Ethical issues arise for nurses involved in all phases of clinical trials regardless of whether they are caregivers, research nurses, trial co-ordinators or principal investigators. Potential problem areas centre on nurses’ moral obligation related to methodological issues as well as the notions of beneficence/non-maleficence and autonomy. These ethical concerns can be highly upsetting to nurses if they are not addressed, so it is imperative that they are discussed fully prior to the initiation of a trial. Failure to resolve these issues (...) can place both the conduct and the results of research in jeopardy. (shrink)

Different opinions are expressed in the literature regarding when children and adolescents can start to make decisions to participate in research and give informed consent. Nurses are frequently involved in research, either as investigators or caregivers, and must therefore have a thorough understanding of consent and related issues. In this article the issues are explored from a Canadian perspective. The argument is put forward that adolescents may be capable of a greater involvement in the research consent process than is the (...) norm. Increasing adolescents’ involvement in research has the potential to enhance their growing autonomy and capabilities. Adolescents appreciate being treated with respect and dignity by adults. This can be achieved in an environment in which protection from harm does not also mean prevention from decision making. The use of empowering processes by nurses to enhance adolescent involvement will provide benefit to adolescents in their transition to adult levels of responsibility. (shrink)

Persons exhibiting mutations in two tumor suppressor genes, BRCA1 and BRCA2, have a greatly increased risk of developing breast and/or ovarian cancer. The incidence of BRCA gene mutation is very high in Ashkenazi Jewish women of European descent, and many issues can arise, particularly for observant Orthodox women, because of their genetic status. Their obligations under the Jewish code of ethics, referred to as Jewish law, with respect to the acceptability of various risk-reducing strategies, may be poorly understood. In this (...) article the moral direction that Jewish law gives to women regarding testing, confidentiality, and other issues is explored. The intent is to broaden nurses' knowledge of how a particular religious tradition could impact on decision making around genetics testing, with the aim of enhancing their understanding of culturally sensitive ethical care. (shrink)

Nursing research in palliative care raises specific and challenging ethical issues. Questions have arisen about whether such research is morally justified, given the low likelihood of direct benefit to dying patients as research participants. The Canadian Code of ethics for registered nurses outlines eight primary values intended to guide nursing practice. We use these values to explore the moral dimensions of research with the palliative care population. Our conclusion is that palliative care research is needed to foster excellent care for (...) these patients and their families, but that nurses must remain constantly vigilant to ensure that participants are protected from resultant harms. Through this exploration we highlight particular considerations that nurse researchers must contemplate when accessing a vulnerable population. (shrink)

This qualitative study was designed to explore ethical issues in public health nursing in the Canadian context, and to begin to identify strategies to support ethical practice. Twenty-two public health nurses, 11 in rural and 11 in urban settings, were asked to describe ethical problems they had experienced in the course of their work. These participants most often described situations that required a relational response rather than an active choice between options. Their goal was to optimize the good, while at (...) the same time maintaining a supportive relationship. Analysis revealed five interrelated themes, each with several subthemes: relationships with health care professionals; systems issues; character of relationships; respect for persons; and putting self at risk. It was clear that all aspects of public health nursing have ethical components. (shrink)

The purpose of this exploratory study was to examine the possibility of designing a satisfactory method, using written responses to hypotheical scenarios, for evaluating the quality of moral reasoning in student nurses. Scenarios were developed from interviews with practising nurses. Nurses and student nurses provided written responses to the scenarios, and nursing faculty members from six institutions sorted the responses according to their perceptions of quality (i.e. 'best', 'next best', 'worst' etc.). There was very little agreement among faculty members on (...) the quality of the responses. Consequently, it was impossible to develop a 'best' response on which the faculty members could agree. Analysis revealed a framework used by the participants for ethical decision-making. The results of this study have important implications for the way in which we think about the teaching and the evaluation of nursing ethics. (shrink)

The interpretive and subjective nature of qualitative research has led to growing utilization of arts-based strategies for data collection, analysis and dissemination. The defining characteristic of all such strategies is that they are largely subjective and intended to invoke personal responses in the ‘audience.’ Following that direction, many qualitative researchers are using metaphor to capture themes emerging from their analysis. In this article, we explore ethical aspects of using metaphor in describing results of qualitative health research and illustrate some of (...) the complexities using a case study of research conducted by one of the authors. Our analysis is designed to sensitize researchers and ethics reviewers to some unique ethical issues inherent to this approach towards data analysis and presentation. Issues related to participant dignity, respect and vulnerability led us to suggest that researchers should take these points into consideration in designing their research and seeking informed consent. Metaphors can be linguistic devices, but also conceptual aids that help develop patterns in analysis or that facilitate re-interpretation. However, there is a thin line between artistic licence for better expression and distorting the participants’ actual experience and meanings. Researchers, and reviewers, must be aware of the danger to participant dignity and integrity when aesthetics overshadow actuality. The use of metaphor may also trigger tensions between researchers and participants, especially if member checking is used. The implications of participant withdrawal must be considered and conveyed to ethics reviewers and participants. It is important to have a plan in place for dealing with some of these issues. These should be detailed in the proposal and communicated to participants. Institutional research ethics boards should, on their part, be prepared to ask questions if such details are lacking in the proposal. (shrink)

Ethics review of research involving humans has become something of an institution in recent years. It is intended to protect participants from harm and, to that end, follows rigorous standards. Giv...

Neonatal intensive care nurses are often involved in research protocols as investigators, research assistants or staff nurses implementing the protocol and providing support and explanations to families. It is important, therefore, that nurses have information about parents’ understanding of and attitudes towards the research process. The purpose of this study was to begin an exploration of parents’ perceptions about research with newborn babies through the development and validation of a survey instrument. The questionnaire included: demographic questions; scaled items about research (...) with newborn babies; scenarios describing research studies that varied in degree of risk and benefit to the newborn baby; questions about parents’ willingness to enrol their newborn baby in the studies described; and questions regarding circumstances under which consent should be sought. Content and face validity were established by an expert panel and a pilot test conducted with a small group of health care professionals and lay persons. A convenience sample of 231 parents of newborn babies completed the final version of the questionnaire. Factor analysis revealed seven factors corresponding to issues identified in the literature, providing evidence of construct validity. Parents appeared to have no difficulty in completing the instrument and all questions were answered by the majority of participants. It was concluded that the questionnaire had adequate psychometric properties and that a mixed method approach can be fruitful in exploring sensitive issues. (shrink)