NSG/456 Week 2: Ethical Issues in Research, sample paper

Studying Your Own Colleagues and Their Errors: Ethical Issues in a Night-Shift Nap Study on a Medical-Surgical Unit

[Student Name]

University of Phoenix

NSG/456: Research Outcomes Management for the Practicing Nurse

Week 2 Assignment

[Instructor Name]

[Date]

The unit, its staff and the study are a composite written for a model paper.

In Week 1, I asked whether giving night nurses a protected half-hour in which they may sleep lowers how sleepy they feel at 0600, and whether it changes how many medication errors and near misses get reported. This paper examines the ethical issues a study of that question would raise. Most research on fatigue carries little physical risk, and it is tempting to call this study minimal risk and move on. The real risks here are not physical; they come from who the participants are and what the study would record about them.

The Framework

The Belmont Report names the principles that should govern any study involving people: respect for persons, beneficence and justice (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979). Respect for persons requires that participants choose freely and with full information. Beneficence requires that risks be minimized and justified by likely benefits. Justice asks who carries the costs of a study and who gains from it, and whether that split is fair. Each principle applies to this study in a specific way.

Respect for Persons: Consent Among Colleagues

The participants would be nurses on my own unit and a comparison unit in the same hospital. I am a staff nurse, but I also precept new graduates and serve on the unit's practice council, and several potential participants know me well. Colleagues may agree to take part because they do not want to disappoint me, or because they assume the manager wants the study to succeed. Consent given under that kind of pressure is not fully voluntary.

Several protections address this. A research assistant from outside the unit, not I, would explain the study and obtain consent. Nurses would be told in writing that declining has no effect on their schedule, evaluation or relationship with the manager, and the manager would not know who declined. Consent forms would state plainly that participants can withdraw at any time, including after the nap period begins, without giving a reason.

A second issue is what consent covers. Nurses would consent to rating their sleepiness and to the study team reviewing event reports from the study period. They should also be told how their event reports will and will not be used, which leads to the most serious risk.

Beneficence: The Risk in the Error Data

Medication errors and near misses are sensitive information. An event report can lead to retraining, discipline or, in rare cases, a report to the board of nursing. If study data linked a named nurse to an error that her manager did not already know about, the study could harm her. Nurses who fear that possibility may also stop reporting near misses during the study, which would harm patients and distort the results.

The study would therefore use only event reports already filed through the hospital's system, which the manager already sees. The research team would receive the reports with nurse identifiers removed by the patient safety office and replaced with a study code. Data would be reported at the unit level, never by individual. No new information about any nurse's errors would be created by the study.

The nap itself carries smaller risks. Sleep inertia, the grogginess after waking, briefly worsened memory in the emergency department trial (Smith-Coggins et al., 2006). The protocol would limit naps to 30 minutes and require a ten-minute recovery period before a nurse resumes medication administration. Patient safety during the nap depends on coverage, so the charge nurse would assign a named colleague to each napping nurse's patients.

Benefits must justify these risks. Participants may feel less sleepy and drive home more safely, which nurses in an earlier implementation project reported (Geiger-Brown et al., 2016), and the unit would gain evidence about a practice it cannot currently evaluate.

Justice: Who Carries the Burden

Justice asks whether the burdens fall fairly. Two risks appear. First, nurses on the comparison unit would receive no nap opportunity during the study, which is fair only if napping is not yet an established standard, and it is not. The comparison unit would be offered the intervention after the study ends if results are positive. Second, nurses covering for a napping colleague carry extra workload. The protocol would limit coverage to one colleague at a time and track any shift when coverage was refused because acuity was too high.

The Researcher's Own Conflict of Interest

A less obvious risk comes from me. I believe napping will help, I am tired on nights myself, and I would like the study to succeed. That wish could shape how I recruit, how I describe the intervention to participants and how I read the results. The protections already described limit my influence on consent, and three more steps limit it on the data. The primary outcome and the analysis would be written down and registered with the research office before any data are collected, so the results cannot be read selectively afterward. A nurse researcher from outside the unit would review the analysis. And the final report would state my role on the unit and my own view of napping, so that readers can judge the findings with that knowledge. Declaring a conflict does not remove it, but it lets others weigh it, which is what honest research requires.

Privacy and Data Security

Sleepiness ratings would be collected on paper forms marked with a study code and stored in a locked cabinet in the nursing research office, then entered into a password-protected file. The key linking codes to names would be kept separately by the research assistant and destroyed after data collection ends.

Institutional Review

Because the study involves human participants and identifiable data, it would require review by the hospital's institutional review board. It may qualify for expedited review as minimal risk research, but the board, not the researcher, makes that decision (Polit & Beck, 2021). Approval from nursing leadership would also be needed before any unit could protect nap time, and that approval process may itself shape the design, as manager reluctance did in the earlier project (Geiger-Brown et al., 2016).

Conclusion

The ethical risks in a night-shift nap study come from the relationships among the participants and from the sensitivity of error data, not from the nap. Independent consent, de-identified unit-level error data, a limit on nap length and fair treatment of the comparison unit address those risks. Week 3 will consider which research design can answer the question within these protections.

References

Geiger-Brown, J., Sagherian, K., Zhu, S., Wieroniey, M. A., Blair, L., Warren, J., Hinds, P. S., & Szeles, R. (2016). Napping on the night shift: A two-hospital implementation project. American Journal of Nursing, 116(5), 26-33. https://doi.org/10.1097/01.NAJ.0000482953.88608.80

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health, Education, and Welfare.

Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.

Smith-Coggins, R., Howard, S. K., Mac, D. T., Wang, C., Kwan, S., Rosekind, M. R., Sowb, Y., Balise, R., Levis, J., & Gaba, D. M. (2006). Improving alertness and performance in emergency department physicians and nurses: The use of planned naps. Annals of Emergency Medicine, 48(5), 596-604. https://doi.org/10.1016/j.annemergmed.2006.02.005