1. Foster, Jan PhD, RN, CNS
  2. Kosmach, Steven MSN, RN

Article Content


The aim of this study was to highlight the defining criteria and ethical issues to consider when designing a quality improvement, evidence-based practice, or research study.



Under pressure from all sides to deliver the highest quality, cost-effective care derived from evidential support while safeguarding patient rights and adhering to ethical principles, determining which activities qualify as quality improvement and which constitute research, grows increasingly dicey.



Several research-intense institutions over the past decade have had their research programs severely curtailed as a result of noncompliance with regulations governing protection of human subjects. At the same time, the healthcare delivery system is undergoing powerful forces of change. Hospitals are required to publish quality outcomes, and reimbursement for numerous hospital-acquired complications has or soon will be withdrawn. Because a key element of clinical nurse specialist (CNS) practice is improving care using research as a basis, to maintain ethical integrity, CNSs must be able to determine which activities are merely quality improvement and which represent research.



Federal agencies overseeing research and human subject protection will be described, along with a historical overview. Findings from the Hastings Center Report (2006), which provides a detailed framework, definitions, and criteria for both quality improvement and research, will be addressed. Penalties imposed on institutions for violating regulations for human subject protection will be described as explanatory models. Several case examples of each study type will be analyzed, with audience participation.



Clinical nurse specialists will be better prepared to recognize differences and properly carry out quality improvement and research activities within an ethical framework.



Analysis of case examples will help to clarify differences in quality improvement and research.


Implications for Practice:

Properly differentiating quality improvement from research activities protects patients' rights, and CNSs and institutions from risk of violating human subject regulations while making clinical care safer and more effective.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.