ASSAM DOWNTOWN UNIVERSITY

FACULTY OF NURSING
SEMINAR

ON

SCOPE OF NURSING RESEARCH: AREAS, PROBLEMS IN NURSING,

HEALTH AND SOCIO RESEARCH, ETHICS IN NURSING.

SUBJECT – NURSING RESEARCH AND STATISTICS.

SUBMITTED TO: SUBMITTED BY:

MS. RUTH LALHMINGTHANG AMANDA KHARSAMAI

ASSOCIATE PROFESSOR 1ST YR. M.Sc. NURSING

FACULTY OF NURSING ROLL NO- 02

ASSAM DOWNTOWN UIVERSITY ASSAM DOWNTOWN UNIVERSITY

SUBMITTED ON: 25/10/2021

CONTENT
1. INTRODUCTION
2. SCOPE OF NURSING RESEARCH
 Research in clinical practice/clinical research
 Research in nursing education
 Research in nursing administration.
3. PROBLEMS IN NURSING, HEALTH AND SOCIAL RESEARCH
4. ETHICS IN NURSING
 Definition
 Importance of ethics in nursing research
 Code of ethics in nursing research
 Principle of beneficience
 Principle of justice
 Principle of research of human dignity
 Consent
 ICMR ethical guidelines for biomedical research
 Code of ethics for nurses in India
 Ethical responsibilities of a nurse researcher
5. JOURNAL REFERENCES
6. BIBLIOGRAPHY
INTRODUCTION

The care provided by nurses must be based on up-to-date knowledge and research that
supports the delivery of the highest standards of care possible. Nurses are developing their
own professional knowledge based with strong foundations built on research. Nurses have a
responsibility in some way to contribute to the development of the profession’s knowledge
through research. Florence Nightingale is often seen as the very first nurse researcher. Her
research in the 1850s focused on soldiers’ morbidity and mortality during the Crimean War.

Kirby (2004) pointing out that the development of nursing research in the United Kingdom
really only started with the inception of the National Health Service (NHS) – now the world’s
largest publicly funded health service—in the late 1940s. Prior to this, the development of
nursing research had relied on a few highly determined individuals and was bound up with
the professionalization of nursing, the demands for suitable nurses and the raising of
educational standards for nurses.

SCOPE OF NURSING RESEARCH

Nursing research encompasses a wide scope of scientific inquiry including clinical research,
health systems and outcomes research, and nursing education research. Health systems and
outcomes research examine the availability, quality, and cost of health care services as well
as ways to improve the effectiveness and appropriateness of clinical practice.

The area or scope of nursing research may be classified in the following categories;

 Research in nursing practice/clinical research

 Research in nursing education
 Research in nursing administration.

 Research in nursing practice/clinical research

 The scope of clinical research ranges from acute to chronic experiences across the
entire life span; health promotion and preventive care to end-of-life care; and care for
individuals, families, and communities in the diverse settings. For example, recent
discoveries in the genetic basis of diseases and behavior may help nurse scientists to
develop more effective strategies to manage symptoms and tailor interventions.
 Nurse researchers study how to assist individuals and groups as they respond to health
and illness experiences (e.g., reducing side effects of illness and treatment) and
address social and behavioral aspects of illness and quality of life. For example,
recent discoveries demonstrate that biological factors (e.g., genetic background,
neuronal connections and brain plasticity) affect behavioral factors and that
behavioral interventions (e.g., diet and exercise) affect biological factors (e.g., cell
functions).
Some of the researchable areas recommended by the INC in nursing practice are:

 Health promotion, maintenance and disease prevention

 Smoking cessation for the secondary prevention of coronary heart disease.
 Frequency of medication errors in an emergency department of a large teaching
hospital
 Work related stress, burnout, job satisfaction and general health of nurses
 Quality of life in people with cognitive impairment: nursing homes versus home care
 Ethical challenges when intensive care unit patients refuse nursing care: a narrative
approach.

 Research in nursing education.

