NSG 3029 Week 4 Discussion-Ethics in Healthcare

NSG 3029 Week 4 Discussion-Ethics in Healthcare

Question 1

I think that alternative forms of community consent should be pursued. If a patient cannot consent due to their condition, those who can legally do so should not have limitations during that process. Everyone learns and understands information differently; options can benefit them and determine their understanding of what they consent to. This study using a computer-based educational intervention showed that it effectively enhanced the understanding of the informed consent process (Shelton, Freeman, Fish, Bachman & Richardson, 2015).

I would be okay with this without my consent if my personal information was not shared, as this would be a HIPPA violation. I believe in research and think that the more research is completed, the better. Healthcare is always evolving, and we must keep up with this. But looking at this from another person’s perspective, they may not be okay with it. It can cause the patient to not trust their providers or the healthcare system. To protect our patients and ourselves, informed consent should be signed with any type of research. Even though their personal information might not be used, it allows the researcher to gain more information about the topic that otherwise might be restricted.

Question 2

This study would be considered research and not quality improvement as it meets several criteria from the checklist in the text (Houser, 2018,1 .69); therefore, it would warrant contact with the Institutional Review Board for review. Qualifying criteria for review are as follows:

• Mechanically ventilated patients would be grouped into nonpainful and painful procedures for
• The study appears to have a goal to increase knowledge in the area of pain assessment on mechanically ventilated patients in critical care.
• Personal health information, as well as their pain assessment results, would be necessary to identify which patients would be included in their prospective

I believe a full review would be necessary for this study. Houser (2018) asserts, “The full committee reviews these studies, with particular attention paid to the methods, consent process, and selection of the subjects. Studies that require direct access to participants use personally identifiable medical information and involve more than minimal risk are subject to full review by the committee” (p. 67). Although mechanically ventilated patients who cannot communicate would not be exposed to more than minimal risk using a pain assessment tool, personal health information would be required to attain appropriate subjects and obtain data from them. This would qualify them for a full review.

Additionally, consent comes into question regarding whether it is required in this case. Pain assessment is a routine task performed in daily nursing care of all patients to collect subjective and objective data. This leads me to wonder if obtaining consent to implement this tool is necessary. In a full review process, a privacy board would be required to conduct an additional review if personal health information is necessary to include in a study. The privacy board may or may not be affiliated with the institutional review board and will decide if patient consent and disclosure notices are warranted. They also can determine if an exemption waiver needs to be given to the researchers that would exclude them from the consent process (Houser, 2018, p. 67).

This study would be considered ethical based on the initial information given. Ethical principles that must be employed in nursing research exist in the goal of this research study. Non-maleficence, or not harm, is extremely vital in the research process (Ingham-Broomfield, 2017, p. 42). The nurses’ desire to test a pain assessment tool’s effectiveness on non-communicative mechanically ventilated patients does not pose a harm as it is a non-invasive assessment. Beneficence is another ethical principle present in the goal of this study. Beneficence, or to do good, is the greatest purpose that a research study should encompass (Ingham-Broomfield, 2017, p. 42). This study would work to improve the accurate pain assessment of these patients so that their pain can be addressed in the best manner with appropriate nursing interventions. As a critical care nurse, I encounter this daily. We have number, letter, and picture boards for communicating pain. If a patient is alert and can point at them to communicate their needs, the presence, and the pain level, it can be addressed appropriately. This is not the case with mechanically ventilated patients who are sedated or have an altered mental status. We then rely on observation for these patients. A tool that can be used to accurately determine the presence and level of pain in non-communicative mechanically ventilated patients would be an excellent contribution to evidence-based practice to promote the best nursing care possible.

NSG 3029 Week 4 Discussion-Ethics in Healthcare

Question 3

During week one, a video was assigned about ethics and how human rights were violated during a study called The Infamous Syphilis Study, officially known as the Tuskegee Study of Untreated Syphilis in the Negro Male (Nix, 2017).

During the study, the men were recruited by coercion and manipulated; the researchers told them they would receive free treatment and medical care for a condition called bad blood and were offered incentives for their participation. The study was conducted to watch how Syphilis developed. In the researcher’s mind, there was never a way to treat and cure this uneducated population. The most seductive inducement was sympathetic attention from trained physicians and nurses (Walker, 2009, p.5).

Around the same years the study was conducted, Walker mentions in his article that Penicillin was already a treatment for Syphilis, but this uneducated African American never received it. The researchers were recompiling data on how Syphilis grows and develops using the most vulnerable population – those who cannot protect themselves from abuse and exploitation (Walker, 2009, p.5).

