Combo with Nursing Research CHP 1 Key Terms and 2 others

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the Cochrane Database of Systematic Reviews

"Gold Standard" for high quality systematic reviews. One of the most popular databases, which reviews and summarizes individual clinical trials and systematic reviews from more than 100 medical journals. Includes complete reviews and protocols.

National. Leauge of Nursing

focuses on nursing education reform and nursing education research

A ____________ is a special type of proposition that has a theoretical basis and can be tested empirically.

hypothesis

Probability is how likely it is that the effect of the dependent variable was caused by the ____________ variable.

independent

The degree to which one can conclude that the independent variable, rather than extraneous variables, produced the change in the dependent variable is known as

internal validity.

three areas of research competence

interpreting and using research evaluating practice conducting research

Manipulation is the ____________, or treatment, that is being tested in an experimental study.

intervention

Basic Research

scientific investigations intended to expand the knowledge base

In which situation does the use of key words provide better results than a controlled vocabulary search

searching full text or citation records

justice

the obligation to be fair to all people; includes fairness, just deserts, and entitlements; social equality and distributive justice

beneficence

the obligation to do good, not harm, to other people

Evidence based nursing practice

the process by which nurses make clinics (patient care) decisions based on the best avaliable research evidence, their clinical expertise, and patient preferences

scientific inquiry

the process of analyzing data critically that have been gathered systematically about a particular phenomenon. A process in which observable, verifiable data is systematically collected from our surroundingsthrough our senses to describ, explain, or predict events.

values clarification

the process of becoming more conscious of naming what one values or considers worthy

risk/benefit ratio

the relationship between potential harm to subjects and potential positive outcomes of participating in a research study

evidence-based practice

use of the best clinical evidence in making patient care decisions.

In research, a(n) ____________ is an observation that can be measured by assigning a number to each dimension.

variable

As a staff nurse, how can you further educate yourself about EBP?

Read evidence related to your area of practice on a regular basis.

Determinism

The belief that phenomena are not haphazard or random, but rather have antecedent causes: an assumption in the postivist paradigm

Inductive reasoning

The process of reasoning from specific observations to more general rule

Which type of bias occurs when the dependent variable is influenced by changes made in the way variables are measured?

Threat of instrumentation

A relationship between variables so that when one variable changes, the other variable changes is a(n)

associative relationship.

research program

tams of researchers engage in a series of related research on important topics, rather than discrete and unconnected studies.

What are the five EBP levels of collaboration

Individual, organizational, regional, national, and international

What type of research, usually based on qualitative methods, is used to develop theory

Inductive

Variables that confuse the effect of the independent variable on the dependent variable, so that the research results do not really reflect a true relationship between the independent and dependent variables are

extraneous variables

A nurse has agreed to assist in collecting data from clients in a long-term-care setting. The nurse becomes concerned upon realizing that many of the clients participating in the study have documented cognitive impairments. Which ethical responsibility is being violated?

Informed consent

Many nurses in clinical settings base nursing interventions on information obtained from

colleagues

Role of Baccalaureate Degree Nurses in Research

"intelligent consumers of research", read, interpret, critique, evaluate, and apply research; understand the basic elements of evidence-based nursing practice, identify nursing research problems that need to be investigated, collaborates on research terms, participates in implementation of scientific studies, shares research findings with colleagues, applies established findings of nursing and other health related research to nursing practice.

Assumption

A principle that is accepted as being true based on logic or reason, without proof.

Evidence hierarchy

A ranked arrangement of the validity and dependability of evidence of causality based on the rigor of the method that produced it

systematic review

A rigorous ans systematic synthesis of research findings on a research question

scientific method

A set of orderly, systematic controlled procedures for acquiring dependable, empirical and typically quantitative information; the meteorologic approach associated with te positivist paradigm.

Of the situations listed, which is the best example of collaboration between the levels described in the model of EBP collaboration?

A staff nurse uses findings from the Joanna Briggs Institute to support an EBP project, evaluates outcomes, and reports the findings at an international conference

Paradigm

A way of looking at natural phenomena that encompasses a set of philosophical assumptions and that guides one's approach to inquiry

Which section of a research article provides an overview of the study?

Abstract

What national organizations can nurses use to locate EBP resources and EBP-based clinical guidelines?

Agency for Healthcare Research and Quality, National Institute of Nursing Research, National Nursing Practice Network, and specialty nursing organizations.

Verify that all material has been subjected to the peer-review process.

Appraise the materials to ensure their integrity and applicability

A nurse conducting a keyword search of a literature database enters the search terms "anorexia NOT bulimia" to obtain what result?

Articles that discuss anorexia only

You are a new nurse working at XYZ hospital. Your preceptor tells you to dangle Ms. Jones' legs on the side of the bed before you attempt to assist her to a chair. You ask your preceptor why this is done and she answers, "Because I said so." This is an example of which type of evidence?

Authority

What compels nurses to continue learning throughout their careers to avoid becoming laggards

Changes over time regarding knowledge of effective practices

A major portion of a research article is the methods section, which includes a discussion of the study design, the sample, and the ____________ collected.

Data

Which international code for ethical conduct by physicians conducting biomedical research followed the Nuremberg Code and provides more specific guidelines

Declaration of Helsinki

the Belmont Report

Defined the principles and applications that have guided more detailed regulations and the American Psychological Association Ethics Code 3 Basic ethical principles are 1) beneficience, 2) respect for persons (autonomy), 3) Justice

Which section of a research article provides an interpretation of the study's results?

Discussion

In which type of designs do neither subjects nor individuals administering the treatments know if subjects are receiving experimental interventions or the standard of care?

Double-blind experimental

Empirical evidence

Evidence rooted in objective reality and gathered using one's senses as the basis for generating knowledge

After completing a database search, if you have any doubts or concerns regarding the validity of articles you've located, what options do you have to resolve the issue?

Exclude any materials for which you have doubts about their integrity. Verify questionable material elsewhere using a reputable source. Ask a nursing faculty member or a librarian for assistance.

Which design type allows researchers to manipulate more than one intervention during the same experiment?

Factorial

A nurse researcher wants to interview parents and their autistic children regarding the children's sleep patterns. This study would require which type of IRB review?

Full review

Which type of IRB review is required for research involving vulnerable populations or when there are substantial risks to participants?

Full review

What type of scholarly material can indicate upcoming "hot" topics and includes unpublished reports, conference papers, and grant proposals?

Grey literature

The ____________ occurs when changes noted in the dependent variable can be a result of subject reactivity and not a result of the independent variable.

Hawthorne effect

What is one step a staff nurse can take to advance EBP at the point of care

Identify clinical questions related to current nursing practice.

Which section of a research article identifies the problem being studied and includes a purpose statement and background information on the topic?

Introduction

Why would a researcher need to be concerned about the administration of a pretest and posttest in a research study?

It is a threat to internal validity.

Level VI

Level of evidence from a single descriptive or qualitative study. case study

Level V

Level of evidence from systematic reviews of descriptive and qualitative studies. individual case control study

Level IV

Level of evidence from well designed case control and cohort studies. outcomes research

Level II

Level of evidence obtained from at least one well designed randomized controlled trial. individual randomized clinical trials

Level III

Level of evidence obtained from well designed controlled trials without randomization. individual cohort study

A researcher interested in studying the effect of hearing loss on self-esteem in adolescents in grades 6 through 12 would need to be aware of what type of threat to internal validity?

Maturation

In conducting a keyword search of a literature database, including the Boolean operator "AND" to connect two words has what effect on the search results?

Narrows the search to include only articles that contain both words

Which of the following best describes a primary source

Original information Journal Article

A widely used EBP model consisting of four components for identifying clinical questions for specific patient problems is known as the ____________ model.

PICO

What is an effective way to control extraneous variables?

Randomization

As a staff nurse, what steps can you take to advance EBP as part of your team or unit

Participate in QI initiatives Participate in implementing practice changes based on evidence. Participate as a member of an EBP project team.

PICO

Patient population, intervention of interest, comparison of interest, outcome of interest.

Once an idea is generated for a research problem, what is the next step?

Perform a review of the literature

Which of the following is the best definition of research?

Planned and systematic activity that leads to new knowledge and/or the discovery of solutions to problems or questions.

Which design type is similar to experimental design but does not meet one of the other essential components of experimental design, lacking either randomization or a control group?

