Chapter 4: ETHICS IN

NURSING RESEARCH

ELVIE A. IMASON-RAMOS, MAN, RN

Chap. 4: ETHICS

IN NURSING RESEARCH

Learning Outcomes:

At the end of the chapter, the learner

should be able to:
Explain what is ethics in nursing
research.
Distinguish between morals and ethics
in nursing research.
Explain the ethical principles and
guidelines in research.
Acknowledge how international and
national codified ethical principles have
influenced ethics in nursing research.

Chap. 4: ETHICS

IN NURSING RESEARCH

Ethics, too, are nothing but

reverence for life. This is what
gives me the fundamental
principle of morality, namely,
that good consists in
maintaining, promoting, and
enhancing life, and that
destroying injuring, and limiting
life are evil.
- Albert Schweitzer

Chap. 4: ETHICS

IN NURSING RESEARCH

The word ethics is Greek for

ethikos.
It refers to the rules of conduct
recognized in certain associations
or departments of human life.
(Simpson, 2004).
Nursing Research uses human
beings as subjects.

Chap. 4: ETHICS

IN NURSING RESEARCH

The researcher must exercise

caution to protect the rights of the
subjects against undue
impositions.
The complex nature of nursing
research may place the researcher
and the participants of the study
in a potentially compromising
situation.

ETHICS
NURSINGIN
RESEARCH
Chap. 4:IN
ETHICS
NURSING

RESEARCH

The Code of Ethics for Researchers

of UST states that the

professional
conduct and relations of the
researcher shall be based on
respect for human rights and
dignity, honor and justices,
truthfulness, freedom, solidarity
and personal integrity.

ETHICS
Chap.IN4:NURSING
ETHICSRESEARCH
IN NURSING RESEARCH

Review the case of Ms. Terri Schiavo

in Florida.
(The health staff decided to stop
feeding Ms. Schiavo and
therefore allow her to die. A case
was filed in court alleging
violation of medical ethics.)

ETHICS
Chap.IN4:NURSING
ETHICSRESEARCH
IN NURSING RESEARCH
(Another was the case in which a

group of medical practitioner

experimented on an abandoned
infant. They wanted to study how
the absence of human touch
affected the growth and
development of an infant. The
experiments using only technology
and audiovisuals allowed the
experiment to proceed even to the
point of allowing the infant to
suffer and die due to deprivation of
human touch and care)

The case was brought to court and the

researchers were charged of INFANTICIDE
for ethical violation of the right to life.

BASIS
FOR
ETHICAL STANDARDS
Chap.
4: ETHICS
IN NURSING RESEARCH

The Universal Declaration of

Human Rights states:

NO ONE SHALL BE
SUBJECTED TO TORTURE
OR TO CRUEL, INHUMAN
OR DEGRADING
TREATMENT OR
PUNISHMENT.

BASIS
FOR
ETHICAL STANDARDS
Chap.
4: ETHICS
IN NURSING RESEARCH

No one shall be subjected

without his free consent to
medical or scientific
experimentation.

(The international
Covenant on Civil and
Political Rights (1966),
United Nations
Organization)

BASIS
FOR
ETHICAL STANDARDS
Chap.
4: ETHICS
IN NURSING RESEARCH

This implies that the nurse

researcher must maintain the
highest ethical standards as social
scientists.
As health researchers, nurse
researcher are also covered by all
the ethical principles in biomedical
research

BASIS
FOR
ETHICAL STANDARDS
Chap.
4: ETHICS
IN NURSING RESEARCH

Several Codes were developed

because of unethical activities in
the name of science:
Nuremberg code
Declaration of Helsinki
Council for International
Organizations of Medical Science
(CIOMS)
Belmont Report
Professional code of ethics for
nurses

NUREMBERG
CODE
Chap. 4: ETHICS

IN NURSING RESEARCH

NUREMBERG CODE
It was developed in 1949 borne out of
Nuremberg trial. Formulated rules to
guide investigators in their conduct of
research
Stipulated the following as essential
requirements of ethical research which
are voluntary consent, withdrawal of
subjects from study, protection of
subjects from physical and mental
suffering, injury, disability and death,
balance of benefits and risk.

DECLARATION
OF HELSINKI
Chap. 4: ETHICS
IN NURSING RESEARCH

DECLARATION OF HELSINKI
This was adopted by the World
Medical Association in 1964
It was last updated in 2000
The main contribution of this
document was the introduction of
the distinction between therapeutic
and non-therapeutic research.

DECLARATION
OF HELSINKI
Chap. 4: ETHICS
IN NURSING RESEARCH

Therapeutic Research the patient

could benefit from experimental
treatment that might have
beneficial results.
Non-therapeutic Research the
main goal is the generation of new
knowledge which might produce
beneficial results to future patients
but less likely to the actual
research subjects.

CIOMS
Chap. 4: ETHICS

IN NURSING RESEARCH

CIOMS
Formally known as International
Ethical Guidelines for Biomedical
Research involving Human Subjects
Set of Ethical Principles regarding
human experimentation
It was created in 1993 by the Council
for International Organizations of
Medical Science (CIOMS) and was
updated in 2002

CIOMS:
GUIDELINES
Chap.21
4: ETHICS
IN

NURSING RESEARCH

The guidelines are general instructions

and principles of ethical biomedical
research.
15 of which were in the original report
Addressed issues including informed
consent
Standard for external reviews
Recruitment of participants
CIOMS-2002-Guidelines.pdf

BELMONT
Chap. 4: REPORT
ETHICS

IN NURSING RESEARCH

BELMONT REPORT
National Research Act was signed
into thereby creating the National
Commission for the Protection of
Human Subjects of Biomedical and
Behavioral Science on July 12, 1974
The commission was to identify the
basic ethical principles that should
underlie the conduct of biomedical
and behavioral research involving
human subjects;

BELMONT
Chap. 4: REPORT
ETHICS

IN NURSING RESEARCH

And also to develop guidelines to

assure that such research of this sort
is conducted in accordance with
those principles.
The report was published by the
commission in 1979 was titled The
Belmont Report.

CONSIDERATIONS
FOR
REPORT
Chap. 4: ETHICS
INBELMONT
NURSING
RESEARCH

The boundaries between biomedical

and behavioral research and the
accepted and routine practice
medicine;
The role of assessment of risk-benefit
criteria in the determination of the
appropriateness of research involving
human subjects;

CONSIDERATIONS
FOR
REPORT
Chap. 4: ETHICS
INBELMONT
NURSING
RESEARCH

Appropriate guidelines for the

selection of human subjects for
participation in such research;
The nature and definition of
informed consent in various research
settings.

CODE
OF4:ETHICS
FORIN
NURSES
Chap.
ETHICS
NURSING RESEARCH

CODE OF ETHICS FOR NURSES

Revised in 2000
Guide for action based on social values
and needs.
Served as standard for nurses
performance worldwide since it was
first adopted in 1953
New version revised for the first time
in 27 years, responds to the realities of
nursing and health care in a changing
society.

ETHICAL
THEORIES
Chap. 4:
ETHICS

IN NURSING RESEARCH

ETHICAL THEORIES
Ethical Principles have their basis on
ethical theories
These standards by which man lives
and acts are anchored on certain
principles such as goodness or
rightness of an act or decision
In research decision-making, one
arrives at either deductively or
inductively.

ETHICAL
THEORIES
Chap. 4:
ETHICS

IN NURSING RESEARCH

Deductive approach
Teleology (greatest good)
Deontology (duty-based)
Intuitionism
Inductive approach
Virtue ethics
Ethics of care
Reflective approach

DEDUCTIVE
APPROACH
Chap. 4: ETHICS
IN

NURSING RESEARCH

DEDUCTIVE APPROACH
A general theory or principle is applied
to a particular case and the right
decision or course of action is
determined by a process of deducting
from a general theory to a particular case
(Houser, 2008)
It is the inverted pyramid
Three (3) thoughts run under this
approach

DEDUCTIVE
APPROACH:
TELEOLOGY (greatest
good)
Chap. 4: ETHICS
IN NURSING
RESEARCH

TELEOLOGY (GREATEST GOOD)

Type of consequentialism
Asserts that actions are determined
by right or wrong, good or bad in
terms of their consequences
Teleology relates to good that
emerges from an action
Concerned with maximizing the
preferences or values of the people
concerned.

DEDUCTIVE
APPROACH:
TELEOLOGY (greatest
good)
Chap. 4: ETHICS
IN NURSING
RESEARCH

Teleology is a doctrine of the

consequence of ethical decision such
as the end justifies the means
In deciding the course of action, the
nurse must be guided by what will
bring out the greatest value for the
greatest number of people

DEDUCTIVE
APPROACH:
TELEOLOGY (greatest
good)
Chap. 4: ETHICS
IN NURSING
RESEARCH

This can be opposed to

utilitarianism in which actions are
guided by a rule that is deemed to
promote the greatest preferred
outcomes. This comes into play for
example in a rule maintaining
confidentiality of clients.
The question arises when instead of
promoting the good of all, breaching
confidentiality would produce the
preferred outcome.

DEDUCTIVE
APPROACH:
(duty-based)
Chap. 4: ETHICS
IN DEONTOLOGY
NURSING RESEARCH

DEONTOLOGY (DUTY-BASED)
Calls for a nurse moral obligation, the
morality of ethical division is separate
from its consequences.
It is a specific action related to the
cause of justice
e.g. To tell the truth no matter who
gets hurt.
-The freedom of the individual is
recognized but the common good is
also considered.

DEDUCTIVE
APPROACH:
(duty-based)
Chap. 4: ETHICS
IN DEONTOLOGY
NURSING RESEARCH

This theory associated with

Immanuel Kant, (1724-1804) who
posited that morality is founded on
reason and the ultimate end of
reason is good will
In contrast to teleology, reason is
autonomous of an individuals
desires or preferences.

DEDUCTIVE
APPROACH:
(duty-based)
Chap. 4: ETHICS
IN DEONTOLOGY
NURSING RESEARCH

Codes of professional conducts are

deontological codes that state the
duties of the profession.
Research codes demand informed
consent from participants and
demonstrate the reciprocity
principles of treating others as ends,
never means to an end.

DEDUCTIVE
APPROACH:
(duty-based)
Chap. 4: ETHICS
IN DEONTOLOGY
NURSING RESEARCH

Conflict occurs when the duty to

promote clients best interest may
conflict with the duty to respect the
same clients autonomous wishes
concerning treatments.

DEDUCTIVE
APPROACH:
Chap. 4: ETHICS
IN INTUITIONISM
NURSING RESEARCH

INTUITIONISM
Knowing what is right or wrong which
is not a matter of rational thought of
learning
The power of mind of knowing things
without conscious reasoning and has
quick and ready insights of what is
good for the client

DEDUCTIVE
APPROACH:
Chap. 4: ETHICS
IN INTUITIONISM
NURSING RESEARCH

e.g., striking a demanding client

need not be taught, however, it is
moral insight of a nurse that
dictates her own actions or
response to any situation

INDUCTIVE
APPROACH
Chap. 4: ETHICS
IN

NURSING RESEARCH

INDUCTIVE APPROACH
Justifications or judgments are
rendered on particular cases
These particular judgments can
eventually serve as patterns for
general cases
The inductive approaches to ethical
decision making tends to emphasize
the particulars of the case at hand.

INDUCTIVE
APPROACH:
ETHICSRESEARCH
Chap. 4: ETHICS
INVIRTUE
NURSING

VIRTUE ETHICS
Focuses on the character of the
moral agent rather than on the
abstract principles
Claiming certain traits of character,
the virtues are being in themselves
morally valuable.
Roachs 5 Cs of caring are examples
of these virtues (Roach, M.S. 1987)

INDUCTIVE
APPROACH:
ETHICSRESEARCH
Chap. 4: ETHICS
INVIRTUE
NURSING

Roachs 5 Cs
- Compassion
- Competence
- Conscience
- Concern
- Commitment
Human Act of Caring, Canadian
Hospital Association, Ottawa)

INDUCTIVE
APPROACH:
ETHICSRESEARCH
Chap. 4: ETHICS
INVIRTUE
NURSING

In the case of nursing, emphasizes

competency or excellence in
performance as nursing moved
towards competency-based
practice.
Concerned with the development of
expertise and excellence in
performance

