Student-faculty joint authorship: ethical and legal concerns.

Although faculty mentoring through joint authorship with students offers benefits to both, the claim of joint authorship of students' works by faculty members may raise ethical and legal concerns. Whether based on institutional policies, faculty members' mandates or suggestions, or even students' invitations, such claims may violate principles of autonomy, fidelity, veracity, and justice. Moreover, such claims may be contrary to basic requirements of copyright law relating to joint authorship and derivative works. Unjustified claims to authorship may have adverse effects on the student-faculty relationship, give rise to professional embarrassment for the individual faculty and the institution, or lead to legal liability. The responsibility to address ethical and legal concerns inherent in such joint authorship rests with the administration and faculty of the individual nursing education department.

Graduate student-faculty collaboration in research and publication.

The nursing profession advocates development of theoretical knowledge as a basis for nursing practice and promotes preparation of graduate students as nursing scholars. This study explored the influence of selected factors on the publishing efforts of student authors who published in the Western Journal of Nursing Research during a 5-year period. Assignments, particularly for a dissertation, provided a significant impetus for publishing. Self-selection of a topic of interest also was an important factor. Approximately one third of the student authors had collaborated with faculty as coauthors. Graduate students make a significant contribution to the creation and dissemination of nursing knowledge. The influence of collaboration with faculty, the defining elements of collaborative mentorship, and inherent ethical issues should be investigated in future studies.

The message of SUPPORT: Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment. Change is long overdue.

The major findings of the Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment (SUPPORT), a multimillion dollar, multisite investigation of the process of dying in American hospitals, were extremely disappointing to the medical community. The major conclusion of this intervention study was that increased efforts to improve communication about patients' preferences for end-of-life care to physicians did not have a significant impact on the care that is provided in hospitals. In a commissioned series of papers to examine the conclusions of the study, numerous factors were identified as the possible reasons for the SUPPORT findings. Among the factors was the role of nurses in communicating patients' preferences to physicians. Nurses, however, were not participants in the design and conduct of this study nor were they among those who were respondents to the conclusions of SUPPORT. In this manuscript, an analysis of the report of the SUPPORT study itself and the commentaries commissioned by its funding agency are reported. Numerous issues about the scientific rigor of SUPPORT, the perceived roles of nurses in end-of-life decision making, and the need for interdisciplinary collaboration in health care and health care research are presented in an effort to ensure that nurses' contributions to the quality of patient care are recognized, acknowledged, and valued in the future.

Factors influencing the publishing efforts of graduate students in nursing.

The purposes of this study were to identify factors influencing publication efforts of graduate students in nursing and determine the extent to which graduate students' scholarly activities contribute to the creation and dissemination of knowledge in nursing, as evidenced by publication in a professional journal. Authors of articles in Nursing Research were surveyed to assess their status as graduate students during the conceptualization, development, and publication of nursing research studies. The sample consisted of 633 authors of manuscripts published in Nursing Research from 1987 to 1991. The study design was descriptive. A survey questionnaire elicited data on graduate student status and factors that influenced the initiation and completion of the project. The data were analyzed using descriptive statistical techniques. The results of the study suggest that graduate students in nursing make important contributions to the advancement and dissemination of nursing knowledge. Factors that influence graduate students to engage in the process include academic requirements (e.g., thesis, dissertation, coursework), faculty involvement and support, and the ability to self-select the research topic.

Nurses' sensitivity to the ethical aspects of clinical practice.

The purpose of this study was to describe the extent to which nurses perceive the ethical dimensions of clinical practice situations involving patients, families and health care professionals. Using the composite theory of basic moral principles and the professional standard of care established by legal custom as a framework, situations involving ethical dilemmas were gleaned from the nursing literature. They were reviewed for content validity, clarity and representativeness in a two-stage process by expert panels. The situations were presented in a written format to a convenience sample of nurses (n = 125), who were primarily staff nurses (65.6%). Respondents' judgements about whether the main issue of each situation concerned ethics ranged from a low of 0.8% to a high of 40%. From analyses of the categories into which the majority of subjects placed each situation, it was concluded that these nurses generally perceived ethics as the main issue in situations that directly involve patients' autonomy. Analysis yielded unanticipated findings about the themes in ethical situations to which nurses in practice may respond.

Disclosure of human immunodeficiency virus status in healthcare settings: ethical concerns.

As knowledge of human immunodeficiency virus (HIV) disease increases, society's attitudes toward disclosure of seropositivity are reverting to a traditional public health approach. Both patients and healthcare professionals fear HIV infection (although the risks of transmission in healthcare are small), and broadly support disclosure. In this article, the disclosure issue is examined within a framework of the ethical principles of autonomy, nonmaleficence, beneficence, and justice, which suggests that patients and healthcare professionals should be required to disclose known seropositivity before exposure-prone procedures are performed. Because of the risk of stigmatization, renewed effort to prevent unwarranted disclosure by healthcare professionals also is required.

Enhancing patients' autonomy.

Although beneficence was the ethical principle applied most frequently in health care situations in the past, the principle of autonomy has gained importance recently. The current application of autonomy over beneficence results in a reconsideration of past "accepted" situations such as assuming informed consent is without coercion, students practicing on patients, and the use of cadavers for practicing techniques. The critical care nurse is in a unique position to assess and balance these two principles for the patient's ultimate benefit.

The JAND (Judgment About Nursing Decision) as a measure of nurses' perception of moral behaviors.

A comprehensive review of research using the Judgment About Nursing Decisions (JAND) as a measure of nurses' ethical decision making raises numerous concerns about the conceptual basis, reliability, and validity of this widely used instrument. These concerns promoted the present study, which raised specific issues about the JAND. Among these issues are the representatives of ethical dilemmas contained in the JAND, the validity of its scoring scheme, the persistence of low-to-marginal reliability across studies, and questionable validity. Findings from studies using the JAND should be interpreted with caution until the instrument is further refined.

Contributions of graduate students to the creation and dissemination of nursing knowledge.

The purpose of this study was to determine the extent to which graduate students' research and scholarly activities, as evidenced by publication, contribute to the creation and dissemination of knowledge in nursing. Authors of articles published in IMAGE: Journal of Nursing Scholarship were surveyed to assess their status as graduate students during the conceptualization, development and publication of research or scholarly papers. The sample consisted of 332 authors of manuscripts published in IMAGE from 1986 through 1990. The study design was descriptive. A survey questionnaire elicited data on graduate student status and factors that influenced the initiation and completion of the published work. Descriptive statistical techniques were employed to analyze the data. The results of this study suggest that graduate education in nursing makes an important contribution to the advancement and dissemination of nursing knowledge.

Nurses on hospital IRBs: a critical voice in protecting human subjects.

The nature and extent of nurses' participation on hospital institutional review boards (IRBs) has not previously been investigated. This descriptive study provides some insights into the characteristics of nurses serving on IRBs and describes the IRBs on which they serve. The nurses are typically master's-prepared nurse managers who have served as volunteer or appointed members of the IRB for an average of 2.67 years. The IRBs have an interdisciplinary membership, and differ widely in structure and procedure, but generally, they conform to the requirements specified in the National Research Act for IRBs. The findings of this study have implications for nursing administration, practice, research, and education.

Refusal to care for patients with human immunodeficiency virus/acquired immunodeficiency syndrome: issues and responses.

Nurses historically have accepted the risk of contagion while caring for patients with infectious diseases. The duty to care for patients is directly related to the care the patient requires, the nurse's knowledge, and the extraordinary risk to the nurse. The current infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) highlights other factors, such as fear, ignorance, and homophobia, that influence a nurse's decision to refuse to provide care. Professional associations, nurse administrators, and educators must assist nurses to gain the knowledge and skill necessary to provide care as well as explore feelings about different life-styles.

