Ethics of Best Practice
Answer 6 sections
Introduction and Purpose of the Paper
1. Describe the frequency and composition of Review Committee
2. Functions of a Nursing Review Committee
3. Describe the guidelines for critiquing the ethical aspects of a study
a). Thoughts regarding these guidelines
b). Are they necessary
c). Why or why not
4. What are the levels of reviews by the Institutional Review Board (IRBs)
a). Explain the different levels
b). Are you familiar with IRBs
c). The functions of an IRB
d). Yes, we have an IRB Committee
e). Meets monthly
5. What is an Informed Consent. What are the general requirements for an Informed Consent
6. Review the American Nurses’ Association (ANA’s
Code of Ethics for Nurses.
a. Describe an ethical concern
b. How it is addressed by a healthcare organization
Ethics of Best Practice
Ethics of Best Practice
The healthcare system is a dynamic process experiencing new and complex issues that require nurses to apply the best practice to protect the scope of nursing practice. Nurses are sometimes challenged to deal with conflicting issues such as patient need for autonomy and care guidelines. Therefore, it is essential to assess the effectiveness of nursing practice regularly and develop the best nursing practice to maintain and elevate nursing standards. The review committee plays a substantial role in evaluating the effectiveness of the adopted caring practice and making judgments considering the elements of care, such as patient safety, quality, and practice advancement. This paper expounds on the functions of the review committee in nursing practice while reviewing the American Nurses Association (ANA’s) Code of Ethics, including a prevalent ethical concern and how it is addressed.
Frequency and Composition of Review Committee
The frequency of review committee meetings depends on the ground rules set at the first meeting. The frequency of the review is mainly once monthly, and the chair of the committee leads the meeting. The research and clinical agenda are decided during the first meeting, which can be short-term or run for three to five years (Zavotsky & Wolf, 2018). The nursing review committee comprises of clinical and non-clinical staff, including clinical nurse specialists, quality improvement (QI) representatives, pharmacists, risk management representatives, nurse managers and leaders, and local community representatives (Zavotsky & Wolf, 2018). Members may be recruited based on interests or be directed by the clinical and administrative leadership to come together and review the issue of concern. Nurses across specialties are involved in the review process to provide a broader perspective on the clinical issue and solutions that best address the matter (Zavotsky & Wolf, 2018). The committee may also include lab technicians and security personnel.
Functions of a Nursing Review Committee
The nursing review committee systematically evaluates, monitors, and judges the quality of nursing care using professional standards. It actively monitors the standards of nursing practice and provides regular feedback to elevate the quality of care through increased patient safety, practice advancement, and role actualization (Roy et al., 2020). Also, the nursing review committee review and develops evidence-based protocols, procedures, and policies while partnering with the quality assurance department to enhance patient care. In addition, the nurse review committee may set a research/evidence-based practice agenda that reflects on the organization’s practice model, including the overall mission and vision (Zavotsky & Wolf, 2018). They also prioritize the most critical issues that must be reviewed in the organization while reflecting on contemporary health issues of concern in the care setting.
Guidelines for Critiquing the Ethical Aspects of a Study
Several guidelines exist for critiquing the ethical aspects of a study. The heart of the ethical review is the existing ethical principles of beneficence, equality, and autonomy. It is essential to assess the validity and reliability of the research, which describes the accuracy of methods, tests, and approaches adopted in conducting research (Hasan et al., 2021). Validity entails identifying precision, while reliability focuses on consistency. Both quantitative and qualitative research should evidence substantial dependability and validity.
The topic of study must be accurate, realistic, engaging, new, problematic, contemporary, and ethical. Critique for the topic entails identifying whether the researcher considered the possibility of the study harming others and the moral issues that may arise from the topic. Research methodology is critiqued based on truthfulness, privacy, reporting data, and confidentiality (Hasan et al., 2021). Consideration is made of all aspects of the research methodology, including the research design and sampling techniques, data collection tools, data collection, and analysis, which must be conducted ethically.
Ethical guidelines for critiquing study results identify whether the results reflect the research finding. Results must support the hypothesis and should not be altered by the authors. In the discussion, the study’s results must be authentic in evaluating independent and dependent variables (Hasan et al., 2021). Also, ethical guidelines for critiquing a study require all references to be authentic and accurate. Ethical concerns in the citation may include using fake citations in validating or invalidating the study or citing sources unrelated to the current study.
Thoughts Regarding these Guidelines
These guidelines provide the framework for conducting research effectively while adhering to moral principles. They act as an avenue for eradicating the mistakes in a study that may misguide the readers. They also provide a framework for increasing the accuracy and reliability of any study conducted while eradicating any form of discrimination by the authors.
The Necessity of the Guidelines and the Reason
These guidelines are necessary for any form of study. This is because they ensure the study’s authors do not conduct it to meet their expectation or desires but instead follow the proper process and present results more coherently. Therefore, they act as a basis for monitoring the actions of authors and noting any malpractices that may exist from the development of the topic to the citing of sources. Readers will therefore be confident that any study they use is based on evidence, not guesswork.
Levels of Reviews by the Institutional Review Board
The Institutional Review Board (IRB) has three review levels: exempt, expedited, and full board review. Exempt review is conducted when research involves minimal risks with a small magnitude and probability of anticipated harm or discomfort (Lapid, 2019). This may include research conducted on commonly or established educational settings such as classroom management methods or if the study involves educational tests such as cognitive and diagnostics, interview procedures and public behavior. Information must be recorded in a way that the research participants cannot be identified either directly or by use of identifiers related to the subject (Lapid, 2019). Exempt review is also adopted where the research involves public officials and does not involve anonymous questions. Studies involving existing data, records, documents, and pathological specimens also fall under exempt review. In addition, an exempt review may be applied if the research has been conducted under the approval of a department or agency head and aimed at examining the public benefits of a given program, change alternatives, and beneficial procedures.
An expedited review is adopted if the research does not have more than minimal risks or in case of minor changes in previously approved research. One or more IRB members conduct the review rather than the full board (Lapid, 2019). Researches that fall under the expedited review include those involving materials such as records, documents, data, or specimens collected solely for non-research purposes, data collected from voice, image, digital, and video recordings, and research on individual or group characteristics such as cognition, perception, identity, cultural belief and practices, language and social behavior. Exempted review is also applied for continuing review of research where the subjects have completed all research-related interventions, there is no enrolment of new subjects, and the research is active only for long-term follow-up of subjects (Lapid, 2019). In addition, this review may be used for research activities limited to data analysis or those in which the subject’s additional risks for enrolled subjects have been identified.
Full board review is used when research risks are greater than minimal or if research does not meet the exempt and expedited categories. Researches that may need full board review include those in which IRB reviewers have done a full review as required and concluded that the research should not be approved (Lapid, 2019). Also, if research involves vulnerable populations such as pregnant women, prisoners, mentally and cognitively compromised, and seriously ill may need full board review. Research involving individuals with less than 18 years also require a full board review. If the research involves sensitive information on the subject matter, such as sexual behavior, drug and substance use, or financial aspects, and where the participant has been assured that their response will be kept confidential, then a full board review will be necessary (Lapid, 2019). Finally, a full board review may be needed when the research involves obtaining and recording behavior that may put the subjects at risk of civil liability, stigmatization, or damaging their insurability, employability, financial standing, or reputation.
Familiarity with IRB
I am familiar with IRB since my working unit has a review board. Meetings are held every month where an assessment is done to ensure that all studies adhere to the established standards while identifying possible risks that may result from this research. My knowledge of IRB extends to its activities and process undertaken in reviewing research and determining which level of review is the most appropriate based on the adopted procedures, process, and research progression.
Functions of IRB
IRB is appropriately and formally designated under federal regulation to monitor and review biomedical research involving human participants. As per the US Food and Drug Administration (FDA) regulation, IRB is authorized to approve, recommend modifications for approval securing, or disapprove any research if it is too risky to the subjects (Lapid, 2019). IRB’s primary purpose is to ensure that the rights, well-being, and welfare of individuals participating in research activities are protected per federal regulations. It champions for the research protocols to respect individual autonomy, justice, and beneficence, including informed consent and compliance assurance (Marzinsky & Smith-Miller, 2019). It has diversified members from ethnic, cultural, racial, gender, and minority groups for the review to be equipped with broad expertise beyond the specific research matter. This ensures that a comprehensive review is done beyond the scientific merit to include the legal, social, and institutional perspectives (Lapid, 2019). The board also evaluates whether the research complies with the ethical principles laid down by federal regulation.
Informed Consent
Informed consent is the process of educating subjects or participants in nursing research or medical care about the benefits, risks, and available alternatives of a certain intervention or procedure (Shah et al., 2022). The subject must be able to make a voluntary decision on whether to participate in such intervention or procedures. Informed consent is both a legal and ethical obligation of medical practitioners in the US, originating from the rights of patients to decide what happens with their bodies (Shah et al., 2022). It involves the collaboration between healthcare professionals and patients whose ability to make informed consent must be respected. Therefore, patients’ unique preferences and priorities must be accounted for in the informed consent process while considering the best available scientific evidence.
Requirements for Informed Consent
The state determines the requirements for informed consent standards. However, a general legal requirement must be fulfilled in the process of making informed consent. The subject standard requires the human participant to be informed of all relevant processes involved in the study, which may directly impact them to make an informed decision (Shah et al., 2022). This includes the procedure’s nature, benefits, risks resulting from the procedure, possible alternatives, and their benefits and risks. Also, the patient must be competent to make decisions on their own. They must not be in any form of illness or physical state that may defect their judgment (Shah et al., 2022). Finally, consent must be made voluntarily, where the patient’s decision-making ability is respected. Patients must not feel as if they are being forced to agree with the provider.
Code of Ethics for Nurses
Ethical Concern
Provision, 4 of the ANA’s code of ethics requires nurses to make decisions and take actions consistent with providing optimal care. Accountability in all aspects of nursing care must align with decision-making (Haddad & Geiger, 2022). The authority must be professional and considerate of the ethical concerns resulting from individual and patient decisions. Decisions must be well thought out, purposeful, planned, and implemented responsibly while considering the unique needs of patients. In their actions, nurses must consider the ultimate results of their decisions, including any possible harm or risk to the patient and self. This is a major ethical concern due to the existing guidelines and the rights of patients to make their own decisions based on their values and beliefs (Haddad & Geiger, 2022). For instance, patients can refuse treatment, medications, surgery, or other clinical interventions regardless of their effectiveness. In such situations, nurses are expected to respect the choice.
Addressing the Ethical Concern by Healthcare Organizations
To address this ethical concern, healthcare organization invests heavily in the training and education of healthcare team to enhance their ethical competencies. Providers are educated on common interventions and procedures that may be adopted in an ethical dilemma and the significance of collaborating with the patient throughout treatment (Hoskins et al., 2018). For instance, the patient may be refusing the adopted plan because the provider did not disclose all relevant information relating to the adopted plan. Therefore, equipping nurses with relevant skills and knowledge provides a critical foundation for dealing with ethical issues that may arise. The training focuses on truth-telling, protecting the patients’ rights and welfare, informed consent, and involving stakeholders such as family in decision-making (Hoskins et al., 2018). Therefore, nurses are prepared to collaborate with other team members in sharing their voices if confronted with ethical issues.
Conclusion
Review committees have been instrumental in initiating efficient measures and interventions to increase the reliability of healthcare research. Ethical guidelines act as directives for reviewing and critiquing the effectiveness of the study so that it does not end up providing false evidence. In addition, the IRBs have been instrumental in analyzing and determining the risks involved in any research to protect the rights and well-being of research participants. For instance, all studies must document informed consent by the participants once they have been adequately informed of the research procedures and interventions, risks involved, and alternatives. In addition, nurses must consider ethical concerns that may arise in their daily interactions with patients. Patient autonomy must be respected, and any decision-making by the nurse must aim at improving the patient’s health outcome. Providing adequate training and education to nurses increases their competence in handling ethical dilemmas that may compromise the quality of care.
References
Haddad, L. M., & Geiger, R. A. (2022). Nursing ethical considerations. https://www.ncbi.nlm.nih.gov/books/NBK526054/
Hasan, N., Rana, R. U., Chowdhury, S., Dola, A. J., & Rony, M. K. K. (2021). Ethical considerations in research. Journal of Nursing Research, Patient Safety, and Practise (JNRPSP) 2799–1210, 1(01), 1–4. http://journal.hmjournals.com/index.php/JNRPSP
Hoskins, K., Grady, C., & Ulrich, C. M. (2018). Ethics education in nursing: Instruction for future generations of nurses. OJIN: The Online Journal of Issues in Nursing. https://doi.org/10.3912/OJIN.Vol23No01Man03
Lapid, M. I., Clarke, B. L., & Wright, R. S. (2019, March). Institutional review boards: What clinician researchers need to know. In Mayo Clinic Proceedings (Vol. 94, No. 3, pp. 515–525). Elsevier. https://doi.org/10.1016/j.mayocp.2019.01.020
Marzinsky, A., & Smith-Miller, C. A. (2019). Nurse research and the institutional review board: Learn how the IRB process works to ensure participant safety and quality research. American Nurse Today, 14(10), 20-25. https://www.myamericannurse.com/nurse-research-and-the-institutional-review-board/
Roy, L., Price-Ward, K., Benjamin, N., & Cooper, S. B. (2020). Developing a clinical nurse-led peer review committee. Nursing2022, 50(4), 1-4. https://doi.org/10.1097/01.NURSE.0000659228.11830.33
Shah, P., Thornton, I., Turrin, D., & Hipskind, J. E. (2022, June 11). Informed consent – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK430827/
Zavotsky, K. E., & Wolf, L. A. (2018). Building an institutional research committee: getting started. Journal of Emergency Nursing, 44(3), 308-309. https://doi.org/10.1016/j.jen.2018.01.017
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