Nursing Inquiry 2016; 23(1): 24–31
Feature
The practice of nursing research: getting ready for ‘ethics’ and the matter of character Derek Sellman University of Alberta, Edmonton, AB, Canada Accepted for publication 21 April 2015 DOI: 10.1111/nin.12102
SELLMAN D. Nursing Inquiry 2016; 23: 24–31 The practice of nursing research: getting ready for ‘ethics’ and the matter of character Few would argue with the idea that nursing research should be conducted ethically yet obtaining ethical approval is considered by many to have become unnecessarily burdensome. This brief article investigates the idea that there might be a relationship between the level of perceived burdensomeness of the research ethics application process on the one hand and the character of the nurse-researcher on the other. Given that nurses are required to be other-regarding, a nurse who undertakes research primarily for self-regarding reasons would seem to be acting in ways inconsistent with the aims of nursing as set out in nursing codes. It is suggested that the self-regarding nurse-researcher may find the ethics application process more burdensome than the other-regarding nurse-researcher who, it is further suggested, is engaged with nursing research as a practice in the technical sense in which that term has been developed by the philosopher Alasdair MacIntyre. Key words: good character, nursing research, other-regarding, practice, research ethics board, research ethics review, virtue.
The most common type of response I have witnessed from both academics and graduate students when the topic of seeking ethical approval for research projects arises is some form of verbal or non-verbal groan. A rolling of the eyes is not uncommon and there seems to be a collective sigh in recognition of the burdensome nature of the process. As it happens, these personal observations find some support from a small academic literature that reflects the anecdotal experiences from which I draw inspiration for this brief article (cf. Howe and Cutts-Dougherty 1993; Dougherty and Kramer 2005; Shore 2009; Labaree 2010). Quite why the mere mention of the ethics review process should elicit negative reactions among those who it is assumed are well aware of the high-profile unethical research practices of the past and who, in the case of nurses at least, profess to act in the best interests of patients and clients remains both unclear and an under-represented phenomenon in the nursing literature.
Correspondence: Derek Sellman, PhD, RN, Associate Professor, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada. E-mail:
While a number of speculative explanations might be offered, in this article, my purpose is to begin to explore the idea of a relationship between the character of a nurseresearcher and the equanimity or otherwise with which that nurse-researcher views and approaches the ethics review process. I will begin with an overview of the idea of nursing as a practice in the technical manner that the philosopher MacIntrye (2007) employs that term before extending that claim to the idea that nursing research can also be understood as a MacIntyrean practice. In this sense, those who engage with the practice of nursing research gain access to a set of internal goods unavailable to those who undertake nursing research purely or primarily in the pursuit of external goods such as reputation or prestige. The claim here is that engaging with nursing research as a MacIntyrean practice is consistent with the requirements of nursing as outlined in various documents produced by, among others, professional associations and regulatory bodies. The further claim made in this article is that because of the nature and features of what makes a practice a practice, those who engage with nursing research as a MacIntyrean practice are likely to find the © 2015 John Wiley & Sons Ltd
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application process for obtaining ethical approval for their research projects less burdensome than those who pursue research in nursing for more prosaic reasons.
NURSING AS A PRACTICE The idea of nursing as a practice has received some attention in the literature (cf. Bishop and Scudder 1991; Edwards 2001) with particular attention given to the idea of nursing as a MacIntyrean practice by Wainwright (1997) and further elaborated in earlier works (Sellman 2000, 2010, 2011). An abbreviated outline of this earlier work is provided below. For MacIntrye (2007), one defining feature of a practice lies in the relationship between the activity and the type of goods available to a person undertaking that activity. Briefly and recognizing the danger of over simplification, for MacIntyre the pursuit of an activity purely or primarily for the purpose of obtaining a particular set of external goods effectively bars access to the internal goods that would be available from engaging in that activity as a practice. MacIntyre’s exemplar is the game of chess. While chess players invariably play to win, they do so with the understanding that winning must be by an appropriate set of means. So winning at chess by cheating would be selfdefeating for there is something in the game of chess that goes beyond mere winning; something to be gained by playing well, by playing with respect to the traditions of excellence in the game, and by playing in honest and trustworthy ways. This captures something of what it is that makes chess the game it is and differentiates it from other games such as snakes and ladders where luck rather than the pursuit of excellence determines how the game proceeds. Winning a game of chess is not then the only thing that matters; for losing having played well has its own rewards. Thus, while chess remains a competitive game, the winner does not take it all. The winner will obtain some external goods, but if played in the proper spirit of the game, both winner and loser have access to the game’s internal goods. There is a rider to be added here for according to MacIntyre not all human activities can be understood as practices. Rather he suggests that only some activities can be practices and further that only those with some community good qualify. He states that a practice is: any coherent and complex form of socially established cooperative human activity through which goods internal to that form of activity are realized in the course of trying to achieve those standards of excellence which are appropriate to, and partially definitive of that form of activity. (187)
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So for the game of chess, the standards of excellence to which serious players of chess aspire include what MacIntyre takes to be the three core excellences, or virtues, of a practice: that is, honesty, courage and justice. That access to the internal goods of chess – that is, the reward of having played true to the spirit of the game – requires honesty and justice as fairness is obvious for as intimated above to cheat or to use unfair means to win is contrary to the spirit of the game. Not so obvious is the requirement for courage. MacIntyre likens this to the courage to confront one’s own inadequacies. He says: We have to learn to recognize what is due to whom; we have to be prepared to take whatever self-endangering risks are demanded along the way; and we have to listen carefully to what we are told about our own inadequacies. (191)
And while this may seem, perhaps, trivial in relation to chess, the implications for other practices are perhaps more apparent. Elsewhere I have argued (Sellman 2000, 2010, 2011) that nursing shares the features of a practice as understood in this MacIntyrean sense. Nursing conceived as a practice is a useful idea partly because the importance of the pursuit of internal goods is a feature commonly expressed, not least by nursing’s regulatory bodies, as one of the features of nursing that defines nursing as the type of thing it is and that differentiates it from other types of occupations. This is not to say that the pursuit of internal goods needs to be the sole motivation as there is nothing in MacIntyre’s account to suggest this; indeed, he acknowledges that other motivations are important. However, the individual motivated primarily by the pursuit of external goods is, by their own actions, denied access to the internal goods and thus cannot be considered as engaged with the activity as a practice. MacIntyre indicates that a practice will only thrive where sufficient numbers of individuals continue to pursue goods internal to that practice, and moreover, the pursuit of internal goods requires individuals to cultivate qualities of character: in particular, the qualities that reflect the core excellences of honesty, courage and justice. And these, as it happens, are the same and very particular qualities of character that permeate proclamations from nursing’s professional associations and regulatory bodies; qualities that nurses are expected to exhibit, and that underpin the ideas of honesty, trustworthiness and altruism made explicit in nursing codes worldwide. In other words, ‘the features MacIntyre identifies as constitutive of a practice are features recognizable within nursing’ (Sellman 2011, 101). 25
