Impact and Assessment of Research Integrity Teaching: A Systematic Literature Review.

Presented here is a systematic literature review of what the academic literature asserts about: (1) the stages of the ethical decision-making process (i.e. awareness, reasoning, motivation, and action) that are claimed to be improved or not improved by RI teaching and whether these claims are supported by evidence; (2) the measurements used to determine the effectiveness of RI teaching; and (3) the stage/s of the ethical decision-making process that are difficult to assess. Regarding (1), awareness was the stage most claimed to be amenable to improvement following RI teaching, and with motivation being the stage that is rarely addressed in the academic literature. While few, some sources claimed RI teaching cannot improve specific stages. With behaviour (action) being the stage referenced most, albeit in only 9% of the total sources, for not being amenable to improvement following RI teaching. Finally, most claims were supported by empirical evidence. Regarding (2), measures most frequently used are custom in-house surveys and some validated measures. Additionally, there is much debate in the literature regarding the adequacy of current assessment measures in RI teaching, and even their absence. Such debate warrants caution when we are considering the empirical evidence supplied to support that RI teaching does or does not improve a specific stage of the decision-making process. Regarding (3), only behaviour was discussed as being difficult to assess, if not impossible. In our discussion section we contextualise these results, and following this we derive some recommendations for relevant stakeholders in RI teaching.

Teaching research integrity as discussed in research integrity codes: A systematic literature review.

Presented here is a systematic literature review of how RI teaching is discussed in national and international research integrity (RI) codes. First, we set out to identify the codes that exist, and performed some generic analysis on them. Following a comprehensive search strategy, which included all 193 United Nations member states, we identified 52 national and 14 international RI codes. RI teaching is addressed in 46 national and 10 international codes. We then examined how the codes address RI teaching under the following headings: the aims, the target audience, the ethics approach proposed, the assessment and/or evaluation strategy, and any challenges identified in relation to RI teaching. There is considerable overlap between the aims of RI teaching in the various codes, for example, promoting awareness of RI. Most codes claim RI teaching is for all researchers, but without any in-depth guidance. While educational programmes, training, and mentorship/supervision are proposed for RI teaching, there is insufficient detail to identify the ethics approach to be used in such teaching. Lastly, only few address assessment and/or evaluation or challenges in RI teaching. Here, we analyzed how current codes address RI teaching; we identified some shortfalls, and in our discussion we advance recommendations.

The principle of double effect and external whistleblowing in nursing.

Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.

Should nurses take a COVID-19 vaccine?

The issue as to whether health care professionals have a moral obligation to take a vaccine for a communicable disease is not new. Nonetheless, this issue takes on a fresh urgency within nursing practice in the context of the present COVID-19 pandemic, i.e., is there an ethical requirement for nurses to take a COVID-19 vaccine? This paper approaches the issue by using a hypothetical example of Nurse X who has inadvertently infected Patient Y. French's (1984a) Principle of Responsive Adjustment is adapted to claim that there would be a moral expectation that Nurse X takes a COVID-19 vaccine (unless there are justifiable reasons not to). The proposition is also made that, should Nurse X not take a COVID-19 vaccine, they could be morally associated with originally infecting Patient Y.

European Nursing Council Code for European nursing and the UN Sustainable Development Goals.

A code of ethics for the practice of nursing seeks to capture, in a written document, the normative values, ethical principles and standards of good care to guide nurses - qua moral agents. A codification of the accepted collective values of nursing can play a constitutional and directional role for the profession. It can further stimulate discussions about nursing that reflect the dynamic essence of the profession. Consequently, there is merit to continually reflecting on a code's function and role especially when a new or revised code is introduced to the nursing profession and the wider public such as the European Nursing Council's Code of Ethics and Conduct for European Nursing. This paper examines codes of ethics in general and the European Nursing Council Code in particular using the framework of Gaumnitz and Lere. Although the European Nursing Council Code has all the ingredients of a contemporary professional ethics code, our position is that future iterations or addenda to this Code should be aligned to the UN Sustainable Development Goals and take a more radical step in becoming an exemplar of a nursing code that can be a catalyst for the advancement of the Sustainable Development Goals.

The principle of salvage in the context of COVID-19.

The prioritisation of scarce resources has a particular urgency within the context of the COVID-19 pandemic crisis. This paper sets out a hypothetical case of Patient X (who is a nurse) and Patient Y (who is a non-health care worker). They are both in need of a ventilator due to COVID-19 with the same clinical situation and expected outcomes. However, there is only one ventilator available. In addressing the question of who should get priority, the proposal is made that the answer may lie in how the pandemic is metaphorically described using military terms. If nursing is understood to take place at the 'frontline' in the 'battle' against COVID-19, a principle of military medical ethics-namely the principle of salvage-can offer guidance on how to prioritise access to a life-saving resource in such a situation. This principle of salvage purports a moral direction to return wounded soldiers back to duty on the battlefield. Applying this principle to the hypothetical case, this paper proposes that Patient X (who is a nurse) should get priority of access to the ventilator so that he/she can return to the 'frontline' in the fight against COVID-19.

"Ought implies can" & missed care.

The concept of missed care refers to an irrefragable truth that required nursing care, which is left undone, occurs in the delivery of health care. As a technical concept, missed care offers nurses the opportunity to articulate a problematic experience. But what are we to make of missed care from an ethical perspective? Can nurses be held morally responsible for missed care? Ethically speaking, it is generally accepted that if a person has a moral obligation to do something, s/he needs to have the capacity to do it. If a person does not have the capacity to fulfil a moral obligation, then s/he cannot be held responsible for failing to do so. This is captured by the "ought implies can" (OIC) principle. This paper brings the OIC principle to the forefront of the discussion on missed care. It is contended that nurses - qua moral agents - may be discharged from a moral obligation to carry out a required caring act because of some inability that is not of their making and therefore may not be morally responsible for missed care. However, the OIC principle may not be applied to all situations of missed care depending on their causes. In addition, following in the thought of Sapontzis (The Southern Journal of Philosophy, 1991, XXIX, 383-393) it is contended that when an original obligation to deliver a required act of care cannot be fulfilled, other obligations may be generated as summed up in the "Principle of Making Amends" and the "Principle of Appropriate Feeling." It is the view of this paper that these further principles could prevent the OIC principle from being used to simply excuse omissions of care from a normative standard and could support the view that nurses continue to have alternative obligations to make amends and to respond with appropriate feelings to missed care.

Diagnostic self-testing: autonomous choices and relational responsibilities.

Diagnostic self-testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point-of-care facilities and at home. Designed to allow earlier detection of diseases, self-testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping society improve health and reduce health costs. However, the full implications of future home-based diagnostic technology for individuals and society remain unclear due to their novelty. We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home-based self-testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation. While the ethical issues are not necessarily new, the development of home-based self-testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities.