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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?
Georgia Fouka1, Marianna Mantzorou2*
1
RN, PhD, Assistant Professor of Nursing, Department of Nursing Β΄, Technological
Educational Institute (TEI) of Athens, Greece
2
RN, MSc, Lecturer, Department of Nursing Β΄, Technological Educational Institute (TEI) of
Athens, Greece

*Corresponding Author:
Mantzorou Marianna
13, Tassopoulou str. Ag. Paraskevi, 15342
Tel : 210 6398958
Mobile: 6937849980
E-mail: [email protected]

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Abstract

Background: Research ethics involve requirements on daily work, the protection of dignity of
subjects and the publication of the information in the research. However, when nurses
participate in research they have to cope with three value systems; society; nursing and
science which may be in conflict with the values of subjects, communities, and societies and
create tensions and dilemmas in nursing. Method and material: Using the Medline and the
Nursing Cinahl data base, the most important ethical issues which appear in bibliography,
will be addressed. After a short description of the nature of nursing, and the advocacy role of
nurses, the writer will attempt to highlight the possible conflicts that nurses have to deal with,
when undertaking or participating in research. Results: The major ethical issues in conducting
research are: a) Informed consent, b) Beneficence- Do not harm c) Respect for anonymity
and confidentiality d) Respect for privacy. However, both the nature of nursing which
focuses on caring, preventing harm and protecting dignity and the advocates role of nurses
which calls for defending the rights of subjects, are sometimes incongruent with the ethics in
research. Conclusions: Ethical issues, conflicting values, and ambiguity in decision making,
are recurrently emerging from literature review on nursing research. Because of lack of
clarity in ethical standards, nurses must develop an awareness of these issues and an effective
framework to deal with problems involving human rights.
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. It refers to a system
of principles which can critically change previous considerations about choices and actions.
[1] It is said that ethics is the branch of philosophy which deals with the dynamics of decision
making concerning what is right and wrong. Scientific research work, as all human activities,
is governed by individual, community and social values. Research ethics involve
requirements on daily work, the protection of dignity of subjects and the publication of the
information in the research.

However, when nurses participate in research they have to cope with three value systems;
society; nursing and science. The societal values about human rights, the nursing culture
based on the ethic of caring and the researcher's values about scientific inquiry. According to
Clarke these values may conflict with the values of subjects, communities, and societies and
create tensions and dilemmas in nursing. [3]

In this paper, the most important ethical issues will be addressed. After a short description of
the nature of nursing, and the advocacy role of nurses, the writer will attempt to highlight the
possible conflicts that nurses have to deal with, when undertaking or participating in research.

Historical overview- Ethical codes

Human experimentation has been conducted even before 18th century. However, the ethical
attitudes of researchers drawn the interest of society only after 1940's because of human
exploitation in several cases. Professional codes and laws were introduced since then in order
to prevent scientific abuses of human lives. [4] The Nazi experiments led to the Nuremberg
Code (1947) which was the leading code for all subsequent codes made to protect human
rights in research. This code focuses on voluntary informed consent, liberty of withdrawal
from research, protection from physical and mental harm, or suffering and death. It also
emphasises the risk- benefit balance. [5] The only weak point of this code was the self
regulation of researchers which can be abused in some research studies. [4] All declarations
followed, forbade nontherapeutic research. It was only in 1964 with the declaration of
Helsinki that the need for non therapeutic research was initiated. [6] The declaration
emphasised the protection of subjects in this kind of research and strongly proclaimed that the
well being of individuals is more important than scientific and social interests. [4]

In terms of Nursing the first inquiry was the "Nightingale Pledge" (1983). Since then there
has been a significant development of professional codes in conduct and research. The
American Nurses' Association (ANA) Guidelines for Research, the Human Rights Guidelines
for nurses in clinical and other research (1985) and the Royal College of Nursing Code for
nurses in research (1977) provide a strong assistance to professional nurses as well as
reassurance to patients, the public and society, of professionals’ intentions. [7-9]
Major ethical issues in conducting research

Informed consent

Informed consent is the major ethical issue in conducting research. According to Armiger: "it
means that a person knowingly, voluntarily and intelligently, and in a clear and manifest way,
gives his consent" . [10]

