of Scotland, for example, the committee invites students to discuss methodology and ethics. This prepares students for the types of peer review questions they are likely to face with the external committee and helps them to become more familiar with the effects of their choices. There is also an opportunity to discuss the likelihood of original work emerging from the chosen methodology. Knowing that the committee considers the relationship between ethics and originality, the student and the supervisor are more likely to have considered the issue in appropriate depth. They will then be more comfortable with the ethics process and their defence of their methodology, and so are more likely to engage in similar style with external committees. Ethics committees want to support original research (Larkin et al 2008). They are much more likely to do so if the student and supervisor want to collaborate with them to this end and can demonstrate they understand the implications of their proposal.
Conclusion It is not always obvious what the right thing to do is. For example, ethical tensions sit at the heart of aspirations to deliver person-centred care
(Francis 2013) in a culture that prioritises risk aversion (Wirtz et al 2006). Original research is therefore needed to deconstruct these ideals into their meaningful components to answer genuinely difficult questions (Cribb and Owens 2010). To develop a robust proposal investigating issues such as these, it is essential that students, supervisors and ethics committees work together to construct the best route. This requires open communication at all levels (Larkin et al 2008). This paper began by criticising research paradigms, showing that nursing research should not begin with a declaration of how the world is but with a practical problem of clinical significance (Rorty 1999, Isaacs et al 2009). The first question to ask is not ‘What is the best method?’ but ‘What is the best question?’ (Risjord 2010). The process of gaining ethics permissions has an unheralded role in helping bridge these two questions (Shaw 2011) and university ethics committees have a highly significant role to play here: by focusing the student and supervisor on the interrelated effect of research question and methodology, they can provide rounded ethical and scientific reviews before external scrutiny. The product should be a more confident and able student capable of collaborating with subsequent ethics committees to generate original, important and ethical nursing knowledge.
Online archive For related information, visit our online archive and search using the keywords Conflict of interest None declared
References Beauchamp T, Childress J (2009) Principles of Biomedical Ethics. Sixth edition. Oxford University Press, New York NY.
Houghton C, Hunter A, Meskell P (2012). Linking aims, paradigm and method in nursing research. Nurse Researcher. 20, 2, 34-39.
Carey E (2010) Navigating the process of ethical approval: a methodological note. The Grounded Theory Review. 9, 3, 19-33.
Hunter D (2011) A hands-on guide on obtaining research ethics approval. Postgraduate Medical Journal. 87, 1030, 509-513.
Cavell S (2002) Must We Mean What We Say? Cambridge University Press, Cambridge.
Iacono T (2006) Further comments on the researched, researchers and ethics committees: a response. Journal of Intellectual and Developmental Disability. 31, 3, 189-191.
Cribb A, Owens J (2010) Whatever suits you: unpicking personalization for the NHS. Journal of Evaluation in Clinical Practice. 16, 2, 310-314. Denzin NK, Lincoln YS (2005) The Sage Handbook of Qualitative Research. Third edition. Sage Publications, Thousand Oaks CA. Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Executive Summary. tinyurl.com/lcsocyg (Last accessed: June 16 2014.) Greaney A, Sheehy A, Heffernan C et al (2012) Research ethics application: a guide for the novice researcher. British Journal of Nursing. 21, 1, 38-43. Gurr GM (2001) Negotiating the ‘Rackety Bridge’ – a dynamic model for aligning supervisory style with research student development. Higher Education Research and Development. 20, 1, 81-92. Holligan C (2005) Fact and fiction: a case history of doctoral supervision. Educational Research. 47, 3, 267-278.