Professional autonomy and ethical decision-making among graduate and undergraduate nursing majors: a replication.

The purpose of this study was to validate the findings of a previous investigation of differences in perceptions of idealistic and realistic moral behavior and attitudes toward autonomy, patients' rights, and traditional role limitations among four groups of nursing students. A sample of 147 associate, generic baccalaureate, degree completion, and master's students anonymously completed the Judgments About Nursing Decisions (JAND) and the Nursing Autonomy and Patient Rights Scale (NAPRS). Only three findings from the original study were validated: that both age and ethics education have effects on attitudes toward autonomy as measured by the NAPRS and that, overall, there is a consistent lack of significant findings on JAND scores among groups studied.

Which patient gets the critical care bed?

Census fluctuations and the failure to develop appropriate guidelines for admitting and transferring patients have made the staffing of critical care units extremely difficult, sometimes with serious ethical and physical consequences to patients. In this report, a case is analyzed to explore some of the ramifications of the use of beds in the critical care unit.

Nursing research in the United States: the protection of human subjects.

In the United States the protection of the rights of human subjects in experimentation has evolved at three levels: professional, public, and private. At the professional level, codes, guidelines and the Patient's Bill of Rights address the issues of protecting the dignity, privacy and autonomy of individuals who serve as research subjects. At the public level, regulations promulgated by the Food and Drug Administration and the Department of Health and Human Services have become the standard for protecting human subjects. At the private level, United States common law regulates the conduct of individual researchers by requiring them to act in a manner consistent with generally accepted standards of care. As professionals, nurses must be actively involved in the formation of public policy regarding the conduct of research and strive to formulate a research agenda that will ensure that the ethics of research in nursing is above question.

Nurses as a key PHC link in Papua New Guinea.

While many developing countries have endorsed primary health care (PHC) as a means of reaching Alma Ata's goal of health for all, effective implementation has been difficult. The major obstacle has been the historic emphasis on curative medicine in the training, licensing and job responsibilities of health care personnel and in the distribution of scarce resources. Moreover, few programmes have been geared to preparing the rural villager and the health delivery team--the two essential components of PHC--to work together to identify and solve problems. Too often health workers fear that the unrealistic expectations of community members will mean losing control of scarce resources. Clearly, central to any PHC programme is deciding where and how to begin developing the trust and interaction necessary to implement PHC beyound its curative aspects. In East New Britain, Papua New Guinea, nurses were the logical resource to reorient the rural health extension changeover to the noncurative aspects of PHC. Below, a report on this successful project.

Continuing learning among registered nurses employed in a community hospital.

This study indicated that hospital nurses learn through a variety of modes and that part-time nurses participated less frequently in certain learning activities than full-time nurses. Findings will be used to identify and expand resources for learning in this setting, devise strategies for enhancing participation of nurses in a variety of educational activities, and broaden the perspective of the administration and staff in relation to what constitutes continuing learning among professionals.

Professional autonomy and ethical decision making among graduate and undergraduate nursing majors.

The purpose of this study was to determine differences in perceptions of ethical dilemmas and attitudes toward autonomy among four groups of nursing students. A randomly selected sample (n = 130) of students enrolled in associate degree, generic baccalaureate, degree completion, and master's study completed the Judgments About Nursing Decisions (JAND), the Nursing Autonomy and Patient's Rights Scale (NAPRS), and a demographic data sheet. Using one-way analysis of variance procedures, significant differences were found among groups on autonomy, patients' rights, and rejection of traditional role limitations. No significant differences were found on perceptions of idealistic and realistic moral behavior. Additional analysis produced significant findings when student groups were compared by age, RN status, and participation in ethics courses and seminars. Lack of significant differences on perceptions of ethical dilemmas may have resulted from the relatively low level of reliability of the JAND with the groups studied. Differences in attitudes are attributed to experience as a registered nurse, participation in an educational offering, and exposure to the bureaucratic environment of the health-care system.