Article

Operational effectiveness of blended e-learning program for nursing research ethics

Nursing Ethics 2014, Vol. 21(4) 484–495 ª The Author(s) 2013 Reprints and permission: sagepub.co.uk/journalsPermissions.nav 10.1177/0969733013505310 nej.sagepub.com

Kap-Chul Cho and Gisoo Shin Chung-Ang University, South Korea

Abstract Background: Since 2006, the Korean Ministry of Education, Science and Technology, and the National Research Foundation of Korea have taken the lead in developing an institutional guideline for research ethics. Objectives: The purpose was to identify the effectiveness of the Good Research Practice program, developed on a fund granted by the National Research Foundation of Korea, for nurses and nursing students whose knowledge and perception of research ethics were compared before and after the implementation of the Good Research Practice program. Research design: This study was conducted to compare the levels of knowledge and perception of research ethics in the participants before and after the program was implemented. Participant and research context: The participants included 45 nurses and 69 nursing students from hospitals, colleges of nursing, and the Korean Nurses Association, located in Seoul, Korea. Ethical considerations: This study was approved by the Institutional Research Board in Korea. Findings: Based on the Analysis, Design, Development, Implementation, and Evaluation model, the Good Research Practice program was made up of a total of 30 h of the blended learning both online and off-line. The results of this study showed that there were statistically significant differences in both knowledge and perception of research ethics in nursing students and nurses before and after the program had been implemented. Discussion: The concepts of professional nursing ethics, moral issues, and bioethics were often confused with one another and not clearly defined. Therefore, the concept and scope of bioethics, moral judgment, and overall nursing ethics should be well defined and conceptualized in the future. Conclusions: This study suggested integrating research ethics education in the nursing curriculum as a required course of study for nursing students and as part of the in-service training program for nurses in order to improve research ethics in nursing research in Korea. Keywords Educational effectiveness, good research practice, knowledge and perception, nursing research, research ethics

Corresponding author: Gisoo Shin, Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 156-756, South Korea. Email: [email protected]

Downloaded from nej.sagepub.com at Selcuk Universitesi on February 2, 2015

Cho and Shin

485

Introduction The guideline for research ethics published by the Ministry of Science and Technology of Korea defined research ethics as a set of fundamental moral principles and rules applying to any researchers to follow with a responsibility when doing research.1 Ethical merit embraces respect for the dignity of research participants, in terms of their integrity, privacy, safety, and human rights. Researchers must obtain the informed consent of all the participants in the research, and the strategies for minimizing risks are required to balance risks against benefits, to make appropriate recompense for time, to provide compensation for any injuries which may occur during the research, to protect confidentiality, and to avoid conflicts of interest.2,3 In response to satisfy the need of a recent change in research ethics, the Korean Society of Nursing Science played a critical role in providing nursing educators with educational opportunities to establish the ethicality of nursing research. However, it has been reported that the efforts to secure nursing research ethics were not as active as other biomedical fields. A study done with 240 master and doctoral students at seven nursing colleges in Korea showed a very low rate of receiving the research ethics education.4 It also showed that the course of research ethics was mainly implemented in the form of seminars, suggesting the need of developing more standardized programs for research ethics with more formal methods of learning. Recently, although clinical nursing research has been actively carried out in Korea with the concept of evidence-based practice in clinical nursing, educational efforts focused on the responsible conduct of research have not been made to keep the same pace with the activation of research studies in nursing, only to be made sporadically by some university hospitals that organized the Institutional Review Board (IRB), or focused only on the Universal Declaration on Bioethics and Human Rights, and some other considerations of professional ethics education.5 Although the scope of research ethics may differ from discipline to discipline, it generally includes the protection and welfare of human participants, conflicts of interest, data management practice, mentor and trainee responsibilities, collaborative research, authorship and publication, and peer review.6 On top of everything, it is important for the recipients of research ethics education to have easy access to the various educational programs for research ethics in order to make ethical preparation for doing research. One of the advantages of web-based learning is that learners will be able to access the online programs any time and at any place. Especially, for nurses with irregular work schedules, time saved by not commuting to and from class or cruising parking lots may be used on studies.7 In addition, the webbased learning will allow a number of learners to take part in conversing so as to reinforce the class participation. According to a study with nurses on web-based learning in ethics education, there was an increase in accurate knowledge of ethics through learning by repetition, which, in turn, changed their perception to influence critical thinking and decision making.8 Therefore, there is an urgency to provide nurses with education for responsible conduct of research, which can be applied to empirical studies on evidence-based practice in clinical settings.9,10 However, considering the complexity of clinical nursing settings and the working condition of nurses with three shifts, it is very difficult to organize an accessible and diverse program for research ethics, which fits in with the working condition of nurses. Furthermore, if research ethics education is planned to offer via collective training or to a cluster of learners, the accessibility of the program to the prospective recipients will decline significantly. On the other hand, if research ethics education is provided online, the online program can serve as an effective way of learning due to constant and repeated use, taking no notice of time and space. It is highly predictable that the educational needs for research ethics will increase rapidly in numbers since clinical case studies, evidence-based clinical studies, and research on nursing education have proliferated. Therefore, it would be high time to develop, implement, and evaluate nursing research ethics education to which nurses and nursing students have access. Therefore, awarded a research grant by the National Research Foundation of Korea, this study was conducted to develop and implement a systematic educational program for Good Research Practice (GRP) appropriate for and highly accessible to nurses and nursing students so as to use it 485

