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SECTION 3: ETHICAL CONSIDERATIONS SPECIFIC TO RESEARCH METHODS OR FIELDS

Ethical Issues

❶R4 the real world of research. The major ethical issues in conducting research are:

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Introduction
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In many cases, it is the ethical assumptions of the previous thirty years that drive this 'go-slow' mentality. After all, we would rather risk denying treatment for a while until we achieve enough confidence in a treatment, rather than run the risk of harming innocent people as in the Nuremberg and Tuskegee events. But now, those who were threatened with fatal illness were saying to the research establishment that they wanted to be test subjects, even under experimental conditions of considerable risk.

You had several very vocal and articulate patient groups who wanted to be experimented on coming up against an ethical review system that was designed to protect them from being experimented on.

Although the last few years in the ethics of research have been tumultuous ones, it is beginning to appear that a new consensus is evolving that involves the stakeholder groups most affected by a problem participating more actively in the formulation of guidelines for research.

While it's not entirely clear, at present, what the new consensus will be, it is almost certain that it will not fall at either extreme: There are a number of key phrases that describe the system of ethical protections that the contemporary social and medical research establishment have created to try to protect better the rights of their research participants.

The principle of voluntary participation requires that people not be coerced into participating in research. This is especially relevant where researchers had previously relied on 'captive audiences' for their subjects -- prisons, universities, and places like that. Closely related to the notion of voluntary participation is the requirement of informed consent. Essentially, this means that prospective research participants must be fully informed about the procedures and risks involved in research and must give their consent to participate.

Ethical standards also require that researchers not put participants in a situation where they might be at risk of harm as a result of their participation. Harm can be defined as both physical and psychological. There are two standards that are applied in order to help protect the privacy of research participants. Almost all research guarantees the participants confidentiality -- they are assured that identifying information will not be made available to anyone who is not directly involved in the study.

The stricter standard is the principle of anonymity which essentially means that the participant will remain anonymous throughout the study -- even to the researchers themselves. Kelman believes that an invasion of privacy happens when private information such as beliefs, attitudes, opinions and records, is shared with others, without the patients knowledge or consent. 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.

Nowadays, there is an increased concern about vulnerable groups and whether it is ethical or not for them to be used as research subjects. 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 risk 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. 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.

What is more, careful choice of method for data collection, to ensure validity and reliability, are two main requirements that must be met in all kinds of research. The choice depends on the object of the study. When human beings are involved, all the ethical issues, discussed above, must be taken into account.

The nature and essence of nursing reflects on human beings and their relationship with health. 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. What exactly does it mean to care? Mayeroff describes caring as an interaction which offers space for personal growth for both the carer and the cared.

As McNeil et al say, "care is the basis and precondition of all cure". 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.

However, caring is not unique in nursing. 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. The rapid change and development of nursing emerged the need for a code of professional conduct to guide nurses in their practice.

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.

A common feature in professional conduct codes and those specific to research is the principle of non-malificence. The ANA Code of conduct declares that 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. If instead of the patient and his needs, the central aims of the committee are personal interests, profits and academic prestige, then nurses will have none to share their concerns with, and deal with their dilemmas in research. The issue of confidentiality which is stated as very important in the Hippocratic oath, is another possible issue of conflict for nurses either as practitioners or researchers.

Clause 10 of the ICN Code for nurses emphasises that all information obtained during nursing practice should be kept secret apart from cases that it should be reported in a court, or in cases that the interests of society are important. According to the professional code they can not reveal confidential information not even to the members of the research team. It is important therefore, to seek advice in ethics committees to get approval for disseminating the results of the data collection including an account of what happened.

The trust showed to them must not be jeopardised. Patients reveal information concerning their body and mind and expect them to be used only in a therapeutic manner. When dilemmas according to confidentiality arise, trust as a basic element of a therapeutic relationship should be considered and maintained. Nurses involved in research, have to consider many ethical problems relating to the issue of informed consent. The ICN code for nurses in research, states that nurses as practitioners may be called upon to witness that informed and voluntary consent has been obtained from the subjects of research.

It suggests that they should make sure that patients have fully understood what has been proposed, which means that they are aware of potential risks or discomforts. Nurses who spend more time with patients are in a good position to judge it. In addition, they must ascertain that patients have understood their right to withdraw at any time. In order to maintain the self-determination of patients, nurses must be fully informed themselves about the study and its purpose.

If nurses find out that it was not obtained in an appropriate manner, they should inform patient and refuse co-operation. Webb suggests that the informed consent is an obligation of the researcher and no nurse should obtain it on behalf of another professional, nor agree to give the explanation as a substitute.

Another conflicting issue is that giving information to patients is accepted as a major role of the nurse; but if for the sake of a research, nurses have to withhold information, this may create conflicts when they have to decide whether to participate or not. Consent, can however, be a major ethical issue for nurses when it involves persons with diminished autonomy, such as children, aged, mentally ill etc.

Nurses should ascertain that consent has been obtained either from the individual, when possible, or, by relatives or guardians. They must also protect the dignity and privacy of such groups who are more vulnerable to loss of dignity and privacy.

Nurses taking part in research on children should be alert, in order to notice any verbal or non verbal dissent which warrants exclusion of the child from the study even if this creates conflicts with the researcher. According to Levine, restricting these groups from research could end in disadvantaging those populations, even further, especially when research involves no risk and a high potential for benefit.

With regard to nurse researchers, the International Council of Nurses declares that they are not responsible for the care of patients. They should only intervene in case that "a harmful situation appears imminent".

This statement is not congruent with the culture of nursing which is "intertwined with the ethic of caring". If a researcher nurse provides physical or psychological care during an interview, the results will be biased and generalisation will be difficult. Burns and Grove suggest that in case that support from the researcher is required, then, it should be given, but the subjects should be excluded from the research.

Nevertheless, most health professionals, no matter how skilled they are in supportive techniques will provide some care if they feel that it is needed in a certain case. This is necessary in order to come into terms with the issue of the researcher's values relative to the individual's rights versus the interests of society. Professional codes, laws, regulations, and ethics committees can provide some guidance but the final determinant of how research is performed, rests with the researcher's value system and moral code.

To prepare future nurses, ethics in research, must receive special attention in nursing curricula. The criticism and uncertainties that arise, should be rather encouraged than suppressed in nursing education. Hunt suggests that in order to liberate nursing from its "technocratic impasse" ethics should be broadly interpreted as an arena of new ideas which can change professional hierarchies, to open cross-disciplinary discussions, and question the concepts "abnormality", "patient" and " illness".

He also declares that nursing, not as a biomedical branch, but as a science and art of caring, is able to start the redefinition of research in health care which was in the recent history dominated by the biomedical "paradigm".

All Published work is licensed under a Creative Commons Attribution 4. What are the major ethical issues in conducting research? Mantzorou Marianna 13, Tassopoulou str. Visit for more related articles at Health Science Journal. 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.

Historical overview- Ethical codes Human experimentation has been conducted even before 18th century. 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 ". Another issue is that the researcher may have to report confidential information to courts which can also cause moral dilemmas.

Respect for privacy The fifth principle of the entitled "A Patient's Bill of rights" document published in by the American Hospital Association AHA , affirm the patient's right of privacy. 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.

Advocacy in nursing Advocacy primarily used in legal contexts, refers to the protection of human rights of people who cannot defend them for themselves. Conflicts in nurses Beneficence-Non malificence A common feature in professional conduct codes and those specific to research is the principle of non-malificence. Confidentiality The issue of confidentiality which is stated as very important in the Hippocratic oath, is another possible issue of conflict for nurses either as practitioners or researchers.

Conclusion Ethical issues, conflicting values, and ambiguity in decision making, are recurrently emerging from literature review on nursing research. Research Ethics and Nursing Science: Journal of Advanced Nursing, ; Moral dilemmas in Nursing Research. Nursing Practice, ;4 4: Nursing Research in the U. International Journal of Nursing Studies, ;27 1: The practice of nursing research: Conduct, critique, and utilization 5th ed.

Informed Consent of special subjects. Professional and Ethical issues in Nursing.

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Ethical Issues There are a number of key phrases that describe the system of ethical protections that the contemporary social and medical research establishment have created to try to protect better the rights of their research participants.

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When most people think of research ethics, they think about issues that arise when research involves human or animal subjects. This means that you need to report your research honestly, and that this applies to your methods (what you did), your data, your results, and whether you have previously published any of it. You should not make up.

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What are the major ethical issues in conducting research? is there a conflict between the research ethics and the nature of nursing?, Mantzorou Marianna. Ethical Considerations can be specified as one of the most important parts of the research. Dissertations may even be doomed to failure if this part is missing. According to Bryman and Bell ()[1] the following ten points represent the most important principles related to ethical considerations.

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Obviously,ethical issues can be raised throughout all phases of research, notably problem definition,stating research objectives/ hypotheses, literature review, choice of research design,questionnaire design, data collection procedures, data editing and cleaning, choice ofstatistical methods, data analysis, conclusions and recommendations, and. The handling of these ethical issues greatly impact the integrity of the research project and can affect whether or not the project receives funding. Because ethical considerations are so important in research, many professional associations and agencies have adopted codes and policies that outline ethical behavior and guide researchers.