Beneficence in nursing practice and Human research. This slide prepared for educational requirments at Haramaya University, Ethiopia. Ph.D. Nursing

1. Beneficence
Ethics in Nursing Research and Practice
PhD in Nursing
Course Code-NRPhD8072
By: Agezegn Asegid(Ph.D.Fellow)
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2. Presentation Outline
oIntroduction
oDefinition and concept
oBeneficence in clinical setting
oBeneficence in human research subjects
oEthical issue in simulation BT
oSummary
oConclusions
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3. Introduction
Benefit
Harm
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Dilemma
We seek solution
Day to day practice

4. Introduction
Purpose of ethical principles
oThey explain why the issue at hand is an ethical issue(WHO 2015)
oHelps to solve ethical conflict and guide day to day ethical issue
(WHO 2015).
oMakes our conduct in lined with social moral understanding(Williams
& Hopper, 2003).
oMakes nurses to be more systematic, logical and enable us to give
rational for our action(DeLaune & Ladne, 2002).
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5. Definition
Beneficence is the duty to promote good and to prevent
harm and/or evil.
◦There are two elements of beneficence:
1. Providing benefit
2. Balancing benefits and harms
◦Beneficence is an act of mercy and charity
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(Bernstein, 2017)
First appear as principles on Belmont report of 1979
(T Beauchamp & J Childress, 2013,PP152, & Bernstein, 2017)

6. Can always possible to prevent all harm?
No
Unintentional harm are common in health care service
Nosocomial infections
adverse drug reactions
the side effects of such treatments as irradiation and
chemotherapy for cancer
Thus the concern or ethical mandate is being disclose
the information to patient and refrain from intentional
harm.
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(Ellis & Hartley, 2004

7. Forms of beneficence
Positive beneficence
◦ He/she provided the benefit
◦ Provision of benefits including the prevention and removal of harm from other
◦ Promotion of welfare of others
Principles of utility:
oSomeone or nurse weigh risk and benefit and decide on best result which is called medical
medical paternalism.
oCarefully analyze, evaluate and promote those actions that bring more benefits to others
others (i.E. Patients) or the general public.
Social beneficence:
Research with human subjects regarded as ethical (or moral) only if we reasonably expect
expect that it will produce results that substantially benefit the public (David B. Resnik, 2018).
2018). 7
Punjani (2014); Mawere 2012)
The deliberate overriding of a patient’s opportunity to exercise
autonomy because of a perceived obligation of beneficence is called
paternalism.

8. Forms of beneficence
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Beneficence
Positive beneficence
Sociil BenficenceUtility principles

9. Is not absolute ….
•Principle of beneficence is not absolute in biomedicine
>>>>>>>> consider the context: Principle of utility
•It can be dangerous in research involving human subjects since:-
Allow research to continue as long it produce much
happiness
Allow hastening of death for harvesting organ from9
(Mawere, 2012)

10. Paternalism
Soft paternalism: protect persons from their own nonvoluntary
conduct like substance abuse
Hard paternalism: person’s risky choices and actions are informed,
voluntary, and autonomous.
Summary of justifiable reasons to practice hard paternalism:-
A patient is at risk of a significant, preventable harm and if the paternalistic action will
action will probably prevent the harm.
The prevention of harm to the patient outweighs risks to the patient of the action taken.
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Beauchamp, T. L., & Childress, J. F. (2013)

