1. Examining Ethics in Nursing Research
The Pennsylvania state university college of nursing
Nursing 200w

2. How does ethical research differ from unethical research?
Ethical studies protect subjects and are carried out using scientific principles.
Unethical research includes:
Scientific misconduct
Fraud, research protocol violations
Fabrication, falsification, forging of data
Plagiarism
Putting subjects at risk without consent

3. What are the elements of ethical research?
Protecting human rights
Understanding informed consent
Understanding institutional review of research
Balancing benefits and risks in a study

4. What are the landmark unethical research studies?
Nazi medical experiments
Tuskegee syphilis study
Willowbrook study
Jewish chronic disease hospital study

5. Nazi Medical Experiments
World War II
Purpose: To conduct extreme experiments
Subjects: Concentration camp prisoners
Problems: Too numerous to list!
Led to Nuremberg Trial (1947)

6. Tuskegee Syphilis Study
(US Public Health Service)
Purpose: To determine natural course of syphilis over time
Subjects: Poor African-American men
Problems:
Deception
Appropriate treatment withheld

7. Williowbrook School Study
Purpose: To study effects of hepatitis
Subjects: Mentally delayed children
Problem: Injected with hepatitis virus

8. Jewish Chronic Disease Hospital
Purpose: To determine patients response to injection of live cancer cells
Subjects: Elderly patients
Problem: Subjects not informed

9. Check Your Understanding: Question
A researcher who does not disclose that a portion of the data from the original study sample was not used in the final data analysis could be accused of:
Infidelity.
Lack of scientific objectivity.
Plagiarism.
Scientific misconduct.

10. Check Your Understanding: Answer
ANSWER: D
A. Examples of scientific misconduct include fabrication, falsification, or forging; manipulation of design or methods; selective retaining or manipulation of data; plagiarism; and irresponsible collaboration.
B. Lack of scientific objectivity is problematic and can lead to biased results.
C. Infidelity does not describe this situation. Infidelity implies not remaining true to the chosen method used.
D. Plagiarism is a specific type of misconduct in which the researcher represents someone else’s work as his or her own.

11. What is the history of ethical codes and regulations?
Nuremberg Code (1949)
Declaration of Helsinki (1964)
Department of Health, Education and Welfare (DHEW) regulations (1973)
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978)

12. What is the Declaration of Helsinki?
Therapeutic research
Results might benefit participants
Nontherapeutic research
Results are not of benefit to participants but might be in the future

13. What ethical principles are addressed in the National Commission for the Protection of Human Subjects guidelines?
Ethical principles:
Principle of respect for persons
Principle of beneficence
Principle of justice
View the DHHS Belmont Report (1978). Retrieved from:

14. Respect for Persons Self-determination (participation and withdrawing)
No coercion
Full disclosure, no deception
Provide ALL information about the study
Voluntary consent
Persons with diminished autonomy have special protections

15. Violations of Respect for Persons
Coercion: Offering large incentives
Covert data collection
Deception: Misinforming participants about true purpose of study
Need for “debriefing” afterwards

16. Beneficence Freedom from harm Freedom from exploitation
Risk/benefit ratios
High anticipated benefit may balance high risks

17. Categories of Harm No anticipated effects Temporary discomfort
Unusual levels of temporary discomfort
Risk permanent damage
Certainty of permanent damage

18. Protection from Exploitation
Researcher will not use information against participants
Examples:
Illicit drug use
HIV status
Researcher-participant relationship should remain professional

19. Justice Fair treatment (even if the person chooses not to participate)
Right to privacy
Anonymity
Confidentiality

20. Title 45 Part 46: Protection of Human Subjects Regulations
Protection of human subjects in research
Additional protection for pregnant women, human fetuses, neonates, children, and prisoners
Documentation of informed consent
Implementation of the IRB process (DHHS, 2005)

21. Additional Government Protections
U.S. Food and Drug Administration (FDA)—regarding clinical investigations with human subjects involving products
Animal studies also included
Clinical trials for drug investigations must comply with FDA regulations.

22. What is HIPAA? Also known as: Public Law 104-191
Implemented in 2003 to protect individuals’ private health information
HIPAA privacy rules are very strict.
Affects research studies by requiring patient consent to use private health information

23. What are the five human rights?
Right to self-determination
Right to privacy
Right to anonymity and confidentiality
Right to fair treatment
Right to protection from discomfort and harm

24. How would you define self-determination?
Humans are autonomous agents with freedom to conduct their lives as they choose.
This principle would be violated by:
Coercion: forcing someone to be in study
Covert data collection: subjects are unaware study is taking place
Deception: misinforming subjects about the study

25. Groups included as those with Diminished Autonomy
Legally and mentally incompetent subjects
Neonates and children
Terminally ill subjects
People confined to an institution
Pregnant women and fetuses

26. Right to Privacy
Freedom to determine circumstances under which private information is shared or withheld from others
Privacy protected if participant…
Is fully informed
Consents to participate
Voluntarily shares information

27. HIPAA Privacy Rule
Protects individually identifiable health information
Deidentifying protected health information is allowed only if the following are removed:
Names, geographic information, dates, phone numbers (+fax/ ), SS numbers, medical record numbers, certificate numbers, vehicle identifiers, device identifiers, URLs, IP addresses, fingerprints/voiceprints, full-face photos, all identifying numbers

28. HIPAA Privacy Rule Data use agreement—must be included in the consent
Covered entities
Health care providers
Health care plans
Employers
Health care clearinghouses

29. Check Your Understanding: Question
The nurse researcher is involved in selecting a sample for an outcomes research study on staffing ratios. Which of the following is a generally accepted guideline to follow?
Specific patients are represented.
Heterogeneous samples are preferred.
Random sampling is very desirable.
Small samples are needed.

30. Check Your Understanding: Answer
ANSWER: B
Heterogeneous samples are preferred because they represent a wider population. For example, in this question, the researcher would poll as many staff as possible to ensure all are represented. The heterogeneous sample can then be generalizable.
A. Specific patient populations or homogenous samples are selected when a specific population or intervention is being examined, for example, dementia interventions with geriatric populations.
C. Random sampling is generally not encouraged in outcomes studies because randomization does not allow for the researcher to influence the sample characteristics.
D. Small samples are useful for pilot studies. Typical sampling criteria for outcomes research include obtaining a very large, heterogeneous sample in which all patients have the likelihood of being represented.

31. Right to Anonymity and Confidentiality
Confidentiality: researcher refrains from sharing information with others
Breach of confidentiality: unauthorized access to raw data
Anonymity: no one, not even the researcher, knows the identity of the subjects

32. Right to Fair Treatment
Based on the principle of justice
Selection of subjects and their treatment during the study are fair for all
Prevents coercion of subjects (e.g., paying subjects large sums of money to participate)

33. Right to Protection from Discomfort and Harm
No anticipated effects
Temporary discomfort
Unusual levels of temporary discomfort
Risk of permanent damage
Certainty of permanent damage

34. What is informed consent?
Essential information for consent
Comprehension of consent information
Competence to give consent
Voluntary consent

35. What is included in the essential information for informed consent?
Introduction of research activities
Statement of research purpose
Selection of research subjects
Explanation of procedures
Description of risks and discomforts
Description of benefits
Disclosure of alternatives
Assurance of anonymity and confidentiality

36. What is included in the essential information for informed consent?
Offer to answer questions
Voluntary participation
Option to withdraw
Consent to incomplete disclosure

37. What is an institutional review board (IRB)?
1974 National Research Act requires research study review
Who serves on the board?
Functions
Protection of rights and welfare
Voluntary informed consent
Benefits exceed risks

38. Institutional Review of Research
Exempt from review procedures: no risk
Expedited review procedures: minimal risk
Complete institutional review procedures
Reviewing studies using vulnerable populations
Have greater than minimal risk

39. What are categories of exempt research?
Research on regular educational strategies
Data are recorded so subjects cannot be identified.
Only public officials can be identified.
Existing data can be collected if no subject identifiers are present.
Studies about public benefit programs
Taste and food quality evaluation

40. What categories are associated with expedited research?
Collection of hair, nails, teeth, dental plaque
Collection of excreta and external secretions
Recordings using noninvasive procedures and study of existing data
Collection of blood samples from subjects in good health
Moderate exercise by healthy volunteers
Research on behavior without stress
Research on drugs that are exempt from new drug investigation

41. What influences are associated with the HIPAA Privacy Rule on institutional review boards?
HIPAA must be followed.
Read report carefully.
Think about procedures that were implemented.
Consider how data were collected.
Were the patients put at undue risk?
What is the risk/benefit ratio?

42. How would you critique the ethics of a study?
Was study approved by the appropriate IRB?
Was informed consent obtained from subjects?
If subject is incompetent, did legally authorized representative give consent?
Were rights protected during sampling and data collection and analyses?
Was privacy protected during study and in final report?
Was benefit/risk ratio of the study acceptable?

43. Questions? Comments?
The end!