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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?




Evidence-Based Practice and Research Program Transcript NARRATOR: Through research, nurses can improve patient care and contribute new knowledge to the profession. In this program, Dr. Marianne Chulay explores the close relationship between research and evidence-based practice. MARIANNE CHULAY: So what is evidence-based practice? Well, evidencebased practice is basing your nursing interventions and your actions with patients on the latest research. So as you're caring for patients, you might be asking questions about, is this the best way to do this? We should be referring to research to answer that question, not relying on this is the way we've always done it. Or maybe, for example, as you're getting policies and procedures ready at your facility, you should be looking to the research to guide what the steps in that procedure are as you're, for example, providing endotracheal suctioning to a patient. Another area where we need to have evidence-based practice is when we make equipment purchases or when we decide to use a piece of equipment on a patient. So there's a variety of circumstances under which research should be guiding our actions with patients. And that's really what evidence-based practice is all about. Well, what might be an example of how evidence or the research has really formed the basis of the way we care for patients? Well, think about intravenous therapy practices that we have today. Today, we're changing intravenous therapy equipment every three or four days at the most frequent. But have any of you remembered a time when we did it more often than that? How often did you change it, Vickie? © 2013 Laureate Education, Inc. 1 Evidence-Based Practice and Research VICKIE: Every 24 hours. MARIANNE CHULAY: Yeah, and that wasn't all that long ago. Probably 10, 15 years ago we were frequently changing intravenous therapy equipment. Because at that time, we didn't have research that told us how often we needed to change it. We thought that made a lot of sense to cut down in infection rates. But lo and behold, since we have research now that's been done, we've come to find out that not only is it not better to do that, it actually increased our infection rate to change the equipment every day. So today, we change our intravenous therapy equipment with patients every three to four days, basically. So that's a huge change in practice that was totally based on research. And that's what it means to have evidence-based practice. Another great example is care of the cardiovascular patient. People who had myocardial infarctions and came to the hospital 25 years ago, I mean, can you remember how long we used to keep them in bed? FEMALE SPEAKER: A week or two sometimes. MARIANNE CHULAY: Yeah. So today, we know that not only is that not very good at all to do them, we try and mobilize them very rapidly. We know that things like having a patient use a bed pan is actually a much more physically strenuous activity, particularly on myocardial oxygen consumption, than allowing the patient to get up out of bed and go to the bathroom. So we've learned to guide our nursing practices by looking at research to tell us what's the best way. Because again, both of those examples are situations where it seemed to us at the time that that made the most sense. It would be the best care to patients. But actually, as research began to unfold and guide the way, we realized that those practices really were actually putting patients in a harmful situation. So evidence-based practice means that we are going to base our nursing interventions and activities on research, if it's available. Or if not, we're going to look to the experts in the field to tell us what is probably the best way to care for © 2013 Laureate Education, Inc. 2 Evidence-Based Practice and Research patients based on the theory that we have to date, until we do get the evidence we need. Well now, what do you think the level of evidence is that we have to form some of our current practices with patients? A great example might be we use sequential compression devices in order to prevent deep vein thrombosis in pretty much any patient who's hospitalized, certainly who's going to be immobilized. Is that well grounded in evidence do you think, or is that one of our practices where we just kind of do it because we think that's probably the best way to do it? Any thoughts? VICKIE: I actually thought there was research out there on that. MARIANNE CHULAY: There is. There actually is. We have quite a bit of evidence about the use of sequential compression devices. And in fact, we know targeted patient populations where that intervention is particularly helpful, for example, the trauma patient. They're at particularly high risk for deep vein thrombosis. So it's been very effective in them. But, an example of what we don't know, because we don't have any research to guide our practices, should we be using elastic TED stockings with sequential compression devices? We don't really know the answer to that yet. So while we may do that in practice, we really are basing that not on research, but on, well, we think that might be helpful. And in fact, the experts don't even have a recommendation on that. They just don't know until we get more research. What about something like oral care to prevent ventilator-associated pneumonia? Now, there's another thing that's being talked about quite a bit in the literature right now. Do we have a strong research basis for oral care and prevention of ventilator-associated pneumonia? VICKIE: There's some literature out there, but I don't think that there's been a lot of research in that area as of yet. © 2013 Laureate Education, Inc. 3 Evidence-Based Practice and Research MARIANNE CHULAY: You're exactly right, Vickie. We have a little bit. We're not quite there yet. And so, in fact, we're trying to encourage research in that area right now to help guide our practice with. Is it important to be doing oral care? And if so, what type of oral care? So those are some examples of how the evidence that we have may be very weak for a practice or very strong. In the case of sequential compression devices, we have a fair amount of research.

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Laureate Education (Producer). (2012d). Evidence-based practice and research. Baltimore, MD: Author.