Response- ETHICAL CONSIDERATIONS

Sewassew Berhane

Aug 4 8:33pm| Last reply Aug 4 10:31pm

Reply from Sewassew Berhane

Comparison of Research, Quality Improvement, and DNP Projects

Healthcare research, quality improvement (QI), and Doctor of Nursing Practice (DNP) projects all aim to improve patient care; however, they differ in their purpose, methodology, generalizability, and ethical requirements. Understanding these differences is essential for selecting the most appropriate approach to address clinical problems while ensuring that ethical standards and participant protections are maintained.

The research study by Tzeng and Yin (2017), the quality improvement (QI) study by Khoja and Moosa (2023), and the Doctor of Nursing Practice (DNP) project by Bangura (2024) differ in their purpose, generalizability, sampling, and ethical requirements. Tzeng and Yin's (2017) research study sought to generate new knowledge by identifying effective interventions to reduce inpatient falls across multiple hospitals. Because the study used a large, multisite sample and systematic research methods, the findings have greater potential for generalizability to similar healthcare settings. Research involving human participants requires rigorous ethical oversight, including Institutional Review Board (IRB) approval, informed consent when appropriate, protection of participant confidentiality, and careful evaluation of potential risks and benefits.

In contrast, Khoja and Moosa's (2023) quality improvement study focused on improving a local clinical process rather than generating generalizable knowledge. The project evaluated the implementation of Tailored Interventions for Patient Safety (TIPS) within a specific healthcare setting using participants directly involved in the improvement initiative. Similarly, Bangura's (2024) DNP project implemented and evaluated a nurse practitioner-directed intentional rounding strategy to reduce patient falls in a veterans' long-term care facility. The project used a convenience sample from one organization, making the findings valuable for local practice improvement but limiting their generalizability to other settings. Although DNP and QI projects generally do not require the same level of regulatory oversight as research, they must still protect participant privacy, minimize risks, obtain organizational approval, and follow ethical principles throughout implementation (Hunt et al., 2021).

The ethical considerations for research differ from those for QI and DNP projects because their primary purposes are different. Research aims to produce generalizable knowledge and therefore requires rigorous protections, including informed consent, IRB review, and careful assessment of risks and benefits. The unethical Tuskegee Syphilis Study illustrates the consequences of failing to uphold these principles. Participants were deceived, denied effective treatment, and were not provided informed consent, resulting in lasting harm and mistrust of healthcare and biomedical research among Black communities (Centers for Disease Control and Prevention [CDC], 2022). These ethical violations contributed to the development of modern research protections, including the  Belmont Report and strengthened federal regulations for the protection of human research participants.

Although QI and DNP projects are designed to improve local practice rather than generate new knowledge, ethical responsibilities remain essential. Hunt et al. (2021) emphasize that QI initiatives should ensure transparency, protect confidentiality, minimize potential harm, and engage stakeholders throughout the improvement process. Likewise, DNP-prepared nurses have an ethical responsibility to implement evidence-based interventions that improve patient outcomes while respecting patients' rights, maintaining confidentiality, and promoting the ethical principles of beneficence, justice, and respect for persons. Whether conducting research, a QI initiative, or a DNP project, maintaining ethical standards is fundamental to protecting participants, improving healthcare quality, and preserving public trust.

References

Bangura, F. (2024).  Development and evaluation of a nurse practitioner-directed intentional rounding strategy, and its impact on decreasing falls in a veterans' long-term care facility (Doctoral dissertation, Wilmington University). ProQuest Dissertations and Theses Global.

Centers for Disease Control and Prevention. (2022, December 5).  The USPHS untreated syphilis study at Tuskegee.  https://www.cdc.gov/tuskegee/index.htmlLinks to an external site.

Hunt, D. F., Dunn, M., Harrison, G., & Bailey, J. (2021). Ethical considerations in quality improvement: Key questions and a practical guide.  BMJ Open Quality, 10(3), e001497.  https://doi.org/10.1136/bmjoq-2021-001497Links to an external site.

Khoja, A., & Moosa, L. (2023).  Impact of tailored interventions for patient safety (TIPS) to reduce fall rates.  MEDSURG Nursing, 32(2), 89–93.

