Skip to main content
NCBI home page
Wiley Open Access Collection logoLink to Wiley Open Access Collection
editorial
. 2026 Jul 25;28(3):e70401. doi: 10.1111/nhs.70401

Interdisciplinary Representation in Research Ethics Committees: Implications for Nursing and Research Governance

María José Ferreira Díaz 1,✉
PMCID: PMC13401221  PMID: 42500832

1. Introduction

Research ethics committees (RECs) play a central role in safeguarding the rights, dignity, and welfare of individuals participating in health‐related research. Historically, REC oversight has focused on procedural compliance, regulatory review, and formal risk–benefit assessment. However, the increasing complexity of contemporary research—including digital technologies, data‐intensive methodologies, global recruitment, and greater recognition of vulnerable populations—has expanded expectations regarding ethical oversight (Schmidt and Frewer 2021; World Health Organization [WHO] 2021).

Nursing practice involves close and continuous contact with research participants, including participation in consent processes and care for individuals experiencing illness, dependency, or vulnerability. Nursing perspectives are often described as relational and context‐sensitive, with attention to changing capacity, power imbalances, and participant burden (Tronto 1993; Hermoso 2011). These perspectives may be particularly relevant in contemporary ethical review, especially in relation to informed consent, vulnerability, and the feasibility of research within clinical settings.

However, the relationship between interdisciplinary representation in RECs and contemporary ethical oversight remains insufficiently explored. This editorial argues that the inclusion of nursing expertise in REC governance deserves greater attention and may contribute to more context‐sensitive ethical review in increasingly complex research environments.

2. Interdisciplinary Representation in REC Governance: Recommendations and Current Practice

International guidance consistently supports interdisciplinary representation as a key component of Research Ethics Committee (REC) governance. The 2024 revision of the Declaration of Helsinki emphasizes context‐sensitive informed consent, vulnerability, structural justice, environmental responsibility, and interdisciplinary ethical oversight, while WHO guidance similarly recommends diverse professional expertise to strengthen ethical decision‐making and contextual understanding within REC processes (World Medical Association [WMA] 2024; World Health Organization [WHO] 2021).

Despite these recommendations, empirical studies continue to show considerable variation in REC composition across institutions and countries, suggesting that interdisciplinary representation is not consistently implemented in practice.

2.1. Operational Patterns of REC Composition

Empirical studies reveal substantial variation in REC membership across national and institutional contexts. Although biomedical, legal, and administrative professionals are consistently represented, the inclusion of clinically experienced professionals—including nurses—remains uneven and often poorly documented (Salas 1996; Perales 2010; Santos and Guerriero 2022; Mehta et al. 2023; Sperling et al. 2025). This limited transparency makes it difficult to determine how interdisciplinary representation is implemented in practice.

2.2. Why Does Nursing Underrepresentation Persist?

Although empirical evidence describing professional composition within Research Ethics Committees (RECs) remains limited, several factors may explain the relatively low visibility of nursing perspectives in REC governance. Historically, ethical review structures developed within research environments dominated by biomedical and legal expertise, reinforcing the perception that scientific and regulatory knowledge represent the primary forms of expertise required for ethical deliberation (Perales 2010; Mehta et al. 2023). Nursing has also traditionally been associated with direct patient care rather than research governance, potentially limiting opportunities and motivation for participation in REC activities despite nurses' routine involvement in informed consent processes, participant support, and the management of vulnerability in research settings (Hermoso 2011; Ribeiro et al. 2022).

However, healthcare research and the nursing profession have evolved substantially over recent decades. Research training is now increasingly embedded in undergraduate and postgraduate education, advanced clinical practice, and doctoral programmes, while growing numbers of nurses participate as principal investigators, research collaborators, implementation scientists, and clinical academics. Contemporary nursing professionals therefore bring research literacy, ethical awareness, and practical experience that may strengthen REC deliberations, raising important questions about whether current committee structures adequately reflect the profession's evolving contribution to research governance.

3. Ethical Areas Influenced by REC Composition

The implications of variability in REC composition become clearer when examining areas in which contextual and relational expertise may influence ethical review processes. The literature reviewed in this discussion highlights five recurrent ethical areas in which professional composition may shape ethical deliberation, as summarized in Figure 1.

