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Theoretical methodology practical ethical considerations and quality criteria

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 which may be in conflict with the values of subjects, communities, and societies and create tensions and dilemmas in nursing. Using the Medline and the Nursing Cinahl data base, the most important ethical issues which appear in bibliography, 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. The major ethical issues in conducting research are: However, both the nature of nursing which focuses on caring, preventing harm and protecting dignity and the advocates role of nurses which calls for defending the rights of subjects, are sometimes incongruent with the ethics in research.

Ethical issues, conflicting values, and ambiguity in decision making, are recurrently emerging from literature review on nursing research. Because of lack of clarity in ethical standards, nurses must develop an awareness of these issues and an effective framework to deal with problems involving human rights. Keywords Research ethics, moral dilemmas in research, nature of nursing, nursing research, nursing advocacy Introduction 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. Scientific research work, as all human activities, is governed by individual, community and social values.

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.

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. 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. It was only in 1964 with the declaration of Helsinki that the need for non therapeutic research was initiated. Since then there has been a significant development of professional codes in conduct and research.

Beauchamp and Childress define autonomy as the ability for self determination in action according to a personal plan.

It also seeks to prevent assaults on the integrity of the patient and protect personal liberty and veracity. 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.

He must also provide a "Noncoersive Disclaimer" which states that participation is voluntary and no penalties are involved in refusal to participate. 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. The Declaration of Helsinki provide some help as it declares that the interest of the subject must always prevail theoretical methodology practical ethical considerations and quality criteria the interests of society and science.

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. Beauchamp and Childress, suggest that "the principle of beneficence includes the professional mandate to do effective and significant research so as to better serve and promote the welfare of our constituents".

Carr says that if the research findings prove that it was not beneficial as it s expected, this can raise immense ethical considerations especially for nurses. According to Burns and Grove "discomfort and harm can be physiological, emotional, social and economic in nature".

A researcher must consider all possible consequences of the research and balance the risks with proportionate benefit. The type, degree, and number of potential risks must be assessed as well as the patients value system which ranks various harms. If the risks outweigh the benefits, the study should be revised. Treece and Treece say that debriefing refers to explaining the exact aim of the study and why the disclosure was not full.

If the researcher is not able to promise anonymity he has to address confidentiality, which is the management of private information by the researcher in order to protect the subject's identity. Clarke addresses the ethical dilemma of the researcher when confidentiality must be broken because of the moral duty to protect society. On the other hand, the deontological theory which ignores the result implies that the moral duty is what really matters.

If a researcher, though, acts deontologically he may feel that he has not protected society. Another issue is that the researcher may have to report confidential information to courts which can also cause moral dilemmas.

In that cases it can be argued that the moral duty and personal ethos can be stronger than legal requirements. Ford and Reutter suggest using pseudonyms and distorting identifying details of interviews when transcribing the tapes used. Department of Health and Human Services DHHS may be useful to help ensure the privacy of research participants especially in studies in which participants and researchers may be exposed to compelled legal disclosure of research data. The researchers must theoretical methodology practical ethical considerations and quality criteria bear in mind all psychological and social implications that a breach of confidentiality may have on subjects.

In order to protect participants, they have to inform them on their rights, and use all possible coding systems that they regard appropriate in each case.

  • This makes it easier for them to understand the concrete procedures;
  • Persons with diminished autonomy are also more vulnerable to invasion of privacy, since their right to privacy is limited in contrast to other's right to know;
  • Hella von UNGER 2012 reports, for example, that capacity building on the part of research partners represents a core aim in community-based participatory research;
  • A review of the literature reveals that one can roughly state that participatory research projects are confronted with the task of demonstrating the quality of their work to such diverse social institutions as:

Respect for privacy The fifth principle of the entitled "A Patient's Bill of rights" document published in 1975 by the American Hospital Association AHAaffirm the patient's right of privacy. A researcher cannot decide on behalf of other persons on those delicate issues.

All aims, instruments and methodology must be discussed with the prospective subject and the research workers prior to the investigation. Treece and Treece suggest that whenever subjects refuse to report personal information as they regard it an invasion of privacy, the researcher ought to respect their views. They also imply that privacy can be invaded when researchers study certain groups without their knowledge and without identifying themselves.

An example of such a study that the researcher hid his identity, was Humphrie's study "Impersonal Sex in public places" in which, he observed homosexuals during sexual activities in public men's rooms. The different opinions about their participation in research can be attributed to their inability to give an informed consent and also to their need for further protection and sensitivity from the researcher as they are in a greater theoretical methodology practical ethical considerations and quality criteria of being deceived, threatened or forced to participate.

Many are in favour of the use of such subjects in research whilst others would argue strongly against it. Most condition their responses according to the seriousness of the research, the level of potential risk and the availability of alternatives. Persons with diminished autonomy are also more vulnerable to invasion of privacy, since their right to privacy is limited in contrast to other's right to know.

