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Aboriginal families and intensive care: ethical issues in research
d
4 AUSTRALIAN CRITICAL CARE
ethical issues in research
-
Menzies School of Health ResearcE Casuarina, Northern Temtory
This paper discusses various methodological and ethical issues encauntered during the data collection phase of a research project looking at cross-cultural communication in the intensive care unit. The aim of the project was to describe the intensive care experience from the viewpoints of both nursing staff and Aboriginal families. Researching the beliefs and perspectives of Aboriginal families during their intensive care experience required that the researcher remain empathetic and respectful of their social and communication conventions. Some Aboriginal people will not talk to strangers and find direct questions offensive. Similarly, researching issues in an emotive area like intensive care required that the researcher remain sensitive to the feelings and beliefs of those studied. Rigour and ethics go hand in hand. To achieve and retain sensitivity and respect, the textbook rules of qualitative research were refined so that meaningful information could be gathered without adding to the anxiety of subjects or breaching Aboriginal social and communication conventions. Information was only sought after a relationship of trust had been developed. In many instances, indirect questioning techniques were used. These refined techniques may have exposed the research to criticisms that it was not rigorous science, that it was too subjective. However, information gathered in a culturally inappropriate way may be meaningless, incorrect or inconclusive, since the respondent may not reply or might simply give the answer they believe the researcher wants to hear.
Developing competency standard for graduates of a postgraduate
extensive student observation, discussion and reflection involving 20 expert clinical educators, together with critical care nurse academics. One domain from the original CACCN Inc. competency standards was changed. The new competency standards were uialled and evaluated throughout 1997, with the project team meeting monthly, including a final evaluation meeting. At the conclusion of the study, the new competency standards were found to be a very satisfactory and effective method of assessing and articulating students' performance. Issues identified during the process included the need for students and educators to be well-informed regarding the use of the competencies and the problem of assessing students' performance mid-course. The competenciesdeveloped for course graduates were again implemented in 1998, with these issues addressed.
I n t k i v e Care Unit, Monash Medical cent&-and *Centre for Graduate Studies in Clinical Nursing, Monash University, Melbourne, Victoria The decision to start and stop enteral feeding in the intensive care unit (ICU) environment is often left to skilled and experienced individual practitioners. However, anecdotal evidence suggests this practice can result inpatients receiving insufficient nutrition. In 1997, the Monash Medical Centre ICU decided to adapt an enteral feeding protocol developed by Guy's Hospital in 1992. Baseline data gathered from the records of 59 patients examined how soon after admission patients were fed, the amount of food they received, the frequency of manual aspirations to assess tolerance, and whether the feed was stopped and why. Following introduction of the protocol, 32 patients were reviewed in the same manner. In addition, staff acceptance of the protocol was gauged using a questionnaire. Preliminary analysis indicates that patients: received larger amounts of feed (day 3 mean = 1213 ml) postthan re-introduction (day 3 mean = 805 ml);
AL Voss,St Vincent's Hospital, Victoria M Hawkins d AL GiU, Box Hill Hospital, Victoria Competency standards were developed by the Confederation of Australian Critical Care Nurses Inc. (CACCN Inc.) to articulate clinical performance for specialist critical care nurses. These competencies resulted from research into the standards expected of critical care nurses with many years of experience in this specialty. In 1996 Deakh University, in collaboration with 1I hospitals, both metropolitan atid non-metropolitan, public and private, implemented, with the permission of CACCN Inc., a project to modify the existing competencies. The aim was to develop, trial and evaluate competency standards that described the clinical performance of new course graduates. The project utilised the CACCN Inc. competency framework to ensure consistency in language and the evolution of a sequential progression of standards. A graduate diploma in nursing (critical care) conducted over 12 months was utihsed to m o w rhe competencies. New cues and exemplar statements were developed from
commenced enteral feeding earlier - 100 per cent (n=32) had commenced by day 3, compared to 55 per cent (n=32) preintroduction; feeds were interrupted less - 6 per cent (n=2) compared to 57 per cent (n=33) pre-introduction; received regular aspiration - 97 per cent (n=3 1) compared to 47 per cent (n=74) pre-introduction. Results from the staff survey indicate that: 100 per cent (n=32) found the protocol easy to use; 93 per cent (n=29) noticed beneficial changes in the management of enteral feeding. Results indicate the potential usefulness of an enteral nutrition protocol in the ICU. Further studies should be directed at measuring patient outcomes and developing the protocol further.