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NURSING RESEARCH AS A PRACTICE Nurses who become involved with the design and execution of research by virtue of their registration continue to be bound by their nursing code. Under these circumstances at least, nursing research can be considered a form of specialist nursing practice. And just as other specialist areas of nursing practice require nurses to develop particular sets of skills additional to those achieved during preparatory programmes, so too nurses undertaking nursing research need to develop sets of skills appropriate to ensure the safe and ethical practice of nursing research. The tenets of nursing codes continue to apply; thus, a nurse-researcher is bound to ensure competence in the tasks required by nursing research just as she or he is bound to ensure competence in performing a clinical skill. Following this logic, nursing research is merely one type of nursing, albeit of a specialized kind, and if it is accepted that nursing can be understood as a practice, then nursing research can also be understood as a practice precisely because it is a nursing role like any other nursing role – at least in terms of professional andethical responsibilities. However, there are many reasons why nurses undertake research. Certainly, nursing codes anticipate that registered nurses engage in some way with research – appreciation, appraisal and application seem a minimum formulation. For some, this is taken to mean that students of nursing should be taught an appropriate set of research appraisal skills. Leaving aside the problematic nature of exactly what this might entail (cf. Lipscomb 2014), there is an expectation that nurses in the academy should be engaged in research at a deeper level than that of students, usually by doing research of some sort. The academy certainly generates this expectation, particularly in research intensive universities. Indeed, for many nurse academics, success in the academy requires actively pursuing research grants and disseminating findings by publication in peer-reviewed journals. As Rolfe (2012) points out, the demand for excellence in research in the university often has more to do with prestige than with utility or practicality. This is to say that the bigger the grant and the more prestigious the grant awarding body, the higher the status of the academic and the more likely tenure or promotion to professor. This raises a tension between a nurse’s primary obligation to others rather than to self on the one hand and the expectations of the academy on the other. Yet as Rolfe, when referring to his obligations according to the nursing code of his country, notes: ‘. . . when I set out a research proposal or write a paper for publication, my first priority should be that it will contribute to the betterment of nursing practice rather than to the greater glory and profit of my university’ (2012; 735), to which might be 26
reasonably added that neither should these things be done primarily for the greater good or profit of the nurse academic. The other-regarding obligation of nurses whatever their area of practice is writ large in nurses codes where injunctions such as ‘The nurse’s primary commitment is to the patient’ (ANA 2001, 1), ‘Make the care of people your first concern’ (NMC 2008, 3) and to use ‘. . . knowledge and skills for the benefit of patients’ (NCNZ 2009, 7) explicitly acknowledge that nursing practice is primarily other rather than self-regarding. Given this injunction what then is the status, ethically speaking, of those nurses engaged in research primarily for reasons of, for example, professional advancement or self-aggrandizement? At face-value, a nurse operating from these motivations would appear to be acting in an unprofessional or unethical way according to the wording and emphasis of any particular nursing code. If true, then the academic who strategically positions her or himself within a particular area of investigation because that area of investigation is attracting funds, or because they believe this to be an area in which they can generate a high profile, or because they perceive the area as particularly ‘of the moment’ and thus can capitalize on exposure opportunities and does so primarily for the purpose of enhancing their reputation, obtaining merit in their institution, increasing their earnings or seeking notoriety should surely earn censure and perhaps even be called to account by their regulatory body. Indeed, by this token, any action by a nurse that is primarily self-serving should earn similar censure. Motivation is, of course, notoriously difficult to establish and who is to say that wrong are those who display raw ambition, ride roughshod over others, and/or do their utmost to extract themselves from teaching commitments so as to ascend to some kind of supremacy in the academy? Especially, when what follows might lead to significant developments or improvements in nursing practice by virtue of a research programme established that would otherwise not have come into existence. For some, a consequentialist argument of this sort can be used to justify dubious means because of a predicted greater good related to specific ends; although it is to be supposed that regulatory bodies would consider this type of defence for unprofessional or unethical practice in the conduct of research unacceptable. In contrast, the stated aims of nursing research are more consistent with the tenets of nursing codes. The International Council of Nurses (ICN), for example, promotes the development of nursing research particularly where this has practical utility (ICN 2007). The Canadian Nurses Association (CNA) recognizes research as one major source of evidence needed to ensure appropriately informed decisionmaking for ethical nursing practice and implies that nursing © 2015 John Wiley & Sons Ltd
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researchers should pursue lines of enquiry that emerge from practice situations (CNA 2013). This suggests that the proper conduct of nursing research is not a function of personal interest in, or passion for, a particular topic, and certainly not for the purposes of self-advancement at the expense of practical value. Further, the CNA has previously stated that registered nurses have an obligation to report all findings whether positive or negative (CNA 2002), and thus, whether they enhance or diminish personal or professional reputation – something that those who seek to discover how things really are would accept as unproblematic, while those with less altruistic motivations might struggle. While the more altruistic – idealistic, even – aspirations of nursing as conceived by those who subscribe to the version of the nature of nursing outlined in the official statements of professional associations and regulatory bodies might be accepted by some, it might be supposed that there are nurses who baulk at the aspirations contained therein. Assumptions that nurses and nursing have homogeneity abound within the nursing literature where phrases on the lines of we as nurses must. . . and the role of the nurse is to. . . are common and used without justification to make normative claims about the idea that nurses share much more than a common desire to improve the lot of those requiring the services of nurses. But as Lipscomb (2013) notes ‘nurses need not share substantive normative beliefs/goals and . . . group descriptors such as ‘nurses’, and ‘nursing’ cannot meaningfully or easily attach to political claims’ (254). While Lipscomb’s analysis remains largely in the political arena, the point that nursing authors often slip into a style of writing that suggests they are speaking on behalf of all nurses without providing grounds for such a claim is a point well made and transfers easily to issues outside of the political domain. Nurses undertake nursing for all sorts of reasons. Some adopt almost evangelical positions regarding what nursing is and what it is not; some simply seek a steady salary. It is likely that the majority of nurses would, if asked, locate themselves at some point between these two extremes depending on whatever else is going on in their lives and the nature of the sociopolitical environment in which they practice. If there is a continuum of this type for nursing in general, then it is reasonable to suppose that a similar continuum exists for nurses engaged in nursing research.
GETTING READY FOR ‘ETHICS’ I imagine I am not alone in overhearing snippets of informal corridor conversation about ethics among and between (post)graduate students and I imagine that similar conversations take place whenever and wherever groups or individu© 2015 John Wiley & Sons Ltd
als are required to seek ethical approval for whatever studies are being contemplated. Within this context, ethics is taken to mean the requirement to obtain ethical approval for research – often referred to as ‘getting ethics’ or ‘going for ethics’ or simply ‘ethics’ – as in the question: ‘where are you in your research?’ and response: ‘Oh, I’m getting ready for ethics’. Often conversations of this nature seem to contain, explicitly or implicitly, a sense that the process of getting ethical approval is overly bureaucratic and exceedingly vexatious, an obstacle to be overcome in order to get on with the real work of research. Shore (2009) acknowledges the process as ‘time-consuming’ (334) and further identifies students’ perceptions of review boards can be engendered by the negative perceptions or experiences of instructors about the process. Shore notes ‘Some instructors may present the IRB as “bureaucratic in nature”, potentially implying that the review process does not contribute to the ethical conduct of research’ (335). It is easy to sympathize with this view especially where an applicant is faced with completing a form that is some 30 or 40 pages long, for then it should come as no surprise that the process feels – to the graduate student at least – overwhelming, overly complicated and overly bothersome (Jamrozik 2004). From this, the leap to perceiving the getting of ethical approval as a hoop to be negotiated or as a barrier to be overcome with the least possible pain is a response that is, perhaps, not only understandable but also foreseeable and predictable. I am being deliberately selective and, of course, anecdotal here and I am well aware that even among those who most vociferously bemoan the growth of regulatory frameworks for obtaining ethical approval for projects involving humans, there remains a core recognition that research enquiry should proceed in an ethical as opposed to an unethical manner. Integrity in research is, after all, one of the core values of the scientific endeavour (Macrina 2005). In answering the charge that the application process is overly burdensome, those involved in the research ethics review process1 might point out that the primary function of ethics review is to uphold the ethical standards of scientific endeavour including, importantly, the protection of participants from unnecessary harm and that for any well thought out research project, explaining how the conduct of that research strives to be ethical should not be burdensome. It would only be burdensome, they might add, if the researcher has insufficiently conceptualized the ethical
Bodies charged with the ethical review of proposed research projects are known by different names. For example, in the United Kingdom, the ethics review body is known as the Research Ethics Committee (REC); in Canada, the Research Ethics Board (REB); and in the United States, the Institutional Review Board (IRB).
