observations on the neglected concept of intervention in nursing research

Journal of Advanced Nursing, 1997, 25, 23–29

Observations on the neglected concept ofintervention in nursing research

Martin Johnson MSc PhD RN RNT

Senior Lecturer in Nursing, School of Nursing Studies, University of Manchester,Manchester, England

Accepted for publication 16 January 1996

JOHNSON M. (1997) Journal of Advanced Nursing 25, 23–29Observations on the neglected concept of intervention in nursing researchIn this paper I will examine the concept of researcher intervention in nursingresearch. I will suggest that the concept is essentially problematic for bothpositivist and qualitative researchers, which may have some bearing upon itsrelative neglect as an area for discussion.

I will examine the redundancy of the more popular moral frameworks indealing with the problems raised by intervention and suggest that nursingresearch, being ‘messy’, requires the articulation of a more reflexive andcontextual approach. This applies both to moral justification and to morepragmatic methodological issues. In the paper I suggest that humanistic actionresearch, informed by recent feminist thinking, has potential to produce a morecreative and clinically relevant future for nursing research than is currently so.

to investigate both types of nursing intervention withinINTRODUCTION

the context of nursing research of various kinds.In this paper I will argue that nurses and other healthresearchers have paid little or no attention to the concept

INTERVENTION: THE HYGIENIC VIEWof intervention. With informed consent, confidentialityand anonymity, perhaps some progress has been made. Researchers and others who carry a predominantly positiv-

ist view of the world feel bound to make two assumptionsIntervention in any or all of its forms is somehow neg-lected. In this paper I am concerned with identifying the about the nature of interventions as they might occur in

nursing research:nature of intervention, the conditions under which it isnecessary, and why it is particularly problematic from both

1 The only nursing interventions which happen shouldmethodological and ethical standpoints.have been planned.In one sense, a nursing intervention is a planned act or

2 Ideally there should be no nursing interventions inacts of nursing care which are based upon an assessmentnursing research.of client need. According to the nursing process, such an

intervention would normally be identified in writing in In relation to the first assumption it is clear that researchadvance (Kratz et al. 1979). In another sense, intervention ethics committees can only operate effectively upon theis a nursing action delivered quickly, some would say premise that all aspects of the research have been plannedintuitively, in response to an unexpected need for care in advance and are identified in the research proposal(Street 1992). This would ideally be recorded retrospec-

which they have before them. Large scale medical clinicaltively but it may have been relatively unimportant, and

trials often reach this level of apparent sophisticationrecording everything is clearly unrealistic. My aim here is

where a series of ‘if... then’ statements can be included inthe protocol. That is to say if the research subject gets anallergy their membership of the study sample can be ter-minated and perhaps medical treatment can be prescribed.Correspondence: Martin Johnson, 45 Hawk Green Road, Marple, Stockport

SK6 7HR, England. e-mail: [email protected] In some cases, therapeutic counselling might even be built

23© 1997 Blackwell Science Ltd

M. Johnson

in and resourced within the trial. Thus interventions of all Particularly problematic would be the ‘placebo’ inter-vention of general chat which the control group had. Thetypes are planned.

Medical trials are usually resourced by multi-national study depended for its success on this having no compar-able therapeutic value. In other words, the waste of clients’drug companies who can stand large liability claims

because they are heavily insured, so ethics committees of time at best and the deliberate withholding of an inter-vention thought to be of value (the teaching) were thetrusts and other health care agencies can take this into

account when allowing potentially harmful agents to be worst possible outcomes.This argument can be developed further. To illustrateused as interventions with their clients. Whether this is

ethics or economics is an interesting question. why intervention may be less welcome in positivisticallyframed research I will cite two other examples. In an earlyThe second assumption is becoming more prevalent in

the modern National Health Service (NHS) context. British study, Jones (1975) (who was a nurse) observed thefeeding of unconscious neurosurgical patients in order to‘Hygienic’ forms of research prevail. By these I mean ques-

tionnaires and semi-structured interviews which are com- conclude that this was unsystematic and nutritionally ill-founded. His most famous observation was that a nursemonly undertaken with samples of convenience such as

student nurses (Melia 1987, Bradby 1990). It seems that poured apparently scalding hot fluid down a nasogastrictube and he felt it would have compromised his place asstudents of research are commonly dissuaded from any

