Nursing

For the initial discussion post, review the article by Miller, Drummond and Carey:

• Miller, J., Drummond Haye, D., & Carey, K. W. (2015). 20 QUESTIONS: Evidence-based practice or sacred cow? Nursing, 45(8), 46-55. doi:10.1097/01.NURSE.0000469234.84277.95

Scenario:

• You begin your career in an acute care hospital as a newly licensed RN. During your orientation, you observe your preceptor checking gastric feeding tube placement by injecting air and auscultating the abdomen, stopping continuous enteral tube feedings before a patient is turned or repositioned, and routinely inserting rectal tubes for patients with diarrhea. You know that ALL three (3) of these practices are currently NOT supported by nursing evidence. When asked, your preceptor responds, “This is the way we have always cared for patients with tube feedings and diarrhea.” You prepare to talk to this peer about necessary changes in nursing practice.

Initial Discussion Post:

Address the following:

• Choose ONE (1) of the practices described in the scenario.
• Describe how you will address this gap in nursing practice with your preceptor. Write out exactly what you might say to this RN to professionally address the current evidence for the nursing care of patients.
• Include when and where you would communicate this information
• Consider any additional information you might provide to your preceptor to support changing nursing practice

Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

power point from this document, 15 slides

Introduction

Depending on the context of the study, researchers often encounter ethical dilemmas that are associated with respect for privacy, establishment of honest and open interactions, and avoidance of misrepresentation. From an ethical standpoint, such challenging circumstances may surface if researchers are grappling with conflicting issues and have to choose between different methodological approaches in complex circumstances. In such circumstances, disagreements among different components including participants, researchers, researchers’ disciplines, the financing organization, and the society might be inevitable. Therefore, there are numerous ethical concerns that should be taken into account when undertaking studies that deal with human subjects. Understanding ethical principles can guide researchers to conduct studies that safeguard the wellbeing of human subjects.

Overview of the Research

In a research work titled Resilience of People Living with HIV/AIDS in Indonesia: a Phenomenological Study, Kumboyono et al. (2018) observe that HIV/ AIDS is among the most prevalent and expanding communicable diseases on the planet. The number of individuals who are diagnosed with HIV/AIDS continues to skyrocket every year in Indonesia and other parts of the world. According to Kumboyono et al. (2018), individuals who suffer from HIV/AIDS often plunge themselves into a series of crises, which indicate the challenges of living with the chronic pathological condition. As such, resilience is one distinct phenomenon that is common among persons living with the diseases Indonesia, a pattern that indicates the results of current health management and expectations of HIV/AIDS patients for better and improved health outcomes. In light of this concern, Kumboyono et al. (2018) undertook a study that sought to examine the mechanism of resilience in Indonesian people living with HIV/AIDS and the factors that influence their specific mechanisms. 

Using qualitative phenomenological design, the researchers sampled a total of 27 people living with HIV/AIDS from a primary health care institution in Malang City, East Java, Indonesia. The participants were selected from different socioeconomic, gender, and sexual orientations. The researchers informed participants about the conduct and processes involved in the study, resulting in their consent to participate in the interview process. The findings of the study indicated that the diagnosis of HIV/AIDS reflects the onset of psychological and social distress. Moreover, Kumbomoyo et al. (2018) found that the spiritual response that follows diagnosis is a state that is characterized by crises. As a consequence, the coping strategies and understanding of life by HIV patients is a definite sign on resilience. Based on these findings, Kumbomoyo et al. (2018) infer that HIV/AIDS is a chronic infection that has the potential to induce the unique mechanism of resilience within the Indonesian social system. Therefore, future health and management of persons living with HIV/ AIDS will be needed to enhance and encourage this strategy to guide persons living with HIV into a more comfortable and healthy way of life. 

Ethical Issues in Research

The relationships and interactions established between the researcher and participants in a study can potentially generate a wide range of varying ethical issues. While ethical codes, policies and principles are highly significant and beneficial, like any set of norms, they do not cater for all situations. Thus, they often have a high potentiality of conflicting. Nonetheless, the vast majority of decisions often entail the straightforward application of ethical codes and practices. Ethics is one of the most important issues that are commonly mentioned by educators in the scientific community. Ethical misconducts most commonly stem from environmental and individual causes. For instance, when people who are morally weak or unaware of the rules participate in research, ethical violations are bound to occur. Thus, many significant forms of the ethical deviations that are observed in many scientific studies are attributed to the fact that some researchers are oblivious of the ethical norms of scientific research. 

Protection of Human Rights

The most important ethical principles in research focus on protecting human rights when dealing with human subjects. Principles of protection of human rights during research emerged out of a dark history that was littered with accounts of abuses undertaken in the name of medical research.  One of the most dreadful of these atrocities were undertaken by the Nazi physicians who utilized convicts for human experimentation (Avasthi et al. 2013). The unearthing of these experiments sent ripples of shock across the world, a situation that resulted in the development of the Nuremberg Code to deter recurrence of similar episodes. The Nuremberg Code was the first international code of ethics in clinical research that laid down the guidelines for research dealing with human subjects. This policy made laid down principles, guidelines and standards to be followed by researchers and make voluntary consent essential, allowed subjects withdraw from the experimentation at any time, banned experiments that could lead to major injuries or fatalities of the subjects, and made it mandatory to have preclinical data prior to the experimentation of humans. However, the Nuremberg Code failed to end unethical practices conducted by certain researchers (Avasthi et al. 2013). As a consequence, a collection of guidelines was developed by the 18th World Medical Association General Assembly, also referred to as the Declaration of Helsinki. 

