Ethical Dimensions of Research Studies

In the best-selling book, The Immortal Life of Henrietta Lacks (Skloot, 2010), the author highlights the true story of an African-American woman who died in 1951 from cervical cancer. What makes her story unique is that prior to her death, cells from her tumor were removed and successfully grown in a petri dish. This was the first time scientists were able to successfully replicate cells outside the body, and it is estimated that billions of Lacks’ cells have been used in medical research. However, Henrietta Lacks was never asked for permission to take a sample and her family was never made aware of the widespread use of her cells. Although the culturing of her cells has been pivotal for advancing research, strong ethical concerns later arose about using these cells without patient or family approval.

Reference:
Skloot, R. (2010). The immortal life of Henrietta Lacks. New York, NY: Crown Publishing Group.

This week’s readings describe historical examples of unethical research, such as a study of syphilis among African-American men in which treatment was withheld and a study in which live cancer cells were injected into elderly patients. Today, stricter controls that seek to protect study participants are placed on researchers, but breaches still occur. Careful attention must be given toward preventing unethical behavior. In this Discussion, you explore ethical considerations and issues in research.

To prepare:

• Select a current health-related case involving research ethics. (If none come to mind, browse the Internet to familiarize yourself with recent cases.)
• As you review the case that you have selected, reflect on the ethical principles discussed in “What Are the Major Ethical Issues in Conducting Research?” article found in this week’s Learning Resources. Which principles were breached in the case you have identified?

Post  a (1) description of the case that you selected and the ethical issues involved. (2) Analyze the ethical principles that were breached by the researchers or organizations in your selected case as well as the possible cause of the breach(es). (3) Suggest how the research might have been conducted differently to avoid or minimize the ethical problems. (4) Discuss how research can be done on sensitive issues while still protecting the rights of the rights of the research subjects

Readings

• Polit, D. F., & Beck, C. T. (2012).  Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom ed.).Philadelphia, PA: Lippincott Williams & Wilkins.
  • Chapter 3, “Key Concepts and Steps in Qualitative and Quantitative Research” (for review)
  • Chapter 4, “Research Problems, Research Questions, and Hypotheses”

    This chapter focuses on the steps in planning a study to generate evidence. These include developing a research question, identifying variables, articulating a problem statement, and generating hypotheses.

  • Chapter 7, “Ethics in Nursing Research”

    In this chapter, the focus is on the ethical dilemmas that occur when planning and conducting research and the ethical principles that have been enacted for protecting study participants.

• Fouka, G., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science Journal, 5(1), 3–14.
  Retrieved from the Walden Library databases.

  This article describes a literature review conducted to determine the most important ethical issues that nurses encounter when undertaking or participating in research. The authors detail the results of the review and make recommendations for solving some of the problems highlighted.

• Newcomb, P. (2010). Evolving fairness in research on human subjects. Journal of Child and Adolescent Psychiatric Nursing, 23(3), 123–124.
  Retrieved from the Walden Library databases.

  In this article, the author describes some of the ethical controversies that may arise in conducting research in human subjects, especially with respect to ownership of genes. The author also stresses the importance of educating research subjects and their families about the ultimate purpose of research.

• Yakov, G., Shilo, Y., & Shor, T. (2010). Nurses’ perceptions of ethical issues related to patients’ rights law. Nursing Ethics, 17(4), 501–510.
  Retrieved from the Walden Library databases.

  The authors of this article detail a study conducted to determine how nursing staff deal with ethical issues in relation to the law. The article emphasizes the difficulty staff had in distinguishing between legal and ethical problems. The authors make several recommendations to deal with legal and ethical problems.

• Delwiche, F. (2008). Anatomy of a scholarly research article in the health sciences. Retrieved from http://danaguides.uvm.edu/content.php?pid=41591&sid=3177873

  This article highlights the primary components of scholarly research articles. The article details the distinguishing factors of scholarly journals, the peer-review process, and the definition of “primary literature.”

• American Nurses Association. (2001). Code of ethics for nurses with interpretive statements.
  Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

  This website provides the code of ethics for nurses to be used in carrying out their responsibilities. There is also a detailed explanation of each provision.

• Document: Literature Review Summary Table Template (Word document)

Media

• Laureate Education, Inc. (Executive Producer). (2012a). Anatomy of a research study. Baltimore, MD: Author.

  This multimedia piece explains the “anatomy” of both quantitative and qualitative research studies. In addition, there is a brief quiz at the end of the tutorial to measure knowledge about research articles.

• Laureate Education, Inc. (Executive Producer). (2012d). Evidence-based practice and research. Baltimore, MD: Author.

  Note: The approximate length of this media piece is 6 minutes.

  In this video, Dr. Marianne Chulay talks about the significance of evidence-based practice and research in nursing. She explains how nurses should apply research findings to health care decisions to improve outcomes.
• Laureate Education, Inc. (Executive Producer). (2012h). Overview of evidence-based practice. Baltimore, MD: Author.

  Note: The approximate length of this media piece is 5 minutes.

  In this video, Dr. Kristen Mauk explains evidence-based practice and its importance to nursing. She also provides a brief overview of the process of conducting original research.

