Journal of Nursing Education

Students as Subjects

Christine A Tanner, RN, PhD, FAAN

Abstract

The editorial of a research journal can occasionally serve ?? remind one's colleagues about important, but murky, quirky or oft-forgotten aspects of the research/ publication enterprise. One such aspect is our moral obligation to our students and our responsibility to protect their rights when they become research subjects/ participants in our investigations. Numerous situations in nursing education research are rife with the potential for violation of the rights of human subjects. For example, common practice in the evaluation of an educational innovation is to require students to complete a battery of instruments that may serve no educational purposes, but are used solely for research on the course effectiveness; should students not have the right to decline completing these instruments without fear of reprisal?

To assure protection of human subjects in research, Federal regulations have required the review of study protocols by an Institutional Review Board (IRB). Within the last decade, these regulations were modified so that certain classes of research, namely those considered to be of little risk, were exempt from IRB regulations. Now exempt from IRB review are studies ". . . conducted within established or commonly accepted educational settings, involving normal educational practices and research . . . involving the use of educational tests," provided that confidentiality and privacy are protected (DHHS, 1983, p. 4). Unfortunately, I think that this exemption from IRB review has given rise to some of the murkiness involved in recruiting students as subjects for our research: Investigators may have misinterpreted it as exemption from all practices that protect the rights of subjects.

In fact, the need for IRB review and the need for other protections are separate matters. Even though IRB review is not required for most nursing education research, we must still fully inform prospective subjects of the study, seek their consent to participate (with the freedom to not participate), and protect their rights to privacy and confidentiality. Here are some of the murky issues in each of these areas:

* Informed Consent. It is pretty easy to detail the components of informed consent - disclosure of the study purposes, risks and benefits, assurance that the prospective subject understands, and choice to participate or not. But, it is sometimes difficult, particularly in circumstances of uneven power and authority, to communicate to students that they can say no. Consider this not-so-uncommon situation: A faculty member who is completing doctoral study asks students to participate in his or her dissertation research and conveys pretty clearly that the students' help is really needed. (It is hard not to convey this message when you're in the throes of your dissertation!) If this faculty member is also the person responsible for the students' evaluation, the students may not feel completely free to decline participation in the study. I think that we must be sensitive to circumstances like this, and devise ways in which coercion, however unintended or subtle, can be avoided.

* Privacy. The Guidelines from the Federal Office for the Protection from Research Risks (OPRR) (DHHS, 1983) define privacy as "having control over the extent, timing and circumstances of sharing oneself with others." A major issue here is related to consent - being sure that the student provides information voluntarily, fully aware that it is for research purposes. Privacy issues arise when data were obtained without consent, and may pose particular problems when we wish to use observational, journal, or other qualitative data that may not be treated only in the aggregate. For example, a faculty member evaluating a new course may quite innocently use student journals as data; then, with encouragement from colleagues, this faculty…

The editorial of a research journal can occasionally serve ?? remind one's colleagues about important, but murky, quirky or oft-forgotten aspects of the research/ publication enterprise. One such aspect is our moral obligation to our students and our responsibility to protect their rights when they become research subjects/ participants in our investigations. Numerous situations in nursing education research are rife with the potential for violation of the rights of human subjects. For example, common practice in the evaluation of an educational innovation is to require students to complete a battery of instruments that may serve no educational purposes, but are used solely for research on the course effectiveness; should students not have the right to decline completing these instruments without fear of reprisal?

To assure protection of human subjects in research, Federal regulations have required the review of study protocols by an Institutional Review Board (IRB). Within the last decade, these regulations were modified so that certain classes of research, namely those considered to be of little risk, were exempt from IRB regulations. Now exempt from IRB review are studies ". . . conducted within established or commonly accepted educational settings, involving normal educational practices and research . . . involving the use of educational tests," provided that confidentiality and privacy are protected (DHHS, 1983, p. 4). Unfortunately, I think that this exemption from IRB review has given rise to some of the murkiness involved in recruiting students as subjects for our research: Investigators may have misinterpreted it as exemption from all practices that protect the rights of subjects.

In fact, the need for IRB review and the need for other protections are separate matters. Even though IRB review is not required for most nursing education research, we must still fully inform prospective subjects of the study, seek their consent to participate (with the freedom to not participate), and protect their rights to privacy and confidentiality. Here are some of the murky issues in each of these areas:

* Informed Consent. It is pretty easy to detail the components of informed consent - disclosure of the study purposes, risks and benefits, assurance that the prospective subject understands, and choice to participate or not. But, it is sometimes difficult, particularly in circumstances of uneven power and authority, to communicate to students that they can say no. Consider this not-so-uncommon situation: A faculty member who is completing doctoral study asks students to participate in his or her dissertation research and conveys pretty clearly that the students' help is really needed. (It is hard not to convey this message when you're in the throes of your dissertation!) If this faculty member is also the person responsible for the students' evaluation, the students may not feel completely free to decline participation in the study. I think that we must be sensitive to circumstances like this, and devise ways in which coercion, however unintended or subtle, can be avoided.

* Privacy. The Guidelines from the Federal Office for the Protection from Research Risks (OPRR) (DHHS, 1983) define privacy as "having control over the extent, timing and circumstances of sharing oneself with others." A major issue here is related to consent - being sure that the student provides information voluntarily, fully aware that it is for research purposes. Privacy issues arise when data were obtained without consent, and may pose particular problems when we wish to use observational, journal, or other qualitative data that may not be treated only in the aggregate. For example, a faculty member evaluating a new course may quite innocently use student journals as data; then, with encouragement from colleagues, this faculty member may decide to publish information about the course, including excerpts from the journals, without the students having knowledge of being a "subject" in an investigation. The students shared their thoughts and feelings with their teacher in a relationship of trust, not ever having considered that it might be shared with others, however anonymously.

* Confidentiality. OPRR guidelines define confidentiality as "the treatment of information that an individual has disclosed in a relationship of trust and with the expectation that it will not be divulged to others in ways that are inconsistent with the understanding of the original disclosure, without permission."

Assuring confidentiality in most of our research is a matter of employing some routine safeguards - assigning code numbers, limiting access to data, etc. As with issues of informed consent and privacy, we must be vigilant to avoid unintended breaches of confidence, e.g., a conversation with another faculty member about the student's performance on an instrument presumably used only for the research, or use of excerpts from qualitative data which, by nature of the description of the situation, identify the subject for some readers.

I invite comments from readers about these and other ethical issues in the conduct of nursing education research. And I encourage all of us to remain sensitive to the multiple issues that may arise in students' participation as subjects in our research.

Special thanks to Linda Budan, doctoral student, and Virginia Tilden, Professor and Associate Dean for Research at the Oregon Health Sciences University School of Nursing, for their thoughtful comments on an earlier draft of this editorial.

References

  • Department of Health and Human Services. (1983). Code of Federal Regulations, Title 45, Public Welfare: Part 46, Protection of Human Subjects. Washington, DC: U.S. Government Printing Office.

10.3928/0148-4834-19911101-03

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