Isaacs S, Ploeg J, Tompkins C (2009) How can Rorty help nursing science in the development of a philosophical ‘foundation’? Nursing Philosophy. 10, 2, 81-90. Kim SY (2011) The ethics of informed consent in Alzheimer disease research. Nature Reviews. Neurology. 7, 7, 410-414. Kramer-Kile ML (2012) Situating methodology within qualitative research. Canadian Journal of Cardiovascular Nursing. 22, 4, 27-31. Lange MM, Rogers W, Dodds S (2013) Vulnerability in research ethics: a way forward. Bioethics. 27, 6, 333-340. Larkin PJ, de Casterlé BD, Schotsmans P (2008) A relational ethical dialogue with research ethics committees. Nursing Ethics. 15, 2, 234-242. Malachowski A (2010) The New Pragmatism. Acumen Publishing, Durham.
© RCN PUBLISHING / NURSE RESEARCHER
McAreavey R, Muir J (2011) Research ethics committees: values and power in higher education. International Journal of Social Research Methodology. doi:10.1080/13645579.2011.565635 Nursing and Midwifery Council (2008) The Code: Standards Of Conduct, Performance and Ethics For Nurses And Midwives. tinyurl.com/737we4y (Last accessed: April 4 2014.) Paley J (2011) The fictionalist paradigm. Nursing Philosophy. 12, 1, 53-66. Risjord M (2010) Nursing Knowledge: Science, Practice and Philosophy. Wiley-Blackwell, Chichester. Rorty R (1999) Philosophy and Social Hope. Penguin, London. Rorty R (1981) Philosophy and The Mirror Of Nature. Princeton University Press, Princeton NJ.
Snowden A (2006) The requirements for original doctoral research in nursing. Nursing Times. 102, 38, 38-40. Snowden A (2011) Medication. In Barker P (Ed) Mental Health Ethics: The Human Context. Routledge, Abingdon. Snowden A (2006) The requirements for original doctoral research in nursing. Nursing Times. 102, 38, 38-40. Snowden A (2013) Research supervision without style. Nurse Education Today. 33, 12, 1462-1464. Snowden A, Atkinson J (2012) Concurrent analysis: a pragmatic justification. Nursing Philosophy. 13, 2, 126-141. Wilson A (2011) Research ethics and the ‘iron cage’ of bureaucratic rationality. Addiction Research & Theory. 19, 5, 391-393.
Sayers GM (2007) Should research ethics committees be told how to think? Journal of Medical Ethics. 33, 1, 39-42.
Wilson A, Hodgson P (2012) Ethics in social research. In Love K (Ed) Studies in Qualitative Methodology: Volume 12. Emerald Group Publishing, London.
Scottish Credit and Qualifications Framework (2012) SCQF Level Descriptors (Revised). tinyurl.com/qgkmxsc (Last accessed: April 4 2014.)
Wirtz V, Cribb A, Barber N (2006) Patientdoctor decision-making about treatment within the consultation: a critical analysis of models. Social Science and Medicine. 62, 1, 116-124.
Sellman D (2006) The importance of being trustworthy. Nursing Ethics. 13, 2, 105-115.
World Medical Association (2008) Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. tinyurl. com/ybajjsp (Last accessed: April 4 2014.)
Shaw DM (2011) The ethics committee as ghost author. Journal of Medical Ethics. 37, 12, 706.
July 2014 | Volume 21 | Number 6 15
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Ethics and originality in doctoral research in the UK Cite this article as: Snowden A (2014) Ethics and originality in doctoral research in the UK. Nurse Researcher. 21, 6, 12-15. Date of submission: April 13 2013. Date of acceptance: July 8 2013. Correspondence Austyn Snowden [email protected] Austyn Snowden PhD, BA(Hons), BSc(Hons), RMN is professor in mental health at the University of the West of Scotland, Paisley, UK Peer review This article has been subject to double-blind review and has been checked using antiplagiarism software Author guidelines rcnpublishing.com/ r/nr-author-guidelines
Abstract Aim To show that the ethics governance process in the UK is not necessarily conducive to innovative investigation by doctoral students. Background Doctoral students need to demonstrate an original contribution to knowledge. This paper critically evaluates the concept of knowledge in relation to the concept of research paradigms. The purpose of this is to situate different claims to originality and show that original knowledge in nursing is always ethical knowledge of nursing. Data sources Academic databases, local and national policy documents.
be detrimental to the construction of original knowledge in nursing. This is because original research in nursing necessarily affects the ethics of care, but the gatekeeping function of risk-averse ethics committees tends to prevent students attempting ethically complex studies. This means less important research gets carried out. Conclusion To mitigate these issues, doctoral students need to develop a solid understanding of the ethics governance process. They need to build relationships with relevant ethics committees. University ethics committees are ideally placed to help with this process.