VOLUME 12 NUMBER 2 JUNE 1999
4 AUSTRALIAN CRITICAL CARE
ethical issues in research
-
Menzies School of Health ResearcE Casuarina, Northern Temtory
This paper discusses various methodological and ethical issues encauntered during the data collection phase of a research project looking at cross-cultural communication in the intensive care unit. The aim of the project was to describe the intensive care experience from the viewpoints of both nursing staff and Aboriginal families. Researching the beliefs and perspectives of Aboriginal families during their intensive care experience required that the researcher remain empathetic and respectful of their social and communication conventions. Some Aboriginal people will not talk to strangers and find direct questions offensive. Similarly, researching issues in an emotive area like intensive care required that the researcher remain sensitive to the feelings and beliefs of those studied. Rigour and ethics go hand in hand. To achieve and retain sensitivity and respect, the textbook rules of qualitative research were refined so that meaningful information could be gathered without adding to the anxiety of subjects or breaching Aboriginal social and communication conventions. Information was only sought after a relationship of trust had been developed. In many instances, indirect questioning techniques were used. These refined techniques may have exposed the research to criticisms that it was not rigorous science, that it was too subjective. However, information gathered in a culturally inappropriate way may be meaningless, incorrect or inconclusive, since the respondent may not reply or might simply give the answer they believe the researcher wants to hear.
Developing competency standard for graduates of a postgraduate
extensive student observation, discussion and reflection involving 20 expert clinical educators, together with critical care nurse academics. One domain from the original CACCN Inc. competency standards was changed. The new competency standards were uialled and evaluated throughout 1997, with the project team meeting monthly, including a final evaluation meeting. At the conclusion of the study, the new competency standards were found to be a very satisfactory and effective method of assessing and articulating students' performance. Issues identified during the process included the need for students and educators to be well-informed regarding the use of the competencies and the problem of assessing students' performance mid-course. The competenciesdeveloped for course graduates were again implemented in 1998, with these issues addressed.
I n t k i v e Care Unit, Monash Medical cent&-and *Centre for Graduate Studies in Clinical Nursing, Monash University, Melbourne, Victoria The decision to start and stop enteral feeding in the intensive care unit (ICU) environment is often left to skilled and experienced individual practitioners. However, anecdotal evidence suggests this practice can result inpatients receiving insufficient nutrition. In 1997, the Monash Medical Centre ICU decided to adapt an enteral feeding protocol developed by Guy's Hospital in 1992. Baseline data gathered from the records of 59 patients examined how soon after admission patients were fed, the amount of food they received, the frequency of manual aspirations to assess tolerance, and whether the feed was stopped and why. Following introduction of the protocol, 32 patients were reviewed in the same manner. In addition, staff acceptance of the protocol was gauged using a questionnaire. Preliminary analysis indicates that patients: received larger amounts of feed (day 3 mean = 1213 ml) postthan re-introduction (day 3 mean = 805 ml);
AL Voss,St Vincent's Hospital, Victoria M Hawkins d AL GiU, Box Hill Hospital, Victoria Competency standards were developed by the Confederation of Australian Critical Care Nurses Inc. (CACCN Inc.) to articulate clinical performance for specialist critical care nurses. These competencies resulted from research into the standards expected of critical care nurses with many years of experience in this specialty. In 1996 Deakh University, in collaboration with 1I hospitals, both metropolitan atid non-metropolitan, public and private, implemented, with the permission of CACCN Inc., a project to modify the existing competencies. The aim was to develop, trial and evaluate competency standards that described the clinical performance of new course graduates. The project utilised the CACCN Inc. competency framework to ensure consistency in language and the evolution of a sequential progression of standards. A graduate diploma in nursing (critical care) conducted over 12 months was utihsed to m o w rhe competencies. New cues and exemplar statements were developed from
commenced enteral feeding earlier - 100 per cent (n=32) had commenced by day 3, compared to 55 per cent (n=32) preintroduction; feeds were interrupted less - 6 per cent (n=2) compared to 57 per cent (n=33) pre-introduction; received regular aspiration - 97 per cent (n=3 1) compared to 47 per cent (n=74) pre-introduction. Results from the staff survey indicate that: 100 per cent (n=32) found the protocol easy to use; 93 per cent (n=29) noticed beneficial changes in the management of enteral feeding. Results indicate the potential usefulness of an enteral nutrition protocol in the ICU. Further studies should be directed at measuring patient outcomes and developing the protocol further.
VOLUME 12 NUMBER 2 JUNE 1999