The Helsinki Declaration had a collection of principles, which emphasize on informed consent, confidentiality of data, vulnerable populations, and requirements of a protocol, including the scientific justifications for the study. All researches had to be reviewed based on these standards by the ethics committee for a research to be declared as ethically fit (Avasthi et al. 2013).  However, it is during the time of the Helsinki Declaration that other major scandals continued such as the Tuskegee Syphilis Experiment in the United States. This malpractice raised concerns in the ethics community, thereby resulting in the establishment of the Belmont Report in 1979. The Belmont Report established the modern regulations and human rights principles associated with research dealing with human subjects in the United States and other parts of the world (Avasthi et al. 2013). Nonetheless, with the growing interest in pharmaceutical, health, and psychological research in the developing and the underdeveloped nations, the Council for International Organization of Medical Sciences, in collaboration with the World Health Organization (WHO) and other health researchers designed the International Ethical Guidelines for Biomedical Research Involving Human Subjects in 1982 (Avasthi et al. 2013).  Thereafter, other professional research organizations such as the American Psychological Organization (APA), have designed similar standards that relate to protection of human rights in studies that deal with human subjects. 

The Five Human Rights that Must Be Protected

There are five cardinal ethical principles that reflect the five human rights that must be protected during research. These principles include: nonmaleficence, beneficence, respect for autonomy, justice, as well as right to self-determination. The principle of nonmaleficence states that the researcher has an obligation to avoid infliction of harm on human subjects in a study. This principle is closely interlinked with the maxim primum non nocere (‘first do no harm’). The principle of nonmaleficence prohibits killing, causing pain or suffering, incapacitating, and causing an offense on the human subject during research. Therefore, this principle encourages researchers to act in ways that do not cause physical or mental harm on the research participants. More precisely, the principle states that researchers should not cause avoidable or intentional harm. This should incorporate avoidance of any possible risks associated with harm (Jahn, 2013). Researchers should avoid intentional and unintentional violations of this ethical principle. For instance, a researcher does not necessarily intend to harm in order to violate this principle. As a matter of fact, knowingly or unknowingly subjecting a research participant to unnecessary risk amounts to violation of the principle of nonmaleficense. 

The principle of nonmaleficense has been applied to this study in many ways. One of the primary focuses of the study was to investigate the coping skills of people living with HIV/AIDS. Thus, when analyzing these coping skills and strategies, the researcher must engage in a one-on-one interview with the participants (Jahn, 2013). In the process, questions that trigger psychological and emotional pain might be asked unknowingly. Such situations are likely to occur in the study, especially when dealing with participants who suffer from HIV/AIDS. In almost all parts of the world, HIV/AIDS patients often witness numerous cases of social stigma. These negative experiences may interfere with the manner in which they respond to interview questions. Therefore, it is the task of the researcher to develop strategies that can help to minimize any possible mental and emotional paint that the persons living with HIV are likely o experience as a result of the data gathering and interview questions. Many studies on nonmaleficense often narrow down to physical harm (Chagani, 2014). However, the concept of harm is broad and dynamic, incorporating all dimensions of human life, including the mental and physical realms. In this particular study, there is no serious physical interaction with the participants that might cause physical pain, harm or death. 

The concept of harm is broad and takes many forms. They range from physical and emotional injuries to deprivation of property or violations of human rights. Within the research context, the primary emphasis of harm is often linked to a narrower definition, such as pain, disability, or death (Chagani, 2014). Within these standards, the research has observed avoidance of harm since all the participants who took part in the study did not die, sustain any physical injury or disability stemming from the research. However, harm can be strongly within the eye of the beholder, and a wider definition of harm is often required during ethical considerations. In light of the above, more than one level of harm may come into play in a situation. For instance, the researchers are more likely to inflict mental pain and suffering in the participants by asking questions related to the way in which they responded to the news that they had been diagnosed with HIV/AIDS. However, in such a situation, the researchers have imposed one harm in order to avoid a greater harm. Nonetheless, in all situations, researchers should be prohibited from acting in ways that are likely to generate undue risks or needless harm to participants. 

The principle of beneficence is a moral obligation to act for the benefit of others. In this respect, any research work that observes this principle should be designed in a way that is meant to promote societal good and wellbeing (Jahn, 2013). There are various ways in which this principle comes into play. For instance, the principle suggests that researchers should act in a manner that provides benefits to the society, and balances benefits with risks or harms. The principle of beneficence is broad and multifaceted. It includes protecting and defending the rights of others, preventing harm from occurring to others, removing conditions that will cause harm, and supporting persons with disabilities. Furthermore, this principle advocates for rescuing persons in danger during and after research. In furtherance of these ethical standards advocated by beneficence, there are various ways in which the study can be assessed. For instance, the outcomes of the study seeks to improve health professionals’ understanding of HIV/AIDS patients’ coping skills and strategies and the psychological pain that they undergo in the process of coping. As a result, it provides health professionals and psychological researchers with insights into ways of developing interventions that are meant to address mental health problems that affect HIV patients. 