In the case of mentally ill, family as well as employers and colleagues have the right to know while patients may not be able to see the testimony of others in their own record. In the case of mentally ill patients, it is important to measure comprehension and develop valid tools for it, before obtaining informed consent to participate in a research study.

In a descriptive study of Beebe and Smith the Evaluation to Sign Consent ESC form was used in order to document comprehension in 29 schizophrenia outpatients. Participants prescribed two antipsychotic medications were significantly more likely to require a prompt than those prescribed only one antipsychotic. According to Lasagna there are strong feelings among professionals who disagree with experimentation on vulnerable groups.

Skills of the researcher Jameton declares that in research the three more important elements are the competency of the researcher, the careful design, and worthwhile expected outcomes. Any lack of knowledge in the area under research must be clearly stated. Inexperienced researchers should work under qualified supervision which has to be reviewed by an ethics committee.

The choice depends on the object of the study.

IFEL8000 - Introduction to Research Methodology, Theory of Science and Ethics

When human beings are involved, all the ethical issues, discussed above, must be taken into account. Raya focuses on the unique element of caring in nursing while Swanson views Nursing in the same scope as "informed caring for the wellbeing of others". Swanson suggests that nursing has to do with "science, concern for humanity and caring.

Mayeroff describes caring as an interaction which offers space for personal growth for both the carer and the cared. Doing for, means predicting individual needs, encouraging, performing tasks with adequate skills and competence, protecting the patient from harm and preserving the dignity. On the other hand, enabling, means enhancing self-care by training, informing and explaining to the patient as well as assisting with finding alternatives.

Other professions can also claim that caring is an important part of their practice. It can not be stated either that all nursing procedures include caring. The vulnerability of the sick and the lack of patient participation in health care, creates a danger of patient exploitation by nurses.

  • However, what is decisive is that remuneration signalizes social recognition of the value of the individual's contribution to research;
  • Normally, these groups have little opportunity to articulate, justify, and assert their interests;
  • Participants prescribed two antipsychotic medications were significantly more likely to require a prompt than those prescribed only one antipsychotic;
  • From question to proposal;
  • Another major ethical issue is obtaining an informed consent from groups with diminished autonomy which will be further discussed later.

The rapid change and development of nursing emerged the need for a code of professional conduct to guide nurses in their practice. Advocacy in nursing Advocacy primarily used in legal contexts, refers to the protection of human rights of people who cannot defend them for themselves.

The rights protection model implies that nurses helps persons to understand and exercise their rights. They also aim to protect and enhance personal autonomy. They should also support the patients' confidence in their own decisions and prevent limitations of their freedom. Last, the respect for persons model focuses on human dignity, privacy and selfdetermined choices that the nurse has to protect if the person is not autonomous or self-determining.

According to Johnstone all professions with a morally significant relationship with a patient ought to fulfil the role of the advocate. Conflicts in nurses Beneficence-Non malificence A common feature in professional conduct codes and those specific to research is the principle of non-malificence. The ANA Code of conduct declares theoretical methodology practical ethical considerations and quality criteria the nurse protects the clients and the public from unethical, incompetent or illegal practice of any person.

Even if nurses are certain about the incompetence of the investigator, which is usually very difficult, they have to deal with serious dilemmas. First they have to consider the fact that if patient learn that they are exposed to professional misconduct, they may lose faith in health care. Jameton though, believes that patient should be informed as they will appreciate the trust shown to him by frankness.

However, even if nurses decide that their duty of caring and being loyal to the patient is more important, they may have to deal with the hierarchical and bureaucratic systems of institutions which demand loyalty to subordinates to the institution. In case the incompetent researcher is a higher status professional, nurses may be obliged to show loyalty, but this can conflict with loyalty to patients.

Consequently, nurses may feel that their patients are vulnerable and exposed and that they can not prevent it because they do not have a voice or power to resist. This is merely why many authors believe that it may not be possible for nurses to act as advocates of subjects in research.

According to the Belmond commission the general aim of practice is to enhance the well being of individuals while the purpose of research is to contribute to general knowledge. This distinction highlights the differences in the aims of a nurse practitioner and a researcher.

It is therefore very difficult for nurses to be engaged in studies whose aim is not directly beneficial to the subject. They must though, consider that these studies may generate and refine nursing knowledge. Another problem that nurses may have to face is taking part in randomised control trials. According to Brink and Wood dedicated nurses are finding themselves under pressure when they are asked to exclude some patients from an obvious beneficial treatment such as relaxation techniques for relief of post operative pain.

Skodol Wilson implies that there should be some provisions for alternative effective care. In order to prevent human exploitation, ethics committees were introduced.

  • During this time, various developments occur in the group of research partners that shape the way they relate to each other;
  • When human beings are involved, all the ethical issues, discussed above, must be taken into account;
  • Journal of Advanced Nursing, 1990;15 5: