Select one of the 4 research studies in your text (page 31), discuss the following: Given an overview of the study, what makes this a vulnerable population, what rights were violated, what could have been done differently, and what was the response to the violation? What is your role as a BSN-prepared nurse in regard to research and protecting vulnerable populations in the practice setting?
this is the chapter;
Nurses who work in clinical settings and who are prepared at the doctoral level are especially well positioned to move EBP forward. Healthcare facilities are expected to embrace EBP to achieve Magnet Recognition. International collaborations, such as the Joanna Briggs Institute, are essential so that when best practices are identified they can easily be shared.
FYI
The Doctor of Nursing Practice degree is the recommended educational requirement for those entering advanced practice nursing. Nurses who are prepared at the doctoral level and who practice in clinical settings can serve as leaders in EBP.
The Challenge
Make a commitment to be an innovator when it comes to EBP! You are already well on your way to having the knowledge and skills needed to overcome barriers that laggards often cite as reasons for not adopting EBP. As you study this text, dont go through the pages just to pass an exam. Learn the material so you can carry it with you throughout your career. To fulfill your commitment, with your next clinical assignment, adopt one or two of the strategies suggested in Table 1-1. Over the course of your career, your actions will convince laggards that EBP really does create excellence in patient care.
CRITICAL THINKING EXERCISE 1-5
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Recall a question you encountered during your last clinical experience. How might you have answered that question using an EBP approach?
TEST YOUR KNOWLEDGE 1-4
1. How can nurses who use EBP best be described?
a. As change agents
b. As early adopters
c. As innovators
d. As laggards
True/False
2. As the cycle of science continues, more middle range and practice theories will emerge that will be useful in clinical settings.
How did you do? 1. b; 2. T
1.5 Keeping It Ethical
At the end of this section, you will be able to:
Identify five unethical studies involving the violation of the rights of human subjects
Scientific research has made significant contributions to the good of society and the health of individuals, but these contributions have not come without cost. In the past, studies have been conducted without regard for the rights of human subjects. It is surprising to learn that even after national and international guidelines were established, unethical scientific research continued. Four major studies involved the violation of the rights of human subjects: (1) the Nazi experiments, (2) the Tuskegee study, (3) the Jewish Chronic Disease Hospital study, and (4) the Willowbrook studies. In addition, falsification and fabrication of data by the Red Wine Researcher provide another example of misconduct.
During World War II, physicians conducted medical studies on prisoners in Nazi concentration camps (NIH Office of Extramural Research, 2011). Most of the Nazi experiments were aimed at determining the limits of human endurance and learning ways to treat medical problems faced by the German armed forces. For example, physicians exposed prisoners of war to mustard gas, made them drink seawater, and exposed them to high-altitude experiments. People were frozen or nearly frozen to death so that physicians could study the bodys response to hypothermia. The researchers infected prisoners with diseases so that they could follow the natural course of disease processes. Physicians also continued Hitlers genocide program by sterilizing Jewish, Polish, and Russian prisoners through X-ray and castration. The War Crimes Tribunal at Nuremberg indicted 23 physicians, many of whom were leading members of the German medical community. They were found guilty for their willing participation in conducting crimes against humanity. Seven physicians were sentenced to death, and the remaining 16 were imprisoned. As a result, the Nuremberg Code, a section in the written verdict, outlined what constitutes acceptable medical research and forms the basis of international codes of ethical conduct. The experiments conducted were so horrific that debate continues about whether the findings from these Nazi studies, or other unethical studies, should be published or even used (Luna, 1997; McDonald, 1985; Miller & Rosenstein, 2002), and professional organizations, such as the American Medical Association (AMA), have published position papers about this dilemma (AMA, 1998).
Nazi experiments: An example of unethical research using human subjects during World War II
Nuremberg Code: Ethical code of conduct for research that uses human subjects
In the 1930s, the Tuskegee study was initiated to examine the natural course of untreated syphilis (NIH Office of Extramural Research, 2011). In this study conducted by the U.S. Public Health Service, black men from Tuskegee, Alabama, were recruited to participate. Informed consent was not obtained, and many of the volunteers were led to believe that procedures, such as spinal taps, were free special medical care. Three hundred ninety-nine men with syphilis were compared to 201 men who did not have syphilis. Within 6 years, it was apparent that many more of the infected men had complications compared with the uninfected men, and by 10 years, the death rate was twice as high in the infected men as compared with the uninfected men. Even when penicillin was found to be effective for the treatment of syphilis in the 1940s, the study continued until 1972, and subjects were neither informed about nor offered treatment with penicillin.
Tuskegee study: An unethical study about syphilis in which subjects were denied treatment so that the effects of the disease could be studied
FYI
In the past, research was conducted with human subjects who were not fully informed of the purpose and/or methods of the study. Today, studies must be reviewed to ensure that human subjects are protected.