Quasi-experimental

Joanna Briggs Institute

Resources in evidence-based nursing and healthcare from South Australlia. Access to restricted/ subscription content such as systematic reviews, evidence summaries, and best practice guidelines

Which of the following is an example of secondary sources

Reviews Commentaries or interpretations Summaries of primary sources

False

Should all nurses conduct research? T or F

Nursing research

Systematic inquire designed to develop knowledge about issues of importance to the nursing profession

Which of the following summarize the results and implications of large quantities of research and include articles addressing the same clinical problem?

Systematic reviews

True

T or F. All nurses should be intelligent consumers of research?

Generalizability

The degree to which the research methods justify the inference that the findings are true for a broader group than study participants

utilitarianism

a theory of ethics that prescribes get quantitative maximization of good consequences for a population. It is best for the largest amount of people. is a form of consequentialism. This good to be maximized is usually happiness, pleasure, or preference satisfaction.

Quantitative Research

The investigation of phenomena that lend themselves to precise measurement and quantification, often involving a rigorous an controlled design.

Qualitative research

The investigation of phenomena, typically in an in depth and holistic fashion, through the collection or rich narrative materials using a flexible research design.

Which one of the following could form the basis for a potential research study?

The majority of patient falls occur on the evening shift.

research methods

The overall plan for addressing a research question, including strategies for enhancing the study's integrity

Deductive reasoning

The process of developing specific predictions from general principles

What provides an essential foundation for nursing practice

Theories and research

In what way can evidence from disciplines other than nursing be helpful?

Theory based non-nursing evidence can provide a basis on which to build new evidence.

What is the purpose of the peer-review process

To ensure confidence in the quality of published works

What is the purpose of formulating a hypothesis or hypotheses?

To provide direction for the research study by identifying possible outcomes

You are a new nurse working at XYZ hospital. Your preceptor tells you to dangle Ms. Jones' legs on the side of the bed before you attempt to assist her to a chair. You ask your preceptor why this is done and she answers, "This is what we have always done, so go do it." This is an example of which type of evidence?

Tradition

Which design type is considered to be the "classic" experimental design in which subjects are randomized into either the intervention group or the control group and measured before and after the intervention is implemented?

Two group pretest-posttest

Which of the following is the best definition of evidence-based practice (EBP)?

Use of theory-derived, research-based information in making decisions about health care delivery, with consideration of individual needs and preferences and the clinical expertise of the provider.

How can a nurse manager advance EBP as part of evaluating his or her staff

Use performance criteria related to EBP.

The advanced practice nurse can work to implement EBP by

Uses evidence to writes and modify practice standards. Locates relevant evidence and synthesizes evidence for practice. Serving as a coach and mentor in EBP.

research

Where do we get a specialized body of knowledge?

Which of the following is the best definition of research utilization

Which of the following is the best definition of research utilization

Which of the following statements should be cited if used in a research paper

Zithromax has shown statistically significant results in the treatment of URIs.

Ethics

a branch of philosophy that deals with/pertains to morals

Abstract

a brief, succinct summary of a research study; usually includes the purpose, methods, and findings of a study.

Patient Oriented Evidence that Matters) info POEMS

a database similar to the ACP journal Club and reviews and provides commentary on recent articles.

MD Consult

a database that provides full text access to textbooks, journal articles, practice guidelines, patient education, handouts, and drug awareness.

National Guideline Clearinghouse

a publicity available database of evidence based clinical practice guidelines and related documents. It provides internet users with online access to guidelines. It is produced by the Agency for Healthcare Research and Quality (AHRQ) and the American Association of Healthcare Pans (AAHP) Foundation

Systematic Review

a research oricess that uses a predefined process; identifying relevant studies, selecting them for inclusion, and collecting and combing their data

Systematic review

a research process used to develop the evidence on which healthcare practices can be based to help identify which forms of healthcare work, which do not, and which are even harmful. Asseses the quality of research studies/ clinical trials. Then the findings are combined to produce both a more statistically reliable result and one that can be more easily applied in other settings.

In searching a database, a controlled vocabulary is

a standardized, hierarchical list of terms that represent major subjects and conditions

meta-analysis

a statistical method that takes the result of many studies in a specific area and synthesizes their findings to draw conclusions regarding the state of the science in the area of focus.

scientific method

a systematic research process that involves the following steps; selecting and defining the problem, formulating research questions or hypotheses, collecting data, analyzing data, and reporting results.

deontology

a theory holding that decisions should be made solely or primarily by considering ones duties and the rights of others; a persons behavior can be wrong even if it results ins the best possible consequences; insists that how people accomplish their goal is usually more important than what people accomplish

values

abstract standards that give a person a sense of what is right and wrong and provides a framework for making decisions

Bixler & Bixler

an extensive university education, unique body of knowledge, and orientation of service to others, autonomy, self regulation, code of ethics, Professional society

evidence based practice

apractices problem solving approach to clinical practice that integrates a systematic search for and critical appraisal of the most relevant evidence to answer a burning clinical question and ones own clinical experience and patient preferences and values.

Researchers formulated hypotheses based on clear definitions of

concepts and variables

According to Florence Nightingale, health is defined as the absence of disease. This is an example of a(n

conceptual definition

The Belmont Report, issued in 1979, identified the following three ethical principles

beneficence, respect for persons, and justice

When extraneous variables influence and distort the relationship between the independent variable (IV) and the dependent variable (DV) so that the findings do not reflect a true relationship between the IV and the DV, the result is

bias

In health-related experimental designs, the group of subjects receiving the standard of care but not the intervention is the

control group.

Which type of design would be used by researchers interested in establishing relationships between two or more variables, for example, the type of coping used by caregivers of older adults having cognitive changes and the occurrence of elder abuse?

correlational

AACN American Association of Colleges of Nursing

culture of inquiry, broad-sharing, evidence based practice

deception

deliberately withholding information about the about the study or providing false information

Role of Associate Degree Nurses in Research

demonstrate awareness of the value or relevance of research in nursing, assist in identify problem areas in nursing practice, assists in collection of data within established structured format

There will be a change in nursing practice after completion of an EBP mentorship program as compared to before the mentorship program." In the preceding statement, "completion of an EBP mentorship program" represents the

dependent variable

In research studies using nonexperimental designs, the purpose is to

describe a phenomenon in detail. predict relationships and differences among variables. explain relationships and differences among variables

Simple Hypothesis

describes the associative or causal relationship between two variables

risk/benefit assessments

designed to determine whether the benefits of participating in a study are in line with the cost

Cause-probing research

designed to illuminate underlying causes of phenomena.

Nursing research

diligent, systematic inquiry, or study to develop knowledge about issues of importance to nursing practice. it encompasses systematic related to clinical practice, basic nursing knowledge and nursing education. Validates and refines existing knowledge related to nursing issues and establish a scientific knowledge base for nursing practice.

post graduate (masters)

evaluate research findings, develop and implement evidence based practice guidelines, design care based on new nursing knowledge, provide clinical expertise about problems, identify practice and systems problems requiring study, collaborate and assist others in initiating research

A theory has credence until

evidence comes forward to refute it.

Ethical research involves citation of previous researchers and their findings to assist in the

evolution of nursing knowledge and practice.

The researcher actively manipulates the independent (causal) variable to determine its effect on the dependent (outcome) variable when using a(n)

experimental design

The three major categories of quantitative research designs are

experimental, quasi-experimental, nonexperimental

In searching database subject headings, you would use the ____________ technique to broaden the search by locating all records indexed to your search term plus any that include the term in a related, narrower category

exploding

As an undergraduate student, which of the following should be the focus of your literature review?

gathering information

Agency for Healthcare Research & Quality (AHRQ)

has promoted evidence based practice through the establishment of 12 evidence based practice centers (EPC's). These EPC's are responsible for developing evidence guidelines and technology assessments on various clinical topics.

stakeholders

healthcare providers, educators, consumers, payers, industry, ect.

Researchers perform a literature review for the purpose of

highlighting areas of needed change. helping to sharpen and focus a research question. identifying gaps in current research.

naturalistic paradigm

holds that there are multiple interpretations of reality, and that the goal of research is to understand how individuals construct reality within there context; often associated with qualitative research

culture of broad sharing

investigators will value the need to share their work with a a variety if audiences- old and new, information will be framed, packaged, and communicated based upon the needs of stakeholders or audiences, will demonstrate a willingness to listen and make their messages meaningful to their varied audiences, sharing results of investigations or projects will be a professional norm.

