Ethics of Nursing Research: Principles, History, and Practice

Ethics of Nursing Research
NCM 111- Nursing Research 1- Prof. Mark Allan B. Juan, RN, LPT MAN

Objectives:
At the end of the 4-hour session, the students will be able to:
Knowledge
1.Explain the importance of ethics in nursing research.
2.Discuss ethical principles governing nursing research.
3.Identify ethical codes and policies used in nursing research.
4.Describe the rights of research participants.
5.Recognize unethical activities in nursing research.
Skills
1.Analyze ethical dilemmas in nursing research.
2.Apply ethical principles in research scenarios.
3.Evaluate whether research studies comply with ethical standards.
Attitude
1.Appreciate the importance of protecting research participants.
2.Demonstrate commitment to ethical research practices.

Pre-Activity

Activity Title:
"Would You Participate?"

Activity Title:
Situation 1
A researcher offers students ₱10,000 to participate in a
clinical trial involving an experimental drug.
Question:
Would you join?
Why or why not?

Activity Title:
Situation 2
A nurse secretly records patient conversations to improve
communication research.
Question:
Is this acceptable? why or why not?

Activity Title:
Situation 3
Researchers fail to tell participants that the study involves
painful procedures.
Question:
Should participants know?

Processing Questions:
1.What makes research ethical?
2.Why should participants be protected?
3.Can good research become unethical?
4.What responsibilities do nurse researchers have?

"Today we will discover why ethics is the
foundation of every nursing research."

What is Ethics?

What is Ethics?
Ethics refers to the moral principles, values, and
standards that guide human behavior and
decision-making. These principles help individuals
distinguish between actions that are morally right
and those that are morally wrong.
Ethics influences how people interact with others,
make decisions, and fulfill their responsibilities in
both personal and professional settings.

What is Ethics?
In nursing and healthcare, ethics serves as the foundation for
delivering safe, compassionate, and patient-centered care. It
ensures that nurses, researchers, and other healthcare
professionals respect human dignity, protect individual rights, and
act with honesty, integrity, and accountability.
In the context of nursing research, ethics ensures that studies are
conducted responsibly and that the welfare, rights, and dignity of
research participants are always prioritized over the interests of
science or the researcher.

What is Ethics?
• According to Polit and Beck (2021): "Research ethics refers to
the moral principles that guide researchers in conducting studies
involving human participants, ensuring respect for persons,
beneficence, and justice."
• LoBiondo-Wood and Haber (2022) describe ethics as: "A system
of moral values and principles that guides professional conduct
and decision-making in research and healthcare."

What is Ethics?
Ethics determines what is:
• Right (identify actions that are morally correct)
• Wrong (identifies behaviors that are morally unacceptable)
• Acceptable (appropriate and responsible)
• Unacceptable (violate professional standards and place
participants at risk.)

What is Nursing Research Ethics?
• Refers to principles that protect human
participants while ensuring honesty, fairness,
and scientific integrity throughout the
research process.

Why Ethics Matters in Nursing Research?
Nurses work with:
• Sick people
• Vulnerable populations
• Children
• Elderly
• Pregnant women
• Persons with disabilities

Why Ethics Matters in Nursing Research?
Research without ethics can
• Harm patients
• Violate rights
• Destroy public trust
• Produce false evidence

Historical Background of
Research Ethics

Historical Background of Research Ethics
Understanding the history of research ethics is essential
because many of today's ethical principles and regulations were
established in response to serious abuses committed in the past.
These historical events demonstrated the devastating
consequences of conducting research without respect for
human rights, dignity, and welfare.
As a result, international ethical codes and guidelines
were developed to ensure that research involving human
participants is conducted responsibly and ethically.

1. Nazi Human Experiments (1939–1945)
During World War II (1939–1945), physicians and scientists
working under Nazi Germany conducted numerous medical
experiments on prisoners held in concentration camps such as
Auschwitz, Dachau, and Buchenwald.
These prisoners included Jews, Romani people, political
prisoners, prisoners of war, and other groups persecuted by the
Nazi regime.

The experiments were performed without the participants'
knowledge or consent. Individuals were forced to participate
and had no right to refuse. Many of the procedures caused
extreme pain, permanent disability, or death.
The Nazi physicians claimed that these experiments would
improve military medicine and scientific knowledge, but they
completely disregarded the value of human life and violated
every principle of medical ethics.

