significance of research project

The Savvy Scientist

Experiences of a London PhD student and beyond

What is the Significance of a Study? Examples and Guide

If you’re reading this post you’re probably wondering: what is the significance of a study?

No matter where you’re at with a piece of research, it is a good idea to think about the potential significance of your work. And sometimes you’ll have to explicitly write a statement of significance in your papers, it addition to it forming part of your thesis.

In this post I’ll cover what the significance of a study is, how to measure it, how to describe it with examples and add in some of my own experiences having now worked in research for over nine years.

If you’re reading this because you’re writing up your first paper, welcome! You may also like my how-to guide for all aspects of writing your first research paper .

Looking for guidance on writing the statement of significance for a paper or thesis? Click here to skip straight to that section.

What is the Significance of a Study?

For research papers, theses or dissertations it’s common to explicitly write a section describing the significance of the study. We’ll come onto what to include in that section in just a moment.

However the significance of a study can actually refer to several different things.

Working our way from the most technical to the broadest, depending on the context, the significance of a study may refer to:

• Within your study: Statistical significance. Can we trust the findings?
• Wider research field: Research significance. How does your study progress the field?
• Commercial / economic significance: Could there be business opportunities for your findings?
• Societal significance: What impact could your study have on the wider society.
• And probably other domain-specific significance!

We’ll shortly cover each of them in turn, including how they’re measured and some examples for each type of study significance.

But first, let’s touch on why you should consider the significance of your research at an early stage.

Why Care About the Significance of a Study?

No matter what is motivating you to carry out your research, it is sensible to think about the potential significance of your work. In the broadest sense this asks, how does the study contribute to the world?

After all, for many people research is only worth doing if it will result in some expected significance. For the vast majority of us our studies won’t be significant enough to reach the evening news, but most studies will help to enhance knowledge in a particular field and when research has at least some significance it makes for a far more fulfilling longterm pursuit.

Furthermore, a lot of us are carrying out research funded by the public. It therefore makes sense to keep an eye on what benefits the work could bring to the wider community.

Often in research you’ll come to a crossroads where you must decide which path of research to pursue. Thinking about the potential benefits of a strand of research can be useful for deciding how to spend your time, money and resources.

It’s worth noting though, that not all research activities have to work towards obvious significance. This is especially true while you’re a PhD student, where you’re figuring out what you enjoy and may simply be looking for an opportunity to learn a new skill.

However, if you’re trying to decide between two potential projects, it can be useful to weigh up the potential significance of each.

Let’s now dive into the different types of significance, starting with research significance.

Research Significance

What is the research significance of a study.

Unless someone specifies which type of significance they’re referring to, it is fair to assume that they want to know about the research significance of your study.

Research significance describes how your work has contributed to the field, how it could inform future studies and progress research.

Where should I write about my study’s significance in my thesis?

Typically you should write about your study’s significance in the Introduction and Conclusions sections of your thesis.

It’s important to mention it in the Introduction so that the relevance of your work and the potential impact and benefits it could have on the field are immediately apparent. Explaining why your work matters will help to engage readers (and examiners!) early on.

It’s also a good idea to detail the study’s significance in your Conclusions section. This adds weight to your findings and helps explain what your study contributes to the field.

On occasion you may also choose to include a brief description in your Abstract.

What is expected when submitting an article to a journal

It is common for journals to request a statement of significance, although this can sometimes be called other things such as:

• Impact statement
• Significance statement
• Advances in knowledge section

Here is one such example of what is expected:

Impact Statement:  An Impact Statement is required for all submissions.  Your impact statement will be evaluated by the Editor-in-Chief, Global Editors, and appropriate Associate Editor. For your manuscript to receive full review, the editors must be convinced that it is an important advance in for the field. The Impact Statement is not a restating of the abstract. It should address the following: Why is the work submitted important to the field? How does the work submitted advance the field? What new information does this work impart to the field? How does this new information impact the field? Experimental Biology and Medicine journal, author guidelines

Typically the impact statement will be shorter than the Abstract, around 150 words.

Defining the study’s significance is helpful not just for the impact statement (if the journal asks for one) but also for building a more compelling argument throughout your submission. For instance, usually you’ll start the Discussion section of a paper by highlighting the research significance of your work. You’ll also include a short description in your Abstract too.