11. In Nursing literatures…Royal college of Nursing:
◦ Royal college of Nursing Principle C resonate the important of benefiting client during care “Nurses and
nursing staff manage risk, are vigilant about risk, and help to keep everyone safe in the places they receive
health care”(RCN, 2020).
Brunner 12th edition(Smeltzer, Bare, Hinkle, & Cheever, 2010).
◦ If form of applied ethics and is the duty to do good and the active promotion of benevolent acts (eg, goodness,
kindness, charity).
◦ Using of ethical principles and value of caring promote nurses to render care with good rationale and widen
scope of discussion with care takers when necessary.
Lippincott’s review book, 2012:
◦ moral principles and duty of promoting good. And as duty nurse required to act in their patients’ best interest.
William et al., 2007
◦ is not just doing care with high technology, but it is care provided with respect for person expressed by
adjusting care to persons believe, feeling and wishes.
◦ But what is good and who is appropriate to decide is common ethical challenges that nurses are facing during
its applications
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12. Clinical application of Beneficence
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13. •The exploration(culture and patient interest) and
adjustment of care also can be taken as means of
benefiting patient or beneficence
•it is unethical or it is not non-maleficence to ignore the
principle of culture sensitive care provision since research
proven that it will improve the wellbeing of patients
(Leininger’s transcultural care theory )
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(Cameron-Traub, 2002).
Culture based care as beneficence

14. Trues telling dilemma
Beneficence in dying/ terminally ill patient:
•We are trying to tell true prognosis which is our obligation
and intended to benefit the patients.
•But, at the same time we may think of hiding the diagnosis
and current stage of disease just to produce relatively
comfortable condition for the dying patients which is a form
of utility beneficence(Punjani et al., 2014).
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Obligation vs Beneficence

15. Rule of double effect
It is legal to give Morphine to treat pain or
respiratory distress at the end of life: But….
Positive effect:
• May treat the pain
and improve patient
conditions
Negative Effect:
• May cause cessation
of breathing and
hasten death
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16. Our context is
different
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But …..?

17. Threat to beneficence/Non-maleficence in clinical practice
As we all know in Hiwot Fana STRH
• Student trained without supervision and adequate training over actual patient
• Invasive procedures done without adequate training
• Nurses already ignored their patient advocator role(ANA, 2015a)
• Poor monitoring of patient progress
• Poor communication among health care team
• Nurses lost their primary responsibility for patient
• Teaching first principles
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Ph.D. Student assessment report, 2019
Breach of Ethical principles In Ethiopia
From three year (2011-2013) report ethical committee analysis
• Fourteen (14/60) claims had proven ethical breach and or
negligence.
• Some of them costs loss of life
(Wamisho, Abeje et al. 2015)


18. Suggested solution
oSynthesize data
oAdvocate patient bill of right implementation by all
parties
oEmpower nurses at each level
oImprove Nursing leadership
oInitiate CPD for Nurses
oIndicate/assign student research topic on the area
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

19. Beneficence in Research
involving human subjects
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20. WHO concern on human research
Recommendation:-
Each research should be scrutinized against
oon how much research benefit the community,
oparticipants are safe in the process and
ofairness of treatment during research process.
(WHO, 2015)
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Thus we can understood that application of ethical principles still is
current issue

21. Application in Research
oAnalysis of risks/benefits
oAssessing whether risks is reasonable in relation to
benefits
oAnonymity and confidentiality are most common method
of maximizing benefit of participants
oMainly relies on researcher genuine analysis and 21

22. Maximum benefit ….
oThere is absolutely no justification for inhumane
treatment
oRisks to participants should always be reduced to the
maximum extent possible.
oIf a significant risk is involved, justification of the
research must be examined with particular care.
oWhenever vulnerable persons are participants, the
need to involve them must be carefully demonstrated.
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23. Role of IRB in Beneficence
oAct as gatekeeper
osafeguard the participant and
their benefit as gatekeeper for
research process all over the world.
oobligate any research process to
maximize benefit protect harm and
implementation of appropriate
compensation for participants and
intentionally controlled groups
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(Vitak, Shilton, & Ashktorab, 2016).
Prior to conducting research the
researcher/sponsor should:
1. Ensure the research
responds to the health
needs and priorities of the
target community.
2. Ensure any product
developed will be made
available to the community.
Research in limited resource setting
Our context:-
• Most for academic requirements
• Community need and direct application is
secondary objective