Tzeng, H.-M., & Yin, C.-Y. (2017).  A multihospital survey on effective interventions to prevent hospital falls in adults.  Nursing Economics, 35(6), 304–313.

· Expand discussion thread from Sewassew Berhane

1 Reply, 1 Unread

1 Reply, 1 Unread

· Reply to post from Sewassew Berhane Reply

· Mark as Unread Mark as Unread

Eugenia Uzoamaka Uzoechi  (She/Her)

Aug 4 7:30pm

Reply from Eugenia Uzoamaka Uzoechi

NURS 8211 WEEK 11 DQ,

Ethical Considerations in Research, Quality Improvement, and DNP Projects

Comparison of Study Characteristics: Research Study, Quality Improvement Study, and DNP Project

Tzeng & Yin (2017) - Research Study: 

Generalizability 

The study by Tzeng and Yin (2017) aimed to identify effective fall prevention interventions in acute hospital settings by surveying registered nurses across multiple hospitals. Due to its broad participation from different hospital units and regions, the study has moderate generalizability.

Sampling 

The study used a cross-sectional survey design, distributing surveys to 2,170 registered nurses across multiple hospitals. Of these, 560 nurses responded, leading to a response rate of 25.81%. While the number of responses is significant, the low response rate raises concerns about potential response bias. Those who chose to participate might have been more engaged in fall prevention efforts, leading to an overestimation of the effectiveness of certain interventions. The survey asked nurses to rate the effectiveness of various fall prevention strategies, but it did not directly measure patient fall rates, which could limit the applicability of its findings in real-world settings.

Ethical Protections 

The research study followed appropriate ethical guidelines, securing Institutional Review Board (IRB) approval to ensure compliance with ethical research standards. Participation in the survey was voluntary and anonymous, protecting the identity of respondents and reducing the risk of bias related to coercion.

Khoja & Moosa (2023) - Quality Improvement (QI) Study:

Generalizability 

Khoja and Moosa (2023) conducted a quality improvement (QI) study to assess the impact of tailored interventions for patient safety (TIPS) on reducing falls in a medical-surgical orthopedic unit. Unlike research studies that aim to produce broadly applicable findings, QI studies focus on improving internal hospital practices. As such, the generalizability of this study is limited to similar hospital settings with comparable patient populations and staffing structures.

Sampling 

This QI study used a pre-post intervention design, with 30 patients included in the pre-intervention phase and 28 patients in the post-intervention phase. The study was conducted in a single 226-bed hospital’s medical-surgical orthopedic unit, which limits the sample size and scope of the findings. Additionally, the study lasted only four weeks, a relatively short duration to assess the long-term effectiveness of the intervention. The small sample size and short study period limit the strength of conclusions drawn from the data, as external factors may have influenced the fall rates independently of the intervention.

Ethical Protections 

Since QI studies are designed to improve existing healthcare processes rather than create generalizable knowledge, they often do not require IRB approval. In this case, the study was conducted under hospital administrative oversight rather than through formal IRB review. The intervention involved implementing nurse-driven strategies to reduce falls, meaning that patient consent was not necessary. The study did not indicate whether additional ethical safeguards, such as data anonymization or staff training in ethical research practices, were in place.

Bangura (2024) - Doctor of Nursing Practice (DNP) Project: 

Generalizability 

Bangura’s (2024) DNP project evaluated the impact of a nurse practitioner–directed intentional rounding strategy on fall rates in a veterans' long-term care facility. Since this was an evidence-based clinical practice change initiative, its generalizability is limited to similar long-term care facilities, particularly those serving veterans. While the intervention effectively reduced fall rates below the national average during the project’s six-week period, its applicability to other populations, such as younger patients or non-veteran long-term care settings, remains uncertain.

Sampling 

The project was conducted in a single 25-bed unit within a veterans' long-term care facility. All patients aged 18 years and older in the unit were included in the intervention, and intentional rounding was performed using the Morse Fall Scale. The study tracked fall rates before, during, and after the intervention. While the sample was appropriate for evaluating changes within the facility, it did not use a control group, which makes it difficult to rule out external factors that may have influenced the results.

Ethical Protections 

The DNP project followed ethical guidelines established by the Human Subject Review Committee (HSRC) and complied with veteran affairs regulations for patient safety and confidentiality. Since the project involved direct patient care, the researcher ensured that ethical standards, such as staff education and proper documentation, were followed.