How to describe the research significance of a study, with examples

Whether you’re writing a thesis or a journal article, the approach to writing about the significance of a study are broadly the same.

I’d therefore suggest using the questions above as a starting point to base your statements on.

• Why is the work submitted important to the field?
• How does the work submitted advance the field?
• What new information does this work impart to the field?
• How does this new information impact the field?

Answer those questions and you’ll have a much clearer idea of the research significance of your work.

When describing it, try to clearly state what is novel about your study’s contribution to the literature. Then go on to discuss what impact it could have on progressing the field along with recommendations for future work.

Potential sentence starters

If you’re not sure where to start, why not set a 10 minute timer and have a go at trying to finish a few of the following sentences. Not sure on what to put? Have a chat to your supervisor or lab mates and they may be able to suggest some ideas.

• This study is important to the field because…
• These findings advance the field by…
• Our results highlight the importance of…
• Our discoveries impact the field by…

Now you’ve had a go let’s have a look at some real life examples.

Statement of significance examples

A statement of significance / impact:

Impact Statement This review highlights the historical development of the concept of “ideal protein” that began in the 1950s and 1980s for poultry and swine diets, respectively, and the major conceptual deficiencies of the long-standing concept of “ideal protein” in animal nutrition based on recent advances in amino acid (AA) metabolism and functions. Nutritionists should move beyond the “ideal protein” concept to consider optimum ratios and amounts of all proteinogenic AAs in animal foods and, in the case of carnivores, also taurine. This will help formulate effective low-protein diets for livestock, poultry, and fish, while sustaining global animal production. Because they are not only species of agricultural importance, but also useful models to study the biology and diseases of humans as well as companion (e.g. dogs and cats), zoo, and extinct animals in the world, our work applies to a more general readership than the nutritionists and producers of farm animals. Wu G, Li P. The “ideal protein” concept is not ideal in animal nutrition.  Experimental Biology and Medicine . 2022;247(13):1191-1201. doi: 10.1177/15353702221082658

And the same type of section but this time called “Advances in knowledge”:

Advances in knowledge: According to the MY-RADs criteria, size measurements of focal lesions in MRI are now of relevance for response assessment in patients with monoclonal plasma cell disorders. Size changes of 1 or 2 mm are frequently observed due to uncertainty of the measurement only, while the actual focal lesion has not undergone any biological change. Size changes of at least 6 mm or more in  T 1  weighted or  T 2  weighted short tau inversion recovery sequences occur in only 5% or less of cases when the focal lesion has not undergone any biological change. Wennmann M, Grözinger M, Weru V, et al. Test-retest, inter- and intra-rater reproducibility of size measurements of focal bone marrow lesions in MRI in patients with multiple myeloma [published online ahead of print, 2023 Apr 12].  Br J Radiol . 2023;20220745. doi: 10.1259/bjr.20220745

Other examples of research significance

Moving beyond the formal statement of significance, here is how you can describe research significance more broadly within your paper.

Describing research impact in an Abstract of a paper:

Three-dimensional visualisation and quantification of the chondrocyte population within articular cartilage can be achieved across a field of view of several millimetres using laboratory-based micro-CT. The ability to map chondrocytes in 3D opens possibilities for research in fields from skeletal development through to medical device design and treatment of cartilage degeneration. Conclusions section of the abstract in my first paper .

In the Discussion section of a paper:

We report for the utility of a standard laboratory micro-CT scanner to visualise and quantify features of the chondrocyte population within intact articular cartilage in 3D. This study represents a complimentary addition to the growing body of evidence supporting the non-destructive imaging of the constituents of articular cartilage. This offers researchers the opportunity to image chondrocyte distributions in 3D without specialised synchrotron equipment, enabling investigations such as chondrocyte morphology across grades of cartilage damage, 3D strain mapping techniques such as digital volume correlation to evaluate mechanical properties  in situ , and models for 3D finite element analysis  in silico  simulations. This enables an objective quantification of chondrocyte distribution and morphology in three dimensions allowing greater insight for investigations into studies of cartilage development, degeneration and repair. One such application of our method, is as a means to provide a 3D pattern in the cartilage which, when combined with digital volume correlation, could determine 3D strain gