Qualitative Approach & Nursing Research

1. Nursing Research: 63-377Dr. Wally J. Bartfay “Great spirits have always found violent opposition from mediocre minds. The latter cannot understand it when man does not thoughtlessly submit to hereditary prejudices but honestly and courageously uses his intelligence.” (Albert Einstein, 1879-1955)

2. Qualitative Approach & Nursing

3. Qualitative Approach & Nursing Note: The researcher is the “instrument” here

4. Phases in Qualitative Research Designs/ Approaches • Phase I: Orientation & overview -determines what is salient about the phenomenon of interest) (e.g., how decision making occurs with treatment options for pt’s with prostate CA) • Phase II: Focused exploration –more focused exploration & in-depth exploration (e.g., information given about Rx choices for prostate CA & expected outcomes) • Phase III: Confirmation & Closure – helps to establish that findings are correct & trustworthy (e.g., go back & discuss what researcher head subject say about Rx. Choices & expected outcomes for prostate CA & how decisions were arrived at alone or in combination)

5. Qualitative Research Methods • (1) Phenomenological: is a process of learning & constructing the “meaning of human experiences” through intensive dialogue with subjects who are living the experiences (e.g., women with breast CA) • (2) Grounded Theory Method: Inductive approach that uses a systematic set of procedures to arrive at theory about basic social processes (e.g., organizational characteristics of self-help groups for parents with special needs children)

6. Qualitative Research Methods • (3) Ethnographic method: derived from Greek term “ethnos” meaning people, race or cultural group- it focuses on the scientific description & interpretation of cultural or social groups & systems (Aboriginal health) • (4) Case-study method: Study of a selected phenomenon that provides an in-depth description of its dimensions & processes (e.g., selenium-deficient induced cardiomyopathy in nutritionally deprived run-away children)

7. What are some human rights requiring protection in terms of research?

8. Human Rights Requiring Protection • Privacy & dignity • Confidentiality & anonymity • Fair treatment • Full disclosure & self-determination (requires informed consent, recognized by Supreme Court of Canada) • Protection from death, disability, discomfort & harm (note: CNA Code of Ethics for Research)

9. Ethical issues R/T research: A brief historical account • Use & abuse of humans & animals for “experimentation” dates back to antiquity • Kings & emperors had their servants sample food & drinks to ensure it wasn’t poisoned • 1731, Stephan Hales, a minister & physiologist, trust a glass tube into a horse’s jugular artery & performed 1st B.P. reading • Mid 1800’s, Dubois used medical students to test chloroform inhalers & dosages (development of anesthesia) • Isabel Hampton Robb (1900s, Victorian era), 1st Hx. account of ethical actions by nurses as health care providers (not to cause injury/ harm, help clients etc)

10. Ethical issues R/T research: A brief historical account • During 1930s & 1940s (WWI), med. experiments on prisoners of war were performed to test human endurance, reaction to infectious agents, untested drugs, etc without consent • Resulted in Nuremberg Code in 1949 & Declaration of Helsinki (1964, revised 2000) • Despite best efforts, abuse still occurs (e.g., San Antonio Contraceptive Study in US in 1969; CIA Brain Washing Experiments using “white noise” etc at the Allan Memorial Institute in Montreal 1960s-70s)

11. Articles of the Nuremberg Code (1949) • (1) Voluntary informed consent from all participants in study • (2) Study should be necessary & not random inquiry • (3) Study be based on animal research & must address nature of problem or disease • (4) Avoid unnecessary physical & mental suffering or injury • (5) No experimentation if death is possible outcome

12. Articles of the Nuremberg Code (1949) • (6) Risk should not exceed expected benefit • (7) Need to have preparation to avoid unnecessary pain, injury, death, etc • (8) Study should be conducted by qualified researchers • (9) Subject has right to terminate study anytime they want to • (10) If researcher suspects risks of injury, disability, death etc, they should terminate study immediately

13. Declaration of Helsinki (1964, 2000) • Based on Nuremberg Code & differentiates therapeutic & non-therapeutic research • (1) Therapeutic: allows subject opportunity to receive an experimental Rx that may have beneficial effects (e.g., vaccine for AIDS) • (2) Non-therapeutic: conducted to generate knowledge & outcomes may benefit future clients (e.g., experimental surgery or Rx)

14. Belmont Report (1979) • Serves as model for many ethical codes & includes: • (1) Respect for persons (self-determination, freedom to participate or not) • (2) Beneficence (do no harm, maximize possible benefits) • (3) Justice (fair treatment)

15. Research Ethic Boards (REBs) • Ensure that study meets criteria of Tri-Council (human subjects) & Canadian Council of Animal Care (CCAC) • Consist of expert panel of researchers & laypersons also • Hold researchers accountable for inappropriate violations of study protocol • Provide quality assurance checks • Helps guide investigators

16. Critical Thinking Decision Pathway: Evaluating Risk/Benefit Ratio of Study

17. Ethical Research Critiquing Criteria: • Was study approved by REB? • Is there evidence of informed consent? • Were the subjects protected from physical or emotional harm? • Were subjects or representatives informed about any potential risks? • Is study designed to maximize benefit & minimize harm? • Were subjects coerced or unduly influenced to participate in study? • Did subjects have right to withdraw without penalty? • Were vulnerable subjects used? • Were appropriate safeguards taken to ensure privacy of subjects? • How has data been kept anonymous &/or confidential & is it stored in a safe & secure location?

18. Smile and the world smiles with you…