 Nursing education is another important area of nursing research where nurse

researchers try to generate or refine the knowledge, which is useful to improve the
teaching learning methods and environment in nursing discipline.
 Nursing education research centers on developing and testing more efficient
educational processes, identifying new ways to incorporate technology in order to
enhance learning, and discovering more effective approaches to promoting
lifelong learning and commitment to leadership.
The lack of recognition and funding for this type of research has greatly impaired
progress in this area.
There are several issues and subareas on which nursing research focus.
 Testing the effectivity and efficiency of the old teaching methods/techniques
and generating newer effective teaching tools and technique
 Effectiveness of patient simulation in nursing education: meta-analysis
 Blended learning on medication administration for new nurses: integration of
e-learning and face-to-face instruction in the classroom
 Developing a global curriculum in school of nursing
 Knowledge use in nursing practice: the importance of practical understanding
and personal involvement
 Extent of strict discipline required for the nursing students to improve their
learning and education.

 Research in nursing administration

There are several main subareas of nursing administration which require investigation
such as

 Assessing existing organizational structure, span of control, communication, staffing

patterns, wages, benefits, performance evaluation practices, etc. and their
effectiveness. In addition, developing new knowledge or refining the old knowledge
regarding nursing administration phenomena.
 Developing and testing different administrative model to enhance swift administration
employees, and customer satisfaction.
  Retention and effective use of nursing personnel in providing the quality of nursing
care.
 Why older nurses leave the workforce and the implications of them staying.
 Employee satisfaction.
 Work related stress, burnout, job satisfaction, and general health of nurses.
 Measures to reduce the workload of the staff nurses
 Projects for increasing job satisfaction and creating a healthy work
environment.
 Health problems of nursing personnel.
 Health problems reported by nursing workers in a public hospital of Bahia.
 Measures to prevent frequent turnover of the staff.
 Effects of role of stress on nurses’ turnover intentions: the mediating effects of
organizational commitment and burnout.
 Analysis of the roles and responsibilities for treatment of patients with Ebola: can a
healthcare provider refuse to treat a patient with Ebola?

PROBLEMS IN NURSING, HEALTH AND SOCIAL RESEARCH

Research is not an easy activity in itself. Moreover, it becomes more difficult when ot is
conducted outside the laboratory. Research in health, nursing, and social sciences is usually
carried out in natural setting, where the researcher faces the following main problems:

 Fallibility of disciplined research: most of the research studies in these fields have
some limitations. Each research question can be solved by different approaches,
depending on several factors. Therefore, it is always confusing to decide a best
approach to solve a research question. It means non of these disciplines can solve a
question completely. However, repeated attempts to solve a similar question with
identical answers may increase the value of generated evidences.
 Handling multiple variables: most of the research studies in these fields usually focus
on the measurements of the multiple variables in single attempt. This attempt of
handling multiple data in single instance not only causes the data collection, analysis,
and interpretation problems, but also needs lots of time, energy and money to handle
these multiple non-numerical data.
 Difficulty in control on external variables: research in nursing, health and social
sciences is usually conducted in natural settings. Therefore, it becomes very difficult
to exert control over external variables while measuring the effect of independent
variable on dependent variable.
 Minimal possibility of laboratory research: research in nursing, health and social
sciences usually deals with phenomena related to humans, where ethically as well as
practically it becomes very difficult to conduct research studies in laboratory. Most of
the researches in these disciplines are conducted outside laboratory, in natural
settings.
 Lack of standardized tools: research in nursing, health and social sciences deals with
natural phenomena where valid and reliable standardized tools are needed to generate
 empirical evidences. However, it is evident that there is significant lack of valid and
reliable tools to measure variables in nursing, health and social sciences disciplines.
 Measuring qualitative phenomenon through quantitative means: it is usually
observed that several phenomena in the field of nursing, health and social sciences are
qualitative in nature. However, it can be commonly seen that these disciplines usually
measure these qualitative phenomena by using quantitative means where effectiveness
of evidence get distorted. This is assumed that this is usually happens because of the
superficial knowledge of qualitative research among professionals of nursing, health
and social sciences.
 Lack of interest among researchers: it is generally observed that people in these
fields conduct research only as a partial fulfillment of a particular degree or due to a
specific compulsion as part of the job.
 Ethical constraints: research studies in nursing, health and social sciences deal with
human beings where safeguarding their rights become an important issue.
 Lack of qualitative research expertise: qualitative research methods are considered to
be best to study phenomena in the field of nursing, health, and social sciences but
there is a significant dearths of experts equipped with the knowledge of qualitative
research.

