The Hair and Care Project

Dr Richard Ward

This project is an ethnographic investigation into managing personal appearance for people with dementia in care settings. The study, undertaken in the north west of England, used a qualitatively-led mix of methods which included observation and filming as well as in-situ interviewing aimed at exploring what goes on in a care-based hairdressing salon. Not all participants had capacity to give consent to participate, and in such instances we sought the guidance of someone who knew them well, usually a relative.

Ethical process

We were required to obtain ethical approval from a specialised NHS Research Ethics Committee, as the research included people who did not have capacity to make the decision to consent to participate in the research.

We produced an ethics protocol that included examples of the possible ethical issues and details of how we would respond if such issues arose. A key feature of the protocol was a section detailing how we would handle unanticipated and unpredicted ethical dilemmas. This document was shared with project stakeholders, both to sensitise people to the ethical dimension of the research but also as a point of reference in the event of any issues arising.

The protocol set out a system for researchers to record ethical events which would then be reviewed and discussed in supervision with the wider team, for example on occasions where the researcher witnessed incidents and was unsure how to respond, and where the researcher was called upon to make split-second decisions without time for reflection. During supervision we were able to spend time reflecting on the ethical issue, using it as an opportunity to explore and develop our understanding of the ethical dimensions of our research.

Realising the sometimes diverging perspectives on ethical issues that emerged from these discussions, ethics became a regular discussion feature in our wider research group meetings. Anonymised ethical dilemmas arising from our research were introduced and discussed.

This process was enlightening as it underlined the variance within the team over how such events were interpreted. On occasions there were clear differences between people according to their background or discipline. For instance, researchers with a nursing background often responded differently to researchers with a social care background in response to particular dilemmas.

During the course of the fieldwork there were no serious ethical incidents, instead the dilemmas that arose were ‘everyday’ (but not insignificant) challenges associated with being a researcher in a health and social care environment.

The recording and discussion of such incidents were educational for all concerned, leading into a broader ethical debate throughout the life of the project, but also proved reassuring to the researcher who was largely required to work alone throughout fieldwork.

Lessons

In addition to the formal NHS ethical governance process, further ethical consideration is required to address the challenges associated with qualitatively-led social research in the field of health and social care. The key issues include:

  • To ensure the consideration of the more unpredictable ethical issues that arise within qualitative research we would recommend introducing your own system for recording, discussing and responding to these issues.
  • The NHS approval process is carried out before the research team enter the field and before they engage with practitioners and other stakeholders. Ethical issues need to be considered throughout the project, and there are clear learning opportunities for researchers and practitioners to discuss shared ethical dimensions of their work with vulnerable older adults.
  • Our experience underlined that we are learning all the time about the nuanced ethical complexities of our work, and that treating ethical dilemmas as learning opportunities is both helpful and part of our natural development as research professionals.
  • For researchers using qualitative approaches to investigation there is a compelling argument for introducing a more dialogue-based approach to the ethical strand of your research. This proved enlightening as we opened up discussions to the wider research group and highlighted the difference in personal and professional responses to ethical dilemmas that occurred in the course of our work.