Intervention research

involves research on interventions for both treating and preventing health problems and adverse outcomes. plays critical role in EBP.

Trial and error is not a preferred approach for delivering nursing care because

it is not based on systematic scientific approaches.

Nursing's Body of Knowledge focuses on

knowing, experiencing, and understanding individuals and their healthcare experiences

Level I

level of evidence from a systematic review or meta-analysis of all relevant randomized controlled trials, or evidence based clinical practice guidelines based on systematic reviews of randomized controlled trials . meta-analysis of randomized clinical trials

Level VII

level of evidence from the opinion of authorities and/or reports of expert committees. Expert opinion

Nuremburg Code (1949)

medical research experiments conducted by Nazi doctors; Numberg trials; internationally recognized set of ethical standards; designed to protect human subjects; based on basic principles of ethics

A type of quantitative study is the ____________, which examines outcomes across a number of studies.

meta-analysis

The concepts that are core to nursing are person, environment, health, and nurse; these are known as the nursing

metaparadigm

When outcomes have many causes, the situation is known as

multicausality

NGC Criteria

must contain systematically developed recommendations, strategies, or other information to assist healthcare decision making in specific clinical circumstances. Must have been produced under the the auspices of a relevant professional organization. Must have included a verifiable, systematic literature search and review of existing evidence published in peer reviewed journals And must be current and most recent version

The following statement: "There will be no difference in practice of nurses after completion of an EBP program as compared to before the mentorship program," is an example of a

null hypothesis.

culture of inquiry

nurses move away from rituals in practice, questioning their practice is expected, change is the norm, practice effects ongoing evaluations, nurses seek answers to their questions and articulate and teach the rationale and teach the rationale for their practices to others.

In the United States during the 1970s, nursing practice included the use of granulated sugar to pack stage III and IV wounds based on the rationale that bacteria would be less invasive of new tissue formation. Over time, this method did not result in statistically significant increase in wound healing time as compared to use of normal saline wet packing. Research was begun to determine what packing method led to best wound healing. The 1970s practices provides an example of

nursing practice based on untested theory

Explicit statements of how a variable will be measured, such as using a rating scale to collect quantitative data regarding pain, are called

operational definitions

post doctoral nurses

opportunity to establish programs or research with formal mentorship from senior researchers/sciences.

Creating an EBP culture is an example of contribution at the

organizational level.

There is a study being conducted of adults over the age of 65 to investigate the effect of caregiver education on calming communication techniques in comparison to sedative medications on the agitation level of clients experiencing stage 2 dementia. In this study, the clients' level of agitation would be the measured

outcome

culture of evidence based practice

practice reflects the current state of the science and is not ritualistic, no gap exists between research and practice, optimal patient outcomes are achieved.

An example of a ____________ is: "The use of alcohol by freshman at XYZ State University contributes to alcohol-related injuries and increasing numbers of visits to the local emergency room

problem statement

clinical nursing research

problems relating to clinical practice

nonmalficence

prohibiting intentional harm; nurses prevent this by reporting unethical/ immora nursing practice

A ____________ is a statement about the relationship between two or more concepts.

proposition

International Council of Nurses Guidelines

publishes guidelines on various topics of relevance to the nursing profession. as a service to nurses worldwide, they have posted guidelines here in PDF format.

An example of a ____________ is: "To determine if brief screening for alcohol use and nursing intervention during orientation reduces self-reported alcohol use, alcohol-related injuries, and visits to the emergency room by college students during their freshman year."

purpose statement

doctoral nurses (research focused)

pursue intellectual inquiry and conduct independent research for the purpose of extending nursing knowledge; plan and launch independent programs

In searching a literature database, you would use the ____________ technique to designate which fields (e.g., author, title, subject, publication date) are to be included in the search.

qualification

systematic inquiry

questioning what we do and why we do it

background questions

questions ask for general knowledge about a condition or thing, disease or disease process. it is usually asked for the need for basic informatio and not to make a clinical decision about a patient. Has 2 essentials components; a question root and a disorder, test, treatment, or another aspect of healthcare.

foreground questions

questions ask for specific knowledge about managing patients with a disease to inform clinical decisions or actions. Has 3 or 4 essential components; patient &/or problem, intervention, comparative intervention (optional), and clinical outcome.

A method of sampling in which all people in the population of interest have an equal chance of being selected to be included in the study is

random sampling.

