BY DAY 3

Post a description of the case that you selected and the ethical issues involved. Analyze the ethical principles that were breached by the researchers or organizations in your selected case as well as the possible cause of the breach(es). Suggest how the research might have been conducted differently to avoid or minimize the ethical problems. Discuss how research can be done on sensitive issues while still protecting the rights of the research subjects.

NURS 6053 Week 4: Nursing Research for Evidence-Based Practice

Alice: Would you tell me, please, which way I ought to go from here?
The Cat: That depends a good deal on where you want to get to.
Alice: I don’t much care where.
The Cat: Then it doesn’t much matter which way you go.
—Lewis Carroll, Alice in Wonderland

Effective research begins with the careful formulation of a research question. Because this question will guide the entirety of the research process, it is important for the question to be specific, answerable, meaningful, and manageable. The question, “What is the cure for cancer?” is extremely significant, but it is not specific or manageable enough to promote effective research. Conversely, the question, “Are individuals who play the violin on Fridays in March more likely to contract hepatitis?” is very specific but lacks clinical significance. In order for research to generate meaningful, precise findings, researchers must begin by carefully crafting a question. In addition, researchers must also explore ethical concerns related to the question that they select. Taking the time to craft a relevant, well-constructed question will enable the researcher to have an unambiguous focus as he or she proceeds.

This week, you examine different models for developing a researchable question and reflect on the ethical considerations of research. You also formulate a research question using the PICOT model.

Reference:
Carroll, L. (1865). Alice in wonderland. London, UK: Macmillan.

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Learning Objectives

Students will:

• Analyze ethical aspects of research studies
• Evaluate the significance of a health care issue to nursing practice
• Develop an answerable PICOT question for an EBP study

Photo Credit: [JGI/Jamie Grill]/[Blend Images]/Getty Images

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Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 3, “Key Concepts and Steps in Qualitative and Quantitative Research” (for review)
• Chapter 4, “Research Problems, Research Questions, and Hypotheses”This chapter focuses on the steps in planning a study to generate evidence. These include developing a research question, identifying variables, articulating a problem statement, and generating hypotheses.
• Chapter 7, “Ethics in Nursing Research”In this chapter, the focus is on the ethical dilemmas that occur when planning and conducting research and the ethical principles that have been enacted for protecting study participants.

Fouka, G., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science Journal, 5(1), 3–14.
Retrieved from the Walden Library databases.
This article describes a literature review conducted to determine the most important ethical issues that nurses encounter when undertaking or participating in research. The authors detail the results of the review and make recommendations for solving some of the problems highlighted.

Newcomb, P. (2010). Evolving fairness in research on human subjects. Journal of Child and Adolescent Psychiatric Nursing, 23(3), 123–124.
Retrieved from the Walden Library databases.
In this article, the author describes some of the ethical controversies that may arise in conducting research in human subjects, especially with respect to ownership of genes. The author also stresses the importance of educating research subjects and their families about the ultimate purpose of research.

Yakov, G., Shilo, Y., & Shor, T. (2010). Nurses’ perceptions of ethical issues related to patients’ rights law. Nursing Ethics, 17(4), 501–510.
Retrieved from the Walden Library databases.
The authors of this article detail a study conducted to determine how nursing staff deal with ethical issues in relation to the law. The article emphasizes the difficulty staff had in distinguishing between legal and ethical problems. The authors make several recommendations to deal with legal and ethical problems.

Delwiche, F. (2008). Anatomy of a scholarly research presentation in the health sciences. Retrieved from http://dana.uvm.edu/Anatomy/
This presentation highlights the primary components of scholarly research articles. The presentation details the distinguishing factors of scholarly journals, the peer-review process, and the definition of “primary literature.”

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html
This website provides the code of ethics for nurses to be used in carrying out their responsibilities. There is also a detailed explanation of each provision.

Document: Literature Review Summary Table Template (Word document)
Note: You will use this document to complete the Project throughout this course.

Media

Laureate Education (Producer). (2012a). Anatomy of a research study. Baltimore, MD: Author.
This multimedia piece explains the “anatomy” of both quantitative and qualitative research studies. In addition, there is a brief quiz at the end of the tutorial to measure knowledge about research articles.

Laureate Education (Producer). (2012d). Evidence-based practice and research. Baltimore, MD: Author.
Note: The approximate length of this media piece is 6 minutes.
In this video, Dr. Marianne Chulay talks about the significance of evidence-based practice and research in nursing. She explains how nurses should apply research findings to health care decisions to improve outcomes.

Laureate Education (Producer). (2012h). Overview of evidence-based practice. Baltimore, MD: Author.
Note: The approximate length of this media piece is 5 minutes.
In this video, Dr. Kristen Mauk explains evidence-based practice and its importance to nursing. She also provides a brief overview of the process of conducting original research.

Optional Resources

National Institutes of Health Office of Extramural Research. (2011). Protecting human research participants. Retrieved from http://phrp.nihtraining.com/users/login.php
This website provides a course on ethical research for those involved in research in human subjects. The course supplies basic concepts, principles, and issues relevant to protecting research participants.