The study encourages researchers to design interventions that are meant to enable HIV patients to bounce back to their normal psychological and social norms after receiving adversities as a consequence of HIV/AIDS diagnosis. Indeed, the nature of resilience among individuals who are diagnosed with chronic infections can be grouped into the crisis and survival stages. The former is characterized by the onset of a psychological and physical struggle that follows after diagnosis with several struggles. This study can inform future evidence-based practices that seek to design cognitive and counseling strategies for improving the quality of life of persons living with HIV/ AIDS. As such, the study fulfills the ethical principle of benefiting the participants and the society at large by promoting greater good and wellbeing for persons living with HIV/AIDS. 

The ethical principles of beneficence and nonmaleficense are multidimensional and intertwined. These dimensions include positivity and utility. Positivity can be described as the benefits that are gained after undertaking the research, which outweighs its costs. For instance, timely understanding of the mental and pain that HIV patients undergo after diagnosis can help to reduce major depression and help to cope will with the disease. On the other hand, utility refers to the benefits of undertaking an action that balances its costs. For instance, in a clinical research that explores psychological pain that patients undergo, the patient control group may only receive psychological treatment-as-usual instead of the experimental treatment that could generate extra gains. Beneficence and nonmaleficence are fundamental ethical principles that are essential in guiding the clinical practice and research in both psychology and healthcare. Beneficence encourages the researcher to exercise responsibility of promoting the wellbeing of the patients, especially participants in clinical trials, often by researching and administering therapeutic interventions with the highest possibility of positive patient responsivity. One of the biggest ethical dilemmas that psychologists confront is the need to strike a balance between beneficence and nonmaleficence. This balance may sometimes entail weighing the possible benefits and limitations or net risks associated with a specific research. In all jurisdictions, researchers are required by law to inform their participants or patients of the possible risks and gains of a research, procedure, or testy. This move allows the study participants to make an informed decision, with theirs being the burden to assess the potential costs and benefits of the available alternatives. 

Autonomy and self-determination are other fundamental human right that the participants should be granted during a research. Thus, respect for autonomy is a practice that obligates the researcher to respect the decisions of adults who have the capacity to make their own decisions. There are three conditions that must be existent for an action by the research subject to be regarded as autonomous. They include: intentionality, understanding, as well as complete absence of controlling influences that determine the subject’s decisions. In order to meet the ethical obligation of autonomy, there are several moral standards or guidelines that can be used. They include: telling the truth, respecting the privacy of others, protecting the confidentiality of information, as well s seeking consent from the participant before commencing the data gathering process. Respect for autonomy represents an obligation to the researcher to respect the decision making capabilities of the participants. It also denotes the provision of choices and alternatives to the subject so that they can practice self-determination. In this study, the participants’ rights to autonomy were observed by providing them with all the relevant information about the study and giving them the opportunity to decide whether or not to participate in the research. This process was primarily exercised through issuance of informed consent forms to the subjects. 

Within the context of this study, the subjects’ autonomy were respected by first giving them all sufficient information that are necessary for the research and then giving them the opportunity to consent or reject proposals to participate in it. Based on this practice, it is the responsibility of the researcher to ensure that the subject is sufficiently competent to practice autonomy. By competency, a research subject should be not only conscious, but also possess the sufficient knowledge and understanding to gain and maintain the information offered to take relevant decisions. Along with this view, the principle also requires the researcher to offer complete information to the participant and not hide anything so that the patient may seek to meet an obligation or can desire to spend some valuable time with family members and friends. The subject, after knowing the truth, may desire to do a hobby with which he or she desired to do. The participant may also seek to select other options of the research that may not be available or provided by the researchers. However, it is the right of human beings to be treated in a way that does not cause pain and anguish. Therefore, the researcher should go by the data gathering method in which the participants are comfortable with in order to avoid restraining the subject from exercising autonomy. In addition, in many jurisdictions, going ahead with a research against patients’ rights and decisions even if it is meant for their goodwill, is considered as an illegal decision. Therefore, a comprehensive justification on legal is often needed to undertake a research involving subjects who are patients against their knowledge and will. The principle of beneficence supports the autonomy of the patients as in the case of telling the truth to the research subject and respecting the subject’s autonomy can go a long way in generating the desired benefits to the participants, who will feel more confident in determining their course of life. 