A. Freezing Experiments
These experiments sought to determine
how long German soldiers could survive in
freezing temperatures and how hypothermia
should be treated.
Prisoners were: Immersed in ice water for
several hours, Left naked outdoors during
w i n t e r , E x p o s e d t o e x t r e m e l y c o l d
environments

B. Poison Injection Experiments
Researchers injected prisoners with toxic
chemicals and poisons to study their effects
on the human body.Other prisoners were
secretly given poisoned food or drinks.
The purpose was to determine:Speed of
poisoning, Organ damage and Possible
antidotes
Most participants experienced severe
suffering and many died.

C. Infectious Disease Experiments
Prisoners were intentionally infected with diseases such
as: Malaria, Tuberculosis, Typhus and Hepatitis
R e s e a r c h e r s w a n t e d t o t e s t v a c c i n e s a n d
medications.Many participants developed severe illness,
permanent disability, or died because treatments were often
delayed or never provided.

The Nuremberg Doctors' Trial
After World War II ended, Allied forces prosecuted Nazi physicians
responsible for these crimes during the Nuremberg Doctors' Trial
(1946–1947). The trial concluded that physicians have an ethical obligation
to protect the people involved in research.As a result, one of the most
important ethical documents in research history was created.
The Nuremberg Code (1947)
The Nuremberg Code is considered the first international code of
research ethics involving human participants.
It established 10 ethical principles to guide researchers and prevent
future abuses.

2. Tuskegee Syphilis Study (1932–1972)
The Tuskegee Syphilis Study is one of the most infamous examples of
unethical medical research in the United States.
The study was conducted by the U.S. Public Health Service in Tuskegee,
Alabama. The researchers recruited approximately 600 African-American men,
including: 399 men who had syphilis and 201 men without syphilis (control
group)
Most participants were poor sharecroppers with limited education and
access to healthcare. Researchers wanted to observe the natural progression
of untreated syphilis in humans. Instead of treating the disease, they chose to
watch how it affected the body over time.Participants did not understand: The
true purpose of the study, The procedures involved and The risks of untreated
syphilis Their participation was therefore not voluntary in an informed sense.

2. Tuskegee Syphilis Study (1932–1972)
The Belmont Report (1979)
In response to the Tuskegee Syphilis Study, the United
States established the National Commission for the
Protection of Human Subjects of Biomedical and Behavioral
Research.
The commission published the Belmont Report in 1979,
which became one of the most influential documents in
research ethics.

These historical events remind us that scientific progress
must never come at the expense of human dignity, rights,
or safety.
The tragedies of the Nazi experiments and the Tuskegee
Syphilis Study led to stronger ethical safeguards that
protect research participants today.

Importance of Ethics
in Nursing Research

Importance of Ethics in Nursing Research
1. Protects Human Rights
Participants have the right to Safety, Privacy and
Freedom.
2. Prevents Harm
Researchers must avoid: Physical harm, Psychological
harm, Social harm, Financial harm and Legal harm.
Example:
Interviewing abused women without emotional support
may retraumatize them.

3. Promotes Trust
Communities are more willing to participate if
researchers are ethical.
4. Ensures Credibility
Ethical studies produce reliable findings.

5. Maintains Professional Integrity
Nurses are trusted professionals.
Ethical research strengthens public confidence.
6. Complies with Laws
Ethical approval is legally required before conducting
research.

Ethical Principles
in Nursing Research

Ethical Principles in Nursing Research
Principle 1: Respect for Persons (Autonomy)
Treat everyone as autonomous individuals.
Application: Obtain informed consent and allow
withdrawal anytime.
Principle 2: Beneficence
Doing good and promoting the welfare of research
participants.
Maximize benefits. Minimize harm.

Principle 3: Nonmaleficence
"Do No Harm" Avoid unnecessary risks.
Principle 4: Justice
Everyone deserves equal treatment. No discrimination.
Fair participant selection.

Principle 5: Veracity
Tell the truth.Provide accurate information and avoid
deception.
Principle 6: Confidentiality
Protect participant information.
Principle 7: Fidelity
Keep promises made to participants.

Ethical Codes and Policies
in Nursing Research

Ethical Codes and Policies in Nursing Research
1. The Nuremberg Code (1947)
The Nuremberg Code is considered the first international
code of research ethics involving human participants. It
established 10 ethical principles to guide researchers and
prevent future abuses:
1. Voluntary Consent is Essential- Participants must
freely agree to participate. Consent should be:voluntary,
informed, and given without force or intimidation
Participants must understand: Purpose of the study,
Procedures, Risks and Benefits.

