Comments on research ethics and nursing student projects

Since I became editor of NJNR, I have become more attuned to the discussions taking place concerning nursing student projects that should or should not involve patients. The main argument for including patients is that the project is conducted within the framework of an educational program. The argument against including patients refers to the country’s legislation concerning research that involves humans. In Sweden, empirical research that involves humans must be submitted to an ethical review board. ¹ Can there be exceptions to this legislation? More specifically, can an empirical study including patients conducted as a student project and not submitted to an ethical review board, be exempted? My answer to these questions is ‘no’ and I will briefly give some background.

In many countries, the process of writing a scholarly paper as a degree requirement may revolutionize students’ perceptions of nursing and the scope of nursing knowledge. For most first-year students in a nursing program, courses in scientific theory and research methodology are new academic subjects. The intention of these courses is to conceptualize nursing as a profession and area of research. Correspondingly, to find out that nursing research is also published in international scientific journals triggers an astonishing reaction, yet an ambition to find out more.

Although there may be exceptions, most studies at an undergraduate level do not involve empirical data including living persons or data protected by legislation, but are conducted as literature reviews of nursing research articles published in international journals. The completed paper is expected to demonstrate that the student has understood the basics of scientific theory and scholarly inquiry, and has the ability to conduct a literature search that includes a critical analysis of published work. Critical analysis includes reflecting on the fundamental principles of research ethics^2,3 and determining whether these are followed or not in the articles selected for the literature review. The completed paper is finally evaluated according to the goals specified in the curriculum and its abstract or summary may be stored in respective university archives.

At a more advanced level of education, such as a master’s program, the student may conduct an empirical study as a course requirement. Often the design of the study is time limited and builds on qualitative inquiry. The time limitation also disqualifies studies that require for example randomization and advanced statistical analysis. The choice of a qualitative design raises other questions that the master’s student may not be aware of at the beginning of planning the research. Let me give a hypothetical case as an example:

A master’s student, who also has much clinical experience as an RN working with patients with dementia at a late stage, has shown interest in finding out how next of kin experience their interactions with the patient. Together with the support of his supervisor, he/she conducted a small study including observations and five interviews with next of kin. The chief physician gave him/her permission and an application to the ethical review board was considered unnecessary. The study results in a paper and the student and supervisor agree that it should be sent to a nursing journal for publication.

The ethical aspects of qualitative methodology, as illustrated by the above study, are problematic. Dissimilar to, for example, randomized studies, the data collection can be described as relational and situational ⁴ and thus ethical problems are not altogether foreseeable when the study is planned.

Publication is the final stage of conducting research and it is my expectation that ethical aspects of the research question, methodology and consequences of publication must be raised at the beginning of the research process. Notwithstanding that obtaining ethical approval is burdensome, ⁵ time consuming, costly and may interfere with the time-plan for the study, permission from the ‘chief of staff’ to conduct the study is inadequate. In respect to the integrity of the respondents who are recruited to the study, if there are plans of publishing, their permission is required.

In summary, when it comes to publishing a study it is the responsibility of the author and co-authors that the research reported should comply with all relevant legislation. There are no exceptions to following the specific legislation. Let’s remember, the student paper was the result of a learning process. Ethical considerations are valuable within this framework. When there is the possibility of publication, an application must go to the ethical review board for approval before the study is completed, not retrospectively.