Healthcare ethics, also referred to as medical ethics or bioethics, is a set of moral principles, beliefs, and values that guide us in making choices about medical care. In the United States, there are four main principles that define the ethical duties healthcare professionals owe to patients: (1) Autonomy, (2) Beneficence, (3) Nonmaleficence, and (4) Justice.

Define and discuss these four principles. In your discussion, provide a healthcare related example of each principle (you can provide an example of either preserving or neglecting).

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.

Reference:
Skloot, R. (2010). The immortal life of Henrietta Lacks. New York, NY: Crown Publishing Group.

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?

Post  a (1) description of the case that you selected and the ethical issues involved. (2) 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). (3) Suggest how the research might have been conducted differently to avoid or minimize the ethical problems. (4) Discuss how research can be done on sensitive issues while still protecting the rights of the rights of the research subjects

Readings

• Polit, D. F., & Beck, C. T. (2012).  Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom ed.).Philadelphia, PA: Lippincott Williams & Wilkins.
  • 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 article in the health sciences. Retrieved from http://danaguides.uvm.edu/content.php?pid=41591&sid=3177873

  This article highlights the primary components of scholarly research articles. The article 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://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf  

  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)

Media

• Laureate Education, Inc. (Executive 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, Inc. (Executive 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, Inc. (Executive 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.phphe research subjects.

An understanding of the factors surrounding women’s and men’s health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient. 

Effective disease analysis often requires an understanding that goes beyond the human systems involved. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact..

An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health. 

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Assignment (1-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following as it applies to the scenario you were provided (not all may apply to each scenario):

• Anemia and the different kinds of anemia (i.e., micro and macrocytic).

Scenario: 67-year-old female presents with chief complaint of shortness of breath, fatigue, weakness, unintentional weight loss, and mild numbness in her feet. She states she feels unsteady when she walks. PMH includes hypothyroidism well controlled on Synthroid 100 mcg/day. No hx of HTN or CHF.

Vital signs: Temp 98.7 F, pulse 118, Respirations 22, BP 108/64, PaO2 95% on room air.

Physical exam revealed pale, anxious female appearing older than stated years.

HEENT- pale conjunctiva of eyes and pale palate. Tongue beefy red and slightly swollen with loss of normal rugae. Turbinates pale but no swelling. Thyroid palpable but no nodules felt. No lymph nodes palpated.

Cardiac-regular rate and rhythm with soft II/VI systolic murmur. Respiratory- lungs clear with no adventitious breath sounds. Abdomen-soft, non-tender with positive bowel sounds. Liver edge palpated two finger breadths below right costal margin. Lab data- hgb, hct, reticulocyte count, serum B12 levels low, mean corpuscle volume, plasma iron, and ferritin levels high, folate, TIBC are normal.

 T/week 5/discussion

Topic 1

Generate a list of questions you will ask during the interview such as teaching strategies, theories, technology, and evaluation techniques.

Conduct the interview.

Your discussion post should include:

The setting.

How the interview was conducted.

The questions asked and the responses given.

Anything else you think to be important.

Setting: Hospital – Director’s Office

The interview was conducted as a one-on-one informal discussion in the Director’s office at the hospital during day shift. There were a few interruptions including a code blue however, we eventually got through it and it was very interesting and informative.

Interview Q&A

Q. Please share with me an example of how you helped coach or mentor someone. What improvements did you see in the person’s knowledge or skills?

A. Early in my nursing career, I worked on the Med-Surg unit and was orienting a new nurse to the unit. She had a patient that was very ill and had multi-organ failure. She was waiting for a hospice consultation when the patient coded. At that time, the patient was a DNR therefore she was not resuscitated. The nurse felt helpless and did not’t know what to do. She literally broke down in tears. I had a one-on-one conversation with her and explained the of end of life process and shared my first experience when I lost a patient. She later came back to me and thanked me for sharing with her as it was very helpful to process hers.

Q. Tell me how you organize, plan, and prioritize your work.

A. I begin each day with staffing which sets the stage for the rest of the team and the day. After staffing I meet with the day shift nurses, prior to them getting report to review and discuss any concerns or new implementations. I then meet with other directors and bed management to evaluate our bed availability and what needs to be done with any transfers or discharges. This information is communicated with the charge nurse and he or she will use this information to plan their day. Obviously, there are many obstacles that may arise or issues that may need to be resolved throughout the day which can’t be planned for. At the end of the day there is another staffing meeting to prepare for the next day. I guess you can say each day begins with and ends with staffing, the backbone to a successful unit and patient experience.

Q. Please share an experience in which you presented to a group. What was the situation and how did it go?

A. I have presented to groups on multiple occasions however, the one that comes to mind is my first. At the time, I was promoted to Clinical Coordinator. I had never been in a management position before and was extremely intimidated and anxious when I had to conduct my first staff meeting. I prepared several days in advance and even rehearsed how I would run the meeting. I did not’t sleep the night before and was worried I would fail my director. Everyone gathered in the break room and I handed out the agenda. At that time, I realized I had nothing to worry about and this was my team. I conducted the meeting flawlessly and took a deep breath when it was over and smiled. 

Q. Share an example of when you went above and beyond the “call of duty”.

A. Wow, that is a tough one. I don’t know that I can remember one in particular. I think it is something I do on a daily basis or whenever the situation arises. I believe that being a nurse you often do more than you are “asked” to do. That is what makes our field and profession different from others. We take care of people. It’s an amazing career.

Q. In your experience, what is the key to developing a good team? 

A. I believe the key to developing a good team starts with good communication. Which includes listening to staff complaints and concerns. If something isn’t working you can try to figure out a solution or how to resolve it. If you don’t know what is wrong, you can’t fix it. Treating others with respect is also key as it promotes professionalism and a positive attitude. All of which are important elements in a good team as well as many others.