Downloaded from nej.sagepub.com at Selcuk Universitesi on February 2, 2015

486

Nursing Ethics 21(4)

without any restraints from time and space. In addition, this study was conducted to compare the levels of the participants’ knowledge and perception of the GRP program before and after the education was given, for the purpose of evaluating the effectiveness of the GRP program.

Methods Design of the study This study was conducted to develop an educational program for GRP for both nurses and nursing students and to compare the levels of knowledge and perception of research ethics in the participants before and after the program was implemented.

Participants The participants in this study were collected from three sources, including hospitals, colleges of nursing, and Korean Nurses Association, located in Seoul, Korea. As many as 55 nurses and 125 nursing students agreed to participate in the GRP program. Among nursing students, freshmen and sophomores who had not had clinical training in a clinical setting were excluded from the study, only to include junior and senior students who had had clinical training experience. Among those 180 participants, 45 nurses and 69 nursing students, 114 in total, were included in the final analysis for both pre- and post-tests. The data were collected twice in December 2009, before the GRP program was initiated, and March 2010, after the GRP program was completed.

Ethical considerations Although the procedure of this study did not contain any danger to the participants, considerations were taken to protect the human rights of the participants. Specifically, with the principle of voluntary participation, the purpose, content, and methodology of the study were clearly explained to the participants, and the consent form was distributed to and collected from each of the participants with the researcher’s identity revealed on it. Only those who enlisted to participate were included in the study. In addition, the data were not used for any purpose other than this research. Participants were completely informed that they could withdraw at any time if they wished to do so, and that the research was being carried out anonymously to avoid dissemination of personal information. This study was approved by the Institutional Research Board of Red Cross College of Nursing in Korea (09-08).

Measurement This study was conducted to measure the knowledge and perception of research ethics in nurses and nursing students in order to identify the effectiveness of the GRP program. Through an advisory group of two medical faculty members and two nursing professors who were in charge of medical ethics and nursing ethics, a selfreported questionnaire of 24 items on a 5-point Likert-type scale was developed to assess the knowledge and perception about research ethics. Twenty-four items consisted of bioethics, research ethics, IRB, research misconduct, publishing ethics and copyright, collaborative research, and conflicts of interest in nursing. To assess the levels of knowledge and perception of the subcategories of research ethics, the participants were asked to respond on a 5-point Likert-type scale, with 1 being the lowest level and 5 the highest level, indicating the higher the score, the better the knowledge and perception. Cronbach’s a for the reliability of the study instrument for the nurses was .895, whereas Cronbach’s a for the nursing students was .861. 486