University of Oxford. (2005). PICO: Formulating an answerable question. Retrieved from http://learntech.physiol.ox.ac.uk/cochrane_tutorial/cochlibd0e84.php

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Discussion: Ethical Dimensions of Research Studies

In the best-selling book, The Immortal Life of Henrietta Lacks (Skloot, 2010), the author highlights the true story of an African-American woman who died in 1951 from cervical cancer. What makes her story unique is that prior to her death, cells from her tumor were removed and successfully grown in a petri dish. This was the first time scientists were able to successfully replicate cells outside the body, and it is estimated that billions of Lacks’ cells have been used in medical research. However, Henrietta Lacks was never asked for permission to take a sample and her family was never made aware of the widespread use of her cells. Although the culturing of her cells has been pivotal for advancing research, strong ethical concerns later arose about using these cells without patient or family approval.

This week’s readings describe historical examples of unethical research, such as a study of syphilis among African-American men in which treatment was withheld and a study in which live cancer cells were injected into elderly patients. Today, stricter controls that seek to protect study participants are placed on researchers, but breaches still occur. Careful attention must be given toward preventing unethical behavior. In this Discussion, you explore ethical considerations and issues in research.

To prepare:

• Select a current health-related case involving research ethics. (If none come to mind, browse the Internet to familiarize yourself with recent cases.)
• As you review the case that you have selected, reflect on the ethical principles discussed in “What Are the Major Ethical Issues in Conducting Research?” article found in this week’s Learning Resources. Which principles were breached in the case you have identified?

By Day 3

Post a description of the case that you selected and the ethical issues involved. Analyze the ethical principles that were breached by the researchers or organizations in your selected case as well as the possible cause of the breach(es). Suggest how the research might have been conducted differently to avoid or minimize the ethical problems. Discuss how research can be done on sensitive issues while still protecting the rights of the research subjects.

Evidence-Based Practice

Mayo Clinic is a non-profit organization that fosters better health wellness through clinical practice, education, and research. The organization focuses on providing expert and whole-person care to the people. Translational research plays an important role in healthcare quality improvement because it helps in the identification of the specific patients’ and public health needs and developing relevant solutions to them. Besides, the organization values inter-professional collaboration. The coordination between physicians, scientists, and community health workers helps in investigating the molecular basis of the patients’ conditions. On the other hand, epidemiologists explore the issue at the population level.

The organization’s vision is to inspire hope and influences the health well-being of people by giving them the best care through integrated clinical practice, education, and research. The vision is consistent with the evidence-based practices (EBP) because it identifies the needs of patients and incorporates the evidence in providing solutions to the needs. The study by Kim et al. (2016), states that lack of understanding among the healthcare providers on the role of evidence-based practices limits its implementation in the healthcare setting. The analysis of the website’s vision shows that the organization’s leadership understands the essentials of evidence-based practices in the patients’ outcomes. The study also reported a positive correlation between the EBP beliefs and its implementation. People who believe in EBP will find it easy to implement it in their areas of operation. Further analysis of the website’s vision statement also confirms their commitment to the EBP. Their vision is to provide an unparalleled experience to the most trusted partners in healthcare. The organization recognizes the contribution of various partners in strengthening the quality of care delivered to the patients (Crabtree, Brennan, Davis & Coyle, 2016).

The Mayo Clinic’s work is grounded in evidence-based practice. The organization integrated the best evidence in managing the patients’ needs. The evidence is obtained from both research and data collected from the patients. For example, the organization focuses on promoting healthy living through regular exercise to eradicate obesity and cardiovascular diseases. The healthcare initiative is supported by the fact that the incidences of obesity are increasing significantly among the populations and this is supported by scientific studies. Furthermore, the study by Boller (2017) indicates that nursing education facilitates safe and quality care delivery. The objectives and modes of operation in the Mayo Clinic support the Triple-A aims as outlined in the study. The Triple-A aims include improving the experience of care, reduce the cost of care, and improving population health. Regular engagement in exercise reduces the cost burdens that could emerge due to the treatment of cardiovascular diseases.

Finally, the information discovered from the Mayo Clinic’s website changed my perception of the healthcare organization. I learned that the institution integrated various modes of practice including research and clinical experiences to improve the quality of care delivered to the patients. Unlike other healthcare organizations that focus on generating wealth, the Mayo Clinic seems to be more interested in improving both the patients’ and population’s health. The integration from various professionals provides sufficient data and expertise needed to address the healthcare needs of the populations. Also, I learned that the organization promotes behavioral changes and this was evident through their initiative to educate people in weight management and physical activeness. There, I have realized that the institution addresses all aspects of human health needs other than the pharmaco-therapeutic interventions.

References

Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot. Journal of Nursing Education, 56(12), 707-708. https://doi.org/10.3928/01484834-20171120-01

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172-175. https://doi.org/10.1111/wvn.12126

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A., & Davidson, J. E. (2016). Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants. Worldviews on Evidence-Based Nursing, 13(5), 340-348. https://doi.org/10.1111/wvn.12171