kind of contact with clients. Indeed some universities and a scientist to have intervened to prevent this. I like to callthis the Wildebeest perspective, as it reminds me of thosetrusts have a hierarchy of levels at which researchers might

reasonably use clients in their research, with even master’s harrowing scenes in documentaries where hyenas stalkand eat vulnerable newborn and ageing animals on thedegree students being confined to literature-based studies

for this reason. The need for the already overburdened Serengheti Plain. It is often argued that for the observingnaturalist to intervene would be to disturb or interfere withethics committee’s approval is the main reason given, this

being seen often as an insurmountable obstacle. nature. Jones was working at the very birth of substantialnursing research in the United Kingdom and perhaps heAnother important but less explicitly stated reason is

the increasing sensitivity of trusts and other service pro- may be forgiven.viders to potentially critical information being available tonon-employees. This, they fear, might appear in the media.

Confounding variableSecondary reasons are the waste of patients’ time or worse,the possibility that patients may be harmed, upset or have Less understandable, if I may reveal my bias for a moment,

is the position taken by Seers (1987,1989) in a much moretheir expectations raised by even interview-based studies.To return more directly to the concept of intervention as recent study. Her whole aim was to collect data on the

management of pain in hospital wards. To this end sheunderstood in the ‘hygienic’ school of thought, we cansee a ‘catch 22’ situation for the researcher who would asked patients how much pain they had and then waited

to see whether analgesia provided by nursing staff metlike systematically to evaluate a novel clinical nursingintervention. patients perceived needs. Seers admits that at no point did

she plan to improve those patients’ chances of gettingTake as a hypothetical example the application of laven-der oil to the perineum of women after delivery. All new analgesia by telling ward staff about their pain. Such an

intervention in ward routine would, she claims, haveprocedures are potentially harmful and harms must be avo-ided for both ethical and financial reasons. Therefore, the compromised the study by introducing her intervention as

a confounding variable.trial of untried interventions is impossible. However, italso seems logical that the trial of previously tested inter- This approach, clearly analogous to my ‘Wildebeest per-

spective’ troubles me. Seers certainly adheres to the primaventions is unnecessary. Thus, it is difficult to envisagethe case for many forms of quasi-experimental research, facie principle of ‘first do no harm’, as there is no direct

intervention attributable to her which might be harmful.except as justified replication in new contexts.Just such a study was, arguably, Boore’s (1978) Prescrip- In other words, no harm came to patients in the study

which would not have been present otherwise. However,tion for Recovery in which she compared 20 minutes gen-eral chat with focused teaching about breathing, exercises patients did presumably experience pain, which she

observed and documented for research purposes, andand other aspects of ‘successful post-operative recovery’.This could only have been justified on grounds of repli- which could have been ameliorated more quickly had she

reported it to nursing staff.cation with modification of a nursing intervention inwhich she had a good deal of confidence already. If Boore Seers’ position here is quite usual and is not necessarily

unethical. It all depends on your point of view. Nothinghad been intervening in a way which was more contro-versial and less obviously sensible, we may wonder happened to patients which would not have happened

otherwise. No action of hers caused any suffering. But thiswhether a modern ethics committee (which she did notface as such) would have allowed such a study. is to take a rather ‘traditional’ view that there is a difference

24 © 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 23–29

Intervention in nursing research

in moral responsibility between acting and failing to act. ethics committee simply to collect data by interview.Instead she decided that giving the information was a riskThe argument is explored most popularly in euthanasia,

where many see the direct killing of a person as worse worth taking in meeting a more important need.Webb took an early step towards the justification of ben-than allowing them to die ‘naturally’. One wonders

whether Seers’ hygienic ‘non-intervention’ rule went this evolent, but not necessarily planned, interventions innursing research. There being a place for such exchangesfar, that she would have failed to intervene not only to

relieve pain but to save a life worth saving. between researcher and researched can be seen as nursesexercising a responsibility to meet any need which, withinI hardly think of the United Kingdom Council’s Code of

Professional Conduct as the last word in such matters, but resources, can be met. She successfully locates thisapproach within a feminist perspective which, providedhere for once it is helpful. Perhaps surprisingly, in

common with utilitarians like Glover (1977) and Harris the reader is sympathetic to these needs taking precedenceover ‘scientific goals’, seems justification enough. But to(1985), it makes no distinction between acts and omissions

in its judgement of nursing responsibility to: take the view that intervention by researchers to meetneeds worth meeting is an essentially and uniquely ‘femin-

ensure that no action or omission on your part, or within yourist’ thing to do is surely mistaken. All health researchers

sphere of responsibility, is detrimental to the interests, conditionshould begin to evaluate the impact of such an approach

or safety of patients and clients.on their research design.