Downloaded from nej.sagepub.com at Selcuk Universitesi on February 2, 2015

Cho and Shin

487

Procedure of developing GRP program The GRP educational program was developed based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model, which has been known as a general model for instructional systems design.11 The stages of the program development were as follows: Analysis stage. Analysis stage was a stage that defined what to teach, which included the score concepts and contents for research ethics drawn not only from the existing literature and educational programs in other countries but also from the Center for Research Ethics Information of the National Research Foundation of Korea. By analyzing and evaluating those programs, the core concepts and contents were revised to fit the Korean situation. Design stage. Design stage included a process that specifies what to teach. The initial core concepts for the GRP educational program included research ethics, research misconduct, intellectual property rights for research papers and publication, data management system, cooperative research, responsibility of researcher, and bioethics.12 Upon composition of the program contents, the expert group was founded to measure the content validity, consisting of two experts on research ethics, two hospital nursing managers, and two nursing faculty members. The content validity of each item was measured on a 5-point Likert-type scale, with 1 being the least appropriate and 5 the most appropriate. Based on the result of the content validity, some of the detailed topics were modified and revised to come up with the final version of the GRP program, which included the following six topics of bioethics, research ethics, research misconduct, IRB, publication ethics and copyright, and collaborative research and conflicts of interest. Subcategories of each topic included the historical background of research ethics and bioethics, the overview of ethical theories, bioethics law, social issues on bioethics, definition and importance of research ethics, definition and functions of IRB, IRB for research with human subjects, research misconduct, data management, research notes, prevention of plagiarism, intellectual property rights, ethics of publication process, ethics on collaborative research and conflicts of interest, and relationships with advisors. Development stage. At the development stage, teaching materials were developed to be used in the program, based on the design specifications that were determined at the design stage. The GRP program was made up of a 2-h credit course for 30 h in total. In order to provide easy access to the participants, the GRP program contained the blended e-learning program in both online and offline learning packages, each of which has a 15-h program. Web contents for the online program were produced based on the curriculum composition. One medical faculty member and two nursing professors were engaged in teaching as experts on bioethics and research ethics. The web contents consisted of 6 topics and 18 subtopics, which were instructed in a one-credit-hour course for 15 h in total (Table 1). The evaluation of the academic achievement of the participants who took the online course was done by the accumulated learning hours recorded on the distance learning system, and the warning alarm was set up to be sent to the participants via short message service (SMS) if they did not complete the requirements for the online instruction. Implementation stage. Implementation stage is a stage that employed the educational program, developed at the development stage, to learners. The GRP program proceeded with a 15-h-online instruction with web-based learning materials as well as a 15-h-off-line instruction. The primary function of the web-based online educational program was to elicit participants’ self-directed learning ability and iterative learning so as to increase the effectiveness of research ethics education. The satisfaction level with the online program was evaluated during the off-line program, through quiz taking and discussion sessions. The 15-h-off-line instruction comprised a 3-h review of the core contents given on the online program, 9-h case analysis and small group discussion, and 3 h of 487

Downloaded from nej.sagepub.com at Selcuk Universitesi on February 2, 2015

488

Nursing Ethics 21(4)

Table 1. Composition of nursing research ethics curriculum. Category

Topic

Detailed subjects

Hours

Online program

Bioethics

Introduction of ethics theory History of bioethics Life ethics Social issue on bioethics Definition of research ethics Importance of research ethics Historical background of research ethics Definition and functions of IRB IRB for research with human subjects Research misconduct Date management Research notes Prevention of plagiarism Intellectual property rights, publication ethics Collaborative research ethics Conflict of interest Relationship with advisor Review of online program Case study and discussion Pre- and post-tests and evaluation

4

Research ethics

Institutional research board

Research misconduct

Publication ethics and copyright

Collaborative research and conflict of interest Off-line program

Small group lecture Small group discussion Evaluation

2

2

2

3

2

3 9 3

IRB: Institutional Review Board.

miscellaneous activities such as orientation to the program, completion ceremony at the end of the program, and evaluation of the program. In the 3-h small group discussion, which was divided into three sessions, the clinical cases of conflict in research ethics that the participants had experienced in clinical settings were discussed and analyzed based on what they had learned from the online program. Evaluation stage. The effectiveness of the program was evaluated by the pre-test before the GRP program and the post-test after the GRP program. The pre-test was conducted with a structured questionnaire in December 2009, in order to identify the levels of their knowledge and perception of research ethics. The result of the pre-test was used as the baseline data to compare with that of the post-test to identify the effectiveness of the program. The post-test was conducted in March 2010, when the GRP program was completed, and the result of the post-test was compared with that of the pre-test.

Data analysis Using SPSS version 20.0 program for Windows (Chicago, IL), demographic data of the participants were analyzed to create frequency and percentage, while knowledge and perception of research ethics in the participants were represented in means and standard deviations (SDs). To compare the differences in knowledge and perception between the pre-test and the post-test, a paired t-test was calculated, and the differences in knowledge and perception between nurses and nursing students were analyzed by analysis of covariance (ANCOVA). In addition, the Duncan test was used for the post hoc test. Significance level was set at p < 0.05. 488

Downloaded from nej.sagepub.com at Selcuk Universitesi on February 2, 2015

Cho and Shin

489

Table 2. Demographic characteristics of participants.