INDUCTIVE
APPROACH:
OF CARE
Chap. 4: ETHICS
INETHICS
NURSING
RESEARCH

ETHICS OF CARE
Concerned most of activities of caring
and therefore focuses on the clientnurse relationship
Moral emphasis in caring ethics is on
the movies of any action or decision,
how the person performs those
actions and or whether the actions
promote or thwart positive
relationship between the nurse and
her client (Melia, 2004)

REFLECTIVE
APPROACH
Chap. 4: ETHICS
IN

NURSING RESEARCH

REFLECTIVE APPROACH
Ones moral beliefs are a reflection of
ones perception in particular cases
Beauchamp and Childress
Principalism/Coherence Theory is an
example
Theory suggest that general principles
can be applied with sensitivity to a
particulars of the case.

REFLECTIVE
APPROACH
Chap. 4: ETHICS
IN

NURSING RESEARCH

Emphasizes that principles need to

be made specific for cases while
analysis of particular cases can gain
much illumination from general
principles
Four (4) principles that are intended
to act as guide to action and
decision making.

REFLECTIVE
APPROACH
Chap. 4: ETHICS
IN

NURSING RESEARCH

Nonmaleficence
Beneficence
Justice
Respect for autonomy
(Beauchamp and Childress, 2001)

Chap. 4: ETHICS IN NURSING RESEARCH

ETHICAL PRINCIPLES
& GUIDELINES FOR NURSE
RESEARCHERS
The Ethical Principle and Guidelines for Nurse

Informed Consent
-The participants must be fully
informed about the nature of
research, its purposes, and potential
risks and benefits.
-They must have the power of free
choice to voluntarily consent to or
decline participation in the study

ETHICAL PRINCIPLES
& GUIDELINES FOR NURSE
Chap. 4: ETHICS IN NURSING RESEARCH
RESEARCHERS
The Ethical Principle and Guidelines for Nurse

Informed Consent
- They must also be informed of the
anticipated results of the study and
how this would affect them and the
target population.
- An essential mechanism for ensuring
that basic ethical principles are
observed when research involves
human subjects

ETHICAL PRINCIPLES
& IN
GUIDELINES
NURSE
Chap. 4: ETHICS
NURSING FOR
RESEARCH
RESEARCHERS
The Ethical Principle and Guidelines for Nurse

Informed Consent
- An individual is able to exercise free
choice without infringement by any
external force such as, fraud, deceit,
or any other form of coercion
- An individuals family member or legal
representative can also give informed
consent on behalf of the individual
who is not competent to personally
give consent such as cases of
vulnerable subjects.

ETHICAL PRINCIPLES
& IN
GUIDELINES
NURSE
Chap. 4: ETHICS
NURSING FOR
RESEARCH
RESEARCHERS
The Ethical Principle and Guidelines for Nurse

Informed consent
-Assent refers to the childs consent to
participate in a research situation. In
case of children, it is normally
required that childs assent be
obtained for children 7 years of age
and above. (Louiselle & McGrath,
2008)

Chap. 4: ETHICS IN NURSING RESEARCH

ETHICAL PRINCIPLES
& GUIDELINES FOR NURSE
RESEARCHERS
e.g. of vulnerable subjects who may be

incapable of giving fully informed

consent.
- physically disables
- terminally ill
- pregnant and or breastfeeding
mothers
- children
(Polit & Beck, 2009)

ETHICAL PRINCIPLES
& GUIDELINES FOR NURSE
Chap. 4: ETHICS IN NURSING RESEARCH
RESEARCHERS
The Ethical Principle and Guidelines for Nurse

Beneficence and Nonmaleficence

-This is a fundamental ethical
principles in research, which means,
to do good and to do no harm to
study participants.

ETHICAL PRINCIPLES
& GUIDELINES FOR NURSE
Chap. 4: ETHICS IN NURSING RESEARCH
RESEARCHERS

The Ethical Principle and Guidelines for Nurse

Beneficence
- is an action to do good
- this is done to benefit others
- beneficient actions can be taken to
mean merely preventing or removing
harm or to simply improve the
situation of others.
- it imposes a duty on researchers to
minimize harm and to maximize
benefits.
- a related principle is nonmaleficence

ETHICAL PRINCIPLES
& IN
GUIDELINES
NURSE
Chap. 4: ETHICS
NURSING FOR
RESEARCH
RESEARCHERS
The Ethical Principle and Guidelines for Nurse
Nonmaleficence
- Means to do no harm
- The term nonmaleficence derives from
the ancient Latin maxim primum non
nocere
- Nurse researchers have a tradition of
utilitarian approaches, meaning that
the greatest good should be
accomplished through any public
health action.