24. Challenge of Beneficence in research
oAnonymity and keeping participant confidential is the two most
common method of maximizing benefit of participants.
oResearch need to address the top urgent community problems.
Challenge
• In the era of electronic media and technological advancement,
many research have been conducted in distance with help of online
technology. It is not easy to keep confidentiality of participant in
online data collection(Vitak et al., 2016).
• Focusing of market based trial than magnitude based research
title selection (WHO,2015)
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25. Saving Community, How?
The WHO recommends following activity to save
community from harmful research conduct:-
Ethical integrity on the part of researchers and research
organizations
Research ethics committees perform the important role of assessing
the potential risks and benefits of involved individual, family and
community in research
Data safety monitoring boards (DSMBs) for clinical trial
Assigning independent clinical monitors
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(WHO, 2015)

26. I suggest
1. All parties at all level should motivate to abide to
already existed ethical principles of research
2. IRB at all area and level should get period capacity
building service
3. Academician and potential researcher need to or
participated on periodic training
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27. Ethical issues in Simulation based teaching
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Issues Possible solution Principle addressed
Use of standard patient
• Portraying and expressing
feeling and situations of
illness may produce
discomfort SP(Truog and Meyer,2013)
Multiple exercise and developing
guideline to train well
Non-
maleficence
• Concern for self safety Use less risky material, procedure and
good communication as research team
Non-
maleficence
• As human subjects of
research
Need to convinced about activity by
proper communication(take informed
consent)
Show compassion and respect throughout
throughout work
Autonomy
and/or Respect
for person
Resource constraint Use of colleague

28. 28
Issues Possible solution Principle addressed
Participants(students)
• Overloaded and busy student
student schedule and potential
potential deflation in student
student class grade
Scheduling challenge/ appropriate
time for study
Non-maleficence
• Fear and anxiety in
participant
(Hulsman et al., 2010)(Budić et al., 2018)
Since fear and anxiety disturb overall
overall physiology adequate
discussion and orientation needed
Non-maleficence
• Participant as human subjects
subjects of research
Need to voluntarily invited to research Autonomy and/or
Respect for person
• Control group Adequate compensation for not
getting Rx during study
Beneficence
• Simulation death create anxiety over
over the students
Proper demonstration and
orientations
Non-Maleficence
Ethical issues in Simulation based teaching

29. Nursing implication
oBeneficence is beyond moral obligation and it is our primary
role
oThere is a decline in patient advocacy role that threaten
patient benefit and welfare
oNurses should motivate again to keep the interest of their
patient and community
oBeneficence is must and non-maleficence is minimum, but
breach in both principle leads to malpractice
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30. Summary
•Beneficence is one of major principle of professional ethics for
clinical practice and research involving human subjects
•Beneficence have three forms: Positive, utility and social
beneficence
•Researcher and agency commitment is pivotal to keep benefit of
community
•IRB acts as gatekeeper for preventing harmful research and
maximize benefit
•Our clinical setting is on a critical condition in keeping 30

31. Conclusion
1. In light of beneficence detail analysis of research
benefit and risk with genuine and scientific procedure
needed before field work.
2. The motivation to maximize patient benefit and
keeping safety is at alarming level in our hospital
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32. Sample reference
1. Beauchamp, T. (2019). The Principle of Beneficence in Applied Ethics. from Stanford Encyclopedia
of Philosophy
2. Bernstein, R. (2017, August 11, 2017). Beneficence Nursing and Ethics. Beneficence Nursing and
Ethics. Retrieved from https://online.husson.edu/beneficence-nursing-ethics/
3. Zaccagnini, M., & White, K. (2011). The doctor of nursing practice essentials : a new model for
advanced practice nursing (A. Sibley, P. Donnelly, & R. Shuster Eds.). USA: Kevin Sullivan.
4. Mawere, M. (2012). Critical reflections on the principle of beneficence in biomedicine. Pan African
Medical Journal, 11(29).
5. DeLaune, S., & Ladne, P. (2002). Fundamentals of nursing: Standards & practice (2nd ed.): Delmar,
a division of Thomson Learning, Inc.
6. Ellis, J., & Hartley, C. (2004). Nursing in todays world: Trends, Issue and Management A Wolters
KLUWER COMPANY lippincott Williams & Wilkins.
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33. Thank
you very
much
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