Ethics In Critical Care Nursing Research

Ethical Foundations for Critical Care Nursing Research

Critical care research is essential to advance the science that improves the overall care and well-being of critically ill patients and their families. Yet, it also raises significant ethical issues, especially when critically ill or injured patients become research participants.

As integral members of the healthcare team, critical care nurses may be actively involved in research at various levels within the critical care environment.

For example, critical care nurses might be part of research teams recruiting human participants or principal investigators responsible for the development, conduct and analysis of their own studies; or, they might be caring for patient-subjects at the bedside where research procedures are being implemented.

Regardless, understanding ethical aspects of the responsible conduct of research is necessary for all individuals who care for critically ill patients and their families.

In addition, ethical issues might arise with respect to the day-to-day operations of running a study, including informed consent, the feasibility of implementing the protocol design and procedures, disagreements within the team, authorship or perhaps even conflicts of interest.

Guiding Critical Care Nurses in Research

Drs. Therese Richmond and Connie Ulrich have teamed up for AACN to provide a unique guideline (a read-only, prerelease version is available while the formal document is being prepared for publication) for critical care nurses to consider when conducting research with critically ill and injured patients and/or caring for them at the bedside.

Their work is based on the seminal article “What makes clinical research ethical?” (JAMA. 2000;283:2701-2711) by Emanuel, Wendler and Grady. Richmond and Ulrich discuss the importance of several concepts from the article, including scientific value, scientific validity, independent peer review, informed consent, fair subject selection, risk-benefit ratio and respect for persons.

Examples help nurses identify significant research problems and subsequently develop research questions and hypotheses to advance critical care nursing. Several case exemplars shed light on informed consent, parental permission and pediatric assent, favorable risk-benefit ratio, scientific integrity and other relevant issues.

Further, three different types of institutional review board reviews are identified: exempt, expedited and full review. For those who conduct basic science, regulations for the safe care and use of animals in research are also discussed.

Finally, Richmond and Ulrich discuss some of the cross-cutting issues that critical care nurses encounter in the process of research that can potentially create conflict. Such issues may include respondent burden and the emotional state of patients and their families, surrogate decision making, waiver of consent and tensions between clinical care and research.

Throughout the guideline document, the importance of scientific integrity is stressed because all critical care nurses are responsible for the safe care of patients in both clinical care and research.

Read the prerelease version of the guideline by Richmond and Ulrich.