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implications of the proposed study. In any case, they might continue, it is only right and proper that the burden of demonstrating ethical conduct of research should lie firmly and squarely on the shoulders of the researcher who, as part of the process of research, should expect to be challenged by a rigorous process in order to convince a body of peers that their research will continue with due regard for the ethical obligations of researchers. Of course, the danger of interpreting guidelines as immutable rules, failing to include expertise in an appropriate range of research approaches, or taking an inordinate amount of time to process applications renders disingenuous claims by research ethics review committees (hereafter, ethics review bodies) to be enabling rather than obstructive. In addition, the inconsistency of decisions between ethics review bodies each with their own sets of idiosyncrasies and particular preferences can leave the researcher who has to gain approval from more than one ethics review body for the same study (e.g., in the case of a multicentre study) bemused by the need to satisfy different sets of conditions dependent purely on the predilections of individual ethics review bodies (Greene and Gieger 2006; Yaghoobi 2011). It is the perceived failure of including an appropriate range of research expertise within an ethics review body that appears – at least informally – as a commonly voiced complaint heard in nursing circles and beyond, along with the claim that this perceived failure in the composition of ethics review bodies tends to put nursing research proposals at a disadvantage because of the purported preferences within those committees for particular (e.g., assumed positivist, medical or quantitative) approaches to research. This charge is often couched in distinctly dismissive terms such as to imply a failure of the ethics review body to understand a particular type of research. Even if true, this might equally indicate a failure on the part of the researcher to explain. Nevertheless, an ethics review body that rejects a proposal on the basis of methodology alone should indeed earn censure, but the charge remains largely unproven and might tell us more about the researcher than about the committee. Leaving these questions aside, here the discussion will focus on the relationship between the character of the researcher and the proper conduct of nursing research.
CHARACTER AND ETHICS IN THE PRACTICE OF NURSING RESEARCH The proper conduct of nursing research is a topic that has exercised many in the academy and beyond. Documents to guide nurses while engaged in nursing research include the 28
following: the Research Governance Framework for Health and Social Care in the UK (DH 2005); the Tri-Agency Framework: Responsible Conduct of Research in Canada (Government of Canada 2011); and the ORI Introduction to the Responsible Conduct of Research in the United States (Steneck 2007). Similar documents can be found in other parts of the world, and each reflects a recognition that researchers have not always behaved in ways that engenders public trust and confidence. Indeed, ethics review bodies exist at least in part because of the general perception that researchers cannot be trusted to be left to their own devices in the conduct of research. This lack of trust is warranted as the history of research, particularly of research involving humans, is littered with examples of unethical practices, but the existence of ethics review bodies offers no watertight guarantee that similar abuses will not occur. Thus, the ethics review body often finds itself between a rock and a hard place, forever required to police a practice over which it exerts minimal, if any, control once project approval has been granted. No wonder then that ethics review bodies require detailed information as its members attempt to determine whether the applicant(s) can be trusted to ensure ethical conduct of a proposed research project. The predictive nature of such decisions should not be underestimated and researchers might well be advised to anticipate the need to devote significant time to the preparation and presentation of applications for ethical approval because ethics review bodies tend to assume a direct relationship between the quality of the application and the qualities of the researcher. And this assumed relationship points towards another potential relationship, that is the relationship between the researcher and her or his motivation for the research project. As suggested earlier, there are many reasons why nurses undertake research despite the received wisdom that nursing research is undertaken to find out more about the current state of nursing with a view to making recommendations that will make things better for future patients. The idea of character is controversial (cf. Merritt, Doris and Harman 2010), but for the purposes of the present discussion, it is assumed that each individual has a set of qualities the expression of which gives rise to the idea that she or he has a particular type of character; for without such a belief, it would not make sense to speak of someone acting characteristically or, indeed, uncharacteristically. On this account, it makes sense to talk of someone of good character as being someone who is, generally speaking, honest and trustworthy, and as someone with integrity. Such a person we imagine to be generally well disposed to others; that is to say, a person of this type can be assumed to not wish to do harm to others. Indeed, if nursing’s regulatory bodies’ versions of © 2015 John Wiley & Sons Ltd
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a nurse are to be believed, then the qualities of honesty and trustworthiness are among the very qualities that nurses must exhibit, regardless of their area of practice. It follows that the nurse engaged in nursing research is required to be honest and trustworthy, and to strive to remain other rather than self-regarding. In other words, nurses undertaking nursing research are to be of good character and thus be motivated by altruistic and not personal motives. If this is true then one might reasonably ask why research ethics bodies cannot merely accept that nurses involved in nursing research will conduct ethical, rather than unethical, research. Why isn’t knowing the requirements of nursing’s regulatory bodies for nurses to be honest and trustworthy and to place the needs of others ahead of their own sufficient to give an ethics review body confidence that a nurse will practice research ethically? Apart from the obvious fact that not all nurses act in honest or trustworthy ways, or put others’ interests first (witness the busyness of disciplinary sections of nursing’s regulatory bodies), research is a form of specialist practice that preregistration nursing education is ill-equipped to deliver. However, (post)graduate nursing programmes are expected to deliver research training that instils the tenets of the proper ethical conduct of research and there are many experienced nurse-researchers working as principal investigators and/or supervisors. One would like to think that when these nurses are practising as researchers, they do so with honesty and trustworthiness while genuinely striving to subsume their own interests to those of research participants. The putting of others’ needs before one’s own is, after all, precisely what professional nursing codes expect of nurses regardless of the focus or area of practice. On this account giving primacy to the interests of the research participant(s) would seem to require that the nurse-researcher embed ethical considerations within the conception and design of a research study and not relegate such considerations to the afterthought only of relevance when arriving at the stage of seeking ethical approval. The claim here is that a research proposal in which the researcher has taken the ethical obligations of research seriously and who has developed the project with the interests of the participants at the forefront of the design will invariably contain implicit and explicit recognition of the need for the project to be conducted with due regard for ethics. Such a proposal will very likely address many of the concerns that members of an ethics review board have for any research proposal. And a wellconsidered study proposal that demonstrates a thoughtful appreciation of anticipated and unanticipated ethical issues is more likely to provide the ethics review board with confidence in the applicant’s ethical competence to undertake or © 2015 John Wiley & Sons Ltd
