Ethics and nursing research. 2: Examination of the research process

Ethics and lactation consultants: developing knowledge, skills, and tools

This article studies the role of ethics in the context of the work of International Board Certified Lactation Consultants. It provides an overview of some of the main ethical approaches with the goal of contributing to the knowledge, skills, and tools required by lactation consultants. Five main sections structure the article: background, current literature, ethical theory and principles, implications for lactation consultants, and decision-making frameworks. Background about the International Board of Lactation Consultant Examiners and International Board Certified Lactation Consultants and the significance of applied ethics in their work are described. Current literature regarding ethics and lactation consultants is reviewed. Because a computer-based literature search yielded a lack of articles, ethics in nursing literature is also presented. Three main ethical theories and 5 key ethical principles are explored with a view to their implications for lactation consultants. Finally, decision-making frameworks are considered as systematic tools for making ethical decisions.

A study on how mental health practitioners address ethical issues in clinical audit

Although much debate has taken place within the literature on the differences between research and clinical audit, the ethical dimensions of audit have frequently been neglected. Furthermore, no research has of yet explored what ethical issues auditors consider in relation to their projects or how they manage them in practice. Using data collected from audit documentation, semi-structured interviews and a researcher-administered questionnaire, this study sought to advance this position by exploring how 14 clinicians undertook audits in one mental health Trust addressed the ethical dimensions of their project. Analysis of the data revealed that the Trust had no formal mechanisms for reviewing and monitoring audit projects whilst other informal mechanisms were not utilized by all auditors. A number of projects had contact with both clinicians and service users through interviews, focus groups and questionnaires; however, issues such as informed consent, confidentiality and anonymity were not adequately addressed by auditors. The implications of these findings are discussed and recommendations for practice outlined.

Interaction between caregivers and families expecting a malformed child

BACKGROUND

Earlier research has shown that the care of families expecting a malformed child should be intensified and that the topic is understudied.

AIM

This study aimed at generating a practical nursing theory of interaction between caregivers and families expecting a malformed child, as experienced by families.

METHODS

A grounded theory study was undertaken at a university hospital, Finland. Data consisted of semi-structured interviews with 29 mothers and fathers, analysed using the constant comparative method.

FINDINGS

The interaction process starts with the confirmation of the diagnosis. It usually comes as a shock to the parents, and gives rise to questions about the nature of the malformation, family members' relationship with themselves, family relationships and relationships with people outside the family. These questions are crucial to the family's coping and form the core of interaction. Families' own coping strategies are either reinforced or undermined by caregivers' actions and are reflected in parents' expectations about caregivers, which in part account for their actions and experiences of interaction. The care system as an interactive environment is part of a process which results in the experiences of being helped or being left without help. The core of the interaction process comprises two dimensions: gaining strength and losing strength in relation to malformation issues.

CONCLUSIONS

The findings of the study are consistent with earlier research and complement it by providing a detailed delineation of the interaction from the perspective of the family. They can be used to formulate recommendations for improving caregivers' interactive skills and awareness of the topic through training. The care system should be developed to ensure that families receive psychological support and that the family as a whole receives proper care. Consideration of the viewpoint of siblings is a challenge for further research.

Research-based care on an acute inpatient psychiatric unit

Many studies of research-based practice in nursing highlight factors that impede the development of practice. With the aim of adding to this body of knowledge, a modified grounded theory approach was used in order to understand more about these barriers and how individual nurses utilize research in their practice. A selective sample of five staff nurses from one acute inpatient psychiatric unit took part in semi-structured interviews. Three main themes were identified, each with two sub-themes. These were (a) activities to utilize research with (i) a 'systematic' model and (ii) a 'latent' model of research utilization (b) enhancing research utilization with (i) organizational culture and (ii) individual attitude and knowledge and (c) impeding research utilization with (i) resources (ii) resistance to change. It is suggested that for these nurses research utilization occurs through their individual knowledge, skill and motivation coupled with organizational commitment. Recommendation is made that further investigation of the 'systematic' and 'latent' models should be carried out. Additionally, it is suggested that these research findings might be used to inform future training, further research-based initiatives and to raise managerial awareness of the impeding factors of research utilization.

Quality issues in clinical research and the implications on health policy (QICRHP)

Scientific (research) misconduct relating to fraudulent behaviors, plagiarism, and violations in research protocol is extant in the literature. These behaviors result in inadvertent infringement on subjects' rights, safety, and confidentiality, and can negatively impact the implementation of health policies. Funding agencies, legislators, regulators, clinicians, and scientists continue to subject researchers' work to scrutiny and in-depth analyses to evaluate its quality because of increased reports of scientific misconduct. Therefore, clinical researchers are motivated to restore and maintain credibility throughout clinical trials to regain public trust because of adverse publicity. Quality in clinical research addresses the study's integrity and merit, which has important practice and policy implications. Study integrity and merit encompass both the scientific and ethical components of clinical research studies. Researchers suggest using structured evaluation processes, educating, and mentoring aspiring scientists on scientific integrity to prevent scientific misconduct. In addressing these issues, this article explicates and provides a synthesized critique of quality issues in clinical research, analyzes its implications on health policy and clinical practice, and proposes a systematic framework to evaluate clinical research studies.

Radiation-induced skin reactions. 3: Evaluating the RISRAS

This article, the last in a three-part series, reports the methods used to evaluate the Radiation-induced Skin Reaction Assessment Scale (RISRAS), along with the results. For a newly developed tool, the results of the elementary reliability and validity testing were satisfactory. The RISRAS could be used in clinical practice following revision and further development and its introduction into clinical oncology practice is recommended as it will improve the assessment process of radiation-induced skin reactions and lead to better care for those patients undergoing radiotherapy. In the first article in the series (Vol 8(17): 1134-40), the extensive nature of radiotherapy-induced skin reactions were reported, along with their significance for the patient undergoing radiotherapy. Previously described assessment scales were examined in preparation for the development of the RISRAS. In the second article (Vol 8(18): 1208-11), the need for holistic yet specific assessment of these reactions was demonstrated and the methods used to develop the RISRAS were described.