Nursing Research Ethics

Nursing Research Ethics 

Most of the professions have established their own code of ethics. The American Nurses Association has formulated ‘human rights guidelines for nurses in clinical and other research’.
In the United States, the National Commission for the Protection of Human Subjects of Bio medical and Behavioral Research issued a report, referred it as Belmont report and served as a model for many of the guidelines adopted by discipline. The Belmont report tells about three primary ethical principles on which standards of ethical conduct in research are based.

I. Beneficence
II. Respect for human dignity
III. Justice

 
I. Principle of Beneficence

 
The principle of beneficence aims at ‘do not harm’. It includes freedom from harm, freedom from exploitation and risk/benefit ratio.
1. Freedom from harm
It is not permitted to harm the study participants during the research. Before proceeds with humans, a new medical procedure or drug is being tested with animals or tissue culture. The psychological harm of the study participants during the study requires close attention and sensitivity, for example, interviewing a rape victim. The psychological harm can be minimized by carefully phrasing questions, obtain informed consent, assure of confidentiality and anonymity, significance of conducting research on the related topic, provide privacy, gain mutual trust, frequent counseling sessions and so on.
2. Freedom from exploitation
The researcher should not place participants at a disadvantage or expose them to situations for which they have not been explicitly prepared. The researcher maintains a relationship and it is crucial that this relationship not to be exploited, for example, sexual exploitation. It is not advisable to utilize the study participants under poor economic circumstances, for example, conducting experimental studies in developing countries by offering free treatment. In qualitative research, the risk of exploitation may be less because that gap between the investigator and participants decrease as the study progresses.
3. Risk/Benefit ratio
The researcher should weigh the potential risks to participants to benefit to society and nursing profession. The degree of risk to be taken by those participating in the research should never exceed the potential humanitarian benefits of the knowledge to be gained. Major potential benefits are accessibility of the treatment when they are in need monetary gains through incentives and so on. The potential risks are physical harm, loss of time, fatigue, boredom, loss of privacy and fear of disclosure. 

II. Principle of respect for human dignity
This principle includes right of self determination, right of full disclosure and informed consent.
4. Right to self determination
The researcher has to respect the study participants for their self determination. The participants have the right to decide voluntarily whether to participate in a study without the risk of increasing any penalty or prejudicial treatment. The participants have the right to ask questions, clarify the doubts, if they do not want to proceed, can terminate their participation. The researcher should be very carful to not to be coercive in the study. Coercion involves implying threats of penalty for failing to participate in a study or excessive rewards from agreeing to participate, for example; rewarding excess internal marks to students, who agreed to participate.
5. Right to full disclosure
The researcher has to describe the study participants regarding the nature of the study, the participant’s right to refuse participation, the researcher’s responsibilities and the potential risks and benefits that would be incurred.
6. Right to obtain informed consent
Informed consent means that the researcher provides adequate information regarding the research to the participants includes study purposes, time period, voluntary nature of the participants, potential risks and benefits and so on. The researcher asks the study participants to sign a consent form prior to the study. In qualitative research, the researcher asks the study participants to sign a process consent, which means consent is viewed as ongoing and transactional process and the researcher continuously negotiates the consent, allowing participants to play a collaborative role in the decision making process regarding their ongoing participation.
Problems related to the principle of respect
There are two biases can be expected in relation to full disclosure to the study participants during the research such as the bias resulting from distorted information and the bias resulting from failure to recruit a good sample. Sometimes, the principle of respect will be questioned while the researcher use two methods in data collection approach such as covert data collection (concealment) and deception technique. If the researcher wanted to observe people’s behavior in real world setting and the informed consent would result in changes in the behavior of interest. Deception is a technique in which, the researcher deliberately withholding information about the study or providing participants with false information. For example, the researcher conduct a study on adolescent drug abuse, might describe the research as a study of student’s health practices. Deception and concealment are problematic from an ethical stand point, if there are anticipated benefits to the society and minimal risk to the participants may be justified to enhance the validity of the findings. 

III. Principle of justice
The principle of justice includes the participant’s right to fair treatment, right to privacy and right to protect vulnerable groups.
7. Right to fair treatment
Participants have the right to fair and equitable treatment before, during and after their participation in the study.
It includes;
-selection of participants non discriminatory
-clarify the doubts of participants
-provide assistance to participants for accessing treatment
-respect their beliefs, habits and life styles
-courteous and tactful treatment at all time
8.  Right to privacy
The researcher should maintain anonymity and confidentiality through out the study. Anonymity occurs when ever the researcher can not link a participant with his or her data. Confidentiality occurs when the researcher promises the participant that any information will not be publicly reported or made accessible to other parties not involved in the research. In qualitative study, the researcher has to take extra precaution to safe guard participant’s identity as the number of participants is small by withholding information about the characteristics of the informant such as age and occupation.
9. Right to protect vulnerable groups
Vulnerable groups such as children, mentally disabled people, physically disabled, institutionalized people, pregnant women, old age groups and patients in unconscious stage are at high risk of unintended side effects because of their circumstances. The researcher should pay extra attention to the ethical dimensions of the study when vulnerable people are involved.

 It includes;
-obtain informed consent from the study participant or guardian of study participant
-explain the procedure to the study participants including benefits and risks
-allow withholding from the study when they wanted
-protect their privacy
-respect their beliefs and practices
Obtain approval of permission from the Institution Review Board or Human Subjects Committee to carry out the study among the vulnerable groups.