Evidence Base Nursing - Essay Example

Inconveniencing the Dying Martha Ward is the CNC for a large tertiary care unit. The unit is responsible for clinical trials involving budgets of several million dollars a year. She works directly on one project involving the monitoring of patients in a multicentre trial for carcinoma of the prostate. The patients are randomised into three groups, each receiving a chemotherapy regimen involving at least four drugs. The patients are all seriously ill. They have received conventional treatments, but their disease has progressed. Most of the men in the study are quite elderly, and many have difficulty getting around. Ms. Ward is responsible for maintaining records for the study and for taking routine blood samples, blood pressure readings, weight, and so on. The protocol calls for these measurements to be taken weekly, at which time the patients are expected to come to the hospital. Ms. Ward is used to such procedures. She has worked on research protocols for several years. Many of them have involved patients receiving medications on an out-patient basis and coming to the hospital regularly for data monitoring. She is troubled by the present protocol, however. She knows how difficult it is for her patients, being seriously ill, to come to the hospital. She realises that they have to make the trip weekly and that most of the visits are solely for the purpose of the research. She also knows that Dr. Hanson, the principal investigator for the study, has never considered any variations in the protocol that would ease the burden on these men. She wonders how much the study would be compromised if the data were gathered only when the men needed to come to the hospital for therapeutic reasons. Alternatively, she wonders whether nurses could visit the men in their homes to get the blood samples and other data. Ms. Ward has been involved in other protocols where patients were inconvenienced for the purpose of the study, and in those cases, it did not trouble her; but these men have such a difficult time getting to the hospital and are in such poor health that she wonders whether she should press for a modification in the study? Introduction Nurses face situations and circumstances with regard to their position, status and role which can present specific challenges about making a particular decision or a specific course to be taken. Nurses may play distinct roles including those of researchers, data collectors, managers, practitioners or any third party witnessing research activity (The Royal College of Nursing Research Society: nurses and research ethics, 2003). Regardless of the role played by nurses, it is essential for them to review their actions and their impact on “vulnerable subjects or participants” (The Royal College of Nursing Research Society: nurses and research ethics, 2003). This paper aims to analyze a specific ethical concern faced by a nurse responsible for collecting data from a subject of elderly males undergoing chemotherapy. Would it be ethical to compromise the quality of the data or to increase the costs of the study? Please explain clearly Why? As the principle investigator, Ms Ward is familiar with the ethical principles and the human rights of the subject. It is also Ms Ward’s responsibility to ensure that appropriate decisions as and when changes are noticed in the condition of the patients while the study is conducted. Ms Ward also bears the responsibility of sharing any important patient related health information with the review board and the protocol committee so that accurate decisions may be taken (American Association of Critical-Care Nurses, Web). Before coming to any strong conclusion, it is important to judge the scenario presented in the case above. The trial is funded by millions of dollars every year Patients are severely ill and are receiving chemotherapy The disease has progressed The men are elderly and have difficulty in moving around Before all else, Ms Ward has the ethical responsibility of making sure that the subjects or participants are not exposed to any kind of harm, direct or indirect when the research is being conducted. She bears the responsibility of safe guarding the subjects and patients from any kind of harm including physical, social, mental, spiritual and financial (American Association of Critical-Care Nurses, Web). Ms Ward is clearly aware of the financial situation and position of the male subjects. Additionally, the subjects have serious illness due to which they are also under physical and psychological pain and pressures. Ms Ward should consider these ethical aspects before all else. Therefore, in the given scenario above, it seems logical to increase the costs of the study than compromise the quality of the data. In case Ms. Ward does have and can use some funds allocated to the study and research, by having nurse to go to the homes of these men for the collection of data and samples. Burdens and benefits should be distributed fairly and looking at the plight of these old and troubled men, it seems only fair that their burdens are reduced. Since all these patients do not appear to be well off, Ms Ward should ask for a change in protocol and get permission for a nurse to visit these men for the collection of samples and data. Is it ethical to ask these men to come to the hospital weekly in order to get slightly better data or to save the project money? Why? All these above facts confirm that the men are not in a good physical state. They are old and have serious physical health problems. Other aspects of the case study which necessitate are: Weekly measurements are required Ms Ward is “troubled by the present protocol” because she works closely with these patients and is well aware of the difficulties they face. Ms Ward “realizes” that the weekly trips by the patients are “solely for the purpose of research”. She knows that variations in protocols are not considered by Dr. Hanson but it is her ethical duty and responsibility to consider the problems and issues of patients. She considers two options to reduce their burden and considers gathering data when the men visit the hospital for therapeutic reasons or to have a nurse visit their homes to collect blood samples and data. From the case study above, it is apparent that the group of male subjects belongs to “vulnerable population”, “those unable or incapable of giving informed consent or those who may be at high risk for unintended consequences” (Colling, 2004). The men are undergoing chemotherapy and their disease has progressed and can be categorized as “terminally ill persons” (Colling, 2004). It is Ms Ward’s ethical duty to carefully weigh the risks and benefits of the research with this vulnerable group and care should be taken “not to add to the physical or psychological distress of this population” (Colling, 2004). According to nursing ethics, it is unethical for Ms Ward to ask the men to come to the hospital to get slightly better data or to save the project money because the main obligation of a nurse “is to patients as opposed to any other professional relationship” (American Association of Critical-Care Nurses, Web). It is primary responsibility of a nurse be able to judge effectively between the needs of the research and the changing needs of patients. While nurses are not responsible for the manner in which research is conducted, it is their duty to ensure that the rights of the patient are protected. In this case Ms Ward is aware of the physical as well as financial constraints of the subjects; as such it her moral and ethical duty to try and reduce these problems by suggesting some changes in the research policy. References American Association of Critical-Care Nurses (1999). Standards for acute and critical care nursing practice. Available www.aacn.org. Colling, Joyce (2004). Procedures, ethics, and funding sources. Urologic Nursing Apr: 30+.  The Royal College of Nursing Research Society: nurses and research ethics. (2003). Nurse Researcher 11.1: 7+. Read More