Optional Resources

• National Institutes of Health Office of Extramural Research. (2011). Protecting human research participants. Retrieved from http://phrp.nihtraining.com/users/login.php

  This website provides a course on ethical research for those involved in research in human subjects. The course supplies basic concepts, principles, and issues relevant to protecting research participants.

• University of Oxford. (2005). PICO: Formulating an answerable question. Retrieved from http://learntech.physiol.ox.ac.uk/cochrane_tutorial/cochlibd0e84.phphe research subjects.

Two assignments to be completed as posted!

Assignment 1:

Create a motivational bulletin of 350 to 700 words that could be posted throughout your workplace, directed to employees, emphasizing effective consumer relations. Include the following:

• The importance of effective consumer relations
• Strategies for effective consumer relations

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Assignment 2:

Leadership has decided to create a new team, making you the manager.

Write a short speech, of 350 to 700 words, to give to your new team at your first team meeting.

Include the following:

• Explain the importance of teamwork in the workplace.
• Identify strategies for effective team communication
• Identify strategies for effective team collaboration.

Include at least two references.

Format your paper consistent with APA guidelines.

a description of the pathophysiology of cardiovascular disorders, including how the factor you selected might impact the pathophysiology. Then, explain how hypertension or dyslipidemia can lead to the alteration you selected for patients with the factor you identified.

3.1 Module III Overview

MODULE III

Decision Making, Delegation,

Time Management and Priority Setting

Learning Objectives

Module III concentrates on the following course outcomes—

1. Apply an ethical/legal framework to a nursing management situation.

Different ethical principles regarding management are discussed; laws and other legal processes related to employment, management and related human resources issues are explored.

2. Identify the human, fiscal and material resources necessary to efficiently achieve quality healthcare outcomes.

Decision-making and problems solving skills are presented as well as discussion of critical thinking. Resource management is discussed via patient safety, time management, and priority setting.

Reading Assignment

Sullivan: Chapters 8, 10, 13

Principles for Delegation ANA. http://www.indiananurses.org/education/principles_for_delegation.pdf (Links to an external site.)

Overview

The professional nurse uses ethical principles and legal frameworks to deliver patient care, both as a staff member and as a manager. Decision-making and problems solving are essential processes to nursing; the use of analytical tools can assist the nurse in delivering patient care and managing others. Federal laws direct the staffing of healthcare organizations. The manager needs to address maintaining adequate numbers of staff for the patient population, whether it is legal to float staff to other units within the hospital or organization and the use of agency nurses (temp staff). Federal law dictates that staffing ratios be made available to patients, families. California is one of the first states to legislate staffing ratios. Other states have followed. Additionally, the American Association addresses staffing ratios, and floating staff from one unit to another. There are guidelines that must be adhered to and each nurse needs to know the law in the respective state and that of the place of employment. Other legal issues that managers must face include employment laws regarding hiring and firing and issues related to discrimination.

Decision making is a purposeful goal driven process that involves choosing between or among options. Problem solving and critical thinking are related concepts. Problem solving is different than decision making and is focused on solving a more immediate problem. Decision making is based on decision making models which serve as frameworks and guides. There are decision making styles and relate to the one making the decision. The styles include autocratic, democratic or participative approach. Styles vary with the individual personality and are influenced by the environment and those within. Autocratic decision making may be used in emergent situations, however participative decision making is more appropriate when working with professionals in general on an ongoing basis. Group decision making has many advantages, like buy in from the group, as they came up with the idea. However, it is time consuming and work within the group may not be carried out equally.

Delegation involves giving responsibility for a task to another while at the same time retaining accountability. There are many guidelines or practice strategies outlined by the American Nurses Association that regulate delegation. First, a nurse must be familiar with the state law and nurse practice act of that state where employed. Some Nurse Practice Acts defines what is within the role of Registered Nurse and Licensed Professional Nurse (LPN). A Registered Nurse cannot legally delegate a task to an LPN that is outside the LPN’s scope of practice. See Principles of Delegation from the ANA cited in the hyperlink under readings. Accountability and responsibility are key concepts related to delegation. Distinction needs to be made between delegation and assignment making. As mentioned with delegation, responsibility is transferred but not accountability, with assigning, both are transferred. Care given by one RN to another is assigning both responsibility and accountability. Whereas, when an RN gives a task to an LNP or unlicensed care giver, accountability is retained (delegation). The RN is always responsible for assessing, diagnosing, planning and evaluation.

Time management has a number of personal and professional implications. Time management contributes to timely outcomes, fiscal responsibility and also to work-life balance. Many factors influence time management and each person needs to assess their own situations to determine factors that enhance or negatively affect time management. A key related concept is priority setting.

Assignment questions: Post answers in Forums Module III. See calendar for due dates.

1. What is the relationship among delegation, authority, responsibility, and accountability?

2. Discuss professional resources such as laws and professional nursing organizations in place for directing delegation.

3. After reviewing the ANA Principles of Delegation, discuss how delegation differs from assignment making.

4. Discuss factors from the reading and your experience that influence priority setting.

5. What issues have you encountered with delegation and how have you handled them?

6. What decision making model is used in your organization as a basis for decision making and is it effective? If not, what would be more effective?