Informed consent is one of the means by which a patient's right to autonomy is protected.
Beauchamp and Childress define autonomy as the ability for self determination in action
according to a personal plan. [11] Informed consent seeks to incorporate the rights of
autonomous individuals through self- determination. It also seeks to prevent assaults on the
integrity of the patient and protect personal liberty and veracity. [3] Of course individuals can
make informed decisions in order to participate in research voluntarily only if they have
information on the possible risks and benefits of the research. [12] Free and informed consent
needs to incorporate an introduction to the study and its purpose as well as an explanation
about the selection of the research subjects and the procedures that will be followed. [8] It is
essential to describe any physical harm or discomfort, any invasion of privacy and any threat
to dignity as well as how the subjects will be compensated in that case. [5] In addition the
subjects need to know any expected benefits either to the subject or to science by gaining new
knowledge.8 A disclosure of alternatives is also required as for example in the Tuskegee
study about syphilis. In this study, rural black men were chosen as subjects in a study of
syphilis. Although a cure for syphilis was found after the start of the study, it was decided not
to treat them and they had not been told that penicillin was effective to their disease. [13] The
researcher must inform the subjects about the methods which will be used to protect
anonymity and confidentiality and indicate a person with whom they can discuss the study.
He must also provide a "Noncoersive Disclaimer" which states that participation is voluntary
and no penalties are involved in refusal to participate. [14] Moreover, the subject must be told
that some information has been deliberately withheld in order to avoid altered behaviours.
The researcher must also take into account that persons with physical, cultural and emotional
barriers may require a very simple language in order to understand him. [15] Finally, the
freedom to withdraw must be explained. [5] This is very important but raises the issue of how
difficult the subjects can withdraw after developing a personal and sometimes friendly
relationship with the researcher. [12] With regard to withdrawal a researcher may be in a
dilemma in case many subjects choose to withdraw at an advanced stage of the study,
because this can affect the validity of the results. The Declaration of Helsinki provide some
help as it declares that the interest of the subject must always prevail over the interests of
society and science. [3] According to this, the will of the subject must be respected at any
cost for the research.

Another major ethical issue is obtaining an informed consent from groups with diminished
autonomy which will be further discussed later. From what has been discussed, it becomes
clear that disclosure, comprehension, competency and voluntariness are the four essential
parts of a consent. [5]

Beneficence- Do not harm

The ethical principle of beneficence refers to the Hippocratic "be of benefit, do not harm".
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". [11]

Beneficence is sometimes difficult to predict when creating a hypothesis especially in

qualitative research. Carr says that if the research findings prove that it was not beneficial as
it s expected, this can raise immense ethical considerations especially for nurses. [16] Ford
and Reutter say that "beneficence relates to the benefits of the research, while non-
malificence relates to the potential risks of participation". [12] Nonmalificence requires a
high level of sensitivity from the researcher about what constitutes "harm". According to
Burns and Grove "discomfort and harm can be physiological, emotional, social and economic
in nature". [5]

When a researcher tries to learn intimate details of the participants lives he has to deal with
opening old wounds. [12] Nonmalificence dictates both preventing intentional harm and
minimising potential harm. A researcher must consider all possible consequences of the
research and balance the risks with proportionate benefit. The type, degree, and number of
potential risks must be assessed as well as the patients value system which ranks various
harms. [17] The risk benefit ratio can only be achieved by identifying these factors. If the
risks outweigh the benefits, the study should be revised. [5]

Last, debriefing at the end of a study, should be mentioned. Treece and Treece say that
debriefing refers to explaining the exact aim of the study and why the disclosure was not full.
[18] Treece and Treece suggest that subjects should feel as much at ease as possible and
express their feelings. [18] In addition, Burns and Grove suggest that if the subjects
experienced a high level of discomfort, they should be debriefed or referred to appropriate
professional intervention as necessary. [5]

Respect for anonymity and confidentiality

The issue of confidentiality and anonymity is closely connected with the rights of
beneficence, respect for the dignity and fidelity. [3] ANA suggests anonymity is protected
when the subject's identity can not be linked with personal responses. If the researcher is not
able to promise anonymity he has to address confidentiality, which is the management of
private information by the researcher in order to protect the subject's identity. [19] Levine
advocates that confidentiality means that individuals are free to give and withhold as much
information as they wish to the person they choose. [20] The researcher is responsible to
"maintain confidentiality that goes beyond ordinary loyalty". Clarke addresses the ethical
dilemma of the researcher when confidentiality must be broken because of the moral duty to
protect society. [3]