FIGURE 1.

FIGURE 1

Open in a new tab

Conceptual overview of interdisciplinary REC composition and ethical areas influencing review processes. The figure illustrates how international recommendations supporting interdisciplinary representation in Research Ethics Committees (RECs) relate to variability in committee composition and to key ethical areas discussed in this paper, including informed consent, vulnerability, recruitment equity, digital oversight, and protocol feasibility within clinical workflows.

3.1. Informed Consent Under Contextual Pressure

Informed consent frequently occurs in environments characterized by emotional distress, diagnostic uncertainty, or clinical pressure (Lolas Stepke 2020). Although formal documentation requirements may be met, situational factors can affect voluntariness and comprehension. Professionals with close and continuous contact with patients may be more likely to recognize decisional fatigue or implicit forms of coercion (Tronto 1993; Domínguez and Rodríguez 2013). However, the extent to which these perspectives are incorporated into REC deliberation remains insufficiently explored.

Beyond procedural aspects of consent, nursing perspectives may contribute to a more participant‐centred understanding of research participation. Nurses frequently observe how individuals interpret information, negotiate uncertainty, express concerns, and make decisions within the context of illness, dependency, or emotional distress. This proximity to participants may provide insights into whether consent is experienced as genuinely informed and voluntary rather than merely documented (Ng 2024). From this perspective, nursing expertise may contribute not only to protecting participants from harm but also to strengthening their autonomy, understanding, and overall experience as research participants.

Greater attention to these contextual dimensions may strengthen the ethical assessment of consent processes beyond procedural compliance alone.

3.2. Dynamic and Situational Vulnerability

The Declaration of Helsinki describes vulnerability as dynamic and context‐dependent (World Medical Association 2024). Clinical literature supports this relational perspective, describing vulnerability as something that may change across illness trajectories and institutional environments (Hermoso 2011; Del Castillo Salazar and Abrahantes 2018; Findley et al. 2024). If ethical review relies mainly on fixed categorical definitions, changing forms of vulnerability may not be fully recognized. This raises the question of whether committee composition influences sensitivity to situational vulnerability.

Failure to recognize changing forms of vulnerability may result in insufficient safeguards for participants, particularly in increasingly complex longitudinal, digital, and data‐intensive research environments.

3.3. Recruitment Equity and Institutional Hierarchies

Recruitment practices are often influenced by institutional hierarchies and informal gatekeeping processes (Perales 2010). Concerns about unequal access to research participation among socially marginalized populations have been widely discussed (World Health Organization 2021). Clinically experienced professionals may identify recruitment dynamics that are not always visible in protocol documentation, although limited evidence exists regarding how these perspectives are incorporated into REC structures. Greater attention to these dynamics may help reduce the underrepresentation of disadvantaged populations and strengthen both the ethical and scientific quality of research (Heffernan et al. 2023).

3.4. Digital and Data‐Intensive Oversight

The expansion of digital health research introduces ethical challenges related to privacy, algorithmic bias, and digital exclusion (Floridi et al. 2018). Although international ethical guidance increasingly addresses issues related to data governance and digital justice, limited evidence exists regarding how REC composition may influence ethical deliberation in digital research contexts. Frontline healthcare professionals often help participants navigate technological processes (Ribeiro et al. 2022), suggesting that practical and contextual expertise may be particularly relevant in digitally mediated research environments.

As digital health research expands, ethical review increasingly requires attention to digital inclusion, accessibility, and algorithmic fairness, concerns that may not always be fully captured through technical assessments alone.

3.5. Protocol Feasibility and Clinical Workflow

Ethical challenges may also arise when research protocols do not align well with everyday clinical workflows (Saldaña and Pantoja 2016). Professionals working directly in care settings may identify feasibility concerns at an early stage, although limited evidence examines whether REC composition consistently incorporates these practical perspectives into ethical review processes.

In addition, nurses occupying leadership and managerial roles frequently contribute to the implementation of approved research protocols by identifying feasibility concerns, workload implications, participant burden, and potential risks to patient welfare. Their involvement therefore extends beyond direct REC membership and may contribute to minimizing harm during research implementation.

