Negotiating Moral Order in Clinical Trials: Balancing the Tension between Knowledge Production and Patient Care

2.50
Hdl Handle:
http://hdl.handle.net/10755/161023
Type:
Presentation
Title:
Negotiating Moral Order in Clinical Trials: Balancing the Tension between Knowledge Production and Patient Care
Abstract:
Negotiating Moral Order in Clinical Trials: Balancing the Tension between Knowledge Production and Patient Care
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2007
Author:Liaschenko, Joan, PhD, FAAN
P.I. Institution Name:University of Minnesota
Contact Address:Center for Bioethics & SON - N504 Boynton, Minneapolis, MN, 55455, USA
Co-Authors:D. DeBruin, Center for Bioethics and School of Nursing, University of Minnesota, Minneapolis, MN; and A. Fisher, Hahn School of Nursing, University of San Diego, San Diego, CA
That there is an inherent tension between knowledge production and patient care in the conduct of clinical trials with sick people has been well documented at least since the 1940s. Balancing this tension is a kind of moral work that continues to the present. This paper presents a major finding of a study of nurses working in clinical trials in two regions of the country. The aim of the study was to identify the ethical challenges encountered by nurses in the everyday conduct of that work. While we cannot say whether physicians currently experience this tension, it was a central ethical concern for these nurses. Three factors: nurses' disciplinary identity, proximity to the patient, and the social organization of clinical trials work influence how nurses act toward subject-patients and what is taken to be an ethical problem. In clinical trials work, nurses are situated at the intersection of research and care work. Taught to look at the whole person rather than to focus narrowly on a diseased part or a diagnosis, nurses are often the first to spot trouble or unexpected responses to treatment. However, attention to the subject-patient's wellbeing sometimes leads to actions that are seen to be in direct conflict with the science. For example, clinical activities supported by the protocol are viewed as part of science while activities undertaken outside the boundaries established by the protocol are considered non-study related care. The latter care provided in response to a subject-patient's condition is defined officially as a "protocol violation" that requires extensive documentation and notification of the study sponsor. Yet, protocol violation may be a moral imperative following from the clinical judgment that comes from being a nurse. Nurses recognized the tension in their work and the paradox that disciplinary identity and proximity to the patient can be both the resolution and the source of these tensions. Critical to both is the quality of the relationships among those whose work constitutes the trial. Managing the tension negotiates the moral order of the trial, and while success depends on more than nurses, they are central. The authors conclude that maintaining the tension is important both to the production of knowledge and to patient care.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleNegotiating Moral Order in Clinical Trials: Balancing the Tension between Knowledge Production and Patient Careen_GB
dc.identifier.urihttp://hdl.handle.net/10755/161023-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Negotiating Moral Order in Clinical Trials: Balancing the Tension between Knowledge Production and Patient Care</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Liaschenko, Joan, PhD, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Minnesota</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Center for Bioethics &amp; SON - N504 Boynton, Minneapolis, MN, 55455, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jliasch@umn.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">D. DeBruin, Center for Bioethics and School of Nursing, University of Minnesota, Minneapolis, MN; and A. Fisher, Hahn School of Nursing, University of San Diego, San Diego, CA</td></tr><tr><td colspan="2" class="item-abstract">That there is an inherent tension between knowledge production and patient care in the conduct of clinical trials with sick people has been well documented at least since the 1940s. Balancing this tension is a kind of moral work that continues to the present. This paper presents a major finding of a study of nurses working in clinical trials in two regions of the country. The aim of the study was to identify the ethical challenges encountered by nurses in the everyday conduct of that work. While we cannot say whether physicians currently experience this tension, it was a central ethical concern for these nurses. Three factors: nurses' disciplinary identity, proximity to the patient, and the social organization of clinical trials work influence how nurses act toward subject-patients and what is taken to be an ethical problem. In clinical trials work, nurses are situated at the intersection of research and care work. Taught to look at the whole person rather than to focus narrowly on a diseased part or a diagnosis, nurses are often the first to spot trouble or unexpected responses to treatment. However, attention to the subject-patient's wellbeing sometimes leads to actions that are seen to be in direct conflict with the science. For example, clinical activities supported by the protocol are viewed as part of science while activities undertaken outside the boundaries established by the protocol are considered non-study related care. The latter care provided in response to a subject-patient's condition is defined officially as a &quot;protocol violation&quot; that requires extensive documentation and notification of the study sponsor. Yet, protocol violation may be a moral imperative following from the clinical judgment that comes from being a nurse. Nurses recognized the tension in their work and the paradox that disciplinary identity and proximity to the patient can be both the resolution and the source of these tensions. Critical to both is the quality of the relationships among those whose work constitutes the trial. Managing the tension negotiates the moral order of the trial, and while success depends on more than nurses, they are central. The authors conclude that maintaining the tension is important both to the production of knowledge and to patient care.</td></tr></table>en_GB
dc.date.available2011-10-26T23:14:39Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T23:14:39Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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