Ethical Issues and Quality ImprovementRachel DuffyEva van SwaaijPhomolo Madome

Ethical Theories

Philosophical Basis for Ethical Theory:• Professional code of ethics• Ethics theories derived from either of 2 basic schools of

thought: naturalism or rationalism

Ethical Theories• Utilitarianism (consequentialism)

-Act-Utilitarianism-Rule-Utilitarianism • Deontology• Virtue ethics (character ethics)

Virtue ethics: Compassion, discernment, trustworthiness, integrity• Moral Particularism

Ethical Requirements for the Protection of Human Participants in Quality Improvement Activities

Requirement Explanation

Social or scientific value The gains from a QI activity should justify the resources spent and the risks imposed on participants.

Scientific validity A QI activity should be methodologically sound (i.e., properly structured to achieve its goals).

Fair participant selection Participants should be selected to achieve a fair distribution of the burdens and benefits of QI.

Favourable risk–benefit ratio

A QI activity should be designed to limit risks while maximizing potential benefits and to ensure that risks to an individual human participant are balanced by expected benefits to the participant and to society.

Requirement Explanation

Respect for participants A QI activity should be designed to protect the privacy of participants and the confidentiality of their personal information.

Independent review Accountability for the ethical conduct of QI should be integrated into practices that ensure accountability for clinical care.Each QI activity should receive the kind of ethical review and supervision that is appropriate to its level of potential risk and project worth

Informed consent Consent to inclusion in minimal-risk QI activities is part of the patient’s consent to receive treatment.Patients should be asked for informed consent to be included in a specific QI activity if the activity imposes more than minimal risk.

Ethical Principles relevant to the project/researchRespect for persons• People have the right to self-determination and right to full-

disclosure.• Participants will be given the right to decide voluntarily

whether to participate in the study or not.• Participants will be allowed to ask questions, to refuse to give

information, or to withdraw from the study.• The nature of the study, the persons right to refuse

participation, and the likely risks and benefits that would be incurred will be fully described.

• Confidentiality will be ensured, using number codes.

Beneficence

• An obligation to do no Harm and maximize benefits. Persons are treated in ethical manner when their decisions are respected and they protected from harm, and efforts are made to secure their well-being.

• Participants will not be subjected to unnecessary risks of harm or discomfort (physical, emotional, social, or financial). Study will be terminated if any kind of harm is suspected during the study.

The right to privacy• Participants privacy will be maintained throughout the study.• Any data provided will be kept in strictest confidence.• Anonymity & confidentiality will be maintained.

Protecting Study Particiants• Informed Consent

• Risk /Benefit assessments

• Assent

• Institutional Review Board.

References• Rashid M., Fan W.L., Guul S., Enoch S. (2009). Clinical Education.

How to undertake research in wound healing.Wounds uk,Vol 5, No 3. Retrived from: http://www.wounds-uk.com/pdf/content_9299.pdf

• Orb A., Eisenhauer L., Wynaden D. Ethics in qualitative research. JOURNAL OF NURSING SCHOLARSHIP, 2000; 33:1, 93-96. ©2001 SIGMA THETA TAU INTERNATIONAL. Retrived from: http://www.columbia.edu/~mvp19/RMC/M5/QualEthics.pdf

• Lynn, J., Baily, M., & Bottrell, M., et al. (2007). The Ethics of Using Quality Improvement Methods in Health Care. Annals of Internal Medicine. 146(9. 666-673.

• Burkhardt, M. A. (2008). Ethical theory. Ethics and issues in contemporary nursing. 24-51 Delmar Learning. Retrieved from http://edocs.library.curtin.edu.au/eres_display.cgi?url=dc60267151.pdf&copyright=1

Collaboration Process

• We divided this weeks presention into two parts- Rachel worked on Ethical Theories and Flex related ethics to our quality improvement issue. Eva began working on the final presentation for class tomorrow.

Research Methods• Rachel: I used my Universities search engine and searched

using key words`Ethical theories´, and ethical theories in nursing.