Introduction
To address the interests of patients, nursing care should be not only high-quality but also ethical. New technologies, medications, and approaches to treating patients are actively developed today, and registered nurses need to respond to the issue of using new strategies and drugs to positively influence the quality of care (Keatings & Smith, 2010, p. 24). The problem is in the fact that the involvement of patients in the process of using new treatment is ethically challenging because nurses should be sure regarding the quality of the expected care and treatment’s impact on patients. This paper aims to analyze the problem of involving patients in the study of new medications with references to the ethical decision-making framework developed by Keatings and Smith and to assess the ethical issues referring to principles and values reflected in the Canadian Nurses Association Code of Ethics for Registered Nurses and the College of Nurses of Ontario.
Ethics of the Situation
The assessment of the ethical situation depends on the analysis of the values and goals of the persons involved in the case. A registered nurse working in a thoracic surgery step-down unit, two of her patients, and the nurse conducting the study are involved in the situation. In the study, it is expected to compare the effects of traditional pain medications usually used for post-operative pain and the effects of a new type of analgesic never used in postoperative pain management. As a result, the patients can be exposed to suffering from severe pain after thoracic surgery if new medications are not effective in this context. Although the drug is not experimental, it is discussed as safe only in limited contexts because of the lack of research. Furthermore, the nurse conducting the study receives the payment for involving more patients in the study of the medication. The situation can be discussed as disadvantageous for the patients involved in the study because they are limited in opportunities to learn more about the possible effects of new medications. However, the situation is advantageous for the nurse conducting the study because he follows his personal interests and receives significant payment. From this point, the goals of the healthcare provider, patients, study nurse, and community are different (Keatings & Smith, 2010, p. 112). If the registered nurse and patients are oriented to relieving pain and improving the patients’ state in the short-term perspective, the study nurse and community are oriented to examine new medications in the sphere of pain management in the long-term perspective.
The registered nurse should address the principle of beneficence and guarantee the provision of safe and competent care (Canadian Nurses Association, 2008, p. 8). As a result, the nurse should be sure regarding the quality of the proposed new medications. Furthermore, the registered nurse should follow the principle of autonomy and address the patients’ right to choose a risky course of action (College of Nurses of Ontario, 2009). The main followed value, in this case, is the well-being of patients. In addition, the study nurse should build trustworthy relationships with patients involved in the study and follow the principle of veracity while guaranteeing that all the information about the study is provided to the patients (College of Nurses of Ontario, 2009). Thus, the nurse conducting the study seems to violate this principle in a way because of having only limited information on the medication. The case also involves legal issues because there is a conflict of interests associated with the fact that the study nurse orients to more receiving compensation rather than to addressing the patients’ interests (Canadian Nurses Association, 2008, p. 19). The patients also seem not to be informed about the adverse effects of using new medications.
Review of Potential Actions
Following Keatings and Smith’s framework, to address the identified issues, the registered nurse should explore alternative or potential actions. To protect the interests of the patients, it is relevant to consult the colleagues on the use of the new medication in different contexts and state possible adverse effects; to guarantee that all the patients are informed about the aspects of the study and risks; to guarantee the withdrawal of patients when their reaction to the treatment is negative to address the principle of nonmaleficence (Keatings & Smith, 2010, p. 112). The study nurse and community can focus on the necessity of conducting the study involving patients from the thoracic surgery step-down unit because of the possible positive outcomes of the new medication for relieving the pain.
Selection of an Ethical Action
The effective ethical course of action should respect the needs of the patients receiving the care because of the possible ineffectiveness of the medication to relieve the pain. However, it is also necessary to address the interests of the community because of the lack of research on the effects of the discussed medication in pain management. Thus, the ethical action should be based on the idea that the nursing research is necessary, but the patients should be informed about the potential and risks of using the new medication (Canadian Nurses Association, 2008, p. 16). Furthermore, following the principles of accountability and beneficence, the patients should receive the right to withdraw from the study if the provided medication causes additional suffering.
Engagement in Ethical Action
The proposed action plan will fit the principles reflected in the code of ethics if the patients involved in the group receiving the alternative medication are informed about all the associated outcomes and risks, make the informed decision, and sign the consent form. Furthermore, the patients should have the right to sign the form mentioning that they can withdraw from the study if they are concerned about negative results of the new medication. Therefore, it is important to collaborate with the nurse conducting the study in order to develop consent forms, discuss the details of the study, and inform the patients about possible threats. In addition, to avoid the development of the conflict of interests, it is appropriate to involve the independent supervisor to communicate with the medication providers (College of Nurses of Ontario, 2009). The separation of roles is important to guarantee the provision of the fair and high-quality care and information.
Review of the Action
The problematic situation can be handled effectively if the described plan of actions is implemented. The proposed options work to minimize risks for the patients because they can make the informed decision regarding the participation in the study without being pressured by the study nurse (Keatings & Smith, 2010, p. 114). Furthermore, the effective distribution of roles in the research contributes to receiving satisfactory results and to addressing the conflict of interests.
Conclusion
The involvement of patients in the nursing study that is not developed according to principles of the code of ethics can result in unexpected negative health outcomes. More attention should be paid to analyzing the situation from the ethical point of view and developing the plan of action to address the identified ethical questions.
References
Canadian Nurses Association. (2008). Code of ethics for registered nurses. Ottawa: Author.
College of Nurses of Ontario. (2009). Compendium of standards of practice for nurses in Ontario. Web.
Keatings, M., & Smith, O. (2010). Ethical and legal issues in Canadian nursing. Toronto: Elsevier.