Further, self-determination is a human right that is also relevant and interrelated to the right to autonomy. Self-determination is a right and principle that plays a critical role in the contemporary research ethics associated with human subject. Put simply, this principle suggests that ultimately, it is the participant who should make the final decision as to whether or not to accept a proposed research process (Lindberg, Johansson & Broström, 2019).  While this principle is widely discussed in many academic works, one of its most significant elements has often been overlooked- the fact that real-world decision making is temporarily extended. In this respect, decision-making is a process that broadly takes a significant period of time from the time at which the researcher determines that there is a need for the subject to participate in the clinical research and that there is a decision that should be made. Moreover, the participant should be able to make it to the point at which they are actually asked for their views. The principle of self-determination is broadly viewed as the center of research ethics and trials in the health sector (Lindberg, Johansson & Broström, 2019).   It is a principle that is commonly codified in legal frameworks and standards across different parts of the world, and has had a major effect on researchers’ understanding of ways of dealing with several legal and ethical issues associated with handling human subjects in research. 

There are several accounts of the content and implications of the principle that have been put into use within the context of this study.  For instance, in all stages of the study, the patients were given the liberty to opt out of the research. Through the issuance of informed consent documents and explaining to them the conduct and content of the study, they were sufficiently empowered to determine whether or not they would like to chat their own path by either remaining or opting out of the research. In view of this phenomenon, it would be deduced that it is the research subject who ultimately, following evaluation of all relevant information offered by the researchers, has the authority to decide whether or not to consent to the research. The principle of self-determination raises many fundamental questions. One such question revolves around who should self-determination be applicable to. In this study, the main subjects of self determination are the participants of the research. They are the HIV/AIDS patients who were interviewed on their psychological coping skills. Since a right to self-determination is often traditionally ascribed only to people with sufficient decision-making capabilities, one major issue that confronts many researchers is what it takes for a patient to be above the recommended threshold. Based on this standard, it is not clear in this study whether or not the HIV patient populations that were sampled were above the recommended normal mental threshold that is required of them to make informed decision on whether or not they should take part in the research. However, it can still be implied that they were mentally upright at the time of decision-making based on the nature of the data that have been gathered. 

When it comes to self-determination, real-world decision-making capabilities can be temporarily extended in that it broadly takes some significant period of time from the point at which the researcher determines that there is a consent decision that should be made, and that the patient is mentally fit or able to make it (Lindberg, Johansson & Broström, 2019).   Moreover, such a situation should extent to the point at which the subject is asked about their views. Such a temporal element of decision-making raises normative questions. For instance, it may not be clear under what situations and length of time the researcher should wait in order to get the feedback from the subject on the decisions that they have made regarding participation in the research. 

Finally, the principle of justice in research can also be used to analyze the ethical standards that were used in the study. The right to justice requires the researcher to exercise equity in the distribution of the benefits of the research. These include the benefits, costs, and resources. The key justice principles in a study include: promotion of equal share, giving each person in accordance with heir efforts, rewarding each individual according to their contributions, and issuing gains made out of the research according to merits (Silver, Ventura & Castro, 2016). In almost all forms, clinical trials require the active participation of human subjects and entail clinical interventions that are comprised of various procedures. However, this study only engaged human subjects in the interviewing process alone. Still, the performance of a study involving human subject can be beneficial to the economy and the whole society, especially the participating country, thereby generating employment opportunities and promoting local scientific and technological progress through the scientific data found and studied in collaboration with many research centers (Silver, Ventura & Castro, 2016). The financial and economic gains of this particular study have not yet been determined. However, its insights can be used to develop interventions that help to promote psychological wellbeing of persons living with HIV/AIDS. In so doing, the study can immensely improve their quality of life. 

Ethical Scientific Integrity

The credibility of a researcher or author is very critical in assessing the authenticity and quality of a specific research work. The personal details of the authors who developed this research work have not been provided in the journal article. However, there are other standards that can still be used to determine the credibility and level of suitability of the researchers to undertake the above study. For instance, the authors have revealed at the end of the article that their study was funded by the Directorate General of Higher Education, Ministry of Culture and Education in the Republic of Indonesia. Based on this standard alone, it can be deduced that the authors have the necessary academic credentials and intellectual acumen or capacity to undertake such a study. In addition, the mere fact that the study was approved by these higher educational bodies raises the credibility of the authors. Another factor that raises the credibility of this particular study is that its findings were assessed and later published by the Research HIV Nursing, which is a widely known reputable international journal that publishes studies on HIV research. 

Plagiarism is one of the ethical issues in research that are hardly ever mentioned. However, its violations can have far-reaching consequences on the credibility and authenticity of a specific body of knowledge. Plagiarism can be defined as the unethical practice of stealing and passing off ideas or group of words as one’s own (Ben-Yehuda & Oliver-Lumerman, 2017). Plagiarism is also the act of utilizing someone’s ideas and works and pretending to be one’s own. In light of the above, there are various ways in which plagiarism manifests itself in research. For instance, many researchers often fail to recognize the originators of their collection of words. However, this specific study can be said to have passed plagiarism test. First, the body section of the study has various in-text citations, indicating that the authors acknowledged the sources or originators of the ideas that were sued in the study (Ben-Yehuda & Oliver-Lumerman, 2017).  In addition, all the in-text citations have their corresponding bibliographic citations. As such, the authors do not have a case of plagiarism or copyright violation. 

