NURS 350 Week 8 Discussion Research in Nursing

Conducting research with strong ethical principles is a critical component of being an effective nurse researcher. In the research simulation activity, which character(s) did you play? What did you learn about ethical principles in research? Are ethics in research clear cut, or do you think there are some gray areas? Provide examples from the simulation activity.

Ethics is rooted in the ancient Greek philosophical inquiry of moral life. It refers to a system of principles which can critically change previous considerations about choices and actions. It is said that ethics is the branch of philosophy which deals with the dynamics of decision making concerning what is right and wrong. Scientific research work, as all human activities, is governed by individual, community and social values. Research ethics involve requirements on daily work, the protection of dignity of subjects and the publication of the information in the research.

However, when nurses participate in research they have to cope with three value systems; society; nursing and science. The societal values about human rights, the nursing culture based on the ethic of caring and the researcher’s values about scientific inquiry. According to Clarke these values may conflict with the values of subjects, communities, and societies and create tensions and dilemmas in nursing.

In this paper, the most important ethical issues will be addressed. After a short description of the nature of nursing, and the advocacy role of nurses, the writer will attempt to highlight the possible conflicts that nurses have to deal with, when undertaking or participating in research.

Historical overview- Ethical codes

Human experimentation has been conducted even before 18th century. However, the ethical attitudes of researchers drawn the interest of society only after 1940’s because of human exploitation in several cases. Professional codes and laws were introduced since then in order to prevent scientific abuses of human lives. The Nazi experiments led to the Nuremberg Code (1947) which was the leading code for all subsequent codes made to protect human rights in research. This code focuses on voluntary informed consent, liberty of withdrawal from research, protection from physical and mental harm, or suffering and death. It also emphasises the risk- benefit balance. The only weak point of this code was the self regulation of researchers which can be abused in some research studies. All declarations followed, forbade nontherapeutic research. It was only in 1964 with the declaration of Helsinki that the need for non therapeutic research was initiated. The declaration emphasised the protection of subjects in this kind of research and strongly proclaimed that the well being of individuals is more important than scientific and social interests.

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In terms of Nursing the first inquiry was the “Nightingale Pledge” (1983). Since then there has been a significant development of professional codes in conduct and research. The American Nurses’ Association (ANA) Guidelines for Research, the Human Rights Guidelines for nurses in clinical and other research (1985) and the Royal College of Nursing Code for nurses in research (1977) provide a strong assistance to professional nurses as well as reassurance to patients, the public and society, of professionals’ intentions.

Major ethical issues in conducting research

Informed consent

Informed consent is the major ethical issue in conducting research. According to Armiger: “it means that a person knowingly, voluntarily and intelligently, and in a clear and manifest way, gives his consent” .
Informed consent is one of the means by which a patient’s right to autonomy is protected. Beauchamp and Childress define autonomy as the ability for self determination in action according to a personal plan. Informed consent seeks to incorporate the rights of autonomous individuals through self- determination. It also seeks to prevent assaults on the integrity of the patient and protect personal liberty and veracity. Of course individuals can make informed decisions in order to participate in research voluntarily only if they have information on the possible risks and benefits of the research. Free and informed consent needs to incorporate an introduction to the study and its purpose as well as an explanation about the selection of the research subjects and the procedures that will be followed. It is essential to describe any physical harm or discomfort, any invasion of privacy and any threat to dignity as well as how the subjects will be compensated in that case. In addition the subjects need to know any expected benefits either to the subject or to science by gaining new knowledge.8 A disclosure of alternatives is also required as for example in the Tuskegee study about syphilis. In this study, rural black men were chosen as subjects in a study of syphilis. Although a cure for syphilis was found after the start of the study, it was decided not to treat them and they had not been told that penicillin was effective to their disease. The researcher must inform the subjects about the methods which will be used to protect anonymity and confidentiality and indicate a person with whom they can discuss the study. He must also provide a “Noncoersive Disclaimer” which states that participation is voluntary and no penalties are involved in refusal to participate. Moreover, the subject must be told that some information has been deliberately withheld in order to avoid altered behaviours. The researcher must also take into account that persons with physical, cultural and emotional barriers may require a very simple language in order to understand him. Finally, the freedom to withdraw must be explained. This is very important but raises the issue of how difficult the subjects can withdraw after developing a personal and sometimes friendly relationship with the researcher. With regard to withdrawal a researcher may be in a dilemma in case many subjects choose to withdraw at an advanced stage of the study, because this can affect the validity of the results. The Declaration of Helsinki provide some help as it declares that the interest of the subject must always prevail over the interests of society and science. According to this, the will of the subject must be respected at any cost for the research.

Another major ethical issue is obtaining an informed consent from groups with diminished autonomy which will be further discussed later. From what has been discussed, it becomes clear that disclosure, comprehension, competency and voluntariness are the four essential parts of a consent.

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NURS 350 Week 8 Discussion Research in Nursing