supervise the research. In other words, a nurse who is characteristically inclined towards honesty, trustworthiness and putting the interests of others first (let us call them applicant A) will likely present an application that reflects these qualities. In so doing, applicant A not only impresses the ethics review board that the project has been well thought through but also will very likely find the questions asked in the application form to be questions already given attention during the conception and design stage of development of the project. In contrast, a nurse who is not characteristically inclined towards honesty or trustworthiness, or, perhaps more importantly, disinclined to put the research participants interests before their own (let us call them applicant Z), will very likely find the application process burdensome because it asks a set of questions to which insufficient attention has been given prior to the point at which ethics approval is sought. If any of this is even vaguely true, then it follows that applicant A will most likely find the application for ethical approval process significantly less burdensome than does applicant Z. It follows also that, ethically speaking, the character of the research practitioner may matter in significant ways. The relationship between character and motivation is complicated, but for the present purposes, it will be assumed that it is reasonable, given nursing’s regulatory body requirements, to expect a nurse of good character to be motivated to act well in the pursuit of altruistic ends. As such, applicant A will be motivated to ensure that no harm comes to others in the pursuit of finding out how things are in the world of nursing because they are characteristically inclined to act in ways that reflect this desire to do no harm. This is to say that while applicant A will most likely have additional and less altruistic motivations for undertaking nursing research, she or he will strive to ensure that these other motivations do not take precedence. In this respect, applicant A might be said to be pursuing goods internal to the practice of nursing research. In contrast, applicant Z may be distracted by the pursuit of external goods – professional success, promotion, status and so on – to the extent that she or he has lost sight of the both the primary purpose of nursing research and the regulatory requirement to be of good character. On this analysis, nursing research might usefully be understood as a MacIntyrean practice. In contrast to applicant Z – for whom the pursuit of external goods is paramount, applicant A might be said to be engaged with nursing research as a practice precisely because of a primary motivation that is other rather than self-regarding. As a thought experiment – and temporarily collapsing motivation and character insofar as motivation might be reasonably supposed to be a function of character, the two applicant types 29
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can represent extremes of a continuum of motivation for undertaking nursing research. For applicant A, the ethics application will be less burdensome than it is for applicant Z; as a thought experiment, this leaves a potential 24 additional perspectives on the burdensomeness, or otherwise, of the ethics application process dependent on which letter of the alphabet represents the motivation of a particular researcher. Few nurse-researchers are likely to be absolute applicant A type or absolute applicant Z type for most researchers will have multiple and sometimes competing motivations for pursing research – which suggests that most nurse-researchers will find themselves occupying the middle ground of motivations – but just so long as that majority have the internal goods of nursing research in their sights, then nursing research as a practice has the opportunity to flourish. If the idea of nursing research as a practice in this sense has any purchase, then it follows that the personal qualities such as honesty, trustworthiness and other-regardingness be cultivated within (post)graduate nursing programmes and within nursing research teams. Just the kind of character development Nightingale regarded as necessary if nurses were to become perceived as professional carers in the 19th century. However, one unfortunate aspect of the Nightingale legacy is this very focus on the personal conduct of nurses for as long as regulatory bodies and others continue to blame failings on individual nurses, those who maintain the status quo of systems that create environments in which the expression of good character is made difficult remain immune from criticism. The controversy surrounding the idea of character hinted at earlier in this article makes just this point. Common in the critique of the idea of enduring character is a claim that there is a general failure to take sufficient cognizance of situation. The personal motivations of individual nursing researchers may be important in generating a thriving practice of nursing research but without an environment in which the desired qualities are given a chance to flourish then the practice may still collapse. MacIntyre notes the importance of the approach of the institution2 in which a practice takes place as a factor in the flourishing or otherwise of a practice. The present austerity condition with its everincreasing deadline-driven and frantic speed requirements undermines much that would otherwise count towards nursing research as a practice. This is to say that while the ideal would be that persons of good character be allowed the time and space to develop well-considered, ethical research proMacIntyre uses the term institution to mean the organizational environment in which a practice is situated. Thus an institution could have a physical or virtual presence, or might exist as an abstract idea.
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posals in which due consideration is given to ensuring participant’s interests are given the primacy they deserve, the reality may be that nurse-researchers are caught up in an environment that frustrates such intentions. In other words, the idea that the ethics approval process is burdensome may be as much a function of structure as it is of agency and thus the blaming of individuals alone for what might be cast as the premature submission of ethics applications may misunderstand the nature of the beast (as it were). The pressures on nurse-researchers to deliver in a time-limited and deadline-driven environment where success is measured in numbers – of grant applications, of papers published, of dollars awarded, of outputs and so on – encourage hastiness and compromise at the expense of careful and measured approaches to the development of well-crafted project proposals. Thus, while applicant A may represent the ideal nursing researcher, applicant Z may yet be the strategic survivor that the environment of academia encourages; as MacIntyre notes, those who pursue the internal goods of practices will very likely forfeit the fame and fortune available to those who ruthlessly pursue external goods.
CONCLUSION Giving primacy to other-regarding aspects of the development of a research proposal would seem to suggest that nursing research could usefully be considered a practice in the sense that Alasdair MacIntyre uses that term. One result of engaging with nursing research as a practice is that it brings to the fore qualities that nursing authorities expect individual nurses to demonstrate and this has the potential to allow practitioners of nursing research to find the requirements of seeking ethical approval for their research less burdensome than it is for those who do not engage with nursing research as a practice. Thus, a case can be made for a stronger approach to the character development of potential nursing researchers, as this is consistent with both the claims made within nursing codes regarding the nature of nurses and the claims made regarding the ultimate purpose of nursing research as a vehicle for improving the lot of patients. However, pursuing nursing research as a practice may come at the cost of reducing opportunities for individuals to thrive in institutions that measure success in terms of, for example, successful grant applications and numbers of peer-reviewed publications. These institutional features generate an environment that is largely antithetical to the idea of nursing research as a practice which means it is very likely that the majority of nursing researchers should expect to find that the process of obtaining ethical approval for research projects will become increasingly burdensome. © 2015 John Wiley & Sons Ltd
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REFERENCES ANA (American Nurses Association). 2001. Code of ethics for nurses with interpretive statements. http://www.nur singworld.org/MainMenuCategories/EthicsStandards/ CodeofEthicsforNurses/Code-of-Ethics.pdf (accessed 3 April 2014). Bishop AH and JR Scudder. 1991. Nursing: The practice of caring. New York: National League for Nursing Press. CNA (Canadian Nurses Association). 2002. Ethical research guidelines for registered nurses. Ottawa: Author. CNA. 2013. Evidence-informed decision-making and nursing practice. http://www.cna-aiic.ca/sitecore%20modules/ web/~/media/cna/page%20content/pdf%20fr/2013/ 07/26/10/48/ps113_evidence_informed_2010_e.pdf# search=%22evidence-informed decision-making %22 (accessed 4 April 2014). DH (Department of Health). 2005. Research governance framework for health and social care, 2nd edn. https:// www.gov.uk/government/uploads/system/uploads/ attachment_data/file/139565/dh_4122427.pdf (accessed 22 April 2014). Dougherty DS and MW Kramer. 2005. A rationale for scholarly examination of institutional review boards: A case study. Journal of Applied Communication Research 33(3): 183–8. Edwards SD. 2001. Philosophy of nursing: An introduction. Basingstoke: Palgrave. Government of Canada. 2011. The tri-agency framework: Responsible conduct of research. http://www.rcr. ethics.gc.ca/_doc/Framework-CadreReference_eng.pdf (accessed 22 April 2014). Greene SM and AM Gieger. 2006. A review finds that multicenter studies face substantial challenges but strategies exist to achieve institutional review board approval. Journal of Clinical Epidemiology 59(8): 784–90. Howe KR and K Cutts-Dougherty. 1993. Ethics, institutional review boards, and the changing face of educational research. Educational Researcher 22(9): 16–21. ICN (International Council of Nursing). 2007. Nursing research [position statement]. http://www.icn.ch/ images/stories/documents/publications/position_statements/B05_Nsg_Research.pdf (accessed 4 April 2014). Jamrozik K. 2004. Research ethics paperwork: What is the plot we seem to have lost? British Medical Journal 329 (7460): 286–7. Labaree RV. 2010. Working successfully with your institutional review board: Practical advice for librarians. College & Research Libraries News 71(4): 190–3.
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Lipscomb M. 2013. Some may beg to differ: Individual beliefs and group political claims. Nursing Philosophy 14: 254–70. Lipscomb M. 2014. Research report appraisal: How much understanding is enough? Nursing Philosophy 15(3): 157–70. MacIntrye A. 2007. After virtue: A study in moral theory, 3rd ed. Notre Dame, IN: University of Notre Dame Press. Macrina FL. 2005. Scientific integrity: Text and cases in responsible conduct of research, 3rd ed. Washington, DC: ASM Press. Merritt MW, JM Doris and G Harman. 2010. Character. In The moral psychology handbook, eds J Doris and the Moral Psychology Research Group, 355–401. Oxford: Oxford University Press. NCNZ (Nursing Council of New Zealand). 2009. Code of conduct for nurses: Regulating nursing practice to protect public safety. http://nur3425s2.handel.2day.com/ Code%20of%20Conduct%20Nov09.pdf (accessed 3 April 2014). NMC (Nursing and Midwifery Council). 2008. The code: Standards of conduct, performance and ethics for nurses and midwives. http://www.nmc-uk.org/Documents/ Standards/The-code-A4-20100406.pdf (accessed 3 April 2014). Rolfe G. 2012. Fast food for thought: How to survive and thrive in the corporate university. Nurse Education Today 32(7): 732–6. Sellman D. 2000. Alasdair MacIntyre and the professional practice of nursing. Nursing Philosophy 1(1): 26–33. Sellman D. 2010. Values in adult general nursing. In Emerging professional values in health care: The challenge for professionals, eds S Pattison, B Hannigan, H Thomas and R Pill, 129–40. London: Jessica Kingsley. Sellman D. 2011. What makes a good nurse: Why the virtues are important for nurses. London: Jessica Kingsley. Shore N. 2009. Student research projects and the institutional review board. Journal of Teaching in Social Work 29 (3): 329–45. Steneck NH. 2007. The ORI introduction to the responsible conduct of research. Retrieved from: www.ori.dhhs.gov/sites/ defautl/files/rcintro.pdf (accessed 15 August 2014). Wainwright P. 1997. The practice of nursing: An investigation of professional nursing from the perspective of the virtue ethics of Alasdair MacIntyre. PhD diss. Wales: University of Swansea. Yaghoobi M. 2011. Theoretical shortcomings of institutional review boards and possible solutions. Archives of Iranian Medicine 14: 202–3.
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The practice of nursing research: getting ready for ‘ethics’ and the matter of character Derek Sellman University of Alberta, Edmonton, AB, Canada Accepted for publication 21 April 2015 DOI: 10.1111/nin.12102
SELLMAN D. Nursing Inquiry 2016; 23: 24–31 The practice of nursing research: getting ready for ‘ethics’ and the matter of character Few would argue with the idea that nursing research should be conducted ethically yet obtaining ethical approval is considered by many to have become unnecessarily burdensome. This brief article investigates the idea that there might be a relationship between the level of perceived burdensomeness of the research ethics application process on the one hand and the character of the nurse-researcher on the other. Given that nurses are required to be other-regarding, a nurse who undertakes research primarily for self-regarding reasons would seem to be acting in ways inconsistent with the aims of nursing as set out in nursing codes. It is suggested that the self-regarding nurse-researcher may find the ethics application process more burdensome than the other-regarding nurse-researcher who, it is further suggested, is engaged with nursing research as a practice in the technical sense in which that term has been developed by the philosopher Alasdair MacIntyre. Key words: good character, nursing research, other-regarding, practice, research ethics board, research ethics review, virtue.
The most common type of response I have witnessed from both academics and graduate students when the topic of seeking ethical approval for research projects arises is some form of verbal or non-verbal groan. A rolling of the eyes is not uncommon and there seems to be a collective sigh in recognition of the burdensome nature of the process. As it happens, these personal observations find some support from a small academic literature that reflects the anecdotal experiences from which I draw inspiration for this brief article (cf. Howe and Cutts-Dougherty 1993; Dougherty and Kramer 2005; Shore 2009; Labaree 2010). Quite why the mere mention of the ethics review process should elicit negative reactions among those who it is assumed are well aware of the high-profile unethical research practices of the past and who, in the case of nurses at least, profess to act in the best interests of patients and clients remains both unclear and an under-represented phenomenon in the nursing literature.
Correspondence: Derek Sellman, PhD, RN, Associate Professor, Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada. E-mail:
While a number of speculative explanations might be offered, in this article, my purpose is to begin to explore the idea of a relationship between the character of a nurseresearcher and the equanimity or otherwise with which that nurse-researcher views and approaches the ethics review process. I will begin with an overview of the idea of nursing as a practice in the technical manner that the philosopher MacIntrye (2007) employs that term before extending that claim to the idea that nursing research can also be understood as a MacIntyrean practice. In this sense, those who engage with the practice of nursing research gain access to a set of internal goods unavailable to those who undertake nursing research purely or primarily in the pursuit of external goods such as reputation or prestige. The claim here is that engaging with nursing research as a MacIntyrean practice is consistent with the requirements of nursing as outlined in various documents produced by, among others, professional associations and regulatory bodies. The further claim made in this article is that because of the nature and features of what makes a practice a practice, those who engage with nursing research as a MacIntyrean practice are likely to find the © 2015 John Wiley & Sons Ltd
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application process for obtaining ethical approval for their research projects less burdensome than those who pursue research in nursing for more prosaic reasons.
