A nurse researcher holds a critical position in the healthcare profession. Nursing research often takes place on the cutting edge of healthcare innovation, with the goal of promoting and improving the health of individuals, families and communities.
Nurse researchers are scientists who specialize in research relevant to nursing and the general healthcare industry. Like all scientists and researchers, a nurse researcher is expected to adhere to industry-approved ethical standards.
The U.S. National Institute of Nursing Research (NINR) exists to support and encourage scientific research by nurses. It provides four main purposes of nursing research, which are:
- Building a scientific foundation for clinical practice
- Preventing disease and disability
- Managing and eliminating symptoms caused by illness
- Enhancing end-of-life care and palliative care practices
Funding for research is always necessary, and the NINR provides a number of suggestions for seeking grants and other sources of money for research.
Nursing research, just as all current medical research in the United States, takes its ethical cues from a 1979 proclamation called the Belmont Report. The Belmont Report was issued by the U.S. Department of Health, Education and Welfare (now the Department of Health and Human Services, or HHS) on April 18, 1979, and established three basic ethical principles for scientific research: respect for persons, beneficence and justice.
More on each of those three principles is found below. First, a brief look at how medical research ethics evolved and why:
Tuskegee, Nuremberg and Ethical Codes
In order to enforce the principles within the Belmont Report, the HHS established the Institutional Review Board (IRB). The role of the IRB is to “provide ethical and regulatory oversight of research that involves human subjects.”
The issuance of the Belmont Report and the establishment of the IRB were the culmination of nearly a century of abuse by scientists and other researchers when it came to human subjects.
Two of the most egregious examples of unethical behavior stand out, even decades later:
- The Tuskegee Syphilis study began in 1932 in Macon County, Alabama. The U.S. Public Health Service recruited 400 African-American men by promising free treatment for “bad blood.” None of the men were given treatment and many died or suffered severe symptoms. The story came to light in 1972, and a civil suit was settled at a cost of $37,500 per subject.
- After World War II, a group of 16 German doctors were tried during the Nuremberg War Criminal Trials for conducting non-consensual medical experiments on prisoners. The Nazi physicians were convicted of crimes against humanity, and the Nuremberg Code of ethical behavior was established to protect human research subjects.
Exposure of these and other cases of ethical lapses in medical research brought to light the potential dangers of unethical medical research practices. The issuance of the Belmont Report marked a turning point in the history of medical research.
The Belmont Report Principles
One of the primary tenets put forth in the Belmont Report was the idea that there should always be a distinct boundary between medical practice and medical research. Research and practice can (and should) co-exist when the research is intended to determine the efficacy of a type of treatment or therapy.
Even then, the research is not intended to influence treatment in real time. Rather, it is intended to provide or reinforce a scientific basis for the treatment, or to test a new hypothesis about an established, accepted treatment.
Treatment and preventive medicine that are not yet considered “standard” or approved by the U.S. Food and Drug Administration (FDA) should be subjected to formal research before they are implemented in practice.
In short, according to the IBR, nursing research that uses human subjects must be “designed, reviewed, approved and implemented in accord with the accepted ethical principles and the U.S. Department of Health and Human Services and U.S. Food and Drug Administration regulations.”
When a formal research program is established, it is based upon the three basic principles of ethics from the Belmont Report.
Respect for Persons
There are two elements within this principle: People should be treated as autonomous agents, and people without autonomy are entitled to protection.
Researchers must defer to the self-determination of individuals and must never inhibit the person’s freedom to act. Research subjects who possess autonomy must agree of their free will to participate in a research project, otherwise, the project itself is considered unethical.
It is no coincidence that the ethical code espoused by the American Nurses Association also incorporates the term beneficence. It is a fancy way of saying that nurses, and researchers, should practice compassion and empathy when interacting with patients in any way.
The short definition of beneficence is acting on behalf of another’s benefit. Its inclusion among the three Belmont Report principles was intended, in part, to incorporate the “do no harm” concept made famous by the pop-culture version of the Hippocratic Oath.
The Belmont Report explicitly states that medical researchers should pledge to not harm subjects and to maximize the possible benefits while minimizing the possible harm.
This ethical principle is intended to ensure that results of nursing research are distributed fairly among those who deserve it. It also is intended to reinforce the first two principles, and the Belmont Report explicitly mentions the Tuskegee experiment and the Nazi concentration camp atrocities as examples of human cruelty that masqueraded as “research.”
The principle also states that it is unethical for publicly funded research results be withheld from members of the public simply because they are unable to pay for it.
In short, nursing research that uses human subjects must be “designed, reviewed, approved and implemented in accord with the accepted ethical principles and the U.S. Department of Health and Human Services and U.S. Food and Drug Administration regulations.”
Nursing theory and research is a core component of the online nursing curriculum at Jacksonville University’s Keigwin School of Nursing. It follows that the capstone course for an MSN in Clinical Nurse Educator degree is a research-based project in which the student is expected to integrate the concepts and research principles learned throughout the educational experience.