RESEARCH METHODOLOGY
3.12 RESEARCH ETHICS
Ethical principles and good research conduct guide all forms of research. Burns and Grove (2010) assert that nursing research inquiry is not only hinged on the researchers’ expertise and diligence in endeavoring with the research study, but also on honesty, integrity and good ethical practice. Terreblanche, Durrheim and Painter (2006) maintain that fundamental ethical principles are essential to protect the welfare of the research participants and to ensure credibility in the research process Botma, Greeff, Mulaudzi and Wright (2010) also emphasize the use of ethical principles in guiding the research study from the conceptualization through to the dissemination of findings, stressing that all aspects of research, not only data collection should be aligned to ethics. Against this backdrop, research ethics were maintained in the following manner in this study.
92 3.12.1 Institutional and Gatekeeper Permission
Following the development and presentation of the proposal to the School of Nursing, University of KwaZulu-Natal, institutional permission and ethics clearance was obtained from the Humanities and Social Science Ethics Committee of the University of KwaZulu-Natal in November 2009, ethical clearance number HSS/0719/09 (See Appendix 7A). Following the onset of the study and data collection and analysis, a re-application for an amendment to the study’s title was made to the Humanities and Social Science Ethics Committee of the University of KwaZulu-Natal. The amendment to the title was approved with ethical clearance number HSS/0719/09D (See Appendix 7B). Gatekeeper permission was obtained from the Provincial Department of Health, KwaZulu-Natal and from the hospital managers of the two district level hospitals that were being used for the study. To obtain gatekeeper permission, a meeting was established with the relevant manager and the study protocol was discussed at the face-face meeting. This allowed for clarifications to be made and a more open discussion on the envisioned study. Following the relevant gatekeeper permission (See appendix 8), a similar information sharing meeting with the nursing management team of the maternal and child health units (i.e. midwifery units) was established. Following buy in and commitment from the department management in terms of the sustained sessions with the sampled nurse practitioners and the nature of the research process, an informal meeting was held with all nurse practitioners working in the maternal and child health units. This allowed for questions, clarification and recruitment of the participants for the study.
3.12.2 Ethical Principles
The core ethical principles of research were maintained in the following manner:
93 Respect for persons: The participant’s right to self determination was maintained throughout the research. Participants were informed that they had the right to withdraw from the study at any time without penalty and that their participation and contribution or the lack thereof in the study did not in any manner of form have any implications on their working environment.
Confidentiality: The nature of data collection through the use of focus group discussions, which served as reflective discourse sessions, posed a threat to internal and external confidentiality of the members of the FGD. Tollich (2009) notes that the nature of FGDs cannot guarantee absolute confidentiality, especially when participants are drawn from the same organization (as is the case in this study). One way of mitigating this threat was establishing group norms or rules in terms of how sensitive information would be handled and preventing nurses from discussing information outside the group. This was an important aspect which discouraged nurses from falling prey to the temptation of gossiping, which may have been strong, especially when participants are from the same social network (Tolich, 2009: 100). The information sheets and related informed consent (See Appendix 9) explicitly highlighted this as a threat to the participants’
confidentiality, so as to create full disclosure of possible threat for the participant in terms of their participation in the study. The informed consent also had a contract that stated the above threat and that participants’ agreement in the study denoted their acknowledgement of the above.
Beneficence and Anonymity: The well being of the participants was maintained through use of a private space for the FGDs and CoP meetings. Participants were informed that all information was confidential and that no names would be used in the process of analysis, as all information was aggregagted for a common meaning. Participants were also informed that they did not need to mention their real names in the FGDs, but could use a pseudonyms if they preferred.
94 Threat to beneficence: Due to the qualitative and enquiry nature of the study, there was a risk of exploring unresolved feelings which might have upset the participants (i.e. issues of moral distress if the participants were HIV positive or affected by HIV). In such a case, the researcher who is a qualified nurse with experience in HIV/Aids related care and counselling with experience in HIV/Aids relateted research, would use her judgment and provide counseling and refer to another support if necessary. However during the prolonged time of data collection, a trust relationship developed between the researcher and the participants which created a safe space for open discussion of personal information, and therefore there were no incidents of participants becoming extremely upset or needing counseling.
Principle of Justice: Selection of research participants was fair and directly related to the study.
None of the participants were known to the researcher to avoid selection bias. Due to the trust that was established and sustained in the developing CoPs, participants were informed that they had the right to indicate the extent to which certain information could be used (e.g. instances of disclosure of own or family members HIV status). During the feedback session, which served as member checking exercise, participants had the opportunity to withdraw any information or excerpts they were not comfortable about using in the results of the study. None of the participants from either site withdrew any information and they all validated that the meaning of the information was correctly described. All tape recorded FGDs, in-depth individual interviews and reflective diaries were used for the purposes of the data analysis only. To maintain anonymity, participants were not required to label their reflective diaries with their names to ensure that data cannot be linked to a specific participant.
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