According to the utilitarian theory, which focuses on the best interest of all involved, the
happiness of society is of greater importance. On the other hand, the deontological theory
which ignores the result implies that the moral duty is what really matters. If a researcher,
though, acts deontologically he may feel that he has not protected society. Another issue is
that the researcher may have to report confidential information to courts which can also cause

moral dilemmas. In that cases it can be argued that the moral duty and personal ethos can be
stronger than legal requirements. [3] Even if there are no duty conflicts, the researcher faces
several problems with respect to maintaining confidentiality especially in qualitative research
where conduct is personal, the sample is smaller and the reports display quotations of
interviews. Ford and Reutter suggest using pseudonyms and distorting identifying details of
interviews when transcribing the tapes used. [12]

In situations that are particularly complex, sensitive, and in which the participants are
extremely vulnerable, a Certificate of Confidentiality issued by the U.S. Department of
Health and Human Services (DHHS) may be useful to help ensure the privacy of research
participants especially in studies in which participants and researchers may be exposed to
compelled legal disclosure of research data.

The researchers must always bear in mind all psychological and social implications that a
breach of confidentiality may have on subjects. In order to protect participants, they have to
inform them on their rights, and use all possible coding systems that they regard appropriate
in each case.

Respect for privacy

The fifth principle of the entitled "A Patient's Bill of rights" document published in 1975 by
the American Hospital Association (AHA), affirm the patient's right of privacy. [21]
According to Levine : "privacy is the freedom an individual has to determine the time, extent,
and general circumstances under which private information will be shared with or withheld
from others ". [20]

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. [22] However, the American Nurses Association says that different persons may
held different opinions about when privacy is invaded. 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. [18] This
may even apply to report of age, income, marital status, and other details that the subject may
regard intimate. 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.
[18] Health care practitioners need to be aware that "an invasion of privacy may cause loss of
dignity, friendship or employment, or create feelings of anxiety, guilt, embarrassment or
shame". [5] In conclusion, all possible measures have to be taken in order to protect subjects
from potential physical, psychological or social damage during the research or after
circulation of the results. [8]

Vulnerable groups of people

Nowadays, there is an increased concern about vulnerable groups and whether it is ethical or
not for them to be used as research subjects." Fisher classifies vulnerability as one
characteristic of people unable to protect their own rights and welfare". [23] So, vulnerable
groups include captive populations (prisoners, institutionalised, students etc), mentally ill
persons, aged people, children, critically ill or dying, poor, with learning disabilities, sedated
or unconscious.
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. [6] According to Burns
and Grove vulnerability increases the need for justification for the use of such subjects.5 An
intense analysis of potential risks and benefits should be the first step of starting such a
research and careful approach should exist both in acquiring consent and during the research
procedure itself. 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. [24] Participants living in supervised housing
were significantly more likely to require prompts than those living alone. 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. [25] However, the potential improvement of their
nursing care raises the issue of careful consideration before rejecting or accepting this kind of
research.

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. [13] The Royal
College of Nurses declares that nurse researchers should have the necessary skills and
knowledge for the specific investigation to be carried out and be aware of the limits of
personal competence in research. 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. [26]

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. [2]

The nature of Nursing

The nature and essence of nursing reflects on human beings and their relationship with
health. [27] Mckenna states that the primary scope of nursing is to help persons to adapt in
different stages of illness which is a rather task-orientated and behaviouralistic approach. [28]
On the other hand, Swanson notes that nursing views persons as a whole and health as a
subjective and meaningful experience of integrating with the environment. [29] Mckenna
views nursing's main elements as interpersonal interactions which involve practical actions
but Chinn and Jacobs make hints on holism as well. [28,30] Literature contains diversed
nursing definitions which indicates the complicate and uncertain nature of it. [28] However,
most authors reflect on caring as the most important part of nursing. 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". [29,31] The ANA policy statement declares
that "Nurses diagnose and treat human responses to actual or potential health problems". [8]
This is quite indicative of the nurses' role, but it does not reflect the values, experience and
passion of nursing. Swanson suggests that nursing has to do with "science, concern for
humanity and caring. [29]

