Nursing Research and Health Care Ethics

Ethics of Research

    The
ethics of research-defined as what one morally ought to do in conducting,
disseminating, and implementing results from systematic investigation or
scholarly inquiry-are determined by both traditional and changing social
values. 

    These values vary within and among cultures worldwide; therefore, as
international nursing research increases, nurse researchers must be attuned to
the ethics of conducting research in other countries (Olsen, 2003). 

    However,
within the preceding context, two points cannot be disputed: 

(a) all research
has ethical dimensions.

(b) all research must be ethical.

 Advancement and Ethical Considerations 

    Rapid
advances in science and technology have led to several important policy
documents and ethical guidelines for nursing research. The policy documents
include the 1980, 1995, and 2003 American Nurses as society’s (ANA) Nursing’s
social policy statement. 

    The ethical guidelines for nursing research include
the ANA’s 1975 and 1985 Human Rights guidelines for nurses in clinical and
other research, as well as part of Provision 7 of the 2001 ANA Code of ethics
for nurses with interpretive statements.

Ethical Considerations In Research and Nursing Responsibilities 

    The
conduct of research with humans imposes strong moral obligations on nurse
researchers, especially in the light of genetic advances and the use of human
biological materials in nursing research (Jeffers, 2001). 

    Nevertheless, once
the ethics of the research have been approved by an institutional review board
or its equivalent, subject or participant selection (or human biological
materials selection) occurs. 

    The decision of whom or what to include and
exclude from a study places the following moral burdens related to the ethical
principle of justice on the researcher: 

(a) how to weigh the ethical pros and
cons of using human biological materials or vulnerable persons as subjects

(b)
how to avoid consistently selecting human biological materials or subjects
based solely or primarily on case of accessibility or any attribute that is not
essential to the study’s objectives

(c) how to avoid overuse or underuse
of human biological materials or any group of research subjects

    Once human
subjects are selected, they should be given sufficient and unbiased information
about all important aspects of the study and their roles in the study before
agreeing to participate. In addition, subjects’ comprehension of information
about the study and the informed consent process should be ascertained
initially and throughout the study as indicated. 

    Subjects have the right to
stop participation in a study at any time and without fear of retaliation. The
preceding steps are based on the ethical principles of autonomy and respect for
autonomy. If subjects are not autonomous, proxy consents must be obtained.

Types of Ethical Principals and Considerations

    The
ethical conduct of research also focuses on the ethical principle of
non maleficence (do no harm). The researcher must understand that the
possibility of harm or potential harm can occur to subjects at any time while
conducting research. 

    Therefore, the researcher must carefully weigh any
benefits against therapeutic harms (ie, harms that are necessary to produce a
greater good in the conduct of the research). However, therapeutic harms always
require moral justification, and under no circumstance the subject should be
used solely as a means for the advancement of science.

    The
ethical principle of non maleficence also applies to scientific misconduct.
Scientific misconduct is viewed as an intended act of deception that deviates
from a discipline’s ethical norms. It typically takes the form of plagiarism,
irresponsible authorship, data falsification, data fabrication, and
questionable research practices. 

    Nurse researchers should be familiar with
their organization’s policies and procedures about scientific misconduct, as
well as federal regulations to determine scientific misconduct. In addition,
nurse researchers should be aware of three reports authored by the Institute of
Medicine on scientific integrity (James, N., Burrage, & Smith, 2003).

Ethical Board or Committee

    When
an interdisciplinary team is involved in the conduct of research, the principal
investigator should be clearly designated and should assume overall
accountability for the study. He or she is responsible for the supervision of
all team members, including research assistants. 

    Each team member must not only
assume accountability for a part of the research but also must understand how
that research builds on that of other team members. Finally, all members of the
interdisciplinary research team must come to a common understanding of what the
ethics of research means for their study.

Guidelines for ethical Principles 

The
conduct of research with animals also has ethical import because of past and
current cruelty to them and because of the increased need for basic research in
nursing. The guiding ethical principles for researchers are:

(a) to use animals
for studies only when necessary.

(b) to inflict the least amount of harm and
suffering to the fewest number of animals while still attaining research
objectives.

(c) to obtain the approval of institutional animal care and use
committees or their equivalent. 

    Some scholars and ethicists would argue that
significant research of high quality that is not disseminated presents an
ethical issue because persons who could benefit from that research are denied
that benefit. Further- more, disseminated research cannot be implemented into
practice. 

    The ethics of the dissemination of research also involves researchers
and peer reviewers. 

    Researchers as authors have an ethical obligation to
clarify primary and coauthor credits as soon as possible during the preparation
of a manuscript; to designate when the manuscript is part of a larger study; to
submit a manuscript to only one editor at a time; to present accurate,
unbiased, relevant, and appropriately.

    Documented information in the manuscript;
to notify appropriate persons when scientific misconduct is detected in one’s
own or other’s studies; to avoid the use of retracted or invalid study results;
and to understand the ethical issues involved in internet research (Mi &
Chee, 2003).

Peer Review and Ethical Obligation

    Researchers
as peer reviewers have an ethical obligation to be objective in their review of
research manuscripts and timely in their return of them; to offer constructive
criticisms that demonstrate respect; to avoid any conflicts of interest; and to
maintain anonymity of authors and confidentiality of content until the
manuscript is published. 

    The research literature indicates that many
practitioners of nursing lack the education needed to understand research or to
use the findings in practice. This lack of knowledge and comprehension
diminishes nurses’ autonomy and puts them at risk for potentially unsound
ethical decision making about research utilization. 

    Therefore, persons
responsible for implementation of research into practice must assist
practitioners of nursing to critical research for scientific and ethical merit
and for clinical applicability. This critique includes the insight that studies
typically are replicated before being implemented into practice. 

    Furthermore,
persons implementing research into practice must ensure that strong and ethical
administrative support exists so that implementation can begin, continue, and
terminate if necessary without causing harm to patients, staff, or the
organization.

Conclusion

    In
summary, the most important aspect of research is that it be ethical. Although
the ethics of research are complex, nurse researchers should respect these
ethics and incorporate them into their studies or scholarly inquiries now and
in the future.