NURSING AS A PRACTICE The idea of nursing as a practice has received some attention in the literature (cf. Bishop and Scudder 1991; Edwards 2001) with particular attention given to the idea of nursing as a MacIntyrean practice by Wainwright (1997) and further elaborated in earlier works (Sellman 2000, 2010, 2011). An abbreviated outline of this earlier work is provided below. For MacIntrye (2007), one defining feature of a practice lies in the relationship between the activity and the type of goods available to a person undertaking that activity. Briefly and recognizing the danger of over simplification, for MacIntyre the pursuit of an activity purely or primarily for the purpose of obtaining a particular set of external goods effectively bars access to the internal goods that would be available from engaging in that activity as a practice. MacIntyre’s exemplar is the game of chess. While chess players invariably play to win, they do so with the understanding that winning must be by an appropriate set of means. So winning at chess by cheating would be selfdefeating for there is something in the game of chess that goes beyond mere winning; something to be gained by playing well, by playing with respect to the traditions of excellence in the game, and by playing in honest and trustworthy ways. This captures something of what it is that makes chess the game it is and differentiates it from other games such as snakes and ladders where luck rather than the pursuit of excellence determines how the game proceeds. Winning a game of chess is not then the only thing that matters; for losing having played well has its own rewards. Thus, while chess remains a competitive game, the winner does not take it all. The winner will obtain some external goods, but if played in the proper spirit of the game, both winner and loser have access to the game’s internal goods. There is a rider to be added here for according to MacIntyre not all human activities can be understood as practices. Rather he suggests that only some activities can be practices and further that only those with some community good qualify. He states that a practice is: any coherent and complex form of socially established cooperative human activity through which goods internal to that form of activity are realized in the course of trying to achieve those standards of excellence which are appropriate to, and partially definitive of that form of activity. (187)
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So for the game of chess, the standards of excellence to which serious players of chess aspire include what MacIntyre takes to be the three core excellences, or virtues, of a practice: that is, honesty, courage and justice. That access to the internal goods of chess – that is, the reward of having played true to the spirit of the game – requires honesty and justice as fairness is obvious for as intimated above to cheat or to use unfair means to win is contrary to the spirit of the game. Not so obvious is the requirement for courage. MacIntyre likens this to the courage to confront one’s own inadequacies. He says: We have to learn to recognize what is due to whom; we have to be prepared to take whatever self-endangering risks are demanded along the way; and we have to listen carefully to what we are told about our own inadequacies. (191)
And while this may seem, perhaps, trivial in relation to chess, the implications for other practices are perhaps more apparent. Elsewhere I have argued (Sellman 2000, 2010, 2011) that nursing shares the features of a practice as understood in this MacIntyrean sense. Nursing conceived as a practice is a useful idea partly because the importance of the pursuit of internal goods is a feature commonly expressed, not least by nursing’s regulatory bodies, as one of the features of nursing that defines nursing as the type of thing it is and that differentiates it from other types of occupations. This is not to say that the pursuit of internal goods needs to be the sole motivation as there is nothing in MacIntyre’s account to suggest this; indeed, he acknowledges that other motivations are important. However, the individual motivated primarily by the pursuit of external goods is, by their own actions, denied access to the internal goods and thus cannot be considered as engaged with the activity as a practice. MacIntyre indicates that a practice will only thrive where sufficient numbers of individuals continue to pursue goods internal to that practice, and moreover, the pursuit of internal goods requires individuals to cultivate qualities of character: in particular, the qualities that reflect the core excellences of honesty, courage and justice. And these, as it happens, are the same and very particular qualities of character that permeate proclamations from nursing’s professional associations and regulatory bodies; qualities that nurses are expected to exhibit, and that underpin the ideas of honesty, trustworthiness and altruism made explicit in nursing codes worldwide. In other words, ‘the features MacIntyre identifies as constitutive of a practice are features recognizable within nursing’ (Sellman 2011, 101). 25
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NURSING RESEARCH AS A PRACTICE Nurses who become involved with the design and execution of research by virtue of their registration continue to be bound by their nursing code. Under these circumstances at least, nursing research can be considered a form of specialist nursing practice. And just as other specialist areas of nursing practice require nurses to develop particular sets of skills additional to those achieved during preparatory programmes, so too nurses undertaking nursing research need to develop sets of skills appropriate to ensure the safe and ethical practice of nursing research. The tenets of nursing codes continue to apply; thus, a nurse-researcher is bound to ensure competence in the tasks required by nursing research just as she or he is bound to ensure competence in performing a clinical skill. Following this logic, nursing research is merely one type of nursing, albeit of a specialized kind, and if it is accepted that nursing can be understood as a practice, then nursing research can also be understood as a practice precisely because it is a nursing role like any other nursing role – at least in terms of professional andethical responsibilities. However, there are many reasons why nurses undertake research. Certainly, nursing codes anticipate that registered nurses engage in some way with research – appreciation, appraisal and application seem a minimum formulation. For some, this is taken to mean that students of nursing should be taught an appropriate set of research appraisal skills. Leaving aside the problematic nature of exactly what this might entail (cf. Lipscomb 2014), there is an expectation that nurses in the academy should be engaged in research at a deeper level than that of students, usually by doing research of some sort. The academy certainly generates this expectation, particularly in research intensive universities. Indeed, for many nurse academics, success in the academy requires actively pursuing research grants and disseminating findings by publication in peer-reviewed journals. As Rolfe (2012) points out, the demand for excellence in research in the university often has more to do with prestige than with utility or practicality. This is to say that the bigger the grant and the more prestigious the grant awarding body, the higher the status of the academic and the more likely tenure or promotion to professor. This raises a tension between a nurse’s primary obligation to others rather than to self on the one hand and the expectations of the academy on the other. Yet as Rolfe, when referring to his obligations according to the nursing code of his country, notes: ‘. . . when I set out a research proposal or write a paper for publication, my first priority should be that it will contribute to the betterment of nursing practice rather than to the greater glory and profit of my university’ (2012; 735), to which might be 26
reasonably added that neither should these things be done primarily for the greater good or profit of the nurse academic. The other-regarding obligation of nurses whatever their area of practice is writ large in nurses codes where injunctions such as ‘The nurse’s primary commitment is to the patient’ (ANA 2001, 1), ‘Make the care of people your first concern’ (NMC 2008, 3) and to use ‘. . . knowledge and skills for the benefit of patients’ (NCNZ 2009, 7) explicitly acknowledge that nursing practice is primarily other rather than self-regarding. Given this injunction what then is the status, ethically speaking, of those nurses engaged in research primarily for reasons of, for example, professional advancement or self-aggrandizement? At face-value, a nurse operating from these motivations would appear to be acting in an unprofessional or unethical way according to the wording and emphasis of any particular nursing code. If true, then the academic who strategically positions her or himself within a particular area of investigation because that area of investigation is attracting funds, or because they believe this to be an area in which they can generate a high profile, or because they perceive the area as particularly ‘of the moment’ and thus can capitalize on exposure opportunities and does so primarily for the purpose of enhancing their reputation, obtaining merit in their institution, increasing their earnings or seeking notoriety should surely earn censure and perhaps even be called to account by their regulatory body. Indeed, by this token, any action by a nurse that is primarily self-serving should earn similar censure. Motivation is, of course, notoriously difficult to establish and who is to say that wrong are those who display raw ambition, ride roughshod over others, and/or do their utmost to extract themselves from teaching commitments so as to ascend to some kind of supremacy in the academy? Especially, when what follows might lead to significant developments or improvements in nursing practice by virtue of a research programme established that would otherwise not have come into existence. For some, a consequentialist argument of this sort can be used to justify dubious means because of a predicted greater good related to specific ends; although it is to be supposed that regulatory bodies would consider this type of defence for unprofessional or unethical practice in the conduct of research unacceptable. In contrast, the stated aims of nursing research are more consistent with the tenets of nursing codes. The International Council of Nurses (ICN), for example, promotes the development of nursing research particularly where this has practical utility (ICN 2007). The Canadian Nurses Association (CNA) recognizes research as one major source of evidence needed to ensure appropriately informed decisionmaking for ethical nursing practice and implies that nursing © 2015 John Wiley & Sons Ltd
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researchers should pursue lines of enquiry that emerge from practice situations (CNA 2013). This suggests that the proper conduct of nursing research is not a function of personal interest in, or passion for, a particular topic, and certainly not for the purposes of self-advancement at the expense of practical value. Further, the CNA has previously stated that registered nurses have an obligation to report all findings whether positive or negative (CNA 2002), and thus, whether they enhance or diminish personal or professional reputation – something that those who seek to discover how things really are would accept as unproblematic, while those with less altruistic motivations might struggle. While the more altruistic – idealistic, even – aspirations of nursing as conceived by those who subscribe to the version of the nature of nursing outlined in the official statements of professional associations and regulatory bodies might be accepted by some, it might be supposed that there are nurses who baulk at the aspirations contained therein. Assumptions that nurses and nursing have homogeneity abound within the nursing literature where phrases on the lines of we as nurses must. . . and the role of the nurse is to. . . are common and used without justification to make normative claims about the idea that nurses share much more than a common desire to improve the lot of those requiring the services of nurses. But as Lipscomb (2013) notes ‘nurses need not share substantive normative beliefs/goals and . . . group descriptors such as ‘nurses’, and ‘nursing’ cannot meaningfully or easily attach to political claims’ (254). While Lipscomb’s analysis remains largely in the political arena, the point that nursing authors often slip into a style of writing that suggests they are speaking on behalf of all nurses without providing grounds for such a claim is a point well made and transfers easily to issues outside of the political domain. Nurses undertake nursing for all sorts of reasons. Some adopt almost evangelical positions regarding what nursing is and what it is not; some simply seek a steady salary. It is likely that the majority of nurses would, if asked, locate themselves at some point between these two extremes depending on whatever else is going on in their lives and the nature of the sociopolitical environment in which they practice. If there is a continuum of this type for nursing in general, then it is reasonable to suppose that a similar continuum exists for nurses engaged in nursing research.
