Page 571 - Encyclopedia of Nursing Research

538 n VULNERABLE PoPULATIoNS

and describing VPs as related to health risk specific to working with VPs are two-fold:
and time across life course (Aday, 2001). That ethics and measurement.
V is, risk to health is directly related to the Since the 1970s the organizational-based
amount of time a person or group is exposed human ethics and research committees have
to health threats as well as the length of been required to provide ethical approval for
time it takes for disease to develop. The research. With regard to ethics in research-
VPs conceptual model (VPCM) for health ing VPs, study design, setting, and situation
and research developed by Flaskerud and are key factors (Perez & Treadwell, 2009).
Winslow (1998) postulates interrelationships When multicentered designs are used, it is
between resource availability, relative risk, imperative that review boards consider the
and health status mediated by access to care local impact of the study on VPs (McCauley-
(Aday & Andersen, 1974). The University of Elmson et al., 2009). Palliative care patients
California, Los Angeles School of Nursing, are considered vulnerable. Ethical consider-
Center for Vulnerable Populations Research ations involve benefit and risk of interrupt-
faculty are experts in the area and have ing natural death experiences, pain, and
explored the health behaviors of many sub- offering false hope to a defined end. Mental
groups in terms of health behavior outcomes health patients are considered VPs. Ethical
using the VPCM as a guide in answering considerations involve risk of further psy-
research questions. Another model that chological distress, exacerbation of illness,
has been used to guide research is the risk of exploitation, and/or coercion. General
Comprehensive Health-Seeking and Coping considerations are more comprehensive than
Paradigm, which explores environment, attaining written approval, but in spending
behavior, social demographics, and health extra time with patients to protect vulnera-
outcomes (Nyamathi, 1989). The focus of the bility (McCauley-Elmson et al., 2009). Prisons
Comprehensive Health-Seeking and Coping and schools require strict adherence to fed-
Paradigm is more on the individual than in eral guidelines for including prisoners and
the population; yet, the model has a research- school children in research (IoM, 2004, 2006;
practice paradigm (Nyamathi et al., 2005). Lerner, 2007). Community-based participa-
Receipt of care has been explored using the tory research offers a conduit for considering
Behavior Model for Vulnerable Populations VPs’ perspectives (McCauley-Elmson et al.,
(Gelberg et al., 2000). The model served to 2009) and can allow for participants to a voice
determine predictors of health service uti- and representation, thus promoting equality.
lization and behavior change (Nyamathi UyBico, Pavel, and Gross (2007) emphasized
et al., 2005). that regardless of study design, recruitment
Each concept of the VPCM uses empir- of VPs need ethical review because financial
ical indicators to predict health status. This reward can represent coercion and payment
model has been fundamental to design- can invoke bias (Bentley & Thacker, 2004;
ing descriptive studies to enhance under- Emanuel, 2004; Halpern, Karlawish, Casarett,
standing and knowledge about VPs. The Berlin, & Asch, 2004).
University of California, Los Angeles, determining bias and valid results in
School of Nursing, Center for Vulnerable relation to VPs was the charge of Strickland,
Populations Research’s contributions to sci- diLorio, Coverson, and Nelson (2005). They
entific literature have been extremely pro- completed a research review on studies
ductive in terms of developing collaborative (n = 133) published in selected nursing jour-
partnerships, multisites for data collection, nals (n = 4) in 2004. About 62% of studies
and timely publications. The current issues involved VPs. When quantitative designs
in developing the nursing science of nursing were used, survey research focused on