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Ethical Principles
Ethics, according to Britannica, is the discipline concerned with what is morally good and
bad and morally right and wrong or any system or theory of moral values or principles (2024).
When ethics is utilized in the medical field it becomes what is good or right and/or what is bad or
wrong concerning patient health care. This goes more in-depth concerning patient rights, privacy,
treatment, fairness, independence, etcetera. There are four principles concerning medical ethics,
beneficence, nonmaleficence, autonomy, and justice. These principles should always be
considered to provide high quality, fair and right patient care.
Beneficence and nonmaleficence derive from Hippocrates and mean “to help and do no
harm” (Varkey, 2020). Beneficence in medical terms means to treat patients treat patients from
conditions that can cause harm, assist people with disabilities, and to promote patient welfare
(Varkey, 2020). The medical team accomplishes beneficence by balancing risks vs benefits
concerning patient care (Haddad, 2023). Nonmaleficence means to not purposely cause harm,
pain or suffering by choosing the best interventions or treatments for patients (Varkey, 2020).
Beneficence and nonmaleficence will be accomplished with this study by attempting to find the
disconnect in postpartum care, bridge the gap, and possibly decrease postpartum mortalities and
morbidities.
Justice is the right for patients to be treated fairly and equally, even in the time of conflict
(Haddad, 2023). Of the many subtopics of justice, distributive justice is the fair and equitable
appropriate distribution of health-care resources (Varkey, 2020). This is pertinent in this study in
that one of the factors in a prior study identified as a potential cause to patient decline being
Medicaid only covering 60 days of the postpartum period (Postpartum Care for Women Up to
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One Year After Pregnancy, 2022). It is fair to assert this is not equal when compared to private
insurance that covers their patients during the postpartum period and beyond, so this must be
investigated.
Autonomy, the most important of all, encompasses all ethical principles. Autonomy
proclaims that patients have the right to make their own decisions (Haddad, 2023). Patients have
the right to be fully advised on any treatment or care they are to receive and allowed comply or
refuse said care. It is the foundation for confidentiality, truth-telling and consent (Varkey, 2020).
When considering autonomy, competence must also be considered. A person must be able to
understand instructions and/or information to make sound decisions.
It is important for all ethical principles to respected and abided by in the entire research
process, but very important during the initial buy in, attaining informed consent. For medical
purposes or research, the requirements for informed consent are 1) the patient must be
competent, 2) receives full disclosure, 3) understands the disclosure, 4) volunteers, and 5)
consents to participate (Varkey, 2020). For this study nurses will distribute flyers and
communicate information during the postpartum discharge teaching. The desire of verbal
communication is to have the study fresh in their minds, and the flyer aims to give potential
participants time to consider and not feel pressured to decide right away. The flyer will have
background information, such as morbidity and mortality rates, the importance of following up
with symptoms, and having all patient concerns addressed. Full disclosure of what the patient is
to expect, how data will be gathered and used, the goal of the study, how confidentiality and
privacy will be protected will be expressed. There will be verbiage about participation being
strictly voluntary along with a link and/or QR code for quick access. The link and/or QR code
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will lead directly to the survey, with a reiteration of the information from the flyer. Participants
will have to click “yes” acknowledging informed consent before beginning the survey.
Participant privacy will be achieved by locking all hard copy data in locked file cabinets.
All electronic correspondence will be stored on a password-protected drive that only the research
team can access. No personally identifying information will be queried, however, unique
identifying numbers will be assigned for ease of managing data. During focus groups and/or
personal interviews, audio recordings may be used via digital recorder. The information will then
be transferred to the password-protected drive. Once data is extracted and transcribed the audio
recordings will be destroyed.
The Institutional Review Board (IRB) will start for this proposal with training. All
members of the research team will complete CITI modules required to build a solid foundation
for the research proposal. An account will be created in the organizations IRB SharePoint.
Review of Activities Preparatory to Research (APTR) to determine if the proposal is sufficient. A
HIPAA Authorization waiver will be filled out due to information coming directly from sources
with no personal identifying markers. All data will then be submitted to the IRB to include
surveys, flyers, the informed consent form, training, HIPAA waiver request, and proposal for
recruitment to be incorporated with postpartum discharge education. A multi-site request will
also be submitted to compare data from more than one local hospital. It will be proposed for this
study to utilize the Expedited Protocols due to the research posing minimal risk to participants.
In research, a risk is the probability of physical, psychological, social or economic harm
caused by participating in a study (Korenman, n.d.). This research study poses minimal risk as
there will not be increased harm to participating subjects that surpass more than their typical
daily encounters (Korenman, n.d.). The benefit of this study is the potential to remedy the
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education and postpartum care disparity and possibly decrease morbidities and mortalities. The
potential benefits greatly outweigh the risks.
References
Encyclopædia Britannica, inc. (2024, February 2). Ethics. Encyclopædia Britannica.
https://www.britannica.com/topic/ethics-philosophy
Haddad, L. M. (2023, August 14). Nursing ethical considerations. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK526054/#:~:text=There%20are%20four
%20main%20principles,and%20values.%5B4%5D
Korenman, S. G. (n.d.). Teaching the Responsible Conduct of Research in Humans (RCRH).
Chapter 3 - appropriate risk to benefit ratio.
https://ori.hhs.gov/education/products/ucla/chapter3/page01.htm
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical
Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119
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