Introduction

Inserted in the interpretative paradigm, narrative inquiry is an approach to understanding experience¹ and how the physical, social, and cultural context influences individual experiences^2,3. This methodology studies how individuals experience the world⁴, using participants' narratives to explore human lives and experiences, which reveal how people understand their lives⁵, and understand the meaning of human experience, including challenges faced after some events and the complexity of human actions⁶. Like all other qualitative methods, narrative inquiry allows understanding and obtaining insights into phenomena through personal perception and meaning, and uncovering themes among the participants that cannot be measured by quantitative research.

Narrative inquiry has been used as an alternative approach to positivism, which views the nature of knowledge as objective and definite⁷. In narrative inquiry, researchers collect and analyze stories narrated by people and retell stories about people's experiences, which challenge views of certainty and knowledge^4,8. Understanding the participants' experiences and perspectives does not reveal objective truths but exposes subjective truths for the participants within their social context^8,9. The representations narrated by the participants cannot be judged as the only truth, but the truth represented by the participants' experiences⁸.

Narrative research focuses on human experience, has a holistic quality⁴ and allows participants to speak about their experiences without restrictions^8,10. It considers all dimensions influencing the experience, such as the hospital environment and social interaction³. Narrative researchers expect what they learn to benefit others and contribute to basic knowledge about the human experience¹¹.

There are diverse approaches to narrative inquiry. Connelly and Clandinin's^1,2 perspective of narrative research, based on Dewey's "theory of experience", involves a transactional ontology and evolutionary epistemology within a pragmatic framework¹² and has as its central element a three-dimensional space^1,2. The three commonplaces of narrative inquiry that delineate the research space dimensions are²:

This Connelly and Clandinin's^1,2 perspective narrative inquiry framework guides the exploration of people's narratives, allows a deeper understanding of the participants' experience³ and highlights the relational characteristics between the researcher and the participant¹¹. The participants tell their stories, and the researcher retells them using the three-dimensional space of narrative inquiry^2,15. This approach demands from the researcher a reflection on all the components of the investigation. He is not just an observer, but someone who is part of the construction of the story¹.

The central ontological view of narrative inquiry recognizes an experience as continuous and relational across time, places, and relationships². This fact makes this methodology different from other methodologies that use narratives.

Narrative inquiry is suitable for health research as it includes social, cultural, and environmental influences on experiences and all dimensions that affect the individual's experience³. In nursing research, narrative inquiry is an appropriate methodology that allows gathering valuable data about personal real-life experiences, understanding illness experiences, and exploring what people value in nursing care value, their wishes, and desires. This methodology often studies nurses' experiences. This knowledge can assist nurses in improving their practice and the quality of nursing care to better supply for the needs of people during their illness experience and can bridge a gap in care. It can improve patient safety and may even provide information for future investigations³.

In health research, patients are often vulnerable, and the challenge is to achieve equality in the relationship³. In this sense, narrative inquiry is a methodology suitable for nursing research and studies that include participants in vulnerable conditions because this methodology studies experience from an individual's perspective, gives voice to the participants and what is experienced by them, and implies validation by the participants.

This paper aims to discuss ethical conduct in narrative inquiry and examine specific ethical issues at different stages of the narrative inquiry process, with a particular focus on nursing research, in line with the ethical principles that guide the nurses' conduct.

Ethical conduct in narrative inquiry

The relational properties between researcher and participant are especially relevant in narrative inquiry. It contributes to making this methodology unique and allows the researcher and the participant to develop a connection and, thus, a deeper understanding of the phenomena under study³.

This methodology's core is relational ethics^13,16, which should guide research relationships and the investigation process. There are ethical concerns regarding the relationship between the nurse researcher and the participant, as well as the study's impact on individuals involved in the research process¹⁷. Beyond the ethical principles that guide nurses' conduct and research process (autonomy, beneficence/non-maleficence, justice or fairness)¹⁸, ethics in narrative inquiry involves a set of responsibilities in human relationships, including respect for dignity, privacy, and participant well-being^9,11.

Engaging in narrative inquiry also implies ethical conduct, which requires mutual respect, receptiveness to different voices, and negotiation (negotiating relationships, research purposes, transitions, and the role of the researcher in those relationships)¹⁵. Researchers must value integrity, respect, and humility as ethical standards and long-term relational accountability with participants⁸.

Ethical conduct is vital since narrative inquiry planning and continues long after the study ends due to long-term relational commitments¹³. Ethical matters shift, and the participant's role may change during the research, including being a data collector, a data interpreter, and even a co-writer of the reports¹.

Ethical issues of research planning

A study that uses this methodology should be designed to be conducted ethically. Participation in the study is completely voluntary and nurses’ researchers must fully explain the study before it starts and be transparent about their interests to ensure a trustful relationship with the participant⁹. Moreover, respecting the principle of autonomy is vital, and the researcher must inform the participants that they can refuse to answer any question, have the right to withdraw consent, and are free to give up on the study at any time without prejudice to themselves and without consequences¹⁹.

The possible consequences should be foreseen, mainly for the participants, and ensure that risks are reduced to a minimum to achieve the study's goal²⁰. Due to the important relational component, the relationship, strict collaboration, and constant sharing between the nurse researcher and the participants are essential in narrative inquiry. A narrative researcher has a responsibility to the participants and also to the community⁹. Respecting the ethical principle of non-maleficence, the researcher must make the meetings' aims clear from the beginning, avoiding sentimental involvement and maintaining a strictly professional relationship¹¹.

Besides this, for some participants, telling their illness stories could be very emotional and can create negative, unpleasant, unwanted feelings or other adverse effects in some people, which could represent a potential ethical risk⁹. The nurse researcher should prepare an appropriate plan if there is a risk of this happening⁹. An essential procedure for safeguarding participants is getting informed consent¹⁹.