(UKCC 1992 p. 2)I have criticised researchers like Seers (1989) who used

This is to say that a registered nurse is as culpable in positivist methods which seem to preclude meeting dayto day unmet client needs. Much as I would wish it other-failing to relieve pain as in causing it where none existed.

I specify registered nurses, as this is where the United wise, as a qualitative researcher I do not necessarily holdany moral high ground here. There is a long traditionKingdom Central Council for Nursing, Midwifery and

Health Visiting (UKCC) may exercise its disciplinary auth- within the non-positivist perspective of covert research inwhich direct intervention to ‘right wrongs’ or relieveority. But does not any person in contact with the sick

have a similar duty to prevent pain where none exists and suffering has been avoided because it would have ‘blownthe researcher’s cover’. Even writing arguably from a fem-take steps to see it relieved where it does? In Harris’ (1985)

view, responsibility to relieve suffering accrues to us all inist perspective there were elements of this approach inLawler’s celebrated study of how nurses manage ‘the body’in proportion to our ability to relieve it, which might,

coincidentally, go hand in hand with being on a pro- in their work and culture (Behind the Screens):fessional register of nurses one of whose first principles is

I needed a good cover because I did not want people to know Ithe relief of suffering.

was ‘making observations’ or ‘doing research’.Whether Seers perceived this situation as a moral

(Lawler 1991 p. 12)dilemma in which the overall satisfaction of the research

Lawler at least discusses this as a moral dilemma andobjectives outweighed the responsibility to relieve pain isnot evident in her publications. What is important is that presents her justifications for us to accept or not as the

case may be. She notes the problem in terms of the depri-researchers attempting ‘hygienic’ non-intervention stra-tegies in pursuit of their ‘pure’ research designs, realize vation of research informants of informed consent to being

observed. Lawler fails to recognize the other moral conse-that their position may not appeal to all — least of all thosewhose pain might have been relieved within a more quence of her covert position, that being covert renders

meaningful intervention to right wrongs or relieve suffer-flexible design.ing or pain very difficult. The role is, for the competentnurse, very frustrating and fraught with the unresolved

INTERVENTION: THE QUALITATIVEconflict of observing nursing practices where standards

PERSPECTIVEmay be at great variance with one’s own.

Unfortunately, this problem is not confined to, althoughWriting of a different mode of suffering, namely unsatisfac-tory and ill-informed recovery from hysterectomy, Webb it may be more acute in, covert research. In ethnographic

work of my own, I worked on a medical ward in the pro-(1984) has argued that to visualize research respondentsas ‘subjects’, mere data sources without feelings or needs, fessional capacity of an unpaid ‘bank staff nurse’. I had an

explicit research agenda and certainly all the staff andis inconsistent with feminist approaches to research. Inher work with women patients, she found that she ident- many of the patients knew that I was collecting data. In

all sorts of ways I was capable of ‘intervention’. I partici-ified learning and health promotion needs in many of herrespondents which she would have felt guilty in not meet- pated in nursing care as planned by the nurses I was

working with, and where I worked with junior students Iing to reasonable levels of professional competence. Sherealized that such intervention might compromise the per- suppose I took the lead in managing aspects of care. Using

my experience and a measure of tact I may have been ablemission she had received earlier from surgeons and the

25© 1997 Blackwell Science Ltd, Journal of Advanced Nursing, 25, 23–29

M. Johnson

subtly to change, and possibly improve, the care of indi- to decisions about care easier as time goes on, but the‘invited status’ is always present and the fragility of theviduals on rare occasions where I felt I could. In general

though, as a mere invited guest, I was constantly in danger researcher–respondent relationship must not be chal-lenged too seriously by interventions of an unacceptableof losing my invitation. Had I had an attitude of suggesting

many or radical changes to the management of care in the nature.So perhaps the point is made that the ethnographer mayward I should soon have been unwelcome. Nurse teachers

feel similarly. not really hold a much stronger position in terms ofintervening systematically to provide better pain relief, orOne example may illustrate my dilemma. One man on

the ward was sat in a chair beside his bed and had a central anything else, than the positivist. Indeed, to intervene sys-tematically would, even for the qualitative researcher,venous (Hickman) line running into his neck. These were

normally sutured into place with plaster over them so that change the nature of the research environment in such away as to raise questions about the credibility of thethey were fairly secure. The time was about 1 pm and the

ward sister was accompanying a medical ward round. research as a description of an extant culture. It wouldhave become something else, namely action research.Waiting for the retinue to reach the man I could not fail to

notice that the line was sliding in and out of its fixation,the suture having come out. The potential dangers should

INTERVENTION: THE ACTIONbe self-evident, but even in my relatively de-skilled pos-

PERSPECTIVEition I felt that introduction of infection and the pain,inconvenience and dangers of having the line re-sited were Many of these problems are, if not solved, then thrown

into a more constructive focus, by action research. Thestrong possibilities. The ward sister had seen it andprobably so had the retinue. whole point of action research as commonly understood,

is intervention. Lathlean (1994 p. 35) argues that:

Dilemma First, action research is about taking action in the real world and

a close examination of the effects of the action taken; thus itMy dilemma was as follows. My first instinct was to rush

always involves intervention.over and fix the line in some way. To do so I would haveinvaded the sister’s territory as she was ‘in control’ of the This position is developed by Hart & Bond (1995), who

argue that in the empowering type of action research thesituation. Rushing over would have shown me to be cap-able of ‘panic’ — something not welcome in this relatively intervention may not be so discrete or identifiable as in the

experimental type and may take many forms. Not only this,‘hi-tech’ area of leukaemia nursing. I would also have beenimplicitly questioning her judgement of the danger this but many of the objections to intervention highlighted

above are less pertinent within the action perspective.man was in. I gave her a long hard look of the questioningvariety and was convinced that her non-verbal behaviour Intervention may be agreed with, even designed by research

participants. It can be planned and, just as importantly,said ‘leave it alone’, which I did. I failed to intervene toright a wrong, if that is how we should look at it. I behaved systematically evaluated. The extreme hygienic view that

there should be no interventions in nursing research stillsimilarly in other, but perhaps less hi-tech situations,complying in large degree with the practices of my prevails. Indeed action research, being so messy, would

never appeal to the true devotee of the hygienic researchco-participants. On reflection, my best justification for notapplying what I thought were at least in some respects my perspective. However, action research is of many forms and

can reasonably appeal both to the phenomenologist and tohigher standards is that I would have lost some of my‘entree’ or my ‘welcome’ as an uncritical participant the neo-positivist. Boore’s (1978) study of a focused teach-

ing intervention and post-operative recovery is, arguably, aobserver.I think it is fair to say that the greater the degree of very structured early form of action research. Certainly, to

take Boore’s work forward to evaluate similar interventionsexchange, the more give and take there is betweenresearcher and researched, the less problematic this situ- by nurses in day to day practice and in consultation with

them would conform to Hart & Bond’s (1995) typology ofation becomes. Any new bank staff nurse who was not aresearcher (or indeed a student) might have felt as I did, ‘experimental’ action research drawing upon concepts like

controlled outcomes and looking for causal processes. Tonot wanting to offend or question the clinical judgementof the ward sister in that delicate early period of negotiat- do such work within even the experimental (largely struc-

tured) action perspective allows for modifications, adap-ing one’s acceptance as a member of the team. With trulyparticipant observation in nursing, a genuine contribution tations and, if necessary, less systematically planned

interventions to meet client needs.to ward work, especially ‘dirty work’ such as emptyingcommodes and mopping up spilled breakfasts, eventually At the ‘empowering’ end of Hart and Bond’s typology of

action research approaches there is even greater flexibility,earns some credibility which is denied the less participantor ‘hygienic’ observer. This credibility makes contributing within a framework of involvement of staff and clients, for



the flexible response of individuals to intervene to improve I find planned intervention of the clinical trial varietyquite hard to fit into any duty-based theoretical framework.care wherever this is possible. Clearly, as Webb (1984) has

argued, such an approach sits well with feminist method- In most such views, the first duty is to the patient beingcared for at the present, so interventions (or their absence)ology. Researchers need not feel that they are impartial

observers of pain and suffering, that they are ‘ripping off ’ as an aspect of research of benefit to future clients are hardto justify. Where there is a distinct possibility that thetheir respondents to get their degree or their publications.