When feasibility issues are identified only after implementation begins, participant burden, protocol deviations, and unintended risks may increase (Florez et al. 2024). Incorporating practical perspectives during ethical review may therefore contribute to more realistic and ethically robust research designs.

4. Conclusions

This editorial examines interdisciplinary representation in Research Ethics Committees (RECs) and its potential implications for ethical review in contemporary healthcare research. International ethical guidance consistently supports interdisciplinary REC membership and highlights the importance of informed consent, vulnerability, equity, and contextual ethical oversight in increasingly complex research environments.

Available evidence suggests that REC composition remains variable across institutions and countries, with limited visibility of clinically experienced professionals, including nurses. The discussion highlighted five ethical areas in which REC composition may be particularly relevant: informed consent, situational vulnerability, recruitment equity, digital oversight, and protocol feasibility within clinical settings. Across these areas, professionals with direct clinical experience contribute practical and contextual perspectives that are not always fully reflected in protocol documentation alone.

Although direct evidence linking REC composition to review quality remains limited, the available literature and contemporary ethical guidance consistently support greater interdisciplinary participation. Nursing perspectives represent a valuable yet still insufficiently visible component of REC governance, and strengthening interdisciplinary representation may contribute to more context‐sensitive, participant‐centred, and practically informed ethical review processes.

Future research should further examine how different professional perspectives influence ethical decision‐making, participant protection, and the implementation of research protocols in increasingly digital and complex healthcare environments.

4.1. Relevance for Clinical Practice

Research ethics governance has direct implications for clinical practice. Decisions made within Research Ethics Committees (RECs) influence study design, informed consent procedures, recruitment strategies, digital management of participant data, and participant burden during research implementation. As research becomes increasingly integrated into routine care, ethical review processes directly influence how clinical teams deliver research‐related interventions.

Nurses and other clinically experienced professionals work closely with patients and may identify ethical concerns that are not always fully visible in protocol documentation, including decisional fatigue, institutional pressure, feasibility constraints, difficulties related to digital processes, and barriers to equitable participation (World Medical Association 2024; World Health Organization 2021; Tronto 1993; Domínguez and Rodríguez 2013). Strengthening interdisciplinary dialogue between ethics committees and frontline clinicians may therefore improve the alignment between ethical guidance and everyday clinical practice.

For nurses involved in clinical research, leadership, or ethics governance, greater understanding of REC processes may facilitate more active participation in ethical deliberation. Continued investment in research ethics education and interdisciplinary preparation may further strengthen nursing contributions to REC activities and support safer, more equitable, and context‐sensitive research practices in increasingly digital healthcare environments (Ribeiro et al. 2022; Wong et al. 2025; Stahl et al. 2025).

Author Contributions

María José Ferreira Díaz: conceptualization, investigation, writing – original draft, methodology, writing – review and editing.

Funding

The author has nothing to report.

Conflicts of Interest

The author declares no conflicts of interest.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

