Thank you for opening the discussion on ethical permissions required for publication (Watson 2006) which, of course, has a direct impact on the pace of research, as ethical approval is often a slow process. Several pertinent issues are obvious, such as whether ethical approval should be obtained for research projects conducted on staff; the differences between countries in their approach to ethical approval for research projects; and when quality projects should require ethical approval.
Guidance can be provided through international policy, such as, the Declaration of Helsinki (World Medical Association 2004) which proposes that both the author and the publisher have ethical obligations in the conduct of research and that these need to be clearly communicated as upheld during the dissemination of research. Principle nine of the Declaration of Helsinki (World Medical Association 2004) explains that researchers should be aware of their country's requirements for research and also be aware of the necessary requirements internationally. While principle 27 states: ‘Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication’ (p. 4).
Further, the International Committee of Medical Journal Editors (ICMJE 2006) has developed guidelines on the Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication that provides advice about protection of humans and animals during the publication of research. Section II.F states that authors should provide a statement indicating they had conducted their research within the relevant organizations’ ethical standards.
Watson's (2006) position on ethical permission consists of a requirement for permission for patients but will consider submissions of manuscripts that involves staff without ethical approval. This reflects a perception common amongst healthcare workers and researchers – that protection of the patient is paramount and that healthcare staff do not require quite the same consideration. Again, one of our central guideposts in ethical decision-making clearly states that ‘all human beings’ (World Medical Association 2004, Point 8, Section A, p.2) are entitled to protection from the unethical conduct of research. From our perspective, nurses are humans too and so for that matter are university students who are another frequent target for research that does not have ethical approval. Whilst it may be easier to try and avoid ethical approval for research that involve staff, it is important to note that, as research subjects, they have the same rights as research participants as patients.
There is a perception that nursing staff do not require the same level of ethical protection as they have an understanding of research and are more aware of their rights including that of refusal. This is somewhat discounted when we look at the literature on research utilization which regularly describes the lack of experience, and knowledge of research including the technical aspects (Dunn et al. 1997, Kajermo et al. 1998, 2000, Thompson et al. 1999, Parahoo 2000, Pallen & Timmins 2002). It is clear from this well known literature that nurses in general are not familiar with research and are likely to be unfamiliar with their rights as research participants.
Different resources and practices exist for the support of ethical conduct of research in different countries; making it difficult for an international journal to provide a standard that fits everyone. Perhaps a solution may be to ask those authors who do not have independent ethical review boards in place to make a statement on how they addressed the ethical aspects of their research as part of their submission process.
In Australia, there has been considerable discussion as to when quality projects must obtain ethical approval. The National Health and Medical Research Council (NHMRC 2003), responsible for the development of ethical standards for the conduct of research on humans and animals, developed a guideline to assist Human Research Ethics Committees decide when a quality assurance project requires ethics approval. It is salient to note that one of the aims of the publication is to assist journal editors in their assessment of manuscripts submitted for publication.
While the application of this publication is not uniform across Australia, it is enabling Human Research Ethics Committees to make informed decisions on what quality projects need to be assessed by the committee. At a local level these guidelines are used to direct staff undertaking projects about the maintenance of ethical standards. A quality project that does not require ethical approval and subsequently proceeds to publication requires a statement assuring the editor that ethical approval was not sought as per the NHMRC (2003) guidelines. An example of this statement has been used in a manuscript published in an issue of JCN (Henderson et al. 2006).
The responsibility of the editor is extensive and the management of submissions with respect to independent ethical review is not always straight forward. With the standard of publications high, it is expected that the author will provide a description of their project that will be open to the scrutiny of their peers. If this is the case the ethical management of submissions that occurs behind the scenes, whether it is attended to through the random audit of papers for evidence of ethical clearance or a standard requirement to supply a copy of letter of independent ethical review is a decision for the editorial board. From a researcher perspective though, independent ethical review occurs prior to the commencement of the project, so the letter should always be accessible if needed for justification that ethical standards have been met.