Anonymity is an ethical issue throughout the narrative inquiry. When selecting the environment for data collection, a quiet, noise-free, comfortable place that would provide confidentiality and anonymity should be chosen. These conditions are essential so that the conversations and interviews are not interrupted, and there is no risk that other people will overhear the information the participants give. Anonymity concerns often shift as participants take on other roles in other parts of the inquiry process, and what seemed to be fixed can change throughout the research¹. Participants can state at the outset that they wish to be identified or clearly state that they wish to remain anonymous by providing them with fictitious names. However, there are other possibilities: in the initial stages of the research, participants may want anonymity, but as the inquiry process proceeds and participants take on different roles, they may decide to be recognized for the coauthoring work¹.

Ethical issues of data collection and composing field texts

Ethical concerns emerged while working in the field and composing field texts (it includes research interviews, conversation texts, and personal diaries)¹.

This methodology uses participants' narratives, usually obtained through interviews⁵. The researcher conducts the interview and asks questions that will assist them in interpreting the participants' world rather than explaining or predicting that world⁸. In studying a person's experience, the researcher should ensure that the inquiry is not more intrusive than it needs to be, and then privacy has to be maintained¹⁹.

Respecting the principle of autonomy, in narrative inquiry participants decide their most essential stories meaningfully and have the right to refuse to answer any question¹⁹. If participants ask not to include certain information or conversation when composing field texts, the researcher will not. However, the researcher has to be conscious that this data will influence him¹.

One characteristic of narrative inquiry is that it requires multiple meetings during the data collection, and the researcher builds a relationship with the participants for extended periods of time. This relationship between nurse researcher and participant over a long period offers a chance to collect a richer and more profound story that can extract "hidden" concerns³. On a personal level, long and often deep conversations can be interpreted by participants as friendship¹¹. To respect the ethical principle of non-maleficence, during data collection, the researcher should repeat the purpose of the meetings to maintain a strictly professional relationship with the participants¹¹.

Moreover, considering the principle of non-maleficence, narrating your illness story may trigger negative, unpleasant feelings or other adverse effects in some people. If this occurs, the option to pause or interrupt the interview should be given, and the participant may withdraw from the study without any prejudice.

Narrative inquiry can have a major role in participants' life. Sharing their stories allows the participants to feel heard, and can make them realize their stories are important.

In line with the principle of beneficence, the participants should benefit from participation in a nursing research. Reporting an experience to a nurse can provide some emotional benefits, as well as understanding and finding the meaning of those experiences and personal growth²¹. Participants often explore how the self or life plan has changed through experiencing vulnerability and question if the ‘real self’ is the ill, the disabled, the vulnerable, or the earlier “normal” self²². Telling an illness story to a nurse may help individuals support acceptance of a situation of vulnerability and construct their versions of reality and identity²².

Ethical issues of data analysis and interpretation

Interpreting somebody's voice has to be done with humility and respect⁸, responsibility and sensitivity¹⁷. According to Connelly and Clandinin's¹ perspective, narrative inquiry data are analyzed using the three-dimensional space³: sociality, temporality, and place intersect in the stories of participants²³.

In the narrative inquiry, the researcher and the participant continually clarify, validate, and negotiate the meaning of the stories throughout data collection and analysis⁹. This aspect maintains the honesty and precision of the search.

The analysis must be carried out from a holistic perspective, respecting the content (what is said) and the form (how it is said), meaning that reported experiences are considered a whole⁵. The text sections are interpreted based on the other parts.

Ethical issues of results presentation (final narrative)

In this methodology, the result of the research is a narrative representing the narratives of the participants' experiences^13,17 with a contextualized meaning attributed to the data, where the researcher usually leaves their voice to be heard²⁴. This final product offers a profound understanding from the participant's perspective, providing readers with excellent knowledge of the phenomenon under study so they can apply it in their contexts⁹. These include, for example, the contexts of nursing care. The studies’ results using narrative inquiry as a methodology cannot be generalized but aim to help nurses to redefine their practice in similar situations and better meet the needs of people during the illness experience²⁵.

In writing and in the final narrative presentation, other ethical issues emerge¹. An ethical attitude implies writing about others respectfully, recognizing that participants can always read what was written¹¹. The participants are the first and the most important audience of a narrative researcher, who have the responsibility not to cause harm to participants and to compose a text that does not rupture the life histories that sustain them¹.

Nurses researchers are also responsible for an enormous audience. People with similar experiences can also read the published results and find commonalities. The integrity of participants' relationships with those who figure in their narratives must also be preserved in presenting the results. The dangers of publication can never outweigh the potential benefits¹¹. Also, when study participants know each other, they can never be harmed by what others have said about them¹¹.

Anonymity is another critical aspect to consider when presenting the results.

Conclusions

All narrative works must be subject to suitable and credible methodological processes to produce nursing knowledge. Narrative inquiry is much more than a simply comprehensive data collection. It contributes to knowledge development and can help evolve nursing as a profession and discipline. Thus, the knowledge gained in a study using this methodology may improve the quality of nursing care and inform future decisions and investigations.

In this methodology, the relational component and the proximity with the participants imply greater responsibility and an ethical attitude throughout the research process. The nurse researcher must respect the participants as constructors of narrative inquiry and honor his duty as an investigator, keeping the research rigorous and producing credible knowledge. Evidencing credibility and quality within narrative inquiry is an arduous responsibility due to its subjective nature, the relational component and singular interpretations.

In recent years narrative inquiry has proliferated in nursing research, and nurses researchers must be prepared to anticipate ethical issues. Due to its inherent characteristics, it is essential to continue debating ethical concerns in narrative inquiry as a nursing research methodology.