Houser, 2018 cited in the class book the following: When humans participate as subjects in research studies, care must be taken to preserve their rights: their right to be informed of the study process and potential risks, their right to be treated fairly and transparently, and their right to withdraw from a study at any time for any reason without question or negative consequences (Franklin, Rowland, Fox & Nicolson, 2012).

The researchers of this study failed to consider ethical values, human rights, the right to know what the study is about, and the right to agree to participate voluntarily or withdraw at any moment; no informed consent at all was discussed with the participants. Participants were attracted to the study because they were uneducated and offered “free medical care.” I believe this study lost control; some participants died, others got complicated from the same disease, some infected their wives, and eventually, the wives infected their children at birth. Instead of avoiding further harm, this study caused harm to these families. Walker (2009)  mentions that the president at that time, Bill Clinton, offered a public apology and funded a center for Bioethics at Tuskegee University; the unrepairable damage to this population was already there.

For this study to be ethical and valid, the researchers should have followed guidelines and codes established after multiple unethical types of research. Houser mentions in Chapter 3 multiple important terms to consider when selecting a population for research. For example, respect for persons, beneficence, justice, right to privacy, and informed consent with full disclosure of the study (Houser, 2018). The study picked a vulnerable population and violated their right to privacy. Informed consent was not given with full information, risks, and benefits, and the participants were coerced to stay in the study. They were not given appropriate study information and had no opportunity to make decisions based on real information. Before conducting research, the study needs to be evaluated by review boards to ensure the study is ethical. It complies with new ethical laws and codes, for example, the Nuremberg and Declaration of Helsinki, to prevent harm and violation of human rights.

References

Shelton, A. K., Freeman, B. D., Fish, A. F., Bachman, J. A., & Richardson, L. I. (2015). A computer-based education intervention to enhance surrogates’ informed consent for genomics research. American Journal of Critical Care, 24(2), 148-155. doi: http://dx.doi.org/10.4037/ajcc2015983

Houser, J. (2018). Nursing Research: Reading, Using, and Creating Evidence (4th ed.). Burlington, MA: Jones & Bartlett Learning. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9781284138887/cfi/6/6!/4@0.00:0

Ingham-Broomfield, R. (2017). A nurses’ guide to ethical considerations and the process for ethical approval of nursing research. Australian Journal of Advanced Nursing (Online), 35(1), 40-47. Retrieved from https://search-proquest-com.southuniversity.libproxy.edmc.edu/docview/1994661917?accountid=87314

Franklin, P., Rowland, E., Fox, R., & Nicolson, P. (2012). Research ethics in accessing hospital staff and securing informed consent. Qualitative Health Research, 22(12), 1727–1738.

Houser, J. (2018) Nursing Research: Reading, Using and Creating Evidence. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9781284138887/

Nix, E. (2017, May 16). Tuskegee Experiment: The Infamous Syphilis Study. Retrieved November 16, 2019, from https://www.history.com/news/the-infamous-40-year- Tuskegee-study.

Walker, C. A. (2009). Lest we forget: The Tuskegee Experiment. Journal of Theory Construction & Testing, 13(1), 5–6. Retrieved from https://search-ebscohost-com.southuniversity.libproxy.edmc.edu/login.aspx?direct=true&db=a9h&AN=38707289&site=eds-live

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NSG 3029 Week 4 Discussion-Ethics in Healthcare

In this assignment, you will study the role of ethics in healthcare. Based on your research, respond to one of the following discussion questions:

Discussion Question 1

Read the article: A Computer-Based Education Intervention to Enhance Surrogates’ Informed Consent for Genomics Research. Ethics guidelines now require that individuals give informed consent to participate in research. Existing ethical guidelines do not help us decide how to seek consent and have allowed managerial experimentation to remain unchecked. Based on your understanding of the topic and the article, answer the question: Do you think alternative forms of community consent should be actively pursued? Why or why not? How would you feel if your medical records were examined and included in research without your consent based on past illnesses?

Discussion Question 2

Scenario

Two nurse researchers are interested in studying whether a pain assessment tool for critical care patients is valid and reliable when applied to patients who cannot communicate verbally due to mechanical ventilation. They designed a validation study in which randomly selected patients will be assessed using the tool after a painful procedure (tracheal suctioning) and a nonpainful procedure (oral care). Suppose patient responses result in higher scores after the painful procedure than after the nonpainful one. In that case, the researchers will conclude that the tool is effective for these patients in differentiating pain responses from responses to nursing procedures in general. Using the checklist in the text, discuss and conclude whether this study will likely be exempt, expedited, or full review. Would the study be considered ethical? Explain your rationale.

Discussion Question 3

Research a historical experiment that impacted or helped shape the development of ethical codes and regulations.

Discuss the experiment and the rights violated within the study (if any). Discuss any outcomes or legislature associated with the study. What type of consent would have been needed to make the study ethical and valid?