NUR 513 Topic 7 DQ 2 What are some of the major ethical issues in conducting research that impacts the advanced registered nurse?
NUR 513 Topic 7 DQ 2
What are some of the major ethical issues in conducting research that impacts the advanced registered nurse? Discuss the role of the advanced registered nurse in advocating for patient safety and rights in conducting research.
To be honest, the human species does not have a stellar track record when it comes to ethical medical research. During World War II, Nazi Germany and the German medical establishment were implicated in harsh, cruel, and immoral human research. Following WWII, the Nuremberg trials were pushed to hold people accountable for some of the most horrible acts of “research” carried out in concentration camps (Vaughn, 2017). The Nuremberg Code, which contains 10 points outlining what is considered permissible medical experimentation, is the result of these trials (Vaughn, 2017).
The Children of Willowbrook case, which began in the 1950s on Staten Island, New York, involved a mentally retarded children’s state school purposefully infecting patients with Hepatitis (Vaughn, 2017). The facility was overcrowded and understaffed, and the patients’ living conditions were appalling. This facility was in use until the 1980s. NUR 513 Topic 7 DQ 2
Then there was the Tuskegee Syphilis study, which lasted from the early 1900s to 1972 in Alabama. Long-term studies on the effects of Syphilis on the human body were conducted by a small group of black men. This was done without the patients’ knowledge or consent, and it continued even after penicillin was discovered and widely used as a cure for syphilis by 1947. (CDC, 2020).
These men did not receive therapy, and the study was not completed until 1972, when a journalist became aware of the situation, causing public outrage (CDC, 2020). The Tuskegee Syphilis Study resulted in the Belmont Report and the 1974 National Research Act. The Belmont Report creates a framework for research ethics based on the principles of respect, beneficence, and justice (Vaughn, 2017). NUR 513 Topic 7 DQ 2
Respect for the autonomy of the patient, informed consent, and the right to confidentiality Beneficience and nonmaleficence are synonyms for “doing good” and “not causing harm.” Finally, justice requires that research be conducted fairly and without exploitation, with costs shared equally by individuals and communities.
Why do we now have codes of conduct, rules, and oaths to guide us in ethical behavior relating to human research and patient care? Because ethical practice must be constantly reexamined, changed, and enforced. As an Advanced Practice Registered Nurse (APRN), it is critical to advocate for patients’ autonomy and rights. The APRN can play a major role in developing research design, frameworks and implementations so there is a duty to do so in an ethical manner. So when developing EBPs, it is important do rigorous research and closely follow the EBP process.
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NUR 513 Topic 7 DQ 2 References
Center for Disease Control and Prevention [CDC]. (2020). U.S. public health services syphilis study at Tuskegee: The Tuskegee timeline. https://www.cdc.gov/tuskegee/timeline.htm
Vaughn, L. (2017). Bioethics: Principles, issues, and cases (3rd). Oxford University Press.
RESPOND HERE (150 WORDS, 2 REFERENCES)
Hello,
I do agree with your finding that the process of making clinical research on human fair and just has achieved remarkable progress over the years. It is the role of the advanced practice nurse to promote the safety of the patients and ensure that the care for the patients and clinical procedures are guided by the ethical standards (Milliken, 2018). I do agree with you that the Nuremberg code of ethics to guide the clinical research was a great step forward towards achieving human dignity in scientific research. NUR 513 Topic 7 DQ 2
The Nuremberg code focus ten key elements of subject giving voluntary consent, the objectives of the research should be for the greater good of the society, the human experiments should be carried out after initial experiments on animals, it should avoid any injury or physical damage, the risks should not outweigh the benefits, subjects should be adequately protected, the research should be conducted by qualified scientists, subject can terminate their participation any time and willingly, incase any death, injury or disability is likely to occur then the scientist should terminate the experiment (WHO | Nuremberg code turns 60, n.d.)