2. Research Must Benefit Society- Research should
produce valuable knowledge that benefits humanity.
3. Animal Research Should Come First- Researchers
should first conduct laboratory and animal studies before
involving human participants whenever appropriate. This
reduces unnecessary risks to humans.
4. Avoid Unnecessary Suffering- Researchers must
minimize pain, injury, and emotional distress. Every
precaution should be taken to protect participants.

5. No Research if Death is Expected- Researchers
should never conduct experiments when death or disabling
injury is expected unless the researchers themselves are
also participants.
6. Risks Must Never Exceed Benefits- The potential
benefits of the study should justify the risks involved.
7. Proper Safety Measures Must Be Available-
Researchers should prepare emergency procedures and
provide qualified medical personnel to protect participants.

8. Only Qualified Researchers Should Conduct
Studies- Research should be performed only by individuals
with appropriate education, training, and competence.
9. Participants May Withdraw Anytime- Participants
have the right to stop participating whenever they choose
without penalty.
10. Researchers Must Stop Harmful Studies- If
continuing the research is likely to cause injury, disability, or
death, researchers must immediately terminate the study.

2. The Declaration of Helsinki
It was developed by the World Medical Association (WMA) to
ensure that medical research is conducted responsibly while
protecting the rights, safety, dignity, and well-being of research
participants.
The Declaration of Helsinki builds upon the principles established
in the Nuremberg Code (1947) and provides more comprehensive
guidance for physicians and researchers conducting biomedical and
health-related research.
Many countries, universities, hospitals, journals, and Ethics
Review Committees (ERCs) require researchers to follow its
principles before approving or publishing research.

2. The Declaration of Helsinki
The Declaration of Helsinki remains one of the most influential
ethical documents in health research because it:
• Protects the rights, dignity, and welfare of human participants.
• Requires independent ethical review before research begins.
• Ensures that risks are minimized and justified by potential benefits.
• Promotes informed consent and voluntary participation.
• Safeguards vulnerable populations.
• Upholds scientific integrity and transparency.
• Serves as the ethical foundation for clinical trials, nursing research, and
biomedical studies worldwide.

2. The Belmont Report (1979)
It provides the fundamental ethical principles that guide
researchers in protecting the rights, dignity, safety, and welfare of
individuals participating in research studies. The Belmont Report
was published in 1979 by the National Commission for the
Protection of Human Subjects of Biomedical and Behavioral
Research in the United States.
Three Basic Ethical Principles
• Respect for Persons
• Beneficence
• Justice

2. The Belmont Report (1979)
Application in Nursing Research Today:
Nurse researchers use Belmont principles in:
• Clinical trials
• Qualitative interviews
• Community health studies
• Student research projects
• Hospital-based research
• Nursing intervention studies
Every stage of the research process should reflect these ethical
principles.

3. The Council for International Organizations of Medical
Sciences (CIOMS) is an international non-governmental organization
established in 1949 by: World Health Organization (WHO)and United Nations
Educational, Scientific and Cultural Organization (UNESCO). Its primary
mission is to provide ethical guidance for biomedical and health research
around the world.
The CIOMS Guidelines focus on:
1. Protection of vulnerable populations
2. Ethical conduct of international collaborative research
3. Fair distribution of research benefits and burdens
4. Prevention of exploitation of disadvantaged communities
5. Respect for cultural diversity while maintaining universal ethical standards

3. The Council for International Organizations of Medical
Sciences (CIOMS)
Importance of CIOMS in Modern Nursing Research
The CIOMS Guidelines are important because they:
• Protect vulnerable populations.
• Prevent exploitation of disadvantaged communities.
• Promote fairness in international research.
• Encourage social justice.
• Strengthen community trust in research.
• Promote culturally sensitive and ethical nursing research practices.

4. Philippine Ethical Guidelines
Prepared by: The Philippine Health Research Ethics Board
(PHREB), an organization that develops national ethical standards
and policies governing health-related research in the Philippines.
The Philippine National Ethical Guidelines for Health and Health-
Related Research provide direction to researchers, institutions, and
ethics committees to ensure that research participants are protected
and that studies are conducted responsibly and ethically.

Major Highlights
1. Institutional Ethics Review Board (IERB/REC) Approval
Before any health research involving human participants can
begin, the study must be reviewed and approved by an accredited
Research Ethics Committee (REC) or Institutional Ethics Review
Board (IERB).
2. Informed Consent
Informed consent is the process of providing potential
participants with sufficient information about the research so that
they can voluntarily decide whether to participate.