ETHICAL PRINCIPLES
& GUIDELINES
NURSE
Chap. 4: ETHICS
IN NURSINGFOR
RESEARCH
RESEARCHERS
The Ethical Principle and Guidelines for Nurse
PRINCIPLES OF BENEFICENCE &
NONMALEFICENCE
Freedom from Physical and
Psychological Harm
Freedom from Exploitation

FREEDOM FROM ANY PHYSICAL AND

Chap. 4: ETHICS IN NURSING RESEARCH
PSYCHOLOGICAL HARM
FREEDOM FROM ANY PHYSICAL &
PSYCHOLOGICAL HARM
The researcher should minimize
all kinds of harm or discomfort
and provide safety measures to
prevent potential injury, distress
or disability imposed on the
study.

FREEDOM FROM ANY PHYSICAL AND

Chap. 4: ETHICS IN NURSING RESEARCH
PSYCHOLOGICAL HARM
The researcher must guarantee
the safety and protection of the
participants from any
detrimental effects of the study
The researcher should also
anticipate for any unforeseen
eventualities and situations that
were not previously accounted
for.

FREEDOM
FROMINEXPLOITATION
Chap. 4: ETHICS
NURSING RESEARCH
FREEDOM FROM EXPLOITATION
The participant must be safe from
situations that will expose them to
threats or liabilities
Any information provided by the
participants must not be used
against them

FREEDOM
FROMINEXPLOITATION
Chap. 4: ETHICS
NURSING RESEARCH
The relationship established during
the research process must be
beneficial to both the researcher
and the participants without any
consequent risks that may arise
from the outcome of the study.
There should also be no
exploitation of self as researcher, as
well as the research assistants
during the study period.

Chap. 4: ETHICS IN NURSING RESEARCH

ETHICAL PRINCIPLES
& GUIDELINES FOR NURSE
RESEARCHERSRESPECT FOR HUMAN DIGNITY

The rights of all involved in the study

must be protected and respected,
these include:
The Right to Self Determination
The Right to Full disclosure
The Right to remain anonymous or
the Right to confidentiality of
Personal Information

Chap. 4: ETHICS

IN NURSING RESEARCH

THE RIGHT TO SELF DETERMINATION

THE RIGHT TO SELF DETERMINATION

The right to perspective participants to
voluntarily participate or refuse to
participate in the study
There should be no undue pressure or
coercion, such as threats of penalty for
failing to participate or excessive
rewards of agreeing to participate

THEChap.
RIGHT
TO FULL DISCLOSURE
4: ETHICS
IN NURSING RESEARCH

THE RIGHT TO FULL DISCLOSURE

Researcher must fully explain to the
participants the nature and purpose
of the study, the right to refuse
participation, the researchers
responsibilities, and the potential risk
and benefits of the study

THEChap.
RIGHT
TO FULL DISCLOSURE
4: ETHICS
IN NURSING RESEARCH

Deception and concealment of

information which is deliberately
withholding information about the
study or providing participants with
false information will interfere with
the right of the participants to make
truly informed decisions about
personal and professional benefits
of participation.

THEChap.
RIGHT
TO FULL DISCLOSURE
4: ETHICS
IN NURSING RESEARCH

Researchers must show respect to

study participants by cautiously
attending to their emotional rights
and the nature of their interactions
Debriefing session after data
collection is completed will allow
participants to ask questions or air
their complaints

THEChap.
RIGHT
TO FULL DISCLOSURE
4: ETHICS
IN NURSING RESEARCH

Debriefing is a formal strategy that

researchers can use to communicate
their respect and concern for the
participants especially when data
collection has been stressful or if
ethical guidelines were ignored
(Polit & Beck, 2008)
The right to self-determination and
full disclosure is embodied in the
informed consent.

