issues in research

Ethical considerations in
phenomenological research
Wendy Walker examines some important ethical issues
that researchers need to consider before and during
­phenomenological research. She argues that failure to
address such issues means putting at risk the rights of
research participants.
key words

research governance
▲ ▲ ▲ ▲

research ethics
phenomenology
witnessed resuscitation 

Introduction and aims

Implementation of the Department of Health’s Research Governance Framework
for Health and Social Care (DH 2001, 2005) has placed increased responsibility
on researchers to demonstrate continuous quality improvements in research
practice. This includes careful planning, preparation of documentation and
adherence to independent review processes to ensure that research meets the
required ethical standards. This article examines ethical issues that required
consideration when planning a research study using phenomenological
research techniques. Key aspects of a quality research culture are explored and
strategies to promote the dignity, rights, safety and wellbeing of those involved
in the research are presented.

Phenomenology
Phenomenology is acknowledged as a suitable methodology for gaining insight
into the essence or structure of the lived experience (Rose et al 1995). The
nature of inquiry is to search for truth and understanding from the perspectives
of those being studied and is especially useful when a phenomenon of interest

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 has been poorly defined or lacks conceptualisation (Polit and Hungler 1999).
Emphasis is placed on co-operative researcher-participant relationships and
open-ended dialogue to appreciate fully the participants’ perceptions of events
(Knaak 1984). This implies the use of qualitative methods of data collection
that allow the researcher entrance to the informants’ world and access to their
experiences as lived (Polit and Hungler 1999).
Topics appropriate to this research methodology include those central to
the life experiences of humans (Streubert and Carpenter 1999) and may
be classified as ‘sensitive’ areas of inquiry due to the potential for intrusion
into the private sphere (Lee and Renzetti 1993). This in turn draws attention
to issues of ethical significance that may be encountered throughout the
research process.

Presenting a case for the research

Munhall (1988) suggests that the question to be asked from an ethical perspec-
tive is: ‘Toward what goal and for what end?’ The Department of Health (DH)
(2001, 2005) also makes explicit the requirements of the researcher in terms of
providing justification for the study from an ethical perspective. The DH argues
that research that needlessly duplicates other work or is not of sufficient quality
to contribute something useful to existing knowledge is in itself unethical.
Once a topic for research had been selected by the author, a detailed liter-
ature review helped to refine ideas, improved understanding of the research
problem, assisted in the development of the research aims and gave early
indication of the most appropriate study design. Polit and Hungler (1999)
suggest that familiarisation with previous studies can be useful in alerting
the researcher to unresolved research problems and can provide a foun-
dation upon which to base new knowledge. Alternatively, Streubert and
Carpenter (1999) advocate postponing the literature review until data anal-
ysis is complete in order to obtain the purest description of the phenomena
under investigation. As a lecturer responsible for evidence-based teaching, I
considered it unrealistic to suspend personal knowledge and judgement on
the research topic. Furthermore, Clifford (1997) suggests that searching the
literature can help researchers determine whether their study is an original
piece of work – an important consideration for PhD students.

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 issues in research

Justification for the study

The practice of witnessed resuscitation – that is, ‘the process of active “medi-
cal” resuscitation in the presence of family members’ (Boyd 2000) – is a con-
troversial issue that has generated considerable discussion and debate within
the literature during the last two decades. Despite a growing trend towards
acceptance of this phenomenon, there remains a lack of empirical evidence to
support decision-making in practice and the credibility of existing research has
been criticised (RCN 2002). The majority of research has been conducted out-
side the UK in acute (secondary) care settings, and researchers have predomi-
nantly taken a positivist approach through the use of retrospective surveys to
examine staff’s and relatives’ perceptions of this practice, leaving the life-world
of participants largely unexplored. Furthermore, no attempt has been made to
research this phenomenon from the viewpoint of UK accident and emergency
ambulance staff who encounter bystanders during cardiopulmonary resuscita-
tion (CPR) outside of hospitals.

What goals?
The goals were:
n to gain insight into the lived experience of accident and emergency ambu-
lance staff who encounter bystanders during CPR outside of hospitals
n to increase understanding of the effects of having bystanders present during
CPR outside of hospitals and, in doing so, add to the knowledge available
on this subject.

To what end?
It is anticipated that the findings of this study will provide a clearer descrip-
tion and deeper understanding of the phenomenon of witnessed resuscitation,
without which ‘future studies to identify and test therapeutic measures will be
built on an incomplete knowledge base’ (Woods and Catanzaro 1988). The
research imperative, therefore, is to contribute to the existing body of knowl-
edge on this topic, generating theories that may be tested at a later stage using
quantitative methods.
Munhall (1988) identifies the potential for conflict between the research role
that uses people as a means to further knowledge (utilitarianism) and the profes-

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 sional duty of the nurse to treat individuals as ends in themselves (deontological
ethical system). She goes on to offer some reconciliation by reminding readers
of the individual’s decision to join the research enterprise voluntarily through the
process of informed consent, possibly even collaborating in the research for the
purpose of advancing a cause of their own. My belief is that the end result of fur-
ther knowledge justifies the means of involving people in the research. Not only
will this assist in the planning of emergency care services outside of hospitals, but
may also inform the policy and practices of healthcare personnel based in second-
ary care settings, where the presence of lay persons during a resuscitation attempt
is yet to be fully sanctioned.

