Ethics in Health Care Research

Health Care Research and Ethics

Research in Nursing Ethics,Why Ethics Needed,Ethical Inquiry in Nursing,Moral Reasoning,Nursing Research on Ethical and Moral Reasoning,Ethical Practices in Nursing,Ethical and Moral Practice in Health Care,Ethical Values and Attributes in Health Care.

Research in Nursing Ethics

     Recent developments in technology have created increased awareness on the part of society and health professionals about the ethical dimensions of high-tech care. It is now recognized that our ability to deal with human and ethical issues has not kept pace with the rapid advancements made possible through various technologies being applied in health care.

Why Ethics Needed

Nursing ethics has evolved from the use of etiquette or rules of conduct to the philosophical or empirical analysis of (1) the moral phenomena found in nursing practice, (2) the moral language and ethical foundations of nursing practice, and (3) the ethical judgments made by nurses (Fry, 1995).

Ethical Inquiry in Nursing 

    It is a salutary development of the past two decades that nurse investigators in increasing numbers have engaged in ethical inquiry. Earlier studies on ethical inquiry were mainly philosophical and normative.

     In more recent years empirical and descriptive studies have predominated, utilizing both qualitative and quantitative methods. The aim of these studies, collectively, has been to understand nurses' ethical decision making and actions under a variety of conditions of ethical ambiguity and conflict, along with the factors that affect these actions and decisions (ethical practice, moral behavior). 

    In addition, there has been interest in understanding how nurses' reason about moral choice (moral reasoning) and what conditions promote high quality reasoning.

Moral Reasoning 

    Moral reasoning is defined as a cognitive and developmental process involving a sequential transformation in the way social arrangements and ethical problems are interpreted. Each successive stage (of six stages) is more complex, comprehensive, and differentiated than the preceding stage. 

    It has been theorized that certain conditions stimulate moral development. These include cognitive development and the nature of the educational and social climates, such as when opportunities are provided for assumption of responsibility or when cognitive disequilibrium is created to show inadequacies in one's mode of thinking (Kohlberg, 1978).

    This conception of morality is ostensibly based on notions of rights, obligations, and justice and is said to reflect a male oriented perspective. Gilligan (1982) challenged this perspective by proposing the ethic of care or care based reasoning, reflecting the way women reason about moral choice. 

    This mode of reasoning does not involve the application of abstract ethical principles; rather, moral conflict and possible choices of action are constructed and defined by the context of the situation and the relationship of self to others who are involved in the conflict. Research to date does not support the polarization of and gender identifications with care (as feminine) and justice (as masculine).

    Further, Gilligan (1982) contended that moral problems can be viewed from both perspectives of justice and care by the same person, and both perspectives contain important moral injunctions; they entail different (but not opposite) ways of approaching moral judgments. 

    Several instruments have been developed to measure care orientation in women. In a few studies using the Ethic of Care Interview, significant relationships have emerged between age, ego identity, and use of care orientation among women.

Nursing Research on Ethical and Moral Reasoning 

    In an integrative review published in 1989, Ketefian reported on empirical studies conducted in ethical practice and moral reasoning and updated this information by a literature search conducted in 1996. 

    Nurse investigators have studied moral reasoning as a dependent variable, trying to predict its development from various educational, cognitive, environmental, and personal demographic variables. Recently, a number of studies have focused on qualitative descriptions of nurses' reasoning and whether they used the care or the justice conceptions of morality. No clear direction emerged.

Ethical Practices in Nursing 

    Ethical practice refers to nursing decisions and actions that reflect high ethical standards, such as those set forth by the nursing profession. Various indices of ethical behavior have been proposed, which makes comparisons across studies difficult. The measures vary as well. 

    The most frequently used tool is Judgments about Nursing Decisions (Kerefian, 1989), but many investigators have developed their own measures. Ethical practice, moral behavior, and ethical decision making are terms utilized interchangeably and have been studied as dependent variables. 

    Educational variables, moral reasoning, and organizational and personal variables have been used as predictors of ethical practice with inconsistent and mixed results.

Ethical and Moral Practice in Health Care

    Caring behaviors originate from a strong interest in something or someone that contributes to the good, worth, dignity, or comfort of others. A number of descriptive studies on nurses caring behaviors have been conducted. 

    In samples composed of patients or others, several aspects of nurses' caring behaviors have been identified empathetic communication, competence, providing continuity, meeting needs, and being respectful, non-judgmental, and solicitous. 

    These aspects of nurses' behaviors provide a starting point for further research on the effects of nurse behaviors on patient satisfaction and patient out comes.

Ethical Values and Attributes in Health Care

    A few studies have identified the attitudes and values of nurses concerning ethical issues, the extent to which nurses understand the concept of ethical dilemmas, physicians' and nurses' perceptions of ethical problems, how nurses address ethical concerns in their practice, nurses' perceptions of powerlessness in influencing ethical decisions, ethical conflicts related to pain management, and ethical issues in caring for patients receiving long-term tube feedings. 

    Other studies have examined nurses' role in end-of-life treatment decisions, practices concerning assisted suicide and euthanasia, and differences among nurses and physicians in their ethical decision making.

    In addition, studies have identified and compared the ethical decision making of nurses in various practice settings. 

    Only a few studies have included variables such as the frequency with which nurses encounter specific ethical issues in their practice, how disturbed they are by them, the relationship of demographic and work related variables to frequency and disturbance, the resources that nurses use to clarify ethical issues, and nurses' knowledge of patient care ethics committees.

    A promising area of research relates to the way in which organizational variables impinge on the quality of nurses' reasoning, behavior, and judgments. There is a need for clearer definition and measurement. Typically, studies in nursing ethics tend to be isolated, individual projects; many are conducted as dissertations, and few are published. 

    There is a need to move toward a programmatic and cumulative approach, along with a need for replications, so that a meaningful body of science can emerge, one in which we can have a degree of confidence.