ETHICS IN NURSING RESEARCH

Definition

‘Ethics in nursing research can be defined as the act of moral principles that the researcher
has to follow while conducting nursing research to ensure the rights and welfare of
individuals, groups, or community under study’.

Importance of Ethics in Nursing Research

Nursing research usually deals with the human being, where implications of the ethics
become very essential. Following are some of the important reason to support the importance
of ethics in nursing research:

 Protect the vulnerable and other study participants from harmful effects of the
experimental interventions.
 Safeguard the participants from exploitation by researchers.
 Establish the risk-benefit ratio for the study subjects.
 Ensure the fullest respect, dignity, privacy, disclose of information, and fear treatment
for study subjects.
Built the capability of subjects to accept or reject participation in study and to have access to
informed or written consent for participation in research study

Code of Ethics in Nursing Research

In 1968, the American Nurses Association developed a set of guidelines for nursing research.
These guidelines, titled Human Rights Guidelines for Nurses in Clinical and Other Research,
were revised in 1975 and 1985. The American Nurses Association published another set of
guidelines in 1995, Ethical Guidelines in the Conduct, Dissemination and Implementation of
Nursing Research. The major ethical principles that should be considered in designing or
reviewing the research studies are beneficence, justice, and respect of human dignity.

Principle of Beneficence

This is the most important ethical principle in nursing research, where every researcher must
ensure the following:

 Establishing the positive risk-benefit ratio, where the risk of researcher should never
exceed expected benefits for people from knowledge generated by the research
activity.
 A potential risk of the research study must be carefully assessed and participants are
protected from any harmful effect of research activity.
 In addition to physical harm, study subjects are also protected from expected adverse
psychological consequences caused by research study. For example, psychological or
emotional distress caused from self-discloser, introspection, fear of the unknown, or
interacting with a stranger.
 Research must be conducted by a scientifically qualified expert to avoid undue
discomfort or distress to study participants.
 Participants must be provided with maximum physical, psychological, social and
religious comfort, and undue disturbance and time utilization of the subjects should
be avoided.

Principles of Justice

This ethical principles directs the researchers to abide the participant’s right of fair treatment
and maintenance of privacy. Therefore, researchers must ensure the following:

 The fair and nondiscriminatory selection of the participants, such as any risk and
benefits will be equally shared by study participants. Participant’s selection should be
based on research requirement and not on convenience, gullibility, or compromised
position of certain type of people.
 The non-prejudicial treatment of individual who decline to participate or who
withdraw from the study after agreeing to participate.
 Anonymity of participants and confidentiality of information must be maintained.
  No information collected from study participants can be used for other than research
purpose.
 The vulnerable subjects, such as children, pregnant women, mentally ill patients,
physically disabled, terminally ill, and institutionalized (prisoners) people, who are
conveniently and easily accessible, must be protected from overuse and undue use for
research purpose.

Principles of Research of Human Dignity

This principles of ethics emphasizes on the freedom of choice, where participants have right
to accept or reject to be a part of the study. In addition, volunteers must be provided full
information about the research study and an informed consent must be obtained, preferably a
written one. Therefore, under this principle, researcher must ensure the following:

 Participants have full rights to question the researcher for any additional information
or clarification of doubts.
 Participants have right to quit from the study at any stage of the research study.
 A fully informed consent must be taken from the participants. In case of the fetus,
infant, toddler, younger child, or psychological, neurological or physical inability to
give informed consent, this can be obtained from parents or legal guardians. In case of
child aged between 7 and 18 years, an assent may be obtained.