GETTING READY FOR ‘ETHICS’ I imagine I am not alone in overhearing snippets of informal corridor conversation about ethics among and between (post)graduate students and I imagine that similar conversations take place whenever and wherever groups or individu© 2015 John Wiley & Sons Ltd
als are required to seek ethical approval for whatever studies are being contemplated. Within this context, ethics is taken to mean the requirement to obtain ethical approval for research – often referred to as ‘getting ethics’ or ‘going for ethics’ or simply ‘ethics’ – as in the question: ‘where are you in your research?’ and response: ‘Oh, I’m getting ready for ethics’. Often conversations of this nature seem to contain, explicitly or implicitly, a sense that the process of getting ethical approval is overly bureaucratic and exceedingly vexatious, an obstacle to be overcome in order to get on with the real work of research. Shore (2009) acknowledges the process as ‘time-consuming’ (334) and further identifies students’ perceptions of review boards can be engendered by the negative perceptions or experiences of instructors about the process. Shore notes ‘Some instructors may present the IRB as “bureaucratic in nature”, potentially implying that the review process does not contribute to the ethical conduct of research’ (335). It is easy to sympathize with this view especially where an applicant is faced with completing a form that is some 30 or 40 pages long, for then it should come as no surprise that the process feels – to the graduate student at least – overwhelming, overly complicated and overly bothersome (Jamrozik 2004). From this, the leap to perceiving the getting of ethical approval as a hoop to be negotiated or as a barrier to be overcome with the least possible pain is a response that is, perhaps, not only understandable but also foreseeable and predictable. I am being deliberately selective and, of course, anecdotal here and I am well aware that even among those who most vociferously bemoan the growth of regulatory frameworks for obtaining ethical approval for projects involving humans, there remains a core recognition that research enquiry should proceed in an ethical as opposed to an unethical manner. Integrity in research is, after all, one of the core values of the scientific endeavour (Macrina 2005). In answering the charge that the application process is overly burdensome, those involved in the research ethics review process1 might point out that the primary function of ethics review is to uphold the ethical standards of scientific endeavour including, importantly, the protection of participants from unnecessary harm and that for any well thought out research project, explaining how the conduct of that research strives to be ethical should not be burdensome. It would only be burdensome, they might add, if the researcher has insufficiently conceptualized the ethical
Bodies charged with the ethical review of proposed research projects are known by different names. For example, in the United Kingdom, the ethics review body is known as the Research Ethics Committee (REC); in Canada, the Research Ethics Board (REB); and in the United States, the Institutional Review Board (IRB).
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implications of the proposed study. In any case, they might continue, it is only right and proper that the burden of demonstrating ethical conduct of research should lie firmly and squarely on the shoulders of the researcher who, as part of the process of research, should expect to be challenged by a rigorous process in order to convince a body of peers that their research will continue with due regard for the ethical obligations of researchers. Of course, the danger of interpreting guidelines as immutable rules, failing to include expertise in an appropriate range of research approaches, or taking an inordinate amount of time to process applications renders disingenuous claims by research ethics review committees (hereafter, ethics review bodies) to be enabling rather than obstructive. In addition, the inconsistency of decisions between ethics review bodies each with their own sets of idiosyncrasies and particular preferences can leave the researcher who has to gain approval from more than one ethics review body for the same study (e.g., in the case of a multicentre study) bemused by the need to satisfy different sets of conditions dependent purely on the predilections of individual ethics review bodies (Greene and Gieger 2006; Yaghoobi 2011). It is the perceived failure of including an appropriate range of research expertise within an ethics review body that appears – at least informally – as a commonly voiced complaint heard in nursing circles and beyond, along with the claim that this perceived failure in the composition of ethics review bodies tends to put nursing research proposals at a disadvantage because of the purported preferences within those committees for particular (e.g., assumed positivist, medical or quantitative) approaches to research. This charge is often couched in distinctly dismissive terms such as to imply a failure of the ethics review body to understand a particular type of research. Even if true, this might equally indicate a failure on the part of the researcher to explain. Nevertheless, an ethics review body that rejects a proposal on the basis of methodology alone should indeed earn censure, but the charge remains largely unproven and might tell us more about the researcher than about the committee. Leaving these questions aside, here the discussion will focus on the relationship between the character of the researcher and the proper conduct of nursing research.
CHARACTER AND ETHICS IN THE PRACTICE OF NURSING RESEARCH The proper conduct of nursing research is a topic that has exercised many in the academy and beyond. Documents to guide nurses while engaged in nursing research include the 28
following: the Research Governance Framework for Health and Social Care in the UK (DH 2005); the Tri-Agency Framework: Responsible Conduct of Research in Canada (Government of Canada 2011); and the ORI Introduction to the Responsible Conduct of Research in the United States (Steneck 2007). Similar documents can be found in other parts of the world, and each reflects a recognition that researchers have not always behaved in ways that engenders public trust and confidence. Indeed, ethics review bodies exist at least in part because of the general perception that researchers cannot be trusted to be left to their own devices in the conduct of research. This lack of trust is warranted as the history of research, particularly of research involving humans, is littered with examples of unethical practices, but the existence of ethics review bodies offers no watertight guarantee that similar abuses will not occur. Thus, the ethics review body often finds itself between a rock and a hard place, forever required to police a practice over which it exerts minimal, if any, control once project approval has been granted. No wonder then that ethics review bodies require detailed information as its members attempt to determine whether the applicant(s) can be trusted to ensure ethical conduct of a proposed research project. The predictive nature of such decisions should not be underestimated and researchers might well be advised to anticipate the need to devote significant time to the preparation and presentation of applications for ethical approval because ethics review bodies tend to assume a direct relationship between the quality of the application and the qualities of the researcher. And this assumed relationship points towards another potential relationship, that is the relationship between the researcher and her or his motivation for the research project. As suggested earlier, there are many reasons why nurses undertake research despite the received wisdom that nursing research is undertaken to find out more about the current state of nursing with a view to making recommendations that will make things better for future patients. The idea of character is controversial (cf. Merritt, Doris and Harman 2010), but for the purposes of the present discussion, it is assumed that each individual has a set of qualities the expression of which gives rise to the idea that she or he has a particular type of character; for without such a belief, it would not make sense to speak of someone acting characteristically or, indeed, uncharacteristically. On this account, it makes sense to talk of someone of good character as being someone who is, generally speaking, honest and trustworthy, and as someone with integrity. Such a person we imagine to be generally well disposed to others; that is to say, a person of this type can be assumed to not wish to do harm to others. Indeed, if nursing’s regulatory bodies’ versions of © 2015 John Wiley & Sons Ltd