Fabrication and falsification are some of the cardinal malpractices ion research conduct. They are commonly regarded as the key concerns in averting research misconduct. Any deviation or departure from such standards often undermines the integrity of a specific body of research for an individual or organization as a whole (Ben-Yehuda & Oliver-Lumerman, 2017).  Falsification can be described as the practice of altering or omitting research findings to support certain claims, hypotheses, as well as other data. This can include the act of manipulating study instrumentation, materials, or procedures. Usually, manipulations of images or representations in a way that distorts the figures or data or reads too much between the lines can also be regarded as an act of falsification (Ben-Yehuda & Oliver-Lumerman, 2017). The process of identifying a case of falsification or fabrication is often a complex one. As such, it was not possible for this specific study to detect any case of falsification. This is because the main data that were being explored were primarily qualitative and they were derived from the interview responses. In the same way, it was not easy to detect any case of outright fabrication. Fabrication is the development of or inclusion of data, observations, or characterizations that never took place during the collection of data. Fabrications are likely to take place during the process of filling out the entire of an experiment runs (Ben-Yehuda & Oliver-Lumerman, 2017).  Moreover, the researchers might come up with claims on the basis of incomplete or presumed findings, which are regarded as outright forms of fabrication. 

Institutional Review Board

Details on the Institutional Review Board (IRB) pertaining to this study have not been written in the article. However, the researchers indicate that they passed through the due process of informed consent and other ethical standards before they were approved to participate in the study. In addition, the study was approved by the Ministry of Higher Education, although such a ministry may or may not develop an IRB to assess the ethical suitability of the researchers. Therefore, it is not easy to determine whether or not the above study was approved by IRB. However, the researchers’ use of human subjects was not experimental in nature. Rather, use of human subjects in this study was minimized to data collection process through interviews. 

The absence of details regarding the IRB in this study calls for the need for future researchers to report as to whether or not their studies were approved by an ethics body. All individual organizations or sponsors may demand that all studies, irrespective of their sources of funding, be assessed and approved by an IRB (Whitney, 2015). An IRB has the specific power and authority over the nature of the research within its jurisdiction. For instance, no clinical research may be approved to stat enrolling participants until it has been given the green light by the IRB. The IRB primarily has the authority to approve, dismiss, or halt all research activities that fall within its jurisdictions in accordance with the relevant government regulations and institutional standards and procedures. The IRB also ensures that a given research meets the needed ethical standards by demanding for modifications in processes, protocols as well as previously approved studies (Whitney, 2015). Furthermore, the IRB has the power and authority to demand that participants in a specific research be granted any extra information that will enable them to make informed decisions to participate in the study. 

One of the most important documentations that the IRB may require is the informed consent form. While researchers who indicate that they provided participants with informed consent might have gone through the IRB, it might not be the case in all situations. All institutions that take part in the research process that engage human subjects are often tasked with the responsibility of identifying an IRB to assess and approve such studies (Whitney, 2015). The IRB is charged with the responsibility of adhering to the requirements and standards recommended by the Office for Human Research Protections. Many study sites may be under the jurisdiction of more than one IRB. Then IRB plays a significant role in safeguarding the rights, safety, and wellbeing of all human study participants. The IRB meets this responsibility by assessing the full research plan for a specific research study in order to ensure that it meets the standards that have been recommended by local and international codes of research ethics (Whitney, 2015). Moreover, the IRB undertakes a confirmation and approval that the study plan does not expose human subjects to unreasonable risks. In this particular study, human subjects are not exposed to unreasonable risks because their role in the research is to simply explain how they psychologically cope with the news of their diagnosis with HIV/ AIDS. 

Informed Consent

Informed consent is the main ethical practice that has been extensively observed by the researchers in this study. For instance, after selecting the populations to participate in the study, the participants were informed regarding the conduct of the research. Thereafter, the researchers report that the participants consented to the proposals to participate in the interview. The researchers also indicate that the study participants were given the opportunity to opt out of the research at any stage if they so wished. Therefore, it can be deduced that the study adhered to the recommended informed consent procedures and standards. 

Informed consent can be described as the voluntary acceptance by a study subject to participate in a research (Minor, 2015). Thus, informed consent should not be treated simplistically as a form that is signed but a process. As a process, informed consent is regarded as an essentiality before registering a participant for study. As such, informed consent should be sought in all forms of human subjects studies, ranging from diagnostics and therapeutic investigations, to intervention and behavioral assessments. 

The process of seeking informed consent entails informing the participants on their rights, objective and role in the study. The processes should of informing the participant should also entail enlightening the human subject about all the possible risks and the advantages involved in participating in the study (Minor, 2015). Usually, the target participants of the research should take part willingly and not through compulsion. Therefore, vulnerable and disadvantaged groups of participants such as prisoners, expectant women, and children should be accorded extra protections in order for them to make more informed decisions during the research process. 

