Culture, context and community: ethical considerations for global nursing research

Abstract

High-quality research is essential for the generation of scientific nursing knowledge and the achievement of the Millennium Development Goals. However, the incorporation of Western bioethical principles in the study design may not be suitable, sufficient or relevant to participants in low-income countries and may indeed be harmful and disrespectful. Before engaging in global health studies, nurses must consider carefully the cultural and social context and values of the proposed setting in order to situate the research within the appropriate ethical framework.The purpose of this paper was to examine the ethical principles and considerations that guide health research conducted in international settings using the example of a qualitative study of Ugandan nurses and nurse-midwives by a Canadian researcher.The application of Western bioethical principles with their emphasis on autonomy fails to acknowledge the importance of relevant contextual aspects in the conduct of global research. Because ethics is concerned with how people interact and live together, it is essential that studies conducted across borders be respectful of, and congruent with, the values and needs of the community in which it occurs. The use of a communitarian ethical framework will allow nurse scientists to contribute to the elimination of inequities between those who enjoy prosperity and good health, and those who do not.

Global Nursing-a literature review in the field of education and practice

“…At the beginning of the millennium, perspectives on nursing education and nursing values in global contexts were topics of concern (Gerrish & Griffith, 2003; Kim, Woith, Otten, & McElmurry, 2006; Swenson, Salmon, Wold, & Sibley, 2005; Wieck, 2003; Wros, Doutrich, & Izumi, 2004). Moving towards the mid‐2010s, global leadership, global competencies and networks have arisen as important questions in the Global Nursing debate (Garner, Metcalfe & Hallyburton, 2009; Harrowing, Mill, Spiers, Kulig, & Kipp, 2010). At the beginning of 2020, the use of nurses’ professional competence in relation to vulnerability in health on a global scale and forming nursing competence in international work has dominated the Global Nursing arena (Brunetto, Farr‐Wharton, & Shacklock, 2012; Gutierrez, Candela, & Carver, 2012; Lesia & Roets, 2013; Squires & Juárez, 2012; Toren, Zelker, & Porat, 2012; Walton‐Roberts, 2012; Zhou, Windsor, Theobald, & Coyer, 2011; Zinsli & Smythe, 2009).…”

“…Nurse professionals’ equal opportunities for professional practice, use of competence and collaboration in academic and practice contexts were described as essential in supportive environments (Garner et al., 2008; Gerrish & Griffith, 2003; Harrowing et al., 2010; Wros et al., 2004). Creating a supportive environment for Global Nursing practice and research was described to require an appropriate ethical framework based on the actual context (Harrowing et al., 2010; Weng et al., 2015; Wros et al., 2004). Hence, it was noted that the tendency towards paternalism that may accompany research based on Western ethical traditions could be moderated in a milieu of collaboration (Harrowing et al., 2010).…”

“…Creating a supportive environment for Global Nursing practice and research was described to require an appropriate ethical framework based on the actual context (Harrowing et al., 2010; Weng et al., 2015; Wros et al., 2004). Hence, it was noted that the tendency towards paternalism that may accompany research based on Western ethical traditions could be moderated in a milieu of collaboration (Harrowing et al., 2010). However, the power of joint nursing values and ethics was recognized in supportive environments and highlighted by Wros et al.…”

“…In these projects, it was important to discuss activities for global networking (Garner et al., 2009; Kim et al., 2006; Swenson et al., 2005). It was also stated that the understanding of the impact of politics on healthcare provision and how it affects global networking could broaden the global perspectives (Garner et al., 2009; Harrowing et al., 2010; Ortiga, 2014; Walton‐Roberts, 2012; Zinsli & Smythe, 2009). Furthermore, growth in leadership competencies and an increased sense of both professional and personal nursing community was described as essential (Garner et al., 2009; Kim et al., 2006; Weng et al., 2015).…”

“…Harrowing et al., 2010). Our concern is that global care chains demonstrate the south to north migration of nurses and this global movement reinforces inequities.…”