Beneficence and non-maleficence

Two of the most fundamental ethical principles applicable to research are
beneficence and non-maleficence (Eddie 1994), which encompass the maxim
‘above all, do no harm’. In assessing the potential adverse effects, risks or
hazards for research participants, it was acknowledged that recollection of a
resuscitation event might be distressing. Those with experience of CPR will rec-
ognise the situation as critical, demanding skilled technical intervention, as well
as being highly charged emotionally. This is captured by Quinn (1998) who
defines cardiac arrest as ‘the ultimate medical emergency’. It could therefore
be argued that research to investigate bystander presence during CPR fulfils the
criteria of a sensitive topic – that is, one that has the potential to arouse strong
emotional responses (Cowles 1988). Practical concerns included recognition
that discussing a life-threatening event such as resuscitation may be distressing
and painful for people who are bereaved. Any staff member with bereavement
issues was therefore advised not to participate in the study.

The phenomenological interview

The strategy for generating knowledge in phenomenological research typically
involves conversational techniques, with the unstructured interview identified
as a valuable approach when collecting data on sensitive topics (Fielding and
Thomas 2001). Potential participants were informed that their involvement in
the interview would last approximately one hour and, with their consent, a
tape recorder would be used to help collect data accurately.

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 issues in research

Smith (1992) suggests that ‘any theoretical framework for ethical interview-
ing must begin with the interviewer’. This includes giving due consideration
to the sensitivity of the material and extended self-disclosure. Confidence to
proceed was drawn from past experience of conducting face-to-face interviews
as a researcher and clinician in acute and critical care situations. It is acknowl-
edged, however, that immersion in the lived experience of others may render
the researcher vulnerable (Robley 1995).
Sque (2000) recommends a period of preparation to allow those carrying
out an investigation to feel confident in their skills. There is also a need for sup-
port systems and periods of reflection to minimise the probability of what she
describes as ‘mortification of self’. Mindful of the emotive topic of resuscita-
tion, a support system of debriefing with a colleague qualified in mental health
was built into the research process.
Kavanagh and Ayres (1998) stress the importance of assessing participants
for signs of distress during research on sensitive topics and identifying strate-
gies for minimising discomfort. In the event that participation in the interview
caused the informant emotional distress, it was made clear that participant wel-
fare would take priority over the research. Acknowledging that follow-up sup-
port may be required, the participant information sheet also contained detail
on available sources of help. This is supported by Coyle and Wright (1996),
who argue that ‘it is ethically questionable for researchers to address sensitive
issues without being equipped to deal with resultant distress’.
In contrast, it was considered that participation in this study might prove
to be an effective way of helping the interviewee understand his or her
experience by engaging in cathartic disclosure. Holloway and Wheeler
(1995) suggest that ‘research interviews can be therapeutic, although ther-
apy is not their purpose’. Nevertheless, it was made clear to participants
that this benefit could not be guaranteed.

Informed consent
According to Polit and Hungler (1999), ‘informed consent means that par-
ticipants have adequate information regarding the research, are capable of
comprehending the information, and have the power of free choice, ena-
bling them to consent to or decline participation in the research voluntar-

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 ily’. The process is embedded within the principle of respect for autonomy
and includes providing participants with information about the benefits
and risks of the research (Holloway and Wheeler 2002). Despite efforts
to predict all the risks at the outset of the study, Smith (1992) warns that
it cannot be known for certain what the interview will uncover. Thus, in
qualitative research, consent is often viewed as ‘an ongoing, transactional
process’ (Polit and Hungler 1999) known as ‘consensual decision making’ or
‘process informed consent’ (Streubert and Carpenter 1999). In other words,
‘continually informing and asking permission establishes the needed trust to
go on further in an ethical manner’ (Munhall 1988).
A further consideration in phenomenological research is recognition that the
lived experience of those who are recruited to participate may render them
vulnerable and less able to act autonomously. It is therefore imperative that
the researcher avoids exploitation of people’s vulnerability (Polit and Hungler
1999), respects the individual’s right to self-determination (Burns and Grove
1999) and remains sensitive to factors that may limit the individual’s freedom
to decline to participate (Cook 1995).
Ethical conduct in gaining the consent from accident and emergency ambu-
lance staff included the provision of explicit information about the research,
taking into account the need for facts to be presented in a way that was under-
standable to the recipient and making sure that a contact point for further
information was made available. Each participant was also given a two-week
period to decide whether or not to take part, thus complying with professional
guidance that recommends no untoward pressure or coercion is applied to
potential participants when making choices (RCN 2004). Non-response was
taken as indication of an unwillingness to participate and no further contact
was made with individuals in such cases. Participants were also given the
option to withdraw from the study at any stage without prejudice.

