Guest editorial

THE IMPACT OF LOCAL RESEARCH ETHICSCOMMITTEES ON THE DEVELOPMENT OFNURSING KNOWLEDGE

There can be few nurse researchers in the United Kingdom

(UK) who have not had a rejection letter from a local

research ethics committee at some point in their careers.

Of course, the rejection may be for entirely legitimate

reasons, such as an ill-thought out design, or poorly

focused research questions which could cause potential

harm to the research participants. Ominous for nursing,

however, is the ethics committee submission which is

rejected because it is not understood by the committee

members (as opposed to not being understandable), or

worse because those on the committee do not like the

research method adopted.

While ethics committees play a critically important role

in protecting patients from researchers who might naively

or wilfully harm them, when these committees result in a

stranglehold on the development of nursing (or other)

knowledge then questions should be raised about their

function.

In the UK, the majority of research ethics committees

have historically had a strongly medical dominance by

professional composition and a positivist outlook by philo-

sophical stance. The longstanding medical perception of

nursing as a subordinate profession with a lower standard of

educational preparation has, on a number of occasions, in

my experience led to the assumption by doctors that they

alone have the intellectual and professional training to

undertake research that is valid and worthwhile.

To be blunt, medical research is seen as more important

and of greater value than nursing research and thus more

likely to be funded (Lorentzen 1995).

The inculcation of positivist ideology begins in medical

school curricula where students are forcefully told that the

so-called `hard sciences', such as biochemistry and phys-

ics, are not only the foundations, but the supporting

infrastructure and building blocks of their practice. Softer

disciplines, such as sociology, social policy and philoso-

phy, are considered little more than expensive decorations

to be added when time and inclination allow. Positivism

becomes the dominating paradigm in most subsequent

medical research, for which medical students actually

have little formal training.

Research agenda

This paradigm is further reinforced by the fact that

randomised controlled trials are considered to be the

`gold standard' of research against which all other research

must be measured. Indeed, Luker (1999 p. 85) observes

that well conducted randomised controlled trials are

considered by many to be more worthy in terms of the

contribution they make to the British National Health

Service (NHS) research agenda than well conducted

qualitative studies.

My comments should not be construed as a criticism of

quantitative research which serves a valuable purpose and

produces much useful information for patients and prac-

titioners in all disciplines. Nursing, which does not have a

strong research tradition, has acknowledged and even

embraced nonpositivist paradigms which have developed

over the latter half of the twentieth century to become the

dominant force in social sciences research. Nursing has

drawn on both world views to provide it with a wide range

of methodologies and tools to address questions of

relevance to nursing.

Medicine, however, has tended to remain reliant on its

tried and trusted methods, denigrating any other which

does not ®t into its own narrow de®nition of research. The

whole two paradigm debate is becoming rather tired as

both sides appear to argue in a war of semantics and

linguistic attrition. But the debate has a direct impact on

the development of nursing knowledge. The traditional

approach of ethics committees too often leads to the

denigration of nonpositivist research approaches which

are considered to be neither rigorous nor valuable, when,

in fact, they may be only poorly understood.

Many nursing research studies attempt to discover

meaning in the patient's experience of care. This often

requires the use of qualitative methodologies, which may

be best suited to exploring these experiences by using

small local samples and research instruments that aim to

uncover depth rather than breadth. So how do the

esoteric arguments, noted above, impact on the develop-

ment of nursing knowledge? The answer lies in the

strategies adopted by nurse researchers to obtain research

ethics committee consent for their proposed research

projects.

In order to gain approval to undertake a study, a

nurse researcher seeking to explore, for example, the

patient's experience of emergency care, will include

quantitative measurement instruments in the study to

suggest to the research ethics committee that the subse-

quent ®ndings may be replicable and generalisable. In

reality, the nurse researcher may be far more interested

in gaining a depth rather than breadth of understanding,

but frequently he/she recognizes that suggesting to the

research ethics committee that quantitative instruments

will be used may be the only way to gain ethics

committee approval.

Ó 1999 Blackwell Science Ltd 1009

Journal of Advanced Nursing, 1999, 30(5), 1009±1010

Research is compromised

The outcome is that precious research time that could

have been spent in gaining insights, understanding and

exploration of previously hidden themes in patients'

experiences of care, is compromised by the pragmatic

imperative to analyse the quantitative data, which,

while of interest, is not really the prime concern of the

researcher.

