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Nursing research is held to the same ethical standards as all other research involving human participants. Nurses need to understand and apply ethical principles to their own research, as well as to the reading and review of research. The Declaration of Helsinki in 1964 is a statement about ethical principles, initially applied to medical research, but which now guides all types of research. Of the three core principles, the most important is ‘respect of persons’ where the participants' welfare takes precedence over interests of the researchers, society or science. Safeguards to participants are paramount and include strategies to mitigate potential harm related to emotional well-being, impact on employment, financial or social status and more.1
The second core principle is benefice, where researchers should strive to maximise the benefits of research for the wider society while minimising risks to research participants. The final core principle is justice. In this case, researchers should ensure that research is conducted fairly and in a way that does not exploit or disadvantage any participants.1
Although we now accept these principles as the norm, it was not always the case. Some historical studies were considered to be so profoundly unethical that they became the catalyst for ethical review guidelines and processes designed to protect human participants during research. One such study was the Tuskegee Syphilis Experiment conducted between 1932 and 1972 in which African-American men in Alabama were not informed of their diagnosis of syphilis and researchers knowingly failed to treat them.2
How do we know if a study has been conducted ethically? When reading research, it is important to look for a description of how ethical standards were upheld. At a minimum, there should be evidence of either approval or exemption by a formal committee designated to review the ethical risks and processes associated with human research. Ethics committees have many names, depending on the location (institutional review board; ethical review board; research ethics board and more) and approval numbers from ethics review are often required for publication.
Ethical principles considered by review committees include the following:
Minimising harm. Strategies for mitigating risk and harm to participants must be specified and implemented during the conduct of the research.
Informed consent. When informed consent is required, participants should understand that they are voluntarily taking part in research and be clear about their role in the research. Any benefits, rewards, risks, inconveniences and demands of them must be outlined ahead of time. The possibility of coercion to participate must be addressed when recruiting participants. Participants must also be given the opportunity to withdraw from research at any point if they change their mind.
Protection of anonymity and confidentiality. In this case, researchers should have a procedure ensuring that participant's identity and all data are kept confidential at all times.3 Data storage arrangements and plans for data sharing and retention are critical components of the study protocol.
There are some cases that require special consideration for research ethics. It is not always feasible for study participants to give informed consent. A study where human behaviour is being observed, such as nurses providing patient care, may result in behaviour being altered by informing participants about being observed. Other studies stretch this farther by using deception; such as telling participants that a survey is testing them for a particular issue, when it is actually determining their level of bias to an issue. Informing the participants may alter the way they answer the survey items.3 In all cases, the protocol of the research study must include strategies to minimise harm to participants.
Another special circumstance in considering the ethics of human research occurs when the participants are part of a vulnerable group. At times, this includes people who are not able to provide informed consent, such as children or patients with dementia. In other circumstances, participants may be at high risk of exploitation due to limitation in personal power, such as the prison population. Finally, there are also groups, such as Indigenous peoples, where community engagement has become an important step in planning research to ensure research reflects cultural practices, is consistent with their worldview and has clear relevance and benefits for participants.4
Ethical principles for nursing research are in many ways the natural extension of ethical principles for professional nursing practice. Whether planning research or reading research, understanding and applying ethical principles is an important element of ensuring the highest quality evidence for practice.
Twitter Follow Roberta Heale at @robertaheale
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.