Evidence-Based Practice for Nurses

One reason that considerable attention is given to the process of obtaining
informed consent is that it is unethical for subjects to feel coerced into partici-
pating in research. Coercion is the threat of harm or the offer of an excessive
reward with the intent to force an individual to participate in a research study.
Healthcare providers must be extremely careful when conducting clinical re-
search to ensure that patients do not feel coerced into participating in studies.
Patients may feel particularly vulnerable if they decline participation because
they may fear that treatment may be withheld (Polit & Beck, 2014). Coercion
can also be a factor in studies involving nursing education. Faculty who con-
duct research involving nursing students must be careful that students do not
feel coerced into participating and must recognize the power faculty has over
students when assigning grades.

Children, because they are minors, cannot give consent to participate in
research; however, researchers are obligated to obtain assent when possible.
Children may have difficulty understanding what a study involves, and they may
agree to participate to please adults. Typically, children 7 years of age and older
must give oral assent, while children 12 years and older must sign an assent
form. Regardless of the age, parents or legal guardians must sign consent forms.

Despite the importance placed on adherence to IRB guidelines and informed
consent, there usually is little discussion about the process used to ensure that
subjects’ rights were not violated. In research articles, authors typically state that
IRB approval was obtained and that the rights of subjects were protected. When
such a statement is made, nurses can assume that ethical principles were upheld.

Sampling methods and how subjects are selected and protected through the
IRB process are critical components in nursing research. The nurse evaluating
nursing research for best evidence to influence clinical practice must understand
the implications of the entire research process.

KEY TERMS

coercion: The

threat of harm

or the offer of an

excessive reward

with the intent to

force an individual

to participate in a

research study

assent: Permission

given by children

to participate in

research

Indicate whether the following actions are ethical or unethical.

1. Allowing a subject who does not speak English to sign a consent form without providing
   an interpreter.


2. Allowing a nursing administrator to see group data from surveys conducted in the
   organization.


3. Keeping a folder for every subject that contains a signed consent form and raw data.


4. Providing subjects with money to reimburse their travel expenses to the data collection site.


5. Promising health care for life to individuals if they choose to participate in a study.

TEST YOUR KNOWLEDGE 11-4

How did you do? 1. Unethical; 2. Ethical; 3. Unethical; 4. Ethical; 5. Unethical

11.4 Keeping It Ethical 305