The end result is that the body of nursing knowledge

remains relatively anorexic as nurse researchers are

steered away from ¯eshing out the conceptual and

philosophical dimensions of what nursing is and instead

add further bulk to the understanding of what nurses do.

As Savulescu et al. (1996) note, research ethics commit-

tees have a wider responsibility to promote the public

interest by helping to ensure that relevant research is

done. This, by de®nition, must mean fostering a climate

in which qualitative approaches to knowledge generation

are seen as just as valid as other, more traditional,

approaches.

In addition, research ethics committees must accept that

challenging legitimate methodological approaches is be-

yond their remit. There have been calls in the UK for

almost 20 years for greater accountability of research

committees to justify their decisions (Lancet 1980; Gilbert

et al. 1989; Gar®eld 1995). Yet, by inappropriately chal-

lenging the methodology rather than concentrating on the

ethics of research, the research ethics committees serve to

undermine their own authority and occasionally lead to

the questionable practice of researchers calling their

studies `audits' in order to circumvent the vagaries and

inconsistencies of research ethics committees.

While the growing number of nurses and social

scientists as members of research ethics committees is

to be welcomed, as are the increasing numbers of

doctors with an interest in qualitative research, the

prevailing culture needs to be challenged. This should

also include reviewing the format of research ethics

committee application forms, many of which still tend

to assume that the proposed research will be quantita-

tive by asking questions about sample sizes and

statistical advice taken, and describing participants as

subjects, etc.

Nursing remains in the adolescent phase of its devel-

opment; constantly seeking to test the boundaries of its

knowledge and clinical practice. If it is arti®cially

constrained, it will, like most adolescents, eventually

rebel in ways that may not always appear to be construc-

tive. To draw a parallel from another discipline, Richard

Feynman, the Nobel Prize winning physicist, once

observed that relations among early scientists were very

argumentative, but today they are very good.

In a series of lectures given in 1963 he noted, `a

scienti®c argument is likely to involve a great deal of

laughter and uncertainty on both sides¼if you get any-

thing new from anyone, anywhere, you welcome it, and

you do not argue about why the other person says it is so'

(Feynman 1998 pp. 21±22). In some respects more and not

less uncertainty is needed in nursing because what we do

not know we will hopefully want to ®nd out.

But if nurse researchers are prevented from asking the

relevant questions merely because the research ethics

committee do not like them, they might end up losing

interest in the questions themselves. And that would

certainly be to the detriment of the development of

nursing knowledge.

Brian Dolan

MSc (Oxon), MSc (Lond), BSc (Hons), RMN RGN CHSM

Nursing Research Fellow,

King's College Hospital Accident

& Emergency Primary Care Service,

London and Doctoral Student,

New College,

University of Oxford,

Oxford

Brian Dolan's post is funded by the Department of Health

(England), as part of a Research Training Fellowship

Scheme. The views expressed in this guest editorial are

personal and do not necessarily re¯ect those of the

Department of Health.

References

Feynman R. (1998) The Meaning of It All: Thoughts of a Citizen

Scientist. Penguin Books, London.

Gar®eld P. (1995) Cross district comparison of applications

of research ethics committees. British Medical Journal 311,

660±661.

Gilbert C., Fulford K.W.M. & Parker C. (1989) Diversity of practice

of district ethics committees. British Medical Journal 299,

1437±1439.

Lancet (1980) Vitamins, neural tube defects, and ethics commit-

tees. Lancet i, 1061±1062.

Lorentzen M. (1995) The way forward: nursing research or

collaborative health care research? (guest editorial) Journal of

Advanced Nursing 27, 675±676.

Luker K. (1999) The dilemma concerning the nurse's role in a

multidisciplinary research agenda. NT Research 4(2),

85±86.

Savulescu J., Chalmers I. & Blunt J. (1996) Are ethics committees

behaving unethically? Some suggestions for improving perfor-

mance and accountability. British Medical Journal 313,

1390±1393.

Guest editorial

1010 Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 30(5), 1009±1010