Causality is the ____________ that exists between a cause and its effect.

relationship

scientific knowledge is

reliable because it is systematic, quantifiable, and undergoes scholarly review.

An area of concern due to a gap in knowledge that requires a solution that can be described, explained, or predicted to improve practice is a

research problem.

applied research

research used to gain knowledge that can be used in a practical setting and is conducted in an actual practice setting (most clinical nursing falls into this category)

The major difference between experimental and nonexperimental designs is the role of the

researchers

The ____________ section of a research article outlines the methods used to analyze the data and notes the findings

results

Federal regulations mandate the establishment of institutional review boards whose purpose is to

review and approve research studies

respect for human dignity

right to self determination and right to full disclosure

major features of NGC

structured, standardized abstracts (summaries) about each guideline and it's development, a utility for compairing attributes of two or more guidelines inns side by side comparison, synthesis of guidelines covering similar topics, highlighting areas of similarity and differences, links to full text guidelines, where available, and/or ordering information for print copies, and annotated bibliographies on guideline development, methodology, structure, implementation, and evaluation.

APC Journal Club

summarizes and interprets the best evidence of one recent study or review article from traditional journals, based on the criteria provided by the practitioner

Nationl Institute for Nursing Research NINR

supports clinical and basic research to establish a scientific basis for the care of individuals across the lifespan, encompass cross-cutting issues (ethnic, cultural, gender differences, biological and behavioral mechanisms, clinical settings in which care is provided, cost effectiveness of interventions)

Nursing Research

systematic inquiry to develop evidence on problems of importance to nurses

Nursing Best Practice Guidelines

the Royal Nurses Association of Ontario launched the Nursing Best Practice Guidelines Program in November 1999 with funding from the Government of Ontarion, Canada

Study validity refers to

the ability to accept that the research results are logical, reasonable, and justifiable based on the evidence presented.

morals

the basic standards for what we consider right and wrong; often based on religious beliefs and to some extent, social influence and group norms

rigorous research studies

the best source of "evidence" is from....

social equity

the concern for society should be directed towards the most disadvantaged because they are the ones least able to speak for themselves

Evidence-Based Medicine (EBM)

the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of this means integrating individual clinical expertise with the best available external clinical evidence from systemic research.

evidence based practice

the conscientious, explicit, and judicious use of current best evidence in making decisions about the delivery of care of individuals or groups of patients in consideration of individual needs and preferences

evidence based nursing

the conscientious, explicit, and judicious use of theory derived, research based information in making decisions about care to individuals or groups of patients and ion consideration of individual needs and preferences.

Evidence-Based Practice

the conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and inconsideration of individual needs and preferences.

External validity refers to

the degree to which the findings can be generalized to other subjects, settings, and times

External validity refers to

the degree to which the findings can be generalized to other subjects, settings, and times.

The advantage of using a quasi-experimental design in nursing is

the design is more adaptable to real-world settings.

distributive justice

the fair distribution of burdens and benefits

A ____________ is a set of concepts linked through propositions to explain a phenomenon.

theory

Research proposals may be eligible for an expedited review by the IRB if they involve minimal risk to participants. This means that:

there is a very low risk of harm or discomfort to study participants, no more than that involved in daily life or routine physical or psychological exams.

Nursing's body of knowledge

this is marked by the growth of knowledge that is useful in solving problems encountered in practice and focuses on knowing and understanding individuals and their health experience

Researchers use nonexperimental, descriptive designs for a variety of purposes, including

to assess current practice for early stages of theory development.

Purpose of Nursing Research

to develop, refine, and expand nursing's knowledge base

Nursing Research Goal

to discover new knowledge and relationships and find solutions to problems or questions

Positivist paradigm

traditional scientific approach, which assumes that there is an orderly reality that can be objectively studied; often associated with quantitative research

doctoral nurses (practice focused)

translate specific knowledge into complex clinical interventions tailored meet individual, family, and community health and illness needs; used advanced leadership knowledge and skills to evaluate the transition of research into practice and collaborate with new researchers/scientist on new health policy research opportunities; focus is on evaluation and use of research rather than the conduct of research.

values conflict

when we must choose between two things, both of which are important to us

Decleration of Helsinki

world medical association; developed guidelines for physicians


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