Confidentiality and anonymity

A further ethical consideration relates to the researcher’s responsibility to give
assurances of confidentiality and anonymity (McHaffie 2000). Where anonym-
ity is impossible – for example, in a face-to-face interview – every effort should
be made to ensure that the principle of confidentiality is upheld (Streubert and

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 issues in research

Carpenter 1999). This implies that data will be used and reported in such a way
that no one is able to identify the source (Behi and Nolan 1995).
Measures to ensure confidentiality of personal information included the
secure storage of data and the use of a system of coding to protect the indi-
vidual’s identity during the process of data analysis and in the publication of
research results. Participants were also given written assurance that audio tapes
would be destroyed on completion of the study. Abbott and Sapsford (1998)
also recommend sampling widely. Sample sizes in qualitative research are typi-
cally small in contrast to quantitative research (Sandelowski 1986, Miles and
Huberman 1994, Morse and Field 1996, Nieswiadomy 1998). For example,
Ray (1994) identifies a single person or a group of eight to 12 participants for
phenomenological studies directed toward discerning the meaning of experi-
ences. This highlighted for me the need for caution in describing any particular
resuscitation event, and a broad statement about the location of the research
setting – ‘an ambulance service in the Midlands’ – was selected for use in
publications.
A decision to conduct the research interviews at a venue external to the
participants’ normal place of work was seen as an important feature of the
study design to safeguard their privacy. It was also considered appropriate to
remind participants before the interview of their responsibility to maintain the
confidentiality and anonymity of clients, peers and colleagues when re-living
their experiences.

Authenticity of data
Munhall (1988) argues that describing the experiences of others in the most
faithful way possible is the most critical ethical obligation of the qualitative
researcher. An important strategy in meeting this responsibility in phenom-
enological research is the notion of ‘bracketing’. The aim of bracketing is to
suspend or set aside one’s beliefs about the phenomenon being studied in
order to avoid influencing both the collection and interpretation of data (Oiler
1982, Knaack 1984, Cohen 1987, Jasper 1994). Although this practice is dis-
missed by some, Burns and Grove (1999) argue that there is still a commitment
to identify beliefs, assumptions and preconceptions about the research topic
at the beginning of the study for the purpose of self-reflection and external

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 review. Procedures built into the design of the study that sought to preserve
the uniqueness of each participant’s lived experience included deliberation
regarding an appropriate framework that would make explicit the procedural
steps taken during phenomenological data analysis and that would provide a
detailed decision trail. It was also proposed that preliminary findings would
be viewed by a small team of academic staff to determine the accuracy of the
interpretations.

Gaining permission to proceed

Tod et al (2002) view ethical probity in health service research as a tripartite
concern that is reliant on the actions of ethics committee members and clinical
research partners in addition to researchers themselves. Consistent with the
ethical principles of research governance (DH 2001, 2005), representatives
from the research setting were actively involved in the design of the study.
This had the advantage of ensuring that the research was accepted and agreed
upon by those participating in it, and appeared to pay dividends when seek-
ing written approval from the chief executive of the research site for access to
study participants.
It was agreed that research participants would be identified from a data
sheet pertaining to cardiac arrest that was routinely completed by ambulance
staff in the research setting and that this information would be obtained ret-
rospectively, thereby preventing any disruption to routine emergency practice.
An integral part of research governance is the requirement to obtain an inde-
pendent scientific and ethical review of the proposed research. This included
application to the local research ethics committee following the new electronic
standard operating procedures that came into force on March 1 2004 (NHS
2004), although it should be noted that a revised of the online form (version
5.2) was released on October 30 2006, aimed at improving the researcher’s
experience of the application process.

Conclusion
This article has considered ethical issues of importance when planning a
research study using phenomenological research techniques. Adherence to eth-
ical standards is arguably heightened when researching the lived experience,

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 issues in research

calling for creative strategies in the research design and careful deliberation of
the potential risks involved. In striving to achieve a quality research culture,
measures to promote safety and wellbeing undoubtedly include preparation
and support for both the researcher and those who have consented to be
researched.

Wendy Walker MSc, Post-graduate Diploma in Adult Education, BSc, Diploma

in Professional Studies in Nursing, is a Lecturer, School of Health Sciences,
University of Birmingham, UK.

This article has been subject to double-blind review

Abbott P, Sapsford RJ (1998) Research Coyle A, Wright C (1996) Using the

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