Comparison of Ethical Considerations: Research vs. QI vs. DNP Project

Ethical considerations in research, quality improvement (QI), and Doctor of Nursing Practice (DNP) projects share fundamental principles such as patient safety, confidentiality, and beneficence but differ in their application, oversight, and regulatory requirements. While research studies typically require Institutional Review Board (IRB) approval, QI and DNP projects often operate under hospital administrative oversight rather than formal research ethics review.

Ethical Oversight and Approval

Research studies, like the one conducted by Tzeng and Yin (2017), require IRB approval before data collection can begin. This is because research aims to generate new, generalizable knowledge, which may involve risks to human subjects, data confidentiality, and informed consent. Ethical guidelines for research ensure that participants are fully informed, voluntarily participate, and understand potential risks and benefits.

In contrast, QI studies, such as Khoja and Moosa (2023), are designed to improve existing healthcare practices rather than generate new knowledge. Since QI initiatives focus on enhancing patient outcomes within a specific institution, they are not always required to obtain IRB approval.

DNP projects, like Bangura’s (2024) study on intentional rounding, also differ from traditional research in that they focus on evidence-based practice implementation. DNP projects often require Human Subject Review Committee (HSRC) approval or institutional permission rather than IRB oversight. Since these projects involve applying proven interventions in clinical practice, they are considered low-risk and do not typically require individual patient consent.

Informed Consent and Data Protection

One of the key ethical distinctions between research and QI/DNP projects is informed consent. Research studies involving human subjects must obtain explicit, voluntary consent from participants, outlining the purpose, risks, and potential benefits of participation. However, QI and DNP projects often integrate interventions into routine care, meaning individual patient consent is not always required, as long as standard care guidelines are followed and patient data remain de-identified.

Data protection is another major ethical concern across all three domains. Research studies follow strict confidentiality protocols, often anonymizing data to protect participants.

Purpose and Ethical Responsibility

Ethically, research is held to a higher standard of scrutiny due to the potential risks involved in testing new hypotheses. Researchers must balance scientific advancement with non-maleficence, ensuring no harm comes to participants. In contrast, QI and DNP projects operate under the principle of continuous improvement, where ethical responsibility lies in ensuring safe, effective, and patient-centered care.

Conclusion

The three studies share a common focus on fall prevention but differ in terms of their approach, generalizability, sampling, and ethical considerations. The Tzeng and Yin (2017) research study aimed to generate generalizable knowledge by surveying nurses across multiple hospitals, while the Khoja and Moosa (2023) QI study focused on improving internal hospital processes with a short-term intervention. The Bangura (2024) DNP project was an evidence-based practice change initiative aimed at reducing falls in a specific veteran population. Although each study provides valuable insights into fall prevention strategies, their applicability depends on the setting, population, and implementation context. While all three types of studies follow core ethical principles, research studies require formal IRB approval, individual informed consent, and strict adherence to regulatory guidelines, whereas QI and DNP projects focus on improving clinical practice with institutional oversight and integrated ethical safeguards.

References

Bangura, F. (2024).  Development and evaluation of a nurse practitioner–directed intentional rounding strategy, and its impact on decreasing falls in a veterans long-term care facility. (Publication No. 30991997) [Doctoral dissertation, Wilmington University]. ProQuest Dissertations and Theses Global. https://www.proquest.com/dissertations-theses/development-evaluation-nurse-practitioner/docview/2932310765/se-2

Khoja, A., & Moosa, L. (2023). Impact of tailored interventions for patient safety (TIPS) to reduce fall rates.  MEDSURG Nursing, 32(2), 89–93. https://www.proquest.com/scholarly-journals/impact-tailored-interventions-patient-safety-tips/docview/2801305464/se-2

Tzeng, H.-M., & Yin, C.-Y. (2017). A multihospital survey on effective interventions to prevent hospital falls in adults.  Nursing Economics, 35(6), 304–313. https://researchexperts.utmb.edu/en/publications/a-multihospital-survey-on-effective-interventions-to-prevent-hospal falls.

· Reply to post from Eugenia Uzoamaka Uzoechi Reply

· Mark as Unread Mark as Unread