Major Highlights
3. Data Privacy and Confidentiality
The Philippine Ethical Guidelines emphasize compliance with the
Data Privacy Act of 2012 (Republic Act No. 10173).Researchers
must protect participants' personal and sensitive information.
4. Community Protection
Research should not only protect individuals but also safeguard
the welfare of communities involved in the study. Researchers must
respect local culture, beliefs, and traditions.

Significance to Nursing Research
The Philippine Ethical Guidelines ensure that nursing research:
• Protects human dignity and rights.
• Produces credible and ethical scientific evidence.
• Promotes patient safety and public trust.
• Ensures compliance with national laws and international ethical
standards.

5. Ethics Review Committee (ERC)
also known as a Research Ethics Committee (REC) or
Institutional Ethics Review Board (IERB), is an independent body
responsible for reviewing research proposals involving human
participants before the study begins.
Its primary purpose is to ensure that research is conducted
ethically and that the rights, safety, dignity, and well-being of
participants are protected.

Responsibilities of the Ethics Review Committee
1. Assess Risks and Benefits- One of the primary responsibilities of
the ERC is to determine whether the potential benefits of the research
outweigh the possible risks.
2. Review the Informed Consent Process- The ERC carefully
examines the informed consent form to ensure that participants can make
a voluntary and informed decision.
3. Protect Research Participants- Participant protection is the
central function of the ERC. The committee ensures that researchers
uphold ethical principles.
4. Approve, Require Modifications, or Reject Research Protocols

Importance of ERC in Nursing Research
• Protects patients and participants from harm.
• Promotes ethical and responsible research practices.
• Enhances the credibility and validity of research findings.
• Ensures compliance with institutional, national, and international
guidelines.
• Is often required for publication, funding, and thesis completion.

Break

Right of Research Participants

Right of Research Partcicipants
1. Right to Self-Determination- Participation is voluntary. No force.
2. Right to Full Disclosure-Know the Purpose, Risks, Benefits and
Procedures.
3. Right to Fair Treatment- Equal respect. No discrimination.
4. Right to Privacy- Personal life should remain protected.
5. Right to Confidentiality- Names replaced with codes. and Secure
storage of data.

6. Right to Withdraw-Participants may leave anytime. No
penalty.
7. Right to Protection from Harm- Researchers must reduce
risks.
8. Right to Compensation- If harmed, appropriate medical care
and compensation may be provided.

9. Informed Consent
The process by which a researcher provides sufficient
information to potential participants so they can make a voluntary
and informed decision about whether to participate in a study.
It is based on the ethical principle of Respect for Persons,
which recognizes an individual's right to make decisions regarding
their own participation in research.
Informed consent is not merely obtaining a signature on a form;
rather, it is an ongoing communication process between the
researcher and the participant.

9. Informed Consent
Essential Elements of Informed Consent
1. Purpose of the Study- Participants must clearly understand
why the research is being conducted. The researcher should
explain:The problem being studied, The objectives of the research
and Why the participant is being invited.
2. Procedures of the Study- Participants must be informed
about what they will be asked to do during the research.This
includes: Interviews or surveys, Physical examinations, Collection of
biological samples, Observation periods and Duration and
frequency of participation

9. Informed Consent
3. Benefits of Participation- Researchers should explain any
potential benefits. Participants should understand what positive
outcomes may result from the study.
4. Risks and Discomforts- Participants should be informed
about any possible risks, inconveniences, or discomfort associated
with participation.
5. Voluntary Participation- Participation in research must
always be voluntary. Participants should never be:Forced,
Threatened, Coercedand Unduly influenced.

9. Informed Consent
6. Confidentiality and Privacy- Researchers must explain how
participant information will be protected.Protects participants from
potential harm arising from disclosure of personal information.
7. Right to Withdraw- Participants have the right to discontinue
participation at any time without penalty.
8. Contact Information- Participants should be provided with
contact details for: Principal researcher, Faculty adviser or
investigator and Research Ethics Committee (REC/ERC).

9. Informed Consent
9. Participant Signature- The participant's signature indicates
that: The information has been explained, The participant
understands the study and Participation is voluntary. Provides
documentation that informed consent was obtained.
10. Researcher Signature- The researcher's signature certifies
that:The study was adequately explained, Questions were answered
honestly and The participant voluntarily agreed to participate. This
demonstrates the researcher's ethical responsibility and
accountability.

9. Informed Consent
Additional Requirements in Special Situations
For Minors: Parent/guardian consent is required, Child assent
may also be needed.
For Vulnerable Populations: Additional safeguards may be
necessary for: Elderly individuals, Persons with disabilities, Patients
with mental illness, Economically disadvantaged groupsand
Indigenous communities

9. Informed Consent
see sample

Unethical Activities in
Nursing Research

Unethical Activities in Nursing Research
1. Fabrication-Making up data or results that never existed.
Example: Inventing patient survey responses that were never
collected.It is unethical because it produces false knowledge and
misleads healthcare practice.
2. Falsification-Manipulating research materials, procedures, or
data to alter results.
Example: Removing data that do not support the research
hypothesis.It Distorts scientific findings and leads to inaccurate
conclusions.

3. Plagiarism-Using another person's ideas, words, or work
without proper acknowledgment.
Example: Copying literature review sections from another thesis
without citation.It Violates intellectual property rights and academic
honesty.
4. Coercion-Forcing or pressuring individuals to participate in
research.
Example: A faculty member requiring students to join a study or
risk receiving lower grades. Violates the principle of voluntary
participation.

5. Undue Influence- Offering excessive rewards that may
improperly influence participation.
Example: Providing a very large amount of money to
economically disadvantaged participants. ItMay impair a
participant's ability to make a free and informed decision.
6. Data Manipulation-Altering statistical analyses or data to
obtain desired results.
Example: Changing statistical values to make findings appear
significant. It produces misleading evidence that may negatively
affect nursing practice.

7. Breach of Confidentiality-Disclosing participants' personal
information without permission.
Example: Revealing the names or medical conditions of
participants.It violates privacy rights and may cause stigma or
discrimination.
8. Lack of Informed Consent-Conducting research without
obtaining voluntary consent from participants.
Example: Administering questionnaires without explaining the
study or obtaining signatures.It disrespects participant autonomy
and rights.

9. Ghost Authorship-Listing an individual as an author despite having little
or no contribution to the study.
Example: Including a senior faculty member's name solely because of their
position.It misrepresents actual contributions and violates academic integrity.
10. Duplicate Publication-Publishing the same study in multiple journals
without disclosure.
Example: Submitting identical research findings to two journals. It mislead
the scientific community and artificially inflates research productivity.
11. Selective Reporting- Reporting only favorable results while hiding
unfavorable findings.
Example: Presenting only positive outcomes and omitting negative effects of
an intervention. It creates biased evidence and may lead to incorrect healthcare
decisions.

Consequences of Unethical
Research Practices

Consequences of Unethical Research Practices
1. Research Retraction
Published articles may be withdrawn from journals due to ethical
violations.
2. Loss of Professional License
Researchers, including nurses, may face disciplinary actions or
loss of professional credentials.
3. Loss of Funding
Funding agencies may terminate grants and prohibit future
research support.

Consequences of Unethical Research Practices
4. Legal Liability
Researchers and institutions may face lawsuits, fines, or criminal
charges for violating laws such as privacy regulations.
5. Institutional Sanctions
Possible penalties include suspension, dismissal, revocation of
research privileges, or academic disciplinary actions.
6. Loss of Public Trust
Unethical research damages confidence in nursing research and
healthcare institutions, making people less willing to participate in
future studies.

Key Message:
Ethical nursing research is essential because the pursuit of
scientific knowledge should never compromise honesty, participant
rights, safety, dignity, and public trust.

Group Activity:

REFERENCES:
1.Nursing Research: Generating and Assessing Evidence for Nursing Practice
Polit, D. F., & Beck, C. T. (2021). Nursing Research: Generating and Assessing Evidence for Nursing
Practice (11th ed.). Wolters Kluwer.
2.Essentials of Nursing Research
Polit, D. F., & Beck, C. T. (2022). Essentials of Nursing Research: Appraising Evidence for Nursing
Practice (10th ed.). Wolters Kluwer.
3.Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice
LoBiondo-Wood, G., & Haber, J. (2022). Nursing Research: Methods and Critical Appraisal for
Evidence-Based Practice (10th ed.). Elsevier.
4.Introduction to Nursing Research
Burns, N., & Grove, S. K. (2021). Introduction to Nursing Research: Building an Evidence-Based
Practice (8th ed.). Elsevier.
5.Gray, J. R., Grove, S. K., & Sutherland, S. (2020). Burns and Grove's The Practice of Nursing
Research: Appraisal, Synthesis, and Generation of Evidence (9th ed.). Elsevier.

Ethics of Nursing Research: Principles, History, and Practice

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