NUR 513 Topic 7 DQ 2 References
WHO | Nuremberg code turns 60. (n.d.). WHO. https://www.who.int/bulletin/volumes/85/8/07-045443/en/
Milliken, A. (2018, January 31). Ethical Awareness: What It Is and Why It Matters. Ojin.nursingworld.org. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
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Re: Topic 7 DQ 2
Health research has a history of abuse, whereas participants were sacrificed for scientific gain (Doody & Noonan, 2016). These human
rights violations within research spanned throughout the 20th century and made recognition of the importance of ethical nursing research to protect all involved. Good ethical nursing research implies adherence to ethical standards and studies are subject to scrutiny by an ethics board or committee, scientifically sound, researchers are supervised or have expertise, and ethical principles are adhered to throughout the process.NUR 513 Topic 7 DQ 2
Four common ethical principles to consider are autonomy, beneficence, non-maleficence, and justice. According to Doody and Noonan (2016), veracity, fidelity, and confidentiality must also be principles considered.
Veracity involves truth and avoids deception. Participants must understand all aspects of the study. In Los Angeles in 1989-91, over 700 minority babies as young as six months were given an experimental measles vaccine. Parents were not informed of the experiment or that the vaccine was unlicensed (Awadu, 1996). This killer vaccine led to the death of 1 of every 13.6 babies in one African experiment. Truth-telling is dishonored in at least two ways; first by lying or deliberately providing inaccurate information; and second, by omission or deliberately withholding information.
Participants put their trust in the researcher, who should reciprocate with two-way trust. Participants who have fidelity or a trusting relationship are more likely to stay in the studies, follow directions, and know there will be no consequences if they want to drop out at any time (Doody & Noonan, 2016). Another aspect to maintain is confidentiality. Consider taking a work-related survey in which you were asked about your boss or employer and how a breach of confidentiality would affect your responses.
By advocating for informed consent and overseeing study benefits to serve the greater society, APRNs can ensure patient safety and rights in research. Keep in mind that, in theory, all research can be harmful and should be regarded as a privilege rather than a right, especially when human lives are at stake.
References
Awadu, K. O. (1996, August). Outrage! How babies were used as guinea pigs in a LA county vaccine experiment. The Conscious Rasta Report, 3(6). http://www.whale.to/vaccines/awadu.html.
Doody, O., & Noonan, M. (2016). Nursing research ethics, guidance, and application in practice. British Journal of Nursing, 25(14), 803–807. https://doi.org/10.12968/bjon.2016.25.14.803
RESPOND HERE (150 WORDS, 2 REFERENCES)
I do agree with you that the history of scientific research on humans in the past century was inhuman and in violation of the dignity to human life. Human life in both the spiritual and cultural understanding is considered sacred and must be treated with uttermost dignity. The indecent and gross human rights violation of the 19th and the 20th century have no space in the modern world of scientific and technological research. NUR 513 Topic 7 DQ 2
Therefore, it is the role of all the stakeholders involved in scientific research to ensure the set standards of the ethical considerations in scientific research are closely observed at all stages of the research (Milliken, 2018).. The advanced practice nurse roles should be focused on promoting safety of the patients and quality care. They should ensure that any clinical procedure done on the patient is out of the voluntary consent of the patient.
The patient has the autonomy to choose on the available alternative intervention measures. Additionally, the nurses should act in the best good for the improvement of the patient’s health. The key ethical standards of beneficence and nonmaleficence should be the guiding principles of the nurse practice in helping the patient recover to better quality of life and good health (Haddad & Geiger, 2020).
NUR 513 Topic 7 DQ 2 References
Haddad, L., & Geiger, R. (2020). Nursing Ethical Considerations. StatPearls. https://www.statpearls.com/ArticleLibrary/viewarticle/92
Milliken, A. (2018, January 31). Ethical Awareness: What It Is and Why It Matters. Ojin.nursingworld.org. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
Re: Topic 7 DQ 2
The advanced registered nurses participate in research to improve healthcare services and help health care professionals promote patients’ outcome. For this reason, promoting professional ethical standards, integrity and compliance during research are the roles of advanced registered nurses. Some values or ethics such as the nursing ethics of caring, preventing harm, protecting dignity of the patient and the societal values about human rights, the researcher’s values about scientific inquiry may contradict the values or beliefs of the subject participating in the research (Davoodvand, Abbazadeh & Ahmadi, 2016).
The issues of informed consents, respect for confidentiality, anonymity and privacy are serious ethical issues that an Advanced Practice Registered Nurse (APRN) might face when conducting research.
Informed consent is a major ethical issue that APRNs face when conducting research. Informed consent is voluntary, but it is mandatory for the APRN to provide subjects with information about the procedures and treatments, benefits and risks expected in the research prior to accepting to participating. An APRN may encounter issues with obtaining informed from older patients, critically ill and children because they are vulnerable to being forcefully misled into participating in the research.NUR 513 Topic 7 DQ 2
Researchers may be required to establish trustworthiness among their participants in this case (Yip, Han & Sng, 2016). Moreover, the informed consent is meant to protect subjects from assault, protect their integrity and freedom. Therefore, before the initiation of the research the APRN must inform the subjects of any physical harm or bodily injury, infringement of privacy that may occur during the clinical research (Yip, Han & Sng,2016).NUR 513 Topic 7 DQ 2
Respect for participants confidentiality and anonymity is the next ethical issue. The APRNs must give participants the opportunity to release their information as they wish. Participants may withhold or release as much information based on their comfort level or level of trust. During research, ethical dilemma may arise if a researcher is required to report confidential information to the court (Yip, Han & Sng,2016).
Respect for privacy is another major ethical issue that APRNs encounter when conducting research. Researchers are not permitted to release participants information to anyone or organization without their consents. Participants will have to decide the degree at which their private information is share with others or withheld from others. The APRNs role is to protect participants privacies when conduccting research (Yip, Han & Sng,2016).
NUR 513 Topic 7 DQ 2 References
Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: A qualitative study. Journal of Medical Ethics and History of Medicine, 9(5), 1-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958925/
Yip, C., Han, N.R., & Sng, B.L. (2016). Legal and ethical issues in research. Indian Journal of Anaesthesia, 60(9), 684-686. Doi: 10.4103/0019-5049.190627NUR 513 Topic 7 DQ 2
RESPOND HERE (150 WORDS, 2 REFERENCES)
Hello,
I do agree with you that the advanced registered nurse practice role transcends beyond normal care for the patients, it also entails actively engaging in clinical research and coming up with advanced clinical findings aimed at promoting efficient and effective care for the patients. These nurses have the trust of the patients and are better placed in guiding the research projects aimed at promoting better clinical outcomes. However, they must adhere to the ethical standards and maintain the trust with the patients. The ethical considerations play a crucial role in the protection of human subjects in clinical research process (Wu et al., 2019).NUR 513 Topic 7 DQ 2
The advanced registered nurses have the responsibility ensuring confidentiality of the patient’s information. Additionally, for the patients to be involved in any research they have to give voluntary consent and have the autonomy to withdraw from the research at any point without victimization. The patients who are underage, mentally incapacitated or older cannot be considered to offer consent and the close relatives have to be consulted in order to give the consent (Axson et al., 2019).
NUR 513 Topic 7 DQ 2 References
Axson, S. A., Giordano, N. A., Hermann, R. M., & Ulrich, C. M. (2019). Evaluating nurse understanding and participation in the informed consent process. Nursing Ethics, 26(4), 1050–1061. https://doi.org/10.1177/0969733017740175
Wu, Y., Howarth, M., Zhou, C., Hu, M., & Cong, W. (2019). Reporting of ethical approval and informed consent in clinical research published in leading nursing journals: a retrospective observational study. BMC Medical Ethics, 20(1). https://doi.org/10.1186/s12910-019-0431-5
Research ethics are essential in ensuring that participants are protected from any undue coercion and voluntarily engage in study studies. Nursing research like other types of researches must be conducted by upholding critical ethical mandates and requirements. Nurses must subject themselves to critical value systems that include society, nursing and science. The societal values are about human rights while nursing culture is based on ethics of caring and researchers value based on scientific inquiry (DeNisco & Barker, 2019).
Therefore, in conducting research, advanced practice registered nurses (APRNs) need to understand ethical principles that include informed consent, beneficence and non-maleficence as well as confidentiality.
Informed consent is a core ethical aspect in carrying out research as it implies that a participant is independent and participates voluntarily in the study. Lack of informed consent from participants in research studies compromises its validity and credibility (Kim et al., 2020).
Consent should be voluntary and should come from sufficient information about what it entails to be subject in such studies. Informed consent means that a participant understands the benefits of such research and that they will not be harmed. Non-maleficence means that nurses conducting studies are keen on offering benefits to participants and society in general.
Confidentiality is an ethical issue that implores nurses to protect the privacy of all research subjects, including if they are patients in their practice. Confidentiality means that any personal information relating to a patient or participant must not be revealed during and even after the study and when dissemination of the findings occurs.
Patients disclose personal information when participating in research and expect the data to be used only for therapeutic reasons and not for any other disclosures (Melnyk & Fineout-Overhold, 2022). The implication is that APRNs conducting studies should have sufficient ethical guidelines so that their findings are not compromised. APRNs must advocate for patient safety and rights while conducting research through effective adherence to ethical mandates and requirements.
References
DeNisco, S. M. & Barker, A. M. (2019). Advanced Practice Nursing: Essential Knowledge for
the profession (4th ed.). Jones & Bartlett Learning.
Kim, M., Mallory, C., & Valerio, T. (2020). Statistics for evidence-based practice in nursing.
Jones & Bartlett Publishers.
Melnyk, B. M., & Fineout-Overhold, E. (2022). Evidence-based practice in nursing &
healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Nurses encounter multiple practice and patient care issues requiring practical interventions. To improve their knowledge and address patient care issues comprehensively, advanced registered nurses conduct research of different types while focusing on diverse populations. Due to methods, exposure to new treatments, and other factors, nursing research is associated with many ethical issues.
The major ethical issues in conducting research that impact the advanced registered nurse are informed consent, respect for anonymity, and potential harm. Informed consent is concerned with protecting participants’ right to autonomy. According to Hoverd et al. (2021), informed consent allows research subjects to participate voluntarily since they adequately understand the risks, benefits, and objectives of the research. Therefore, the advanced registered nurse conducting research should obtain informed consent from participants before the study begins. Dougherty (2021) described respect for anonymity as the researcher’s commitment to concealing participants’ identities. This implies that researchers should not collect or share identifiable personal information from participants. Research can also pose considerable risk to participants. The non-maleficence principle requires researchers to conduct harmless studies (Elton, 2021). As a result, all studies should be approved by the appropriate ethics committee at the study site.
The advanced registered nurse has a critical role in advocating for patient safety and rights in conducting research. Abbasinia et al. (2020) demonstrated advocacy as acting on behalf of patients to ensure their rights are not abused. In the research context, the advanced registered nurse should ensure all research subjects consent to participate through oral and written agreements. Therefore, patients involved in a study should be adequately informed about the procedures, benefits, and risks before any engagement. Participants should also be allowed to withdraw from research without providing any explanation. The other nurse’s role is to facilitate risk-free procedures and exclude vulnerable populations.
References
Abbasinia, M., Ahmadi, F., &Kazemnejad, A. (2020). Patient advocacy in nursing: a concept analysis. Nursing Ethics, 27(1), 141-151.https://doi.org/10.1177/0969733019832950
Dougherty, M. V. (2021). The use of confidentiality and anonymity protections as a cover for fraudulent fieldwork data. Research Ethics, 17(4), 480-500.https://doi.org/10.1177/17470161211018257
Elton, L. (2021). Non-maleficence and the ethics of consent to cancer screening. Journal of Medical Ethics, 47(7), 510-513.http://dx.doi.org/10.1136/medethics-2020-106135
Hoverd, E., Staniszewska, S., & Dale, J. (2021). The informed consent process in health research with under-served populations: a realist review protocol. Systematic Reviews, 10(1), 103. https://doi.org/10.1186/s13643-021-01652-2