JUSTICE
Chap.&
4: FAIRNESS
ETHICS

IN NURSING RESEARCH

JUSTICE AND FAIRNESS

Study participants deserve fair
and equitable treatment before,
during and after the study period.

- The right to fair treatment

- Anonymity and Confidentiality
- Right to Intellectual Property

THEChap.
RIGHT
TO FAIR TREATMENT
4: ETHICS
IN NURSING RESEARCH

THE RIGHT TO FAIR TREATMENT

Researcher should provide all target
participants equal chances in the
selection process, must comply with
agreements as regard to procedures,
techniques or benefits due to the
participants.

THEChap.
RIGHT
TO FAIR TREATMENT
4: ETHICS
IN NURSING RESEARCH

Adequate orientation and

training must likewise be
provided to the participants if
needed, as well as giving them
due respect and courtesy at all
times

ANONYMITY
& CONFIDENTIALITY
Chap. 4: ETHICS
IN NURSING RESEARCH

ANONYMITY & CONFIDENTIALITY

Research participants have the right
to privacy and confidentiality,
consistent with respect for human
dignity, particularly when
anticipated results have negative
implications on them.
Researcher shall exercise prudence
in making pronouncements
regarding the results of the study.

RIGHT
TO4:INTELLECTUAL
PROPERTY RESEARCH
Chap.
ETHICS IN NURSING

RIGHT TO INTELLECTUAL PROPERTY

Researcher should respect the right
to intellectual property
He must guarantee factual and
evidence-based data
There should ne no plagiarism or
presenting the ideas or words of
another as ones own, or distortion
or fabrication of data for purposes of
completing research on time

RIGHT
TO4:INTELLECTUAL
PROPERTY RESEARCH
Chap.
ETHICS IN NURSING

RA 8293 (Philippine Copyright Law)

protect the intellectual property
rights of authors and artists with
respect to his or her personal
relationship with their work and
utilization of these by others.
It is a good policy to have ones
work undergo an evaluation by a
review board before inception

Chap. 4: ETHICS

IN NURSING RESEARCH

ELEMENTS OF SUCCESSFUL RESEARCH ETHICS

Researchers may encounter difficulty

in assessing risks and benefits or in
developing procedures to protect
human rights.
Their commitment to conduct the
study may influence their judgment,
hence the ethical dimension of the
study is usually subjected to external
review.
Elements of Successful Research Ethics.doc

Chap. 4: ETHICS

IN NURSING RESEARCH

ELEMENTS OF SUCCESSFUL RESEARCH ETHICS

Institutional policies in granting

researchers access to study
participants may involve review
Institutional policies in granting
researchers access to study
participants may involve review of
proposed research plan by
independent Research Ethics Board
(REB) or Institutional Review Board
(IRB)

Chap. 4: ETHICS

IN NURSING RESEARCH

ELEMENTS OF SUCCESSFUL RESEARCH ETHICS

REB or IRB are tasked to assess that

ethical standards are met in relation to
research involving the protection of the
rights of human subjects in hospitals
and universities before the study gets
underway.
They are empowered to direct
modification or termination of research
conducted within the institution if
ethical violations are observed.

Chap. 4: ETHICS

IN NURSING RESEARCH

ELEMENTS OF SUCCESSFUL RESEARCH ETHICS

An example is the case of research

undertaken by a group of student
researchers who undertook a study
on the effectiveness of bubble
blowing as a diversional activity in
the management of pain
experienced by pre-school children
during IV line insertion.

Chap. 4: ETHICS

IN NURSING RESEARCH

ELEMENTS OF SUCCESSFUL RESEARCH ETHICS

Researchers obtained approval

for their study from the hospital
ethics review board before
conducting the study in order to
ensure compliance of the ethical
guidelines set by institution.

Chap. 4: ETHICS

IN NURSING RESEARCH

ELEMENTS OF SUCCESSFUL RESEARCH ETHICS

Set of ethical guidelines sustains

the paramount value of
research, which is respect for
human life and dignity, the
expediency of knowledge and
the ideals of truth.

Chap. 4: ETHICS

IN NURSING RESEARCH

A wise man proportions his

belief to the evidence.
-DAVID HUME

Chap. 4: ETHICS

IN NURSING RESEARCH