Introduction
Research can be defined as a “thorough and systematic inquiry or investigation into a subject in order to discover or confirm facts, theories and their applications” (Philippa 2005). There are several types of research that are identified depending on the nature and purpose of the study. Participant action research is more commonly identified as the reflective process of ongoing solution seeking that is often spearheaded by a group of people working with others to identify ways through which solutions to certain issues can be identified or improved (Naomi 2005). Just like any other type of research, participant action research has an epistemological and ontological basis. This paper is interested in describing the ontological and epistemological basis for participant action research in healthcare with particular emphasis on non-medical prescribing.
Epistemology and ontology
In order to correctly identify and describe the ontological and epistemological basis for participant action research in healthcare with particular emphasis on non-medical prescribing, one needs to understand the basic tenets of epistemology and ontology. Thus the two branches of philosophy will be described briefly below.
Epistemology is often described as a branch of philosophy that pertains to the nature and span of knowledge (Leonard 2001). It seeks to identify the essential and sufficient conditions of knowledge, the sources of knowledge and its limitations. Knowledge as a justified belief requires epistemology to identify how it is a justified belief (philippa 2005).
Ontology on the other hand pertains to analytic philosophy and is concerned with identifying whether given categories of being can be described as fundamental, and if so, in what sense are they fundamental. Ontological studies investigates the extend to which beings are, in so much as they can be described as beings (Janie & Karen 2005). Fundamental ontological questions are thus raised to determine entities that can be said to exist, the different categories of existence, and how they can be sorted.
Ontological and epistemological basis for participant action research in healthcare
Action research is basically identified as a methodology that often combines action and investigation to gain answers to specific questions regarding a phenomenon or an issue. This is “achieved through observation and reflection, and deliberate intervention to improve practice” (Heidegger 1993, p. 54).
The ontological and epistemological basis of participant action research in healthcare can be described under a larger category identified as the philosophy of healthcare. The maintenance of the health of human beings requires a code of ethics, individuals and established processes. The “philosophy of healthcare therefore studies the ethics, processes and the individuals who are tasked with the maintenance of the health of human beings” (Callahan 2001). The philosophy of healthcare raises several questions. However, those of epistemological and ontological concern revolve around what encompasses health, whether healthcare is a universal right and the identification of the different parameters that guide trials during health studies. The ethical premises of healthcare are too complex to be discussed together with other forms of morality (Brody 1998). This mainly accrues from the fact that not all decisions regarding one’s health are his/her, especially in complex health conditions.
Complex health states have send scholars into research to identify the most effective ways to deal with them. Thus different methodologies that are thought to proper and efficient have been and are still being developed to address research questions arising from different phenomena.
The healthcare industry has come up with new strategies to ensure that health care delivery is accessed by as many people as possible in the most sufficient way.
As pert of the modernization strategies in several countries around the world, the authority to prescribe has been given to nurses, “pharmacists and other allied health care professionals (AHPS), such as radiographers, physiotherapists, podiatrists” (Norman 1998, p. 112). Through participatory action research, the prescribing rights have been extended basically to address the challenges of effectiveness, quality and efficiency.
In epistemological context, research in non medical prescribing seeks to gain more knowledge on the practice, including its ability to improve health care, as well identifying its limitations. In plain philosophy, the action research methodology should be able to answer the question as to whether the new methods developed will reduce the challenges that are being faced currently. Whether, it will make non medical prescribing to save more lives than it does now?
A major philosophical question often arises during the testing phase of new drug inventions and also during the extension of prescribing authority to other professionals who were initially not considered. This is often based on the virtue that new interventions should be identified in the overall process of trying to help patients. Huge scientific, ethical and practical issues arise. The practical question, seeks to validate the new method of approach in healthcare before it can be accepted as conventional. In the context of non medical prescribing, the competence of a certain pool of professionals is tested before the prescribing authority is bestowed on it. In the worst scenario, generally, reliability is achieved after hundreds, or probably thousands of people have been harmed (Brock 2001). Benchmarking clinical research trials on the epistemological and ontological concerns is a good way to validate the ethical issues that arise.
As such, human beings are considered as a top entity, whose overall health should be guaranteed, even if extreme measures are to be taken to gain sufficient knowledge on new methods. Thus the clinical methods designed seem to approve the exposure of a small group of individuals, in most cases the critically ill, to potential new methods of healthcare delivery (Australian Government 1999). The trials directed towards a subset of humans clearly focuses on ways to improve human well-being, basically by identifying new methods of treating and preventing sickness. Prior to identifying whether a certain category of healthcare professionals have the ability to prescribe medications in the right dose and safe conditions that will ensure the achievement of desired treatment, the skills of the professionals need to be tested. The future prospects of healthcare delivery make it worthwhile to try new methods.
What really separates healthcare from other specialties is its integral function in the life of individuals. The morality the guides practice in other disciplines cannot apply to health due to the fact that human subjects are required to sacrifice for the benefit of others. Fundamental ethical questions always arise during clinical research due to the fact that subjects are often exposed to risk in order to benefit others (Brody 1998). Thus many guidelines are used to ensure that the overall risk to which subjects are exposed remains low. Research related to non prescribing studies has low risk levels compared to researches conducted in other areas of medicine.
The basic concerns that rise for a given case seeks to answers the question as to whether it has become appropriate to conduct a study, and possibly expose some individuals to different risks and burdens in order to benefit others (Leonard 2001).
To address the ontological and epistemological issues concerning research in healthcare, and particularly that which pertains to non medical prescribing, the following description will be given to show the pertinent steps that have been taken. Precisely, this section will expound on the efforts made by different healthcare stakeholders to ensure that knowledge generated regarding non medical prescribing is justified, and is able to address some healthcare challenges.
Non medical prescribing, which begun by nurse prescribing as part of a larger process that was aimed at improving the efficiency ad effectiveness of health services. At the time, nurses were not using their time well by requesting prescriptions from a general practitioner for activities such as wound dressing (Leonard 2001). Since the year 1999, several countries included the nurse prescribers Formularly into their nurse practitioner programs (Naomi 2005). Up to the year 2006, this form of prescribing was still a major component in the education of nurses who had qualified for a stand alone or integrated course and whose non prescribing status was recognized by a regulatory body such as the nursing council in some countries (Philippa 2005). Later in that year and early in 2007, several countries begun to adopt standards that were necessary for the preparation of medical prescribers that were more independent. The task was thus to be undertaken by institutions of higher education so as to offer a program that would meet the required standards for approval. Designated medical practitioners were used, and are still being used to assess and ensure that desired learning outcomes are achieved to ensure that the non medical prescribers are competent.
Several researches have been advanced to understand how non medical prescription has impacted on healthcare provision. The studies touched on both independent and supplementary prescription. The studies have also involved some grey literature relating to policy and legislation (Janie 2005).
Conclusion
This paper sought to identify the ontological and epistemological basis for participant action research in healthcare with particular emphasis on non medical prescribing. It has been established that research on human subjects, as much as it is intended for the benefit of humans, has the most outstanding ethical issues.
In the ontological and epistemological context, participant research in non medical prescribing might be justified if it leads to generation of valuable knowledge that will benefit or wellbeing of humans. However, questions remain unanswered when the individual human undergoing the trials is considered. This might be considered to be exploitation especially when the subject is not able to give consent, for instance, the critically ill.
Reference list
Australian Government., 1999. National Health and Medical Research Council. National Statement on Ethical Conductin Research Involving Humans. Ch 2.1: 92. Commonwealth of Australia.
Brock, D., 2001.Quality of Life Measures in Health Care and Medical Ethics, Bioethics. New York: Oxford University Press.
Brody, B.A., 1998. The Ethics of Biomedical Research: An International Perspective, Oxford: Oxford University Press.
Callahan, D., 2001. Terminating Life-Sustaining Treatment of the Demented. New York: Oxford University Press.
Heidegger, M., 1993. What Is Metaphysics? Basic Writings. New York: HarperCollins Publishers.
Janie, B., & Karen, R.,2005 Moral and Ethical Dimensions in Professional Nursing Practice. Sudbury: Jones and Bartlett Publishers.
Leonard, J., 2001. Business Ethics in Healthcare: Beyond Compliance. Bloomington: Indiana University Press.
Naomi, B., 2005. Murderous Medicine: Nazi Doctors, Human Experimentation, and Typhus. Westport: Praeger Publishers.
Norman, D., 1998. Healthcare Needs and Distributive Justice. New York: Oxford University Press.
Philippa, S., 2005. Combining Interpretive Methodologies: Maximizing the Richness of Findings, Beyond Method: Philosophical Conversations in Healthcare Research and Scholarship. Madison: University of Wisconsin Press.