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 misconduct
Fraud, research protocol violations
Fabrication, falsification, forging of data
Plagiarism
Putting 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, 1930s
Thalidomide England, 1950s
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 persons
Principles of beneficence
Principle 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 harm
Freedom from exploitation
Risk/benefit ratios
High anticipated benefit may
balance high risks

Principle of Jutice
Fair treatment
(even if choose not to participate)
Right to privacy
Anonymity
Confidentiality
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 peoples 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