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a nurse are to be believed, then the qualities of honesty and trustworthiness are among the very qualities that nurses must exhibit, regardless of their area of practice. It follows that the nurse engaged in nursing research is required to be honest and trustworthy, and to strive to remain other rather than self-regarding. In other words, nurses undertaking nursing research are to be of good character and thus be motivated by altruistic and not personal motives. If this is true then one might reasonably ask why research ethics bodies cannot merely accept that nurses involved in nursing research will conduct ethical, rather than unethical, research. Why isn’t knowing the requirements of nursing’s regulatory bodies for nurses to be honest and trustworthy and to place the needs of others ahead of their own sufficient to give an ethics review body confidence that a nurse will practice research ethically? Apart from the obvious fact that not all nurses act in honest or trustworthy ways, or put others’ interests first (witness the busyness of disciplinary sections of nursing’s regulatory bodies), research is a form of specialist practice that preregistration nursing education is ill-equipped to deliver. However, (post)graduate nursing programmes are expected to deliver research training that instils the tenets of the proper ethical conduct of research and there are many experienced nurse-researchers working as principal investigators and/or supervisors. One would like to think that when these nurses are practising as researchers, they do so with honesty and trustworthiness while genuinely striving to subsume their own interests to those of research participants. The putting of others’ needs before one’s own is, after all, precisely what professional nursing codes expect of nurses regardless of the focus or area of practice. On this account giving primacy to the interests of the research participant(s) would seem to require that the nurse-researcher embed ethical considerations within the conception and design of a research study and not relegate such considerations to the afterthought only of relevance when arriving at the stage of seeking ethical approval. The claim here is that a research proposal in which the researcher has taken the ethical obligations of research seriously and who has developed the project with the interests of the participants at the forefront of the design will invariably contain implicit and explicit recognition of the need for the project to be conducted with due regard for ethics. Such a proposal will very likely address many of the concerns that members of an ethics review board have for any research proposal. And a wellconsidered study proposal that demonstrates a thoughtful appreciation of anticipated and unanticipated ethical issues is more likely to provide the ethics review board with confidence in the applicant’s ethical competence to undertake or © 2015 John Wiley & Sons Ltd
supervise the research. In other words, a nurse who is characteristically inclined towards honesty, trustworthiness and putting the interests of others first (let us call them applicant A) will likely present an application that reflects these qualities. In so doing, applicant A not only impresses the ethics review board that the project has been well thought through but also will very likely find the questions asked in the application form to be questions already given attention during the conception and design stage of development of the project. In contrast, a nurse who is not characteristically inclined towards honesty or trustworthiness, or, perhaps more importantly, disinclined to put the research participants interests before their own (let us call them applicant Z), will very likely find the application process burdensome because it asks a set of questions to which insufficient attention has been given prior to the point at which ethics approval is sought. If any of this is even vaguely true, then it follows that applicant A will most likely find the application for ethical approval process significantly less burdensome than does applicant Z. It follows also that, ethically speaking, the character of the research practitioner may matter in significant ways. The relationship between character and motivation is complicated, but for the present purposes, it will be assumed that it is reasonable, given nursing’s regulatory body requirements, to expect a nurse of good character to be motivated to act well in the pursuit of altruistic ends. As such, applicant A will be motivated to ensure that no harm comes to others in the pursuit of finding out how things are in the world of nursing because they are characteristically inclined to act in ways that reflect this desire to do no harm. This is to say that while applicant A will most likely have additional and less altruistic motivations for undertaking nursing research, she or he will strive to ensure that these other motivations do not take precedence. In this respect, applicant A might be said to be pursuing goods internal to the practice of nursing research. In contrast, applicant Z may be distracted by the pursuit of external goods – professional success, promotion, status and so on – to the extent that she or he has lost sight of the both the primary purpose of nursing research and the regulatory requirement to be of good character. On this analysis, nursing research might usefully be understood as a MacIntyrean practice. In contrast to applicant Z – for whom the pursuit of external goods is paramount, applicant A might be said to be engaged with nursing research as a practice precisely because of a primary motivation that is other rather than self-regarding. As a thought experiment – and temporarily collapsing motivation and character insofar as motivation might be reasonably supposed to be a function of character, the two applicant types 29
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can represent extremes of a continuum of motivation for undertaking nursing research. For applicant A, the ethics application will be less burdensome than it is for applicant Z; as a thought experiment, this leaves a potential 24 additional perspectives on the burdensomeness, or otherwise, of the ethics application process dependent on which letter of the alphabet represents the motivation of a particular researcher. Few nurse-researchers are likely to be absolute applicant A type or absolute applicant Z type for most researchers will have multiple and sometimes competing motivations for pursing research – which suggests that most nurse-researchers will find themselves occupying the middle ground of motivations – but just so long as that majority have the internal goods of nursing research in their sights, then nursing research as a practice has the opportunity to flourish. If the idea of nursing research as a practice in this sense has any purchase, then it follows that the personal qualities such as honesty, trustworthiness and other-regardingness be cultivated within (post)graduate nursing programmes and within nursing research teams. Just the kind of character development Nightingale regarded as necessary if nurses were to become perceived as professional carers in the 19th century. However, one unfortunate aspect of the Nightingale legacy is this very focus on the personal conduct of nurses for as long as regulatory bodies and others continue to blame failings on individual nurses, those who maintain the status quo of systems that create environments in which the expression of good character is made difficult remain immune from criticism. The controversy surrounding the idea of character hinted at earlier in this article makes just this point. Common in the critique of the idea of enduring character is a claim that there is a general failure to take sufficient cognizance of situation. The personal motivations of individual nursing researchers may be important in generating a thriving practice of nursing research but without an environment in which the desired qualities are given a chance to flourish then the practice may still collapse. MacIntyre notes the importance of the approach of the institution2 in which a practice takes place as a factor in the flourishing or otherwise of a practice. The present austerity condition with its everincreasing deadline-driven and frantic speed requirements undermines much that would otherwise count towards nursing research as a practice. This is to say that while the ideal would be that persons of good character be allowed the time and space to develop well-considered, ethical research proMacIntyre uses the term institution to mean the organizational environment in which a practice is situated. Thus an institution could have a physical or virtual presence, or might exist as an abstract idea.
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posals in which due consideration is given to ensuring participant’s interests are given the primacy they deserve, the reality may be that nurse-researchers are caught up in an environment that frustrates such intentions. In other words, the idea that the ethics approval process is burdensome may be as much a function of structure as it is of agency and thus the blaming of individuals alone for what might be cast as the premature submission of ethics applications may misunderstand the nature of the beast (as it were). The pressures on nurse-researchers to deliver in a time-limited and deadline-driven environment where success is measured in numbers – of grant applications, of papers published, of dollars awarded, of outputs and so on – encourage hastiness and compromise at the expense of careful and measured approaches to the development of well-crafted project proposals. Thus, while applicant A may represent the ideal nursing researcher, applicant Z may yet be the strategic survivor that the environment of academia encourages; as MacIntyre notes, those who pursue the internal goods of practices will very likely forfeit the fame and fortune available to those who ruthlessly pursue external goods.
CONCLUSION Giving primacy to other-regarding aspects of the development of a research proposal would seem to suggest that nursing research could usefully be considered a practice in the sense that Alasdair MacIntyre uses that term. One result of engaging with nursing research as a practice is that it brings to the fore qualities that nursing authorities expect individual nurses to demonstrate and this has the potential to allow practitioners of nursing research to find the requirements of seeking ethical approval for their research less burdensome than it is for those who do not engage with nursing research as a practice. Thus, a case can be made for a stronger approach to the character development of potential nursing researchers, as this is consistent with both the claims made within nursing codes regarding the nature of nurses and the claims made regarding the ultimate purpose of nursing research as a vehicle for improving the lot of patients. However, pursuing nursing research as a practice may come at the cost of reducing opportunities for individuals to thrive in institutions that measure success in terms of, for example, successful grant applications and numbers of peer-reviewed publications. These institutional features generate an environment that is largely antithetical to the idea of nursing research as a practice which means it is very likely that the majority of nursing researchers should expect to find that the process of obtaining ethical approval for research projects will become increasingly burdensome. © 2015 John Wiley & Sons Ltd
The practice of nursing research
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