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. [32] Roach says that caring
describes precious moments when participants realise their common base of humanity". [33]
Burnard and Chapman suggest that the most important elements of caring are: "knowledge,
alternating rhythms in relationships and continuous changes in reactions to others, patience,
honesty, trust, humility, hope and courage". [9]

In Nursing however, the element of caring is undervalued because the profession was viewed
as "women’s work" in which, care is governed by sentiment and not by logic. [34] Nursing
was perceived by society as an extension of medicine while curing is regarded more
important than "enhancing life quality" and preserving human dignity". [29] On the other
hand, Roach says that the curecare dichotomy used to distinguish nursing from medicine is an
artificial one. [33]

As McNeil et al say, "care is the basis and precondition of all cure". [34] Swanson proposes a
structure for caring which includes maintaining belief in persons, knowing the other person,
being with, doing for, and enabling. [29] The last two are the most important parts related to
research. 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. [29] Leininger supports the thesis
that:"there is no discipline that is so directly and intimately involved with caring needs and
behaviours than the discipline of Nursing". [35]

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. [29] What is more, can nursing today be a synonym of caring? The vulnerability of
the sick and the lack of patient participation in health care, creates a danger of patient
exploitation by nurses. [13] . The rapid change and development of nursing emerged the need
for a code of professional conduct to guide nurses in their practice.

Advocacy in nursing

Advocacy primarily used in legal contexts, refers to the protection of human rights of people
who cannot defend them for themselves. [17] The role of nurses as advocates is closely
related to the purpose of nursing, the nurses views about humans and the needs of persons in
health care. [36] In literature advocacy is described in three different models: The rights
protection model implies that nurses helps persons to understand and exercise their rights.
They also aim to protect and enhance personal autonomy. [37] The value based decision
model suggests that nurses should not impose decisions but assist persons to decide which
choices are most consistent with their values. They should also support the patients'
confidence in their own decisions and prevent limitations of their freedom. [17] This model is
considered by Gadow in the "existential advocacy" which focuses on the clarification and
reconsideration of the values of the patients by self examination. [38] According to Fowler
and Arrif this thesis is distinct from both "paternalistic and consumer rights protection" and
declares the fundamental rights of self determination. [17] However according to Johnstone,
Gadow does not provide adequate reasoning why self-determination is the most important
value or why the human rights claim to selfdetermination are quite different from a patients
rights claim to self-determination. 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. [1] Murphy argues that this model which she calls the
advocate model of the nurse-patient relationship, reflects the basic value of nursing which is
the best possible care for patients. [39] However, nurses should not be considered as being in
a solely position to act as patients advocates.

According to Johnstone all professions with a morally significant relationship with a patient
ought to fulfil the role of the advocate. [1] The ANA Code for nurses though, refers to the
nursing role of advocate in safeguarding the well being of the client and the society. [8]
However, both the nature of nursing which focuses on caring, preventing harm and protecting
dignity and the advocates role of nurses which calls for defending the rights of subjects, are
sometimes incongruent with the ethics in research.

Conflicts in nurses

Beneficence-Non malificence

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. [8] This
statement raises the issue of advocacy when nurses have to protect patients from the
researchers’ incompetence or unethical behaviour. 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. [13] If the researcher does not inform or compensate patient then nurses have to
decide between the duty to safeguard the well-being of patient and be loyal to them, and the
loyalty to colleagues.

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. Many support the idea that the prohibition
from the advocacy role comes from the origins and development of nursing as a women’s
occupation dominated by medicine in a bureaucratic system. [40]
Another possible issue of conflict is that the caring nature of nursing with regard to the right
of patients to the best treatment/care is sometimes conflicting with the aim of research in non
therapeutic studies. 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. [41] So, they suggest that whenever it
is possible to predict such problems for nurses, the control data should be collected before
introducing the beneficial variable. Skodol Wilson implies that there should be some
provisions for alternative effective care. [42] Finally, Brink and Wood recommend that
withholding benefits can be rectified at the end of an experiment. [41] This compensation
must be planned in advance so that enough money and time will be available.

