NUR 513 Topic 7 DQ 2 What are some of the major ethical issues in conducting research that impacts the advanced registered nurse?

NUR 513 Topic 7 DQ 2 What are some of the major ethical issues in conducting research that impacts the advanced registered nurse?
What are some of the major ethical issues in conducting research that impacts the advanced registered nurse? Discuss the role of the advanced registered nurse in advocating for patient safety and rights in conducting research.
Re: Topic 7 DQ 2
To be frank, the human race does not have the best track record related to ethical medical research. Nazi Germany and the German medical community were very complicit in conducting inhumane, cruel and unethical human research during World War II. After World War II, the Nuremberg trials were shepherded to hold those responsible for some of the heinous acts of “research” conducted in concentration camps (Vaughn, 2017). The outcome of these trials came to be called The Nuremberg Code, which are ten points that outline what is deemed permissible medical experimentation (Vaughn, 2017).
The Children of Willowbrook, was another situation that began in Staten Island, NY in the 1950s when a children’s state school for the mentally disabled was purposely infecting patients with Hepatitis (Vaughn, 2017). The facility was overcrowded, understaffed, and patients were living in inhumane conditions. This facility did not close until the 80s.
Then there was the Tuskegee Syphilis study that took place in Alabama from the early 1900s all the way to 1972. Basically, a small group of black men were used to study the long-term effects of Syphilis on the human body. This was done without informed consent and continued on even after penicillin was discovered and a by 1947 was a well-known cure for Syphilis (CDC, 2020). These men were not offered treatment, and the study did not end until 1972 when a journalist took wind of the situation and created public outcry (CDC, 2020). The Tuskegee Syphilis Study led to the Belmont Report and the National Research Act of 1974. The Belmont Report provides an ethical framework to conduct research stemming from the principals of respects, beneficence, and justice (Vaughn, 2017). Respect, referring to autonomy of the patient and informed consent, and the right to confidentiality. Beneficence and nonmaleficence, meaning “doing good” and avoiding doing harm. And lastly justice, meaning that research must be conducted fairly, in a non-exploitative manner, and there must be a fair distribution of cost to both individual and community.
Why we now have codes of conduct, laws, and oaths to guide us in ethical practice related to human research, and care of patients, one must not forget that ethical practice is one that must constantly be reexamined, adapted and enforced. As an Advanced Practice RN (APRN), it is of up most importance to advocate for the patients, their autonomy and their rights. The APRN can play a major role in developing research design, frameworks and implementations so there is a duty to do so in an ethical manner. So when developing EBPs, it is important do rigorous research and closely follow the EBP process.
Center for Disease Control and Prevention [CDC]. (2020). U.S. public health services syphilis study at Tuskegee: The Tuskegee timeline.
Vaughn, L. (2017). Bioethics: Principles, issues, and cases (3rd). Oxford University Press.
I do agree with your finding that the process of making clinical research on human fair and just has achieved remarkable progress over the years. It is the role of the advanced practice nurse to promote the safety of the patients and ensure that the care for the patients and clinical procedures are guided by the ethical standards (Milliken, 2018). I do agree with you that the Nuremberg code of ethics to guide the clinical research was a great step forward towards achieving human dignity in scientific research. The Nuremberg code focus ten key elements of subject giving voluntary consent, the objectives of the research should be for the greater good of the society, the human experiments should be carried out after initial experiments on animals, it should avoid any injury or physical damage, the risks should not outweigh the benefits, subjects should be adequately protected, the research should be conducted by qualified scientists, subject can terminate their participation any time and willingly, incase any death, injury or disability is likely to occur then the scientist should terminate the experiment (WHO | Nuremberg code turns 60, n.d.)
WHO | Nuremberg code turns 60. (n.d.). WHO.
Milliken, A. (2018, January 31). Ethical Awareness: What It Is and Why It Matters.
Re: Topic 7 DQ 2
Health research has a history of abuse, whereas participants were sacrificed for scientific gain (Doody & Noonan, 2016). These human
NUR 513 Topic 7 DQ 2 What are some of the major ethical issues in conducting research that impacts the advanced registered nurse
rights violations within research spanned throughout the 20th century and made recognition of the importance of ethical nursing research to protect all involved. Good ethical nursing research implies adherence to ethical standards and studies are subject to scrutiny by an ethics board or committee, scientifically sound, researchers are supervised or have expertise, and ethical principles are adhered to throughout the process. Four common ethical principles to consider are autonomy, beneficence, non-maleficence, and justice. According to Doody and Noonan (2016), veracity, fidelity, and confidentiality must also be principles considered.
Veracity involves truth and avoids deception. Participants must understand all aspects of the study. In Los Angeles in 1989-91, over 700 minority babies as young as six months were given an experimental measles vaccine. Parents were not informed of the experiment or that the vaccine was unlicensed (Awadu, 1996). This killer vaccine led to the death of 1 of every 13.6 babies in one African experiment. Truth-telling is dishonored in at least two ways; first by lying or deliberately providing inaccurate information; and second, by omission or deliberately withholding information.
Participants entrust themselves to the researcher, which should reciprocate a two-way trust in return. Fidelity or a trusting relationship often leads to participants remaining in the studies, following directions, and knowing there will be no consequences for wanting to drop out at any time (Doody & Noonan, 2016). Confidentiality is another element to uphold. Recall taking a work-related survey asking about the boss or employer and how a breach in confidentiality will affect responses.
APRNs can ensure patient safety and rights in research by advocating for informed consent and overseeing study benefits to serve the greater society. Keep in mind, all research, in theory, can be harmful and should be considered a privilege and not a right especially when human lives are involved.
Awadu, K. O. (1996, August). Outrage! How babies were used as guinea pigs in a LA county vaccine experiment. The Conscious Rasta Report, 3(6).
Doody, O., & Noonan, M. (2016). Nursing research ethics, guidance, and application in practice. British Journal of Nursing, 25(14), 803–807.
I do agree with you that the history of scientific research on humans in the past century was inhuman and in violation of the dignity to human life. Human life in both the spiritual and cultural understanding is considered sacred and must be treated with uttermost dignity. The indecent and gross human rights violation of the 19th and the 20th century have no space in the modern world of scientific and technological research. Therefore, it is the role of all the stakeholders involved in scientific research to ensure the set standards of the ethical considerations in scientific research are closely observed at all stages of the research (Milliken, 2018).. The advanced practice nurse roles should be focused on promoting safety of the patients and quality care. They should ensure that any clinical procedure done on the patient is out of the voluntary consent of the patient. The patient has the autonomy to choose on the available alternative intervention measures. Additionally, the nurses should act in the best good for the improvement of the patient’s health. The key ethical standards of beneficence and nonmaleficence should be the guiding principles of the nurse practice in helping the patient recover to better quality of life and good health (Haddad & Geiger, 2020).
Haddad, L., & Geiger, R. (2020). Nursing Ethical Considerations. StatPearls.
Milliken, A. (2018, January 31). Ethical Awareness: What It Is and Why It Matters.
Re: Topic 7 DQ 2
The advanced registered nurses participate in research to improve healthcare services and help health care professionals promote patients’ outcome. For this reason, promoting professional ethical standards, integrity and compliance during research are the roles of advanced registered nurses. Some values or ethics such as the nursing ethics of caring, preventing harm, protecting dignity of the patient and the societal values about human rights, the researcher’s values about scientific inquiry may contradict the values or beliefs of the subject participating in the research (Davoodvand, Abbazadeh & Ahmadi, 2016). The issues of informed consents, respect for confidentiality, anonymity and privacy are serious ethical issues that an Advanced Practice Registered Nurse (APRN) might face when conducting research.
Informed consent is a major ethical issue that APRNs face when conducting research. Informed consent is voluntary, but it is mandatory for the APRN to provide subjects with information about the procedures and treatments, benefits and risks expected in the research prior to accepting to participating. An APRN may encounter issues with obtaining informed from older patients, critically ill and children because they are vulnerable to being forcefully misled into participating in the research. Researchers may be required to establish trustworthiness among their participants in this case (Yip, Han & Sng, 2016). Moreover, the informed consent is meant to protect subjects from assault, protect their integrity and freedom. Therefore, before the initiation of the research the APRN must inform the subjects of any physical harm or bodily injury, infringement of privacy that may occur during the clinical research (Yip, Han & Sng,2016).
Respect for participants confidentiality and anonymity is the next ethical issue. The APRNs must give participants the opportunity to release their information as they wish. Participants may withhold or release as much information based on their comfort level or level of trust. During research, ethical dilemma may arise if a researcher is required to report confidential information to the court (Yip, Han & Sng,2016).
Respect for privacy is another major ethical issue that APRNs encounter when conducting research. Researchers are not permitted to release participants information to anyone or organization without their consents. Participants will have to decide the degree at which their private information is share with others or withheld from others. The APRNs role is to protect participants privacies when conduccting research (Yip, Han & Sng,2016).
Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses’ viewpoint: A qualitative study. Journal of Medical Ethics and History of Medicine, 9(5), 1-8.
Yip, C., Han, N.R., & Sng, B.L. (2016). Legal and ethical issues in research. Indian Journal of Anaesthesia, 60(9), 684-686. Doi: 10.4103/0019-5049.190627
I do agree with you that the advanced registered nurse practice role transcends beyond normal care for the patients, it also entails actively engaging in clinical research and coming up with advanced clinical findings aimed at promoting efficient and effective care for the patients. These nurses have the trust of the patients and are better placed in guiding the research projects aimed at promoting better clinical outcomes. However, they must adhere to the ethical standards and maintain the trust with the patients. The ethical considerations play a crucial role in the protection of human subjects in clinical research process (Wu et al., 2019). The advanced registered nurses have the responsibility ensuring confidentiality of the patient’s information. Additionally, for the patients to be involved in any research they have to give voluntary consent and have the autonomy to withdraw from the research at any point without victimization. The patients who are underage, mentally incapacitated or older cannot be considered to offer consent and the close relatives have to be consulted in order to give the consent (Axson et al., 2019).
Axson, S. A., Giordano, N. A., Hermann, R. M., & Ulrich, C. M. (2019). Evaluating nurse understanding and participation in the informed consent process. Nursing Ethics, 26(4), 1050–1061.
Wu, Y., Howarth, M., Zhou, C., Hu, M., & Cong, W. (2019). Reporting of ethical approval and informed consent in clinical research published in leading nursing journals: a retrospective observational study. BMC Medical Ethics, 20(1).

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