It is important to acknowledge the place of feminist intervention may be of benefit to the ‘subject’ then duty-based ethics would support it, but only where the nursethought, both in methodology and in ethics, in developing

this view. I will argue, however, that within a framework would have had a duty to provide it anyway. If there is acontrol (no intervention condition) in the trial we returnof humanistic research, a similar position must be taken.

This is one in which empowerment, the raising of con- to our duty to provide useful care wherever and wheneverit can be resourced, which makes the use of ‘controls’sciousness and negotiated interventions potentially of ben-

efit to all and thoroughly evaluated, are possible. Where problematic.interventions are disadvantageous they may be modifiedor stopped in consultation with participants.

Ethical frameworks

Whilst ethical frameworks vary and each has its uses,INTERVENTION: THEORETICAL

health care ethics textbooks continue to appeal primarily,CONSIDERATIONS

and in some cases exclusively, to the so-called ‘justice’ orpatriarchal perspectives of utility and duty. DiscussionsPopular ethical theory may suffer from a certain redun-

dancy in the context of wider discussions of intervention depend upon clarity, prediction of consequences, and gen-eralizability of principles from one situation to another,by health researchers. In common with the ‘hygienic’ or

positivist perspective in research, much moral theory essentially also the tenets of logical positivism (see forexample Beauchamp & Childress 1989 and their many imi-relies on interventions and their consequences being pre-

dictable. The utilitarian can give an opinion that Boore’s tators). Although it may be important to be aware of suchviewpoints, I will argue that with ethics, as with method-(1978) study, though half the ‘subjects’ got no useful teach-

ing, was ethically justified in terms of the improved teach- ology, feminist thinkers have made advances insufficientlyrecognized by nurses and their textbook writers. Here too,ing and communication received by generations of

subsequent patients. Such a decision was possible in with ethics as with methodology, I do not argue that femin-ists are uniquely fitted to address the moral problems pre-advance, since Boore presumably undertook to dissemi-

nate her findings and has, of course, done this. Seers’ sented by intervention in nursing research. Indeed muchof the theoretical background to modern emancipatory(1989) study might have a similar utilitarian justification

for her failure to intervene to relieve known pain. To have feminist thought was originally coined by men such asMarx, Mill, Habermas and Polanyi. What is important iscompromised the data by changing the circumstances

would have rendered the study ‘invalid’ and less generaliz- that feminist thought has encompassed the personal, thereflexive, the contextual and the political factors whichable. Thus, future patients in similar circumstances would

not be likely to benefit from the hard-won conclusions come to bear on moral decisions in research much moreeffectively than those nurses working within a more tra-drawn by Seers.

Nurses, and nurse researchers in particular, do not usu- ditional perspective of positivism (such as Seers) or whatI might term low-participation ethnography (such asally articulate appeals to utilitarianism in justifying their

behaviour. Rather, duty-based ethics prevail, at least in the Melia).Williams (1991) has suggested that ethics has been pre-rhetoric of most codes of conduct, with ‘human rights’ to

autonomy, confidentiality, informed consent, etc., being sented traditionally as thinking in ‘either/or’ terms.Discussion has centred on whether to intervene or notprominent (Gallagher & Boyd 1991). The justification of

potentially uncomfortable or even harmful procedures is according to well established principles. So far I too haveaddressed this issue in similar terms. Williams takes ouralso usually advanced in utilitarian terms of benefits to

future clients, although this occurs much more commonly thinking forward in a way which I suggest nurses (not justwomen) can identify with. First she makes the point thatin large scale medical research than in nursing. In the

latter, clinical trials remain a relative rarity. An essential role boundaries are never so clear in life as they are inresearch reports or ‘ethical case studies’. We bring to thedifficulty with utilitarian justifications is the need to have

some ability to predict the consequences of intervention research encounter ourselves as nurses, as researchers, aspeople in the wider world, and as women or men. It iswith a degree of certainty which may render the trial

unnecessary. That such trials have and do take place regu- naive to imagine that such facts of social context do notand should not impinge upon our decisions about researchlarly outside nursing circles may be a matter of marketing

rather than clinical evaluation. activity, or anything else. In particular, Williams identifies