In order to prevent human exploitation, ethics committees were introduced. [3] The criteria
on which the proposals are to be judged are the physical and mental discomfort or harm of
subject, the qualifications and experience of the supervisor, the scientific value, the adequate
consent procedures and the adequate information given to subjects. [43] Clark warns that
there is a danger that the members may have vested interests in a research. [3] The success of
any ethics committee will always depend on the commitment and moral competency of its
members. 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. [1] Nurses, need a greater
accessibility to committees and demand a multidisciplinary synthesis in order to deal with
very difficult cases. [26] Moreover, the committees should be less strict so as not to prevent
knowledge development in nursing.

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. 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. [9] On the other hand the ICN Code for nurses in research
states that: "Nurses acting as data collectors must recognise that they are now committed to
two separate roles " . [26]

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. [26] In addition, they have to deal with the issue of anonymity
when some features of the research make the subjects easy to identify. [15] It is very
important that nurses always bear in mind that they should protect the privacy of the patient.
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. [9]

Informed consent

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. [44] The patient's consent should be obtained
freely, with full awareness of implications. 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. [40] If a nurse tries
to get a consent, then the persons will feel obliged to participate, either because information
is coming from their carer that they trust and depend on, or, because they feel grateful for the
care they are receiving. [15]

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. [40] Hurst suggests
that if nurses cannot tell patients about the true research objectives, they should provide a full
explanation at the end of data collection. [45] Provided, of course, that a supervisor body has
decided that disclosure should not be full in order not to invalidate the research outcome.

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. [46] In the same prospect,
nurses must act as advocates when vulnerable groups are used in research, and not prevent it.
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. [20]

Researcher role conflict

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". [3] The commitment of nurses to caring, may
create dilemmas according to the conflict between the researcher's and clinician's role.
If a researcher nurse provides physical or psychological care during an interview, the results
will be biased and generalisation will be difficult. [5] Another issue raised from the ICN
statement, is to determine when a "harmful situation appears imminent" and the intervention
of the researcher is required. [26] The declaration of Helsinki says that the interest of the
individual should prevail over the interests of society of science. [3] This can solve some of
the ethical dilemmas of the nurse, but in case the situation is not lifethreatening, the conflict
remains. 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. [5] They also
recommend that another alternative, is to seek help in other professionals to proceed with the
data collection. 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.

Conclusion

Ethical issues, conflicting values, and ambiguity in decision making, are recurrently emerging
from literature review on nursing research. Because of lack of clarity in ethical standards,
nurses must develop an awareness of these issues and an effective framework to deal with
problems involving human rights. 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".

References

1. Johnstone M. Bioethics. A Nursing Perspective. 5th edition Churchil Livingstone

Elsevier, 2009.

2. Kilpi H., Tuomaala U. Research Ethics and Nursing Science: an empirical example.
Journal of Advanced Nursing, 1989;14: 451-458.

3. Clarke J. Moral dilemmas in Nursing Research. Nursing Practice, 1991;4(4): 22-25.

4. Oddi L.F., Cassidy, V.R. Nursing Research in the U.S.: the protection of human
subjects. International Journal of Nursing Studies, 1990;27(1): 21-34.

5. Burns N., Grove, S.K. The practice of nursing research: Conduct, critique, and
utilization 5th ed. St. Louis, MO: Elsevier/Saunders, 2005.

6. Watson A.B. Informed Consent of special subjects. Nursing Research,1982;(1): 43-

47.
7. Royal College of Nursing, Ethics related to Research in Nursing, London,1977.

8. ANA (1985) Code of Ethics for Nurses. Encyclopedia of Nursing & Allied Health.
Available at: www.enotes.com/nursingencyclopedia/ code-ethics-nurses.Αcessed on
1-7-2010.

9. Burnard P., Chapman C. Professional and Ethical issues in Nursing. 3rd edition,
Bailliere Tindall, 2005.

10. Armiger B. Ethics in Nursing Research: Profile, Principles, Perspective. Nursing

Research, 1997;26 (5): 330-333.

11. Beauchamp T. L. & Childres, J. F Principles of Biomedical ethics, 5th ed, Oxford
University Press, Oxford, 2001.

12. Ford L., Reutter L. Ethical dilemmas associated with small samples. Journal of
Advanced Nursing, 1990;15, 187-191.

13. 13.Jameton A. Nursing Practice. The ethical issues. Prentice Hall, New Jersey, 1984.