Informed Consent

Informed consent is more than a form of signature; it is process of information exchange.

In nursing research involving human participants, the investigator must obtained the
informed consent of the prospective participant or in the case of an individual who is not
capable of giving informed consent, the consent of a legal guardian.The contents of an
informed consent must include the following:

 Title of study and name(s) of investigator(s).

 Introduction and invitation to subjects.
 Purpose of the research study.
 Basis of subject selection.
 Procedural process and any intervention involved in the study.
 Expected time and nature of participants’ involvement in the study.
 Type of data/information to be obtained for respondents.
 Details of the potential discomfort or risk for participants in the study.
 Details of the support available in case any harm occurs to participants.
 Mechanisms to protect privacy and anonymity of participants.
 Contact detail to collect information and clarification about doubts.
 Statement about voluntary participation of subjects and right of termination without
any penalty.
 Description of the expected benefits of the research study.
 Signature lines (to obtain the signature of the subjects and counter signature by
investigator who obtained the consent).

Format of consent form for Research study

IEC Protocol Number:
IEC Application Date:
Consent Form to participate in Research Study
Study title:
Purpose of study:
Researcher (s) / Investigator(s):
Sponsor: Indian Medical Council of Research (IMCR) , New Delhi
Procedure / Task:
Duration:
Risk and Benefits:
Confidentiality:
Incentive:
Participation right:
Contacts and questions:

Signing the Consent Form

I have read (or someone has read to me) this form and I am aware that I am being
asked to participate in a research study. I have had the opportunity to ask questions
and have had them answered to my satisfaction. I voluntarily agree to participate in
this research study. I am not giving any legal right by signing this form. I will be
given a copy of this form.

--------------------------------------
----------------------------------------
Name of Subject / Authorized person Signature of subject /
Authorized
Person
Date and time:
-------------------
Investigator /Research Staff
I have explained the research to the participant or his /her representative before
requesting the signatures above. A copy of this form has been given to the participant
or his / her representative.

-----------------------------
---------------------------
Name of person Obtaining Consent Signature of person
obtaining
Date and time: ---------------
Waiver of Informed Consent

It is mandatory to obtain a voluntary informed consent from each research participant.

However, it may be waive off in the situation where risk on the participant is very minimal,
emergency condition with involved risk and participants are duly protected for both privacy
and confidentiality and do not violet the rights of participants, then IEC may waive off
informed consent in following situations:

 An emergency situation, where it is practically not possible to obtain surrogate

consent.
 In a situation, where it is not practically not possible to conduct research since
confidentiality of personally identifiable information has to be maintained throughout
the research as may be required by the sensitivity of the research objective, e.g. study
on disease burden of sexually transmitted disease.
 In a situation, where research study is to be conducted on anonymized biological
samples from deceased individuals, left over samples after clinical investigation, cell
lines or cell free derivatives, like viral isolates, DNA or RNA from recognized
institutions or qualified investigators, samples or data from repositories or registries,
etc.
 In a research study, where data to be obtained from publicly available information,
documents, records, works, performances, reviews, quality assurance study, archival
materials or third party interviews, service programmes for benefit of public having a
bearing on public health programmes, and consumer acceptance studies.

Responsibilities of an Investigator in Obtaining Informed Consent

The investigator carries out the following responsibilities adequately in obtaining the
informed consent:

 Investigator must provide all the necessary and desired information to the participant .
 It must be ensured by the investigator that none of the participant is unduly influenced
or intimidated.
 Investigator should ensure that preferably informed written is maintain obtained only
after adequate information to participant.
 A verbal informed consent may be obtained, when participant refuses to give sign or
thump impression or cannot do so. However, it is better to documented through audio
or video.
 In case of an abandoned institutionalized individual or a person under judicial
custody, surrogate consent may be obtained from authorized relative or legal
custodian or head of the institute.
 A surrogate consent cannot be obtained, if the participant losses consciousness or
competences of consent during research study.
  Investigator must ensure that none of the way patient-clinician relationship is affected
and treatment/care is influenced by the decision of individual to participate or not in a
particular research study.