Category Gender Age (years)

Education

Religion

Experience of engaging in research Experience of learning research ethics

Clinical working career (years)

Male Female Less than 25 26–30 31–40 Over 40 College student College graduate Masters degree Christian Buddhist Catholic None Others Yes No At college In clinic None None Less than 5 Less than 10 Over 10

Nurse (N ¼ 46) N (%)

Nursing student (N ¼ 69) N(%)

1 (2.2) 45 (97.8) 2 (4.3) 25 (54.3) 8 (17.4) 11 (23.9) None 36 (78.3) 10 (21.7) 17 (37) 7 (15.2) 5 (10.9) 15 (32.6) 2 (4.3) 18 (39.1) 28 (60.9) None 7 (15.6) 39 (84.8) None 24 (52.2) 9 (19.6) 13 (28.3)

64 (92.8) 5 (7.2) 54 (78.3) 15 (21.7) None None 69 (100) None None 29 (42.0) 6 (8.7) 14 (20.3) 19 (27.5) 1 (1.4) 3 (4.3) 66 (95.7) None None 69 (100) 69 (100) None None None

Results Demographic characteristics Among 114 participants, there were 108 female and 6 male participants. The average age of nursing students was 23.4 years (SD ¼ 1.94 years), and the average age of nurses was 31.6 years (SD ¼ 1.94 years). The average length of the nurses’ clinical working career was 9 years and 1 month (SD ¼ 1.3 years). As much as 39.1% of the nurses appeared to have experiences of participating in nursing research, whereas only 6.7% of nursing students did (Table 2).

Knowledge about research ethics On a scale of 1–5, nurses’ average score of knowledge on research ethics was 3.24 (SD ¼ 0.67) and nursing students 2.67 (SD ¼ 0.50) before the implementation of the GRP program, whereas the nurses scored 3.96 (SD ¼ 0.83) and the nursing students 3.86 (SD ¼ 0.60) after the program, which showed the statistically significant differences in knowledge between the nurses and the nursing students before and after the program (Table 3). For the subtopics of research ethics, before the program was implemented, both the nurses (2.64) and the nursing students (1.96) showed the lowest scores on bioethics but showed the biggest change in scores after the program (nurses, 1.36 and nursing students, 2.12). The result of the comparison between the nurses and the nursing students in terms of knowledge on research ethics showed significant differences in bioethics (F ¼ 11.13, p ¼ .001), research ethics (F ¼ 11.44, p ¼ .001), IRB (F ¼ 28.30, p ¼ .000), 489

Downloaded from nej.sagepub.com at Selcuk Universitesi on February 2, 2015

490

Nursing Ethics 21(4)

Table 3. Knowledge level of participant’s research ethics. Knowledge M (SD) Nurse (N ¼ 45) Category Bioethics Research ethics IRB Research misconduct Publication ethics and copyright Collaborative research and conflict of interest

Before

After

t/F

2.64 (.65) 3.15 (.52)

4.0 (.79) 4.2 (.69)

Nursing student (N ¼ 69) p

Before

After

t/F

Difference between groups p

Before F

p

After F

p

9.23* .000 1.96 (.47) 4.07 (.26) 37.33* .000 11.13* .001 90.02* .000 10.42* .000 2.46 (.50) 3.80 (.78) 12.06* .000 11.44* .001 2.73 .101

3.33 (.88) 3.58 (1.14) 3.67 (.77) 4.36 (.68)

3.77* .000 2.97 (.30) 3.96 (.65) 11.75* .000 28.30* .000 5.83* .000 2.59 (.50) 3.70 (.69) 12.88* .000 18.66* .000

3.90 0.18

.051 .673

3.47 (.59) 3.89 (.86)

4.56* .000 3.45 (.58) 3.86 (.65)

8.79* .004

2.32

.130

3.20 (.59) 3.76 (.80)

5.14* .000 2.61 (.62) 3.74 (.59) 11.44* .000

3.45

2.11

.149

5.19* .000

.066

IRB: Institutional Review Board. *p < .05.

research misconduct (F ¼ 18.66, p ¼ .000), and publication ethics and copyright (F ¼ 8.79, p ¼ .004) before the program, whereas bioethics (F ¼ 90.02, p ¼ .000) after the program, respectively.

