consistent with good medical and nursing care for the individual patient, there
does seem to be a conflict in orientation. Research aims to benefit the community,
and it must be pursued with scientific, methodical rigour. Care for the sick and
vulnerable aims at benefiting the individual and is essentially personal and non-
universalisable. The very idea of methodical care 'seems to be an oxymoron, yet is implicit in the collection of clinical data and carrying out of research procedures at regular intervals, especially in the context of busy hospital settings with the whole range of other clinical duties to be carried out, by the researcher or his or her colleagues. What is at stake here is an ethical relationship between the patient and the professional caring for them, which depends on respect for the dignity and autonomy of the patient, and maintenance of the integrity and professionalism of the carer. This can be a difficult balance to strike and is particularly acute when we reflect on the idea of the nurse as patient's advocate. To some extent this is possible where the nurse is not the principal investigator, but it is very difficult to maintain this stance where the nurse is both patient advocate and advocate of his or her own research. The risk here is that the nurse uncritically assumes that his or her goals are shared by the patient, hence that advocating the research is advocacy of the patient's interests and views. The ethical concept of most importance here is the concept ofvirtue': the researcher must maintain the virtues of the health care
professional 'care for the well-being of others, integrity and responsibility, for
instance) at the same time as the virtues of the researcher 'scrupulosity, honesty
and curiosity, for instance).
This balance can be struck by many remarkable individuals, but it is more
important that it is struck at the level of institutions ± individuals working in teams
with a shared institutional culture. The trend toward quality improvement and
`research governance 'in part marks this attempt to achieve an institutional
balance; there is a cultural shift in the health service to see research and treatment
as complementary activities, rather than activities in tension. A central question in
research ethics today is whether this cultural shift is coherent, or whether it is a
sort of institutional delusion.
12.13 Conclusion
Research will be an increasing part of the work of nurses in the coming years, and
arguably this can only improve the care given by nurses. In this chapter I have
described some of the ethical dilemmas that arise in research at a rather abstract
and reflective level. As I point out at various places in this chapter, the growth in
the role and importance of research outside of the narrow biomedical context
which has historically shaped research ethics raises difficult philosophical and
professional concerns, which guidelines alone will not solve. What is clear, how-
ever, is that attention to the core principles of good nursing ± respect for the dignity
and autonomy of patients, beneficence, non-maleficence, justice and integrity ±
will remain essential. The best research, and best practice in research, embodies
and promotes these principles.
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