HIPAA

The study was conducted outside the jurisdictions of the United States. As such, it is not bound by the standards, laws and regulations of the Health Insurance Portability and Accountability Act (HIPAA). However, if the study and its findings were to be used to inform evidence-based practices in the United States, it would be bound by HIPAA laws. One of the most sensitive and important area of research is dealing with the privacy of HIV/AIDS patients during research. Indeed, the privacy of patients is safeguarded by the US Department of Health and Human Services in line with HIPAA regulations. 

The Authority of HIPAA goes beyond protection of patient privacy and confidentiality within the health setting to incorporate protection of welfare of human study subjects. While this does not indicate that the privacy and confidentiality of participants’ data were protected, HIPAA calls for the safeguarding of the human rights of research subjects under the Basic HHS Policy for Protection of Human Research Subjects, also widely referred to as Common Rule (Majumder & Guerrini, 2016). While the word ‘privacy does not feature in HIPAA’s title, almost all sections of this law calls to attention the need for researchers to safeguard the privacy and confidentiality of participants (Majumder & Guerrini, 2016).  As such, privacy is critical to the realization of HIPAA’s goals. 

Risk to Benefit Ratio

In this article, the researchers do not show if they calculated a risk to benefits ratio. However, the research can comfortably be categorized as a minimal risk study. A minimal risk is a situation in which the likelihood and degree of harm or discomfort expected in a proposed study are not higher or greater in them than those that are commonly encountered in daily situations during the furtherance of normal physical or psychological assessments or tests (Melnyk & Morrison-Beedy, 2012).  The potential risks posed by this study are low because there is no physical engagement of the bodies of human subjects in the study. Instead, the human subjects were only required to answer interview questions regarding their HIV psychological coping skills. 

Benefits are associated with the potentiality of the research treatment to eliminate a condition or address certain problems. These problems can especially relate to an individual or population that is being surveyed (Melnyk & Morrison-Beedy, 2012).   For instance, some of the problems that the research focused on are the psychological and emotional pain that HIV patients undergo. The potential benefits that can be gained from the study include providing insights into the development of interventions to improve HIV/AIDS patients’ resilience after facing adversities due to HIV diagnosis. In addition, the study provides benefits to the study population by providing strategies of fighting stigma. 

Conclusion

Ethical problems are bound to occur in all studies. However, researchers who deal with human subjects must take extra caution not to affect the participants. Study participants might be exposed to various malpractices that can adversely affect their wellbeing. For instance, researchers may fail to protect them from physical and mental harm. Moreover, their privacy and confidentiality rights might be at risk during the study process. However, understanding ethical practices that guide dealing with human subjects can ensure that the study passes the tests recommended by the IRB.

References

Avasthi, A., Ghosh, A., Sarkar, S., & Grover, S. (2013). Ethics in medical research: General 

principles with special reference to psychiatry research. Indian journal of 

psychiatry, 55(1), 86.

Ben-Yehuda, N., & Oliver-Lumerman, A. (2017). Fraud and Misconduct in Research: 

Detection, Investigation, and Organizational Response. Michigan: University of 

Michigan Press.

Chagani, S. M. I. (2014). Telling the truth-A tussle between four principles of ethics. Journal of 

Clinical Research & Bioethics, 5(2), 172.

Jahn, W. T. (2011). The 4 basic ethical principles that apply to forensic activities are respect for 

autonomy, beneficence, nonmaleficence, and justice. Journal of chiropractic 

medicine, 10(3), 225.

Kumboyono, K., Sukotjo, C.T., Lesatri, Y.C., & Wijayanti, P.D. (2018). Resilience of people 

living with HIV/AIDS in Indonesia: a phenomenological study. HIV Nursing, 18(1), 

4–7.

Lindberg, J., Johansson, M., & Broström, L. (2019). Temporising and respect for patient self-

determination. Journal of medical ethics, 45(3), 161-167.

Majumder, & M.A., Guerrini, C.J. (2016). Ethical foundations, sources of confusion in clinical 

medicine, and controversies in biomedical research. AMA Journal of Medical Ethics.

Melnyk, B., & Morrison-Beedy, D. (2012). Intervention research: Designing, conducting, 

analyzing, and funding. New York: Springer Publishing Company.

Minor, J. (2015). Informed consent in predictive genetic testing: A revised model. New York: 

Springer.

Silva, CFD, Ventura, M., & Castro, CGSOD (2016). Bioethical perspective of justice in clinical 

trials. Revista Bioética , 24 (2), 292-303.

Whitney, S. N. (2015). Balanced ethics review: A guide for institutional review board members. 

New York: Springer.

Infections disease: a global perspective

Recent Health Care Legislature (within 3 years)

· Literature review regarding issue (4 peer reviewed articles) 

· Statistical data related to issue, population impacted, and health outcome of issue and legislature. 

· Nursing role in passing the legislature

·  References within 5 years

· 10 Pages including Title page and Reference page

· APA Format

Based on “Case Study: Fetal Abnormality” and other required topic study materials, write a 750-1,000-word reflection that answers the following questions:

1. What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
2. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
3. How does the theory determine or influence each of their recommendations for action?
4. What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. 