ICMR Ethical Guidelines for Biomedical Research

The Indian Council of Medical Research (ICMR) brought out the ‘Policy Statement on
Ethical Considerations Involved in Research on Human Subjects’ in 1980 and revised these
guidelines in 2000 as the Ethical Guidelines for Biomedical Research on Human Subjects’.
The general principles that are common to all areas of biomedical research and any research
using the human beings as participants should follow these principles.

I. Principles of essentiality.
II. Principles of voluntariness, informed consent and community agreement
III. Principles of nonexploitation
IV. Principle of privacy and confidentiality
V. Principles of precaution and risk minimization
VI. Principles of professional competence
VII. Principles of accountability and transparency
VIII. Principles of the maximization of the public interest and of distributive
justice.
IX. Principles of institutional arrangements
X. Principles of public domain
XI. Principles of totality of responsibility
XII. Principles of compliance

Code of Ethics for Nurses in India

Indian Nursing Council (INC) has published the Code of Ethics for Nurses in India in the
year 2006. The code of ethics for nurses is critical for building professionalism and
accountability. Ethical considerations are vital in any area dealing with human beings
including nursing research because they represent values, rights, and relationships. Therefore,
the same code of ethics may imply for nurses dealing with human subject while conducting a
research study. The Code of Ethics for Nurses in India (2006) are as follows:

1. The nurse respects the uniqueness of an individual in provision of care

Nurse
 1.1: Provides care individuals without consideration of caste, creed, religion,
culture, ethnicity, gender, socioeconomic and political status, personal
attributes or any other grounds
 1.2: Individualizes the care considering the beliefs, values and cultural
sensitivities
 1.3: Appreciates the place of individual in the family and community, and
facilitates participation of significant others in the care
 1.4: Develops and promotes trustful relationship with individual(s)
  1.5: Recognizes uniqueness of response of individuals to interventions and
adapts accordingly

2. The nurse respects the rights of individuals as partners in care and helps in making
informed choices
Nurses
 2.1: Appreciates individuals’ rights to make decisions about their care and,
therefore, gives adequate and accurate information for enabling them to make
informed choices
 2.2: Respects the decisions made by individual(s) regarding their care
 2.3: Protects public from misinformation and misinterpretations
 2.4: Advocates special provisions to protect vulnerable individuals/groups

3. The nurse respects individuals’ rights to privacy, maintains confidentiality and shares
information judiciously
Nurse
 3.1: Respects the individuals’ rights to privacy of their personal information
 3.2: Maintains confidentiality of privileged information except in life-
threatening situations and uses discretion in sharing information
 3.3: Takes informed consent and maintains anonymity when information is
required for quality assurance/academic/legal reasons
 3.4: Limits the access to all personal records written and computerized to
authorized persons only

4. The nurse maintains competence in order to render quality nursing care

Nurse
 4.1: Nursing care must be provided only by a registered nurse
 4.2: Nurse strives to maintain quality nursing care and upholds the standards
of care
 4.3: Nurse values continuing education, initiates and utilizes all opportunities
for self-development
 4.4: Nurse values research as a means of development of nursing profession
and participates in nursing research adhering to ethical principles

5. The nurse is obliged to practice within the framework of ethical, professional and legal
boundaries
Nurse
 5.1: Adheres to code of ethics code of professional conduct for nurses in India
developed by India Nursing Council
 5.2: Familiarizes with relevant laws and practices in accordance with the law
of the state

6. The nurse is obliged to work harmoniously with members of the health team
Nurse
  6.1: Appreciates the team’s efforts in rendering care
 6.2: Cooperates, coordinates and collaborates with members of the health team
to meet the needs of people
7. The nurse commits to reciprocate the trust invested in nursing profession by the society
Nurse
 7.1: Demonstrates personal etiquettes in all dealings
 7.2: Demonstrates professional attributes in all dealings

Ethical Responsibilities of a Nurse Researcher

Following are some of the essential ethical responsibilities of a nurse researcher.