References

  1. Del Castillo Salazar, D. , and Abrahantes T. N. R.. 2018. “La Ética de la Investigación Científica y su Inclusión en Las Ciencias de la Salud.” Acta Médica Del Centro 12, no. 2: 213–227. [Google Scholar]
  2. Domínguez, M. L. P. , and Rodríguez I. I. B.. 2013. “Aspectos Éticos en la Investigación Cualitativa.” Revista de Enfermería Neurológica 12, no. 3: 118–121. [Google Scholar]
  3. Findley, M. G. , Ghosn F., and Lowe S. J.. 2024. “Vulnerability in Research Ethics: A Call for Assessing Vulnerability and Implementing Protections.” Proceedings of the National Academy of Sciences of the United States of America 121, no. 34: e2322821121. 10.1073/pnas.2322821121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Florez, M. , Smith Z., Olah Z., Martin M., and Getz K.. 2024. “Quantifying Site Burden to Optimize Protocol Performance.” Therapeutic Innovation & Regulatory Science 58, no. 2: 347–356. 10.1007/s43441-023-00602-5. [DOI] [PubMed] [Google Scholar]
  5. Floridi, L. , Taddeo M., and Turilli M.. 2018. “Ethical Challenges in Big Data and Artificial Intelligence.” Journal of Medical Ethics 44, no. 2: 119–125. 10.1136/medethics-2017-104328. [DOI] [Google Scholar]
  6. Heffernan, M. E. , Barrera L., Guzman Z. R., et al. 2023. “Barriers and Facilitators to Recruitment of Underrepresented Research Participants: Perspectives of Clinical Research Coordinators.” Journal of Clinical and Translational Science 7, no. 1: e193. 10.1017/cts.2023.611. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hermoso, V. E. 2011. “La Ética de la Investigación Enfermera.” Revista Enfermería CyL 2, no. 2: 3–14. [Google Scholar]
  8. Lolas Stepke, F. 2020. “Ética de la Investigación en la Perspectiva Global.” Revista Médica de Chile 148, no. 3: 360–366. 10.4067/S0034-98872020000300360. [DOI] [Google Scholar]
  9. Mehta, P. , Zimba O., Gasparyan A. Y., Seiil B., and Yessirkepov M.. 2023. “Ethics Committees: Structure, Roles, and Issues.” Journal of Korean Medical Science 38, no. 25: e200. 10.3346/jkms.2023.38.e200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ng, I. K. S. 2024. “Informed Consent in Clinical Practice: Old Problems, New Challenges.” Journal of the Royal College of Physicians of Edinburgh 54, no. 2: 153–158. 10.1177/14782715241247087. [DOI] [PubMed] [Google Scholar]
  11. Perales, A. 2010. “Reflexiones Sobre Ética de Investigación en Seres Humanos.” Revista Peruana de Medicina Experimental y Salud Pública 27, no. 3: 438–442. 10.17843/rpmesp.2010.273.1589. [DOI] [PubMed] [Google Scholar]
  12. Ribeiro, O. M. P. L. , Martins M. M. F. P. S., Tronchin D. M. R., and Silva J. M. L.. 2022. “Nursing Research Training: From Basic Education to Advanced Practice.” Journal of Nursing Scholarship 54, no. 1: 7–15. 10.1111/jnu.12740.34841651 [DOI] [Google Scholar]
  13. Salas, S. 1996. “Estructura y Función de Los Comités de Ética de la Investigación Clínica.” Cuadernos Del Programa Regional de Bioética 3: 94–110. [Google Scholar]
  14. Saldaña, R. B. , and Pantoja J. E. G.. 2016. “Propuesta de Clasificación Ética y Metodológica de Las Investigaciones en Seres Humanos.” Revista CONAMED 21, no. 2: 70–74. [Google Scholar]
  15. Santos, E. P. d. V. , and Guerriero I. C. Z.. 2022. “Professional and Academic Profile of the Brazilian Research Ethics Committees.” Revista Bioética 30, no. 3: 560–569. 10.1590/1983-80422022303553EN. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Schmidt, U. , and Frewer A.. 2021. History and Ethics of Human Research: The Nuremberg Code and the Declaration of Helsinki. Oxford University Press. [Google Scholar]
  17. Sperling, D. , Doron I., and Yakov G.. 2025. “Hospital Ethics Committees: Responsibilities, Competencies and Challenges.” BMC Medical Ethics 26: 65. 10.1186/s12910-025-01365-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Stahl, B. , Aucouturier E., Lekstutiene J., et al. 2025. “Knowledge Needs of Research Ethics Committees for the Integration of Ethics in Research and Technology Development.” Journal of Responsible Innovation 12, no. 1: 904. 10.1080/23299460.2025.2466904. [DOI] [Google Scholar]
  19. Tronto, J. C. 1993. Moral Boundaries: A Political Argument for an Ethic of Care. Routledge. [Google Scholar]
  20. Wong, V. , Hassan N., Wong Y. P., et al. 2025. “Nurses' Adherence to Ethical Principles: A Qualitative Study.” Nursing Ethics 32: 1162–1176. 10.1177/09697330241291159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. World Health Organization . 2021. Standards and Operational Guidance for Ethics Review of Health‐Related Research With Human Participants. WHO Press. [PubMed] [Google Scholar]
  22. World Medical Association . 2024. “Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects.” https://www.wma.net/policies‐post/wma‐declaration‐of‐helsinki‐ethical‐principles‐for‐medical‐research‐involving‐human‐subjects/. [PubMed]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Articles from Nursing & Health Sciences are provided here courtesy of Wiley

RESOURCES