Rubric

Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is clear, thorough, and explained with a deep understanding of the connection between them. Explanation is supported by topic study materials. 30%

The theory or theories that are used by each person to determine the moral status of the fetus is explained clearly and draws insightful relevant conclusions. Rationale for choices made is clearly supported by topic study materials and case study examples. 15%

Explanation of how the theory determines or influences each of their recommendations for action is clear, insightful, and demonstrates a deep understanding of the theory and its impact on recommendation for action. Explanation is supported by topic study materials. 15%

Evaluation of which theory is preferable within personal practice along with how that theory would influence personal recommendations for action is clear, relevant, and insightful. 10%

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Writer is clearly in command of standard, written, academic English.

All format elements are correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Define the nursing process a systematic problem solving approach toward providing individualized nursing care. What is NANDA-I North American Nursing
Diagnosis Association International What are the characteristics of the nursing process? 1-framework for care to indiv, families, & communities 2-orderly & systematic 3-interdependent 4-provides specific care for the indiv, fam, & comm 5- client centered 6-appropriate for use throughout lifespan 7-used in ALL settings What are the steps of the nursing process? ADPIE A=assessment D=diagnosis P=planning I=implementation E=evaluation How does the nurse obtain assessment info? 1- initial (or admission assessment) 2- focused assessment 3- emergency assesment How does the nurse obtain assessment info? past medical hx – family hx – reason for admission – current meds – previous hospitalizations & surgeries – psychosocial assessment – nutrition – complete physical assessment focused assessment Collects data about a problem that has already been identified. This type of assessment determines whether
the problem still exists, or any changes. focused assessment questions – What are your symptoms?
– When did they start?
– What activity were you doing ?
– What makes it better or worse?
– What are you doing to relieve the symptom? Emergency assessment Performed to identify a life-threatening problem (choking, stab wound, heart attack). subjective data Information verbalized or stated by the client. objective data – Observable and measurable information.
– Remember to include your senses: smell, hearing, touch and sight. sign An objective finding perceived by the examiner ex. (fever, rash, etc.) symptom Subjective findings verbalized or stated by the client ex. (“I have a headache” ” I feel sick in my stomach.”) signs are objective symptoms are subjective 2 sources of data primary & 2ndary primary source of data -Information obtained from the patient (only) secondary sources of data – Family members
– Significant others
– Past & current health records, laboratory tests,diagnostic procedures, consultations from other healthcare professionals. collect the data then BLANK the data VALIDATE
-Confirm and verify the information.
– Keep it free from errors, bias, or misinterpretation. Data is 1,2,3 collected, validated, then clustered clustering of data often contains defining characteristics which are specific assessment findings that support a
nursing diagnosis. during the clustering of data what is used critical thinking is used to analyze and synthesize the information that is
collected. The data is then put into specific clusters that describe a specific client problem. identify sources of data for obtaining information from the client subjective & objective, primary & secondary, people, healthcare professionals, medical chart, test & lab results etc identify how you develop a nursing diagnosis As you cluster data, you begin to consider various diagnoses that may relate to the client. You must remember that if certain defining characteristics do not exist for a specific diagnosis, then you must not use the diagnosis. identify how you develop a nursing diagnosis (what is first / next etc) 1. Complete thorough assessment of the patient.
2.Highlight or underline relevant symptoms (defining
characteristics).
3. Make a list of symptoms.
4. Cluster and interpret the symptoms.
5. Analyze and interpret the symptoms.
6. Select a nursing diagnosis based on the definition
found in the nursing diagnosis manual by Doenges,
Moorhouse and Murr.
7. Remember to prioritize the identified problems. what is the difference between a medical and nursing dx A medical diagnosis describes a disease process. A nursing diagnosis describes an individual, family or
group response to an actual or potential problem. medical dx -Identification of a disease condition based on specific
findings such as diagnostic tests and procedures.
– Remains the same as long as the disease is present. nursing dx – Clinical judgment in response to actual or potential
health problems.
– Provides a basis for providing nursing care through
various interventions to achieve outcomes.
– Changes possibly from day to day as the patient’s
response changes. what are the 4 types of NANDA-I dx 1. Actual diagnosis
2. Risk diagnosis
3. Health promotion diagnosis
4. Wellness diagnosis actual dx Represents a problem that has been validated by the
presence of defining characteristics (signs and
symptoms). risk dx Is defined by NANDA-I , “describes human responses to health conditions/life processes that may develop in a vulnerable individual, family, or community. It is supported by risk factors that contribute to increased
vulnerability” (NANDA, 2007). Ex. infection after surgery health promotion dx Clinical judgment of a person, family, or community desire to enhance their well being and readiness to implement health behaviors of a higher level. Ex. nutrition wellness dx Describes the human responses to levels of wellness in an individual, family or community that have readiness to enhance well being. Ex.Coping, readiness of enhanced related to successful cancer treatment. how do you formulate an actual nursing dx; what does it consist of A nursing diagnosis consists of 3 parts or what is referred to PES format:
P= Problem
E =Etiology
S =Signs and Symptoms what is the purpose of the problem to identify the health status or
problem of the individual using the approved NANDA – I list. Ex.Pain, acute what is the etiology the cause ; Identifies the physiologic, psychological, sociologic, spiritual, or environmental factors assumed to be the
cause of the problem or a contributing factor. the etiology is linked to the problem with the phrase “related to” ; The etiology cannot be related to a medical diagnosis. signs & symptoms Identified as subjective and/or objective data that supports the problem.
– Identified by the nurse from the clustering of
significant data including assessment findings. signs & symptoms are linked to the etiology by the phrase “as evidenced by” how do you formulate a risk dx? what does a risk dx consist of? consist of a problem and the etiology only – there are NO signs & sypmtoms because it hasn’t happened yet what does the planning phase of the nursing process consist of develop a plan of care.This is accomplished by developing client centered goals
and expected outcomes. – use critical thinking to develop nursing interventions to resolve the client’s problem and achieve the goals. 3 helpful guides in prioritizing needs 1-Maslow 2- Pt preference what does the pt think is important 3-Anticipation or future problems Maslow Maslow’s Hierarchy of Needs
a. physiological needs
b. safety needs
c. love and belonging needs
d. self-esteem needs
e. self-actualization needs prioritizing nursing dx ex 1 1 -airway 2- urinary 3- sexual 4- skin integrity prioritizing nursing dx ex 2 1-gas exchange 2-hypothermia 3-knowledge defecit 4- infection prioritizing nursing dx ex 3 1-pain 2-mobility 3- social isolation 4-self esteem define a goal ” a broad statement that describes the desired change in a client’s condition or behavior.” components of a correctly written goal include expected outcomes or
measurable criteria to evaluate the achievement of the goal. short term goal an objective behavior or response
you expect the client to achieve in a short period of time usually less than one week. long term goal An objective behavior or response you expect the client to achieve in a longer period of time possibly over several days, weeks, or months. what is an expected outcome An outcome is a measurable change in the client’s status that you expect to occur related to the implemented care. guidelines to remember when writing goals 1-client centered 2-singular 3-observable 4-measurable 5-time limited 6-mutual 7-realistic what are nursing interventions Are actions or treatments based on knowledge or judgment that the nurse performs to meet the patient outcomes. what are the 3 types of nursing interventions – provide examples 1-independent ex. positioning 2-dependent ex. med admin 3-collaborative or interdependent ex. OT what are frequent errors when writing nursing interventions 1-Failure to be precise or fully indicate the nursing action. 2-Failure to indicate frequency 3-Failure to indicate quantity 4-Failure to indicate method what is the purpose of scientific rationale for student nurses is the reason for choosing the particular intervention based on supportive evidence
from textbooks, journals, and/or online nursing
references (so we know why we are doing the task we are doing) what is the implementation phase of the nursing process This step begins after the care plan has been developed by the nurse. This is the step of the nursing process where the nurse performs the interventions as a means
of achieving the goals. interventions can be BLANK or BLANK direct (performed through interaction with the client) or indirect (without the client but on their behalf) the implementation process takes into account 5 activities 1-reassessing 2-review/revise existing nursing dx & care plan 3-organizing resources & delivery of care 4-Anticipating/preventing any complications 5-Implementing interventions Implementing Interventions: requires 3 skills 1-cognitive 2-personal 3-psychomotor Implementing Interventions :cognitive skills critical thinking ; good decisions Implementing Interventions: personal skills communication ; therapeutic interactions Implementing Interventions ; psychomotor skills proper performance and knowledge of skills what is the evaluation phase of the nursing process Evaluation is the final stage of the nursing process. You as the nurse determine if the patient has achieved the expected outcomes not if the nursing interventions were completed. the evaluation phase has 5 components 1. Identifying criteria and standards.
2. Collecting data to determine if the criteria or
standards are met.
3. Interpreting and summarizing findings.
4. Documenting findings and any clinical judgment.
5. Terminating, continuing or revising the care plan.

Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas. Medical liability reform is a recent force in health care. Decreases in practicing physicians and high cost of healthcare due to ordering of tests to protect the provider from possible liability, have created the barriers to accessing health care for many individuals. You have been asked by the Community Relations Committee of Healing Hands Hospital to evaluate how the hospital can improve access to healthcare resources by members of the community and create strategies to improve access to care within your geographic region. Discuss the barriers that patients experience when accessing health care resources. How can health care organizations improve patients’ access to health care for all? Why do barriers continue to exist when it comes to access and equal health care? Include 3 reference sources, besides the textbook, and be sure to document your references using APA format.

Q2

Write a paper of 800+  words examining your personal values and beliefs. Include the following:   1. Describe your personal values and spiritual beliefs.   2. Using the elements of cost, quality, and social issues to frame your description, differentiate your beliefs and opinions about health care policy. Give examples of relevant ethical principles, supported by your values.   3. Analyze how factors such as your upbringing, spiritual or religious beliefs/doctrine, personal and professional experiences, and political ideology affect your current perspective on health care policy.   4. Examine any inconsistencies you discovered relative to the alignment of your personal values and beliefs with those concerning health policy. Discuss what insights this has given you.   APA format (heading, title page, in text citation, references page)