I am a novice researcher in the area of qualitative research and I read with interest in the special 30th Anniversary issue of JAN the re-publication of Tina Koch's 1994 paper Establishing rigour in qualitative research: the decision trail (Koch 1994, 2006). Although written over a decade ago, the establishment of trustworthiness in qualitative research remains an integral, but challenging, part of the research process. I agree with Latimer's (2006) commentary in that the focus of Koch's paper was in terms of methodology, but part of its impact comes ‘from what it reports’ (p. 102). I would argue that the impact of Koch's paper also lies in the actions that were taken as a result of what was observed.

Koch reports that various situations caused ‘ethical predicaments for me as a nurse but I intervened when I believed such intervention was in the interest of the patient’; and, further, that she ‘did not expect to encounter neglect and inadequate care’ (p. 94). Koch wrote in her journal about her ‘concern about the apparent disregard for patients’, about being the ‘first to notice a change in a patient's condition’, and about having ‘an obligation to report such changes’ (p. 95). Clearly, her journaling acknowledges the neglect that precipitated her ethical dilemma. It also shows her resolve to report what she was seeing.

As she continued in her work, Koch's response to the ethical dilemma changed. It no longer appears to be an obligation to report. Rather, she debated whether she should report these abuses to the administrators, thereby risking the study's completion. Her decision was to continue the study. Furthermore, Koch acknowledges that ‘giving care ate into my research time’ (p. 96). After three months she changed her focus and devoted less time to giving patient care.

Reading these journal entries evoked a negative feeling in me. I kept asking myself: where is the human side of this ethical dilemma? Trustworthiness and rigour in a research study starts with the criteria of credibility. I would argue that the credibility of the person is part of this as well. In this case, the person (i.e. Koch) took on three roles: the human being, the professional giving nursing care, and the researcher examining the experiences of older patients. In all three roles, the credibility relies on the ethical standard of the person and that credibility carries over into all other roles one takes on.

In the role of a professional giving nursing care, nursing philosophy reflects on the concept of the nurse being accountable for his/her actions. Tschudin's (2006) commentary in the same issue of JAN, but in response to another of its papers on the question of the role of a professional code of practice, pointed out that a code of professional conduct can demand accountability. But, according to Tschudin, ‘for someone who wants to be truly accountable, a code is not the first port of call. Nurses who have been educated to the level of safe practice are accountable for their own practice’ (p. 113).

The same accountability holds true for a researcher. Beneficence, or the obligation to do no harm, as defined in The Belmont Report, is a cornerstone of research practice (National Commission for the Protection of Human Subjects of Biomedical and Behavior Research 1979). The benefit of the research should outweigh any risk to its participants. However, The Belmont Report does acknowledge that difficult choices must be made when greater than minimal risk is involved. That risk may give no immediate direct benefit to those involved, but it could give the promise of benefit in the future. The human side of the researcher needs to assess the justification of the research and then decide if it is morally justified.

The human being lives by a moral code of ethics and makes choices on a regular basis, based on that code. Society decides on people's credibility on the basis of the choices that they make.

Koch was writing to enlighten us about a method of qualitative research that brings trustworthiness to the process. She sought to demonstrate a means to establish rigour as she shared her journal entries and gave the reader the ability to audit the events. In doing so, she opened up another dilemma: namely, the credibility of process that was used in gathering the data. From my perspective, this dilemma overshadowed the aim of the paper, calling to the forefront the human side of an ethical dilemma. In making the decision to carry on as researcher, and therefore not to report the inhumane experiences being witnessed, I have to question the credibility of the research process. As was pointed out in the commentaries, this is a much-cited paper that brings light to the question of establishing rigour in qualitative research. However, I would add that Koch's paper also opens doors into the area of ethical considerations in nursing research.


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