Perception of research ethics On a scale of 1–5, nurses’ perception of research ethics was 3.17 (SD ¼ 0.68), and nursing students 2.71 (SD ¼ 0.53), on the average, before the program was implemented, whereas the nurses averaged 3.30 (SD ¼ 0.78) and the nursing students 3.94 (SD ¼ 0.62) after the program was completed, which showed significant differences in perception of research ethics between the two groups before and after the program (Table 4). There were significant differences between the two groups in the perception of IRB (F ¼ 7.91, p ¼ .006) and publication ethics and copyright (F ¼ 12.30, p ¼ .001) before the program, whereas bioethics (F ¼ 9.77, p ¼ .002) and IRB (F ¼ 8.05, p ¼ .004) after the program.

Knowledge and perception of research ethics with experience of research and clinical career Table 5 showed the relationships of knowledge and perception of research ethics with the participants’ experience of engaging in research efforts and clinical career. Those who had had experience of participating in research studies were more likely to have high scores on research ethics, IRB, research misconduct, publishing ethics and copyright, and collaborative research and conflicts of interest than those who had not, which was statistically significant (p > .05). Furthermore, there were significant differences both in knowledge and perception of research ethics according to the clinical working career of the nurses. 490

Downloaded from nej.sagepub.com at Selcuk Universitesi on February 2, 2015

Cho and Shin

491

Table 4. Perception level of participant’s research ethics. Perception M (SD) Nurse (N ¼ 45) After

t/F

Difference between groups

Nursing student (N ¼ 69) p

Before

After

t/F

p

Before F

Before

Bioethics Research ethics IRB Research misconduct Publication ethics and copyright Collaborative research and conflict of interest

2.4 (.72) 3.87 (.69) 3.4 (.62) 4.07 (.75)

12.51* .000 1.52 (.63) 3.83 (.45) 25.49* .000 6.06* .000 2.54 (.56) 3.84 (.78) 11.48* .000

3.33 (.92) 3.47 (1.08) 3.44 (.69) 4.27 (.72)

2.60* .000 3.14 (.39) 4.03 (.59) 10.53* .000 6.22* .000 2.80 (.56) 3.94 (.71) 11.50* .000

3.24 (.48)

3.8 (.69)

5.14* .000 3.42 (.50) 4.03 (.59)

6.73* .000 12.30

.001 2.55

.113

3.22 (.63) 3.67 (.77)

4.78* .000 2.84 (.53) 3.70 (.60)

8.59* .000

.739 0.00

.981

0.06 0.00

p

After F

Category

p

.081 9.77* .002 .080 0.20 .653

7.91* .006 8.05* .005 2.46 .120 1.04 .310

0.11

*p < .05.

Discussion This study was conducted to develop and implement a GRP program, which both nurses and nursing students had an easy access to. It was also to compare the levels they had experienced in real clinical settings. Therefore, among other findings in this study, the following two considerations were particularly worthy of further discussion. First, the participants of this study appeared to show significant increase in both knowledge and perception of research ethics after they had participated in the GRP educational program. The concept of bioethics has a twofold meaning: One is related to life ethics as part of interdisciplinary research areas, and the other is professional ethics which is a set of behavioral standards and rules adopted by a professional community. On the contrary, research ethics are referred to as the researcher’s ethical principles or behavioral patterns that should be followed throughout the entire process of research when the researcher carries out any research.2,3 Generally, the effectiveness of bioethics education has been evaluated with the learners’ Defining Issues Test, and it has been reported that bioethics education for Korean nurses, medical students, and nursing students was not statistically effective.13,14 Especially, the existing research studies have shown that Korean nurses and nursing students did not cope adequately with the ethical problems, indicating that there were not many Korean universities that have set up research ethics education as an independent course of study in the nursing curriculum, and that the research ethics courses were taught by instructors or professors who had not majored in ethics.15 Furthermore, research ethics education for Korean nurses and nursing students was not organized as a required course of study in the university curriculum. According to a study on the research ethics education with 161 nursing faculty members, 31.7% of the participants taught research ethics, but the average length of instruction for research ethics was only 2 h, indicating that the research ethics education was not sufficiently given.16 By and large, there was little or no existing research work to measure the effectiveness of research ethics education so that the implications of this study could not be compared with existing study 491

Downloaded from nej.sagepub.com at Selcuk Universitesi on February 2, 2015

Downloaded from nej.sagepub.com at Selcuk Universitesi on February 2, 2015

*p < .05. a, b, c, d: Post hoc test.

Clinical working career (years)

Nonea

Operational effectiveness of blended e-learning program for nursing research ethics.

Since 2006, the Korean Ministry of Education, Science and Technology, and the National Research Foundation of Korea have taken the lead in developing ...
156KB Sizes 0 Downloads 0 Views