M. Johnson

the meaning of relationships as crucial in the interplay of I suggested that qualitative researchers, with theiremphasis on meanings and how people feel, might havefactors which are part of the research act and decisions

therein. This aspect of her paper, perhaps more than any room for complacency that they, at least, have people atheart in their research. On the contrary, many qualitativeother, shares perspective with other key contributions to

the feminist ethics literature (see for example Frazer et al. studies are essentially hygienic in nature, that is they avoidtoo much direct contact with real people, especially1992) upon which we can all draw. Williams’ thesis is that

there is a situational logic to ethical practice which is ‘messy’ people like patients and clients. In particular,intervention in care as an aspect of the research processnowhere evident in prominent textbook accounts of either

research or ethics. which should be explicit is rendered problematic and,therefore, to be avoided. I note that even when the designWilliams does not pretend that such a situational pos-

ition in thinking about ethics makes principles like ‘I am is explicitly participative the degree of intervention nego-tiable in any context is variable. It depends on the socialcommitted to practice in such a way as not to hurt those

I encounter’ (p. 66) irrelevant. She is, however, concerned skills and tact of the researcher and the extent to whichthey are seen as ‘natives’ or prepared to offer hard physicalto identify such principles as problematic, that is, they are

not free of the contradictions and difficulties of everyday and emotional labour in return for the right both to dataand to offer constructive criticism of participants in thepractice.

Clearly such a position creates a framework within research process. I myself have felt unresolved conflict inboth intervening and failing to intervene as a patient advo-which practising nurse researchers can confront the vari-

ous forms of intervention in research (or its avoidance) in cate in certain circumstances where patient care or basicstandards were under threat.a more constructive way than by obeying rules. Ethical

behaviour is seen as negotiated from day to day given the During the execution of a substantial ethnographic pro-ject ( Johnson & Webb 1995), I became troubled by whatsocial reality of the situation. Relationships, power and

roles are investigated and discussed in resolution of situ- could be seen as the fundamental ethical flaw. That is (toparaphrase Karabel & Halsey 1977) a troubled world needsations as they arise, with prima facie principles like ‘first

do no harm’ having an important, but not exclusive, part change, not mere understanding. I was able to help peoplein small ways but had neither mandate nor real mechanismto play in deciding nursing and research strategy.

Adherents to ‘rule-based’ ethical perspectives and proto- for substantial change. I argue that action research, despiteits problematic nature, contains the potential to remedycols will be quick to see what may be dangers in such a

contextual approach. ‘Codes of conduct’ and rules aimed both of these omissions. Properly negotiated and in consul-tation with participants in the setting, useful interventionsat discouraging interventionist research styles grew, argu-

ably, out of experiences of wilful abuse of patients’ rights can be planned and executed which have the mandate ofthose present and are logistically sensible. Ethics com-both to informed consent and not to be harmed in various

contexts, not least Nazi Germany. But whatever the ‘rules’, mittees and supervisory bodies for research need to recog-nize this and adopt a more facilitative approach to thishuman conduct depends very much on the qualities of the

people concerned and the context within which they are form of interactive action research than I perceive ispresently the case.brought to act. Surely an ethical approach which takes

these seriously into account and raises them to awareness I suggested that utilitarianism and duty-based ethics canoffer some justifications for the strategies which research-has much to offer.ers employ when interventions or their avoidance can bepredicted and planned for (i.e. hygienic). These frame-

CONCLUSIONSworks are, however, ineffective in resolving the ethicalturmoil of much real world research which is ‘messy’. II have argued that hygienic conceptions of research are

reducing the potential for nurses to engage directly in work went on to explore briefly the potential of contextual orrelational ethics in which much progress has been madeof real clinical relevance. The pressures are to do research

which avoids contact with clients, and especially avoids by feminist thinkers such as Williams (1991).It can be argued that as a man I am liable to encroachintervention in their lives. Perhaps paradoxically I have

argued that in some cases the ‘hygienic’ perspective has upon feminist thinking to make it relevant to my ownneeds, and in doing so sanitize it of its radicalism, itsallowed nurses to collect data from patients where, as

nurses and as people, they should have been empowered inherent threat to the dominant position of men, andtheir own epistemology and ethical perspectives. Ofto intervene, for example, to relieve pain or maintain stan-

dards. Instead, because of their ‘hygienic’ research design, course, here I am vulnerable to such a criticism. On theother hand, I can appeal to feminist ethics in its sense ofthey felt that they should not. The overall point remains

valid, that ‘hygienic’ research avoids intervention with relativism and relevance to context, to argue that a ‘messy’ethics is necessary for a ‘messy’ context for researchclients and therefore distances itself from useful

application. such as nursing. I suggest that it may be constructive to



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observations on the neglected concept of intervention in nursing research

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