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Ethics in Nursing Research
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Ethics for Nursing Research and Evidence-based Practice
Objectives
• Ethics and research•Historic overview of ethics•Discuss the protection of Human
subjects• IRB•Review Lit review•Discuss Quantitative Research•Discuss Qualitative Research
Introduction
•Nurses obligated to do no harm to their patients•Researchers must understand all of the elements required to maintain the highest ethical standards•Requires specific ethical constraints and standards
Ethical vs. Unethical Research
Ethical studies protect subjects and are carried out using scientific principles.
Unethical research includes:Scientific misconductFraud, research protocol violationsFabrication, falsification, forging of dataPlagiarismPutting subjects at risk without consent
Ethical Theories
•Principles •Value of life, goodness, or rightness• Justice or fairness•Truth-telling or honesty• Individual freedom•Normative or descriptive
Code of Ethics Underpinnings
• Teleology (consequentialism or utilitarianism)• Deontology (non-consequentialism)• Values Theories• Principles of Ethics• Respect• Autonomy• Justice• Beneficence• Non-maleficence
Historical Overview
•Edward Jenner – England, 1789•Moses Maimonides – Western Europe, 1135-1204•Claude Bernard – France, 1865•Nazi - Europe, 1943-1946•Tuskegee Syphilis – US, 1930’s•Thalidomide – England, 1950’s•Hexamethonium – US
Codifying Research ethics
• Nuremberg Code of 1846• National Commission for the Protection of
Human Subjects of Biomedical and Behavioral Research – 1973• International Council of Nurses • American Nurses Association
National Commission for the Protection of Human Subjects
Ethical principles:Principle of respect for personsPrinciples of beneficencePrinciple of justice
These may be seen in the DHHS Belmont Report
(1978).
Principle of Respect for Persons
Self-determination (participation and withdrawing)
No coercion Full disclosure, no deception Voluntary consent Persons with diminished autonomy
have special protections
Principles of Beneficence
Freedom from harmFreedom from exploitationRisk/benefit ratios
High anticipated benefit may balance high risks
Principle of Jutice
Fair treatment(even if choose not to participate)
Right to privacyAnonymityConfidentiality
Institutional Review Board (IRB)
•Offers protection to the institution, the researcher, and the human subjects•Code of Federal Regulations which
govern• Five members of different
backgrounds at minimum•Research must be honest
Developing a Researchable Topic
• Critical factor – protection of the vulnerable subject
• Certificate of confidentiality
• Real interest to researcher
Participant Recruitment and Informed Consent
•Vulnerable Populations•Very young•Frail elder•Prisoners•Mentally incompetent•Women•Freedom of Choice
Data Collection and Data Analysis
•Protection of vulnerable human subjects remain critical issue•Privacy•Confidentiality•Honesty and trustworthiness•Scientific misconduct
EPB and Ethical Implications
•Quality Improvement issues•Patient autonomy•Quality of life• End of life• Internal Pressures
Other Issues
•Publication• Issues in Quantitative and Qualitative Research•External Pressures•Emerging Issues in Research and EBP
Summary Points• History has many lessons • Lessons results in development of national and
international ethical codes of conduct• ICN and ANA acknowledge obligations of the
nursing profession• Ethical theories guide the standards• Vulnerable populations do exist• Each step of research process involves ethics• Privacy and confidentiality must be guaranteed• Informed consent a must• Honesty and trustworthiness are crucial
Parts of Lit. Review
•Purpose of the study• Sample size and selection•Design of the study•Data collection procedures•Analysis of the data•Conclusion
Overview of the Research Process
• Abstract• Introduction• Identification of a research problem• Purpose• Literature review• Theoretical Framework• Hypothesis/research question
Research Process Contd.
•Research design•Sampling•Data collection methods•Results•Discussion•Summary
Types of Research
•The two main research paradigms in nursing are quantitative and qualitative.
Research Designs and Methods
•Quantitative Research Design•Draws conclusions about some procedure.•Uses statistical methods.•Uses deductive reasoning, logic, and measurable aspects of experience.
Quantitative Research Design
•Descriptive • Exploratory • Survey•Historical review•Cross-sectional• Longitudinal
Quantitative Research Design
•Retrospective•Prospective•Correlational•Quasi-experimental• experimental
Quantitative Research
•Descriptive Studies •Describe a phenomenon of interest
(clinical observation).
Quantitative Research
• Exploratory Studies •Describe in detail the phenomena
and try to identify contributing factors.
Quantitative Research
• Survey Method • Surveying a group of individuals for
responses to certain questions.
Quantitative Research
•Historical Research •Systematic data collection relating to past events.•Places concepts in perspective.•Establishes parameters for continued research in a specialized area.
Quantitative Research
•Cross-Section Studies •Data collected at one specific
measurement point about a single event.•A relatively large number of
individuals is sampled in a short period of time.
Quantitative Research
• Longitudinal Studies •Data collection on the same subjects
studied over time. •Data is collected on a number of
variables.
Quantitative Research
•Retrospective Studies •Review existing data from medical
records/hospital charts.•A carefully conducted retrospective
study can provide the research questions for a prospective study.
Quantitative Research
•Prospective Studies •Actively follow subjects over the
period of the study.• The researcher is able to control all
information collected.
Quantitative Research
• Correlational Designs – Investigate the correlation (relationship) of one
variable to another.– Useful for studying the relationships among large
numbers of variables associated with “human research.”
Quantitative Research
•Quasi-Experimental Design •A modified experiment exposing all
subjects to the independent variable.• Less robust than a true
experimental design.
Quantitative Research
Experimental design • Tests an “independent variable”
against a “dependent variable.”• Subjects are randomized to a
treatment group or a control group.• “Gold standard” in research design.
Qualitative Research Design
•Qualitative Research Design• The systematic collection and
consideration of data relating to humans’ interactions in and with the world.• Frequently involves interview data.•Provides a more holistic approach
that is conducted in natural settings.
•Biographical•Case Study Method• Ethnography• Ethnomethodology•Grounded Theory•Phenomenology
•Biographical Method• Involves writing about people’s
lives.• Sources of data include historical
documents: artifacts, diaries, letters, personal stories, related historical facts.•Data analysis involves sorting and
relating all the information gathered.
•Case Study Method •May refer to a single case, subject,
group, or institution.•Multidimensional approach using a
variety of data-collection strategies.
• Ethnography• Longitudinal, descriptive research
approach used by anthropologists to describe behaviors of a culture. •Data sources include observation of
participant behavior, interviews, artifacts.
• Ethnomethodology• Interpretive descriptions of how
people make sense of their social world.
•Grounded Theory• Field research used in hospitals,
nursing homes, clinics.• Investigates social and decision-
making processes of clients.• Involves theoretical sampling until
data saturation is reached.
• Phenomenology• Approach uses a variety of distinctive,
yet related, philosophical approaches.• Begins in profound reflection on the
phenomenon to be studied.•Multiple sources of data collection.• Requires intense reflection to
understand its meaning.
Homework
Go to the NIH website and complete online course and print certificate