Review methods Ethics governance procedures in nurse research in the UK are summarised. These are contrasted with ethical issues embedded in day-to-day nursing practice.
Implications for research/practice Without original research practice will remain reactive. Originality entails risk on the part of both researcher and ethics committee. Positive risk taking is more feasible in the context of collaboration and mutual understanding. Nurses should become more active in research governance.
Discussion The author’s argument is that current methods of ethics governance for doctoral research in the UK can
Keywords Doctoral study, ethics, ontology, originality, PhD, research governance, supervisor
Introduction DOCTORAL STUDENTS, like all nurse researchers in the UK, need to demonstrate and defend an original contribution to knowledge (Holligan 2005, Snowden 2006, Scottish Credit and Qualifications Framework 2012). For them to claim originality, the nature of knowledge needs to be understood (Snowden 2006). This is not straightforward, as there is no agreed definition of knowledge. Instead, there is broad agreement that it consists of cognitive processes including belief, perception, association and reasoning (Cavell 2002). This position is most easily summarised as the ‘paradigm view’ (Denzin and Lincoln 2005), which situates knowledge as a component in an internally valid structure 12 July 2014 | Volume 21 | Number 6
that includes the relationship of knowledge to ontological and methodological assumptions (Table 1). For example, if it is someone’s view (belief) that the world is socially constructed, then his or her knowledge of that world must be logically coherent with that view. The problem with this is that, by selecting a particular paradigm, researchers are embedding their own assumptions about the world (ontology) into their research. While paradigms offer a robust, internally logical method of developing knowledge based on those assumptions (Paley 2011), they do nothing to externally verify them. Paradigms therefore eliminate externally valid claims about what is true (Snowden and Atkinson 2012). © RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 30, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Innovation
Ethics as process Ethics are enacted by considering a balance of agreed values. Ideally, an action would do good, do no harm and respect an individual’s autonomy, within the spirit of agreed principles of justice (Beauchamp and Childress 2009). These values often compete, which is the origin of most ethical dilemmas (Figure 1), but the basic principles are consistent. For example, ethical frameworks used in the judgement of safe research align with the ethical principles underpinning human rights legislation and the code of practice in nursing (Nursing and Midwifery Council 2008). The ethics governance process in UK research applies these principles to come to a judgement on the safety and quality of a research proposal. All student research has to be approved by university ethics committees. All research involving users of NHS services needs to go through the Integrated Research Application System (IRAS) for ethics approval. Permission is also required from local research and development departments. These processes can be daunting for novice researchers (Hunter 2011, Greaney et al 2012). The IRAS form consists of 80 different sections about the basic protocol information and then requires further site-specific details. Ethics committees scrutinise an application alongside the paperwork proposed for use in the study, including consent forms, participant information sheets, detailed protocol, Gantt charts and timelines. Gaining ethical approval is therefore extremely useful for researchers in clarifying exactly what they want to do and to whom, as well as where, how, when and why. Shaw (2011) went as far as to suggest that ethics committees should be © RCN PUBLISHING / NURSE RESEARCHER
Table 1
Summary view of two paradigms
Paradigm
Positivist
Constructivist
Ontology
There is a true version of events
The world is co-created by its participants
Facts and numbers
Stories and texts
Experiment
Interpretation
Statistical demonstration of correlation and causality
Complex and disputed, but includes ethics, parsimony
Epistemology Method Quality beacon
considered co-authors because of their role in this process. By the time ethical approval has been received, researchers can be confident they have workable projects. However, the prime purpose of the ethics committee is the protection of patients: ‘In medical research involving human subjects, the wellbeing of the individual research subject must take precedence over all other interests’ (World Medical Association 2008). This generates three related problems. The first is that, while the ethics process provides approval to proceed, it may not help to determine the best way of answering the research question, particularly if the ethics committee is unfamiliar with the proposed methodology. To pass ethical scrutiny, the researcher has to ‘stand firm’ on ethics committees (Carey 2010). This may be difficult for novices and the researcher may be tempted to choose an easier method, to the detriment of originality. For example, the onus to obtain informed consent is on the researcher (Iacono 2006) and, where this is difficult, such as Figure 1 Four ethical principles in tension
Beneficence
Autonomy
Justice
Non-maleficence
Adapted with permission from Nurse Education Today
Although this is an extreme position, it is important because students need to understand any limits to their claims to originality. These issues are rarely discussed in articles about paradigms, such as Houghton et al (2012). While it is necessary to understand the importance of coherence between assumptions and evidence (Kramer-Kile 2012), it is unnecessary to show that one set of assumptions is superior to another. Rorty’s (1981) pragmatism is important because it bypasses the issue, suggesting the best research has a social function; his priority was the ethics of research, not its ontology. This essentially political perspective is pertinent to nursing research (Malachowski 2010), where the focus is fundamentally moral. To be original, a nursing PhD always has to address the issue of the right thing to do (Snowden 2011).
July 2014 | Volume 21 | Number 6 13
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Nurse Researcher
Autonomous
Autonomy generation
Possible conflict
s
die
tu hs
ug
hro
yt wa
Dependent
Candidate’s status
Figure 2 Negotiation of the ‘rackety bridge’
ath lp
a Ide
Appropriate support
Benign neglect
Hands on Hands off Supervisor’s recent style (Adapted from Gurr 2001)
with vulnerable populations (Wilson and Hodgson 2012), the researcher may avoid this route and either investigate a less important question or conduct the research with a less relevant population. The second problem is that viewing ethical judgements in research as gatekeeping has the potential to minimise the originality of research over time. If researchers view ethics as a bureaucratic hurdle to successful research, instead of as an integral aspect of it, presuppositions will tend to go unchallenged (Wilson 2011). For example, worthy focuses of mental health nursing research are stigma, inequality, consent and capacity, but ethics committees may inadvertently discourage such investigations by protecting groups they consider vulnerable because of these issues. Wilson and Hodgson (2012) claimed that such procedural prioritisation devalues the perspectives of the people most likely to make accurate judgements, such as those people deemed incapable and the nurses caring for them. The issue of vulnerability and research participation is complex (Lange et al 2013), but it is rational to aim for ‘authentic’ (Kim 2011) research. Kim (2011) defines authenticity as a function of congruence between a person’s values and decisions. Because he is defining authenticity in the context of autonomy for people with cognitive problems, he sees authenticity as a moral imperative. To generalise this point, authentic research would not only do no harm, it would also do good. While ethics committees want the latter, their final judgements are focused on the former. The third problem is that ethical judgements are difficult to make, particularly when the research methodology is not entirely familiar to the committee (Carey 2010). As a consequence, there is marked inconsistency in the types of judgements 14 July 2014 | Volume 21 | Number 6
made by ethics committees (Sayers 2007). For example, one committee recently deemed without ethical scrutiny that a study in which I was involved was safe to proceed. The local research and development department disputed this because it had concerns about the potential inclusion of people with capacity issues. This department then forwarded their query to Scotland A REC, a special committee held to review complex cases such as those entailing adults with capacity issues. This committee decided that the study was instead suitable for ‘proportionate review’, a form of review entailing a subgroup of a full committee. This committee in turn decided that a full REC committee should instead review the application, bringing us round in a complete cycle. All these judgements were defensible and made by rational people, but they are difficult and inconsistent. As such, the relationship of the researcher to the committee can have a significant effect on the outcome (Larkin et al 2008). In the example above, the committees that did not know the research team made the more riskaverse judgements. Generating original knowledge through a PhD therefore needs an expert guide who understands the moral and legal implications of the proposal, the academic requirements of the PhD and the potential points of conflict between the two in the research. This is an evolving process (Figure 2). However, the structure of the research process means the issue of ethics arises early, when the student is least experienced. As a consequence, the supervisor needs to be more proactive in this discussion than would be the case if the student were more autonomous (Snowden 2013). I would also argue, after Larkin et al (2008), that ethics committees should be included in these discussions as early as possible so they will be better placed to judge the researcher’s authenticity. If the committee trusts the researcher, it is more likely to believe the project is in safe hands (Larkin et al 2008). The best way to demonstrate trustworthiness in research is to demonstrate clear thinking and communication (Sellman 2006). Universities are best placed to facilitate this in the first instance. The student’s university is responsible for formally approving all research projects, a position critiqued in the spirit of this paper by McAreavey and Muir (2011). University approval involves scrutiny of the research proposal in the same manner as approval by ethics committees. However, there is also a potential opportunity for a more informal discussion of the best way of constructing © RCN PUBLISHING / NURSE RESEARCHER
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 30, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Innovation the research project, including a detailed examination of decisions made to date. At the University of the West of Scotland, for example, the committee invites students to discuss methodology and ethics. This prepares students for the types of peer review questions they are likely to face with the external committee and helps them to become more familiar with the effects of their choices. There is also an opportunity to discuss the likelihood of original work emerging from the chosen methodology. Knowing that the committee considers the relationship between ethics and originality, the student and the supervisor are more likely to have considered the issue in appropriate depth. They will then be more comfortable with the ethics process and their defence of their methodology, and so are more likely to engage in similar style with external committees. Ethics committees want to support original research (Larkin et al 2008). They are much more likely to do so if the student and supervisor want to collaborate with them to this end and can demonstrate they understand the implications of their proposal.
Conclusion It is not always obvious what the right thing to do is. For example, ethical tensions sit at the heart of aspirations to deliver person-centred care
(Francis 2013) in a culture that prioritises risk aversion (Wirtz et al 2006). Original research is therefore needed to deconstruct these ideals into their meaningful components to answer genuinely difficult questions (Cribb and Owens 2010). To develop a robust proposal investigating issues such as these, it is essential that students, supervisors and ethics committees work together to construct the best route. This requires open communication at all levels (Larkin et al 2008). This paper began by criticising research paradigms, showing that nursing research should not begin with a declaration of how the world is but with a practical problem of clinical significance (Rorty 1999, Isaacs et al 2009). The first question to ask is not ‘What is the best method?’ but ‘What is the best question?’ (Risjord 2010). The process of gaining ethics permissions has an unheralded role in helping bridge these two questions (Shaw 2011) and university ethics committees have a highly significant role to play here: by focusing the student and supervisor on the interrelated effect of research question and methodology, they can provide rounded ethical and scientific reviews before external scrutiny. The product should be a more confident and able student capable of collaborating with subsequent ethics committees to generate original, important and ethical nursing knowledge.
Online archive For related information, visit our online archive and search using the keywords Conflict of interest None declared
References Beauchamp T, Childress J (2009) Principles of Biomedical Ethics. Sixth edition. Oxford University Press, New York NY.
Houghton C, Hunter A, Meskell P (2012). Linking aims, paradigm and method in nursing research. Nurse Researcher. 20, 2, 34-39.
Carey E (2010) Navigating the process of ethical approval: a methodological note. The Grounded Theory Review. 9, 3, 19-33.
Hunter D (2011) A hands-on guide on obtaining research ethics approval. Postgraduate Medical Journal. 87, 1030, 509-513.
Cavell S (2002) Must We Mean What We Say? Cambridge University Press, Cambridge.
Iacono T (2006) Further comments on the researched, researchers and ethics committees: a response. Journal of Intellectual and Developmental Disability. 31, 3, 189-191.
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