 Ensure the respect of individuals’ autonomy in consenting to participate in research

and also take care for adequate protections are in place to protect study subjects from
any potential harm.
 An adequate protection of the vulnerable group in study, such as children, elderly,
pregnant women, mentally ill patients, physically disabled, terminally ill and
institutionalized people, etc.
 The nurse researcher must ensure the optimum balance between risk-benefit ratio
through ensuring minimizing potential harms and to maximizing the possible benefits
for all subjects enrolled in study.
 The benefits and risk associates with the study must be equally distributed among
identifying prospective study subjects.
 The privacy, confidentiality and anonymity must be promised and protected during
entire study period.
 Maintaining competence in identified research area and to maintain proficiency in
research methods.
JOURANAL REFERENCE

1. International Journal of Health Sciences and Research, The Barriers and Challenges
of Conducting Nursing Research and Communicating Research Findings into
Practice, Dr. Gitumoni Konwar, Jayshree Kalita, vol 8; Issue 6, June 2018.
Abstract
Background: Nurses were facing various challenges and barriers while conducting a
nursing research and communicating a research findings to practice. The study aims
to explore those barriers and challenges.
Methods: A descriptive study that applied quantitative and qualitative research
methods of data collection was adopted for the study. Data were collected through a
Likert scale and open ended questionnaire from 116 registered nurses of India.
Quantitative portion of the tool were analyzed by using SPSS version 18.0 and
qualitative portion analyzed by using thematic analysis.
Results: Most of the nurses (63.8%) occasionally looks for new literature, 39.7%
nurse strongly agree that there is inadequate manpower. There is lack of authority of
the nurses in changing patient care procedure (37.9%strongly agree). According to
44.8% nurses, nursing expert often differ in their opinion related to methodology.
Thematic analysis of the open ended questionnaire showed that nurses faced problems
related to organizational factor, resource related problem, knowledge and competency
related problem and communication problem. In organizational factor most of them
found ethical constrain as a major barrier; whether resource related factors include all
money, material and manpower issues. Different opinions of nursing expert confuse
the nurses and they found difficulty in getting related literature.
Conclusion: The study shows that, nurses faces barriers and challenges of conducting
nursing research and communicating research findings into practice. Barriers are
mainly related to poor organizational support, resources, different opinion of experts
on methodology, communicating findings to journals because lo high payment, and
lack of literature.
2. European Journal of Molecular and Clinical Medicine, Ethics in Nursing Research, P.
Priyadarshini, vol 07, issue 07, 2020
Abstract: Ethics are the rules for correct behavior. Professional ethics for nurses will
state the idea, ways in which a nurse should behave in all relationships including
those with the patient, patient’s relative s, co-workers members of the other
professions and the public. The discussion of the professional adjustment is complete
only when ethics are included. Research involving human subjects in the medical,
social and behavioral sciences poses complex ethical issues which requires careful
thought and consideration on the part of both researchers and research participants.
Ethics in research are very important when we are going to conduct an experiment.
BIBLIOGRAPHY :

1. Sharma. K. Suresh , “ Textbook of Nursing Research & Statistics” , 2 nd Ed ,2014 ,

Reed Elsevier India Private Limited ,New Delhi.
2. Nursing research, B.T Basavanthappa, second edition, jaypee publication, Page no 12-
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and Assessing Evidence for Nursing Practice ” , 9 th Ed,2012 ,Wolters Kluwer
( India ) Pvt,Ltd , New Delhi .pg no .150-151, 170-171.
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2012 Page no 16-18.
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i. https:google weblight .com
ii. http://www.indiannursingcouncil.org
iii. https://www.nursing times.com
iv. www.monstercrawler.com