14. D.H.S.S Ceri Davies Report Under-used and surplus property in the National Health
Service: report of an Enquiry into ways of identifying surplus land and property in the
National Health Serice. London, 1983.

15. Robinson K. Research module: R4 the real world of research. Part II = Research
Ethics. Nursing Times, 1992; 88: 44.

16. Carr L. The strengths & weaknesses of quantitative and qualitative research. What
method for Nursing? Journal of Advanced Nursing, 1994;20: 716-721.

17. Fowler M., Arriff J. Ethics at the bedside, Lippincot, Philadelphia. 1987.

18. Treece E.W., Treece J.W. Elements of Research in Nursing, Mosby, St-Louis, 1982.

19. Nieswiadomy R.M. Foundations of Nursing Research, 5th ed, Prentice Hall, 2007.

20. Levine. Preliminary Papers prepared for the commission, The Belmond Report,
DHEW Publication, Washington DC, 1976.

21. AHA A Patient's Bill of Rights. Chicago: American Hospital Association, 1975.

22. Kelman H.C. Privacy and Research with Human Beings. Journal of Social Issues,
1977;33: 169?195

23. Fisher C.B. Integrating science and ethics in research with high risk children and
youth. Social Policy Report, 1993; Vol. VII, ??.4,

24. Beebe L.H., Smith, K. Examining Informed consent in Persons with Schizophrenia.
Issues in Mental Health Nursing, 2008;29 (4): 397-410
25. Lasagna L. Some ethical problems in clinical investigation. In Ethical Views in
Modern Medicine, (Hunt, R. & Arras, J. eds), Mayfield Publishing, California,1997.

26. Hunt G. What is Nursing Ethics? Nurse Education Today, 1992;12: 323-328.

27. Mitchell G. Diagnosis: Clarifying or obscuring the nature of Nursing? Nursing

Science Quarterly, 1992;4: 2

28. Mckenna G. Unique theory-is it essential in the development of a science of Nursing?

Nurse Education Today, 1993;13: 121-127.

29. Swanson K. M. Nursing as informed caring for the well-being of others. Image:
Journal of Nursing Scholarship, 1993;25(4): 352-357.

30. Chin P.L, Jacobs M.K. Theory and Nursing, a systematic approach. 2nd ed. St. Luis
MO: CV Mosby,1983.

31. Raya A. Can knowledge be promoted and values ignored? Implications for nursing
education. Journal of Advanced Nursing, 1990;15(5): 504-509.

32. Mayeroff M. On Caring, New York, N.Y.: Harper and Row, 1971.

33. Roach M.S. The human act of caring. A blueprint for the health profession. Canadian
Hospital Association, Ontario,1987.

34. McNeill D., Morrison D., Nouwen H.J. Compassion. New York, Doubleday &
Company, 1982.

35. Leininger M. Culture care diversity and universality: a theory of nursing. New York.
National League for Nursing, 1991.

36. Leddy S., Pepper M. Conceptual Bases of professional Nursing. 7th ed, Lippincot
Co., Philadelphia, 2009.

37. Winslow G. From loyalty to advocacy: a new metaphor for nursing. Hastings Center
Report, 1984;14(6): 32–40

38. Gadow S. Existential advocacy: philosophical foundation of nursing. In: Spicker SF,
Gadow S, eds. Nursing, Images and Ideals: Opening Dialogue With the Humanities.
New York, NY: Springer Pub Co, 1980.

39. Murphy C. Nurses' views important on ethical decision team. Am. Nurse, 1983;
15(10): 12, 14.

40. Webb C. Speaking up for advocacy. Nursing Times, 1987;83 (34): 33-35.

41. Brink P., Wood M. Basic steps in planning Nursing Research. From question to
proposal. Jones & Bartlett, Boston, 2001.
 42. Skodol W.H. Research in Nursing, 2nd ed, Addison - Wesley Publishing Co.,
California, 1989.

43. Hunt G. local Research Ethics Committees and Nursing: A critical look.

44. Price B. The thorny path of Nursing Research. Nursing Times, 1989; 85 (23): 62-63.

45. Hurst K. A real debate by two imaginary people. Nursing Mirror, 1985; 160 (24): 34-
35.

46. Akers J., Bell S.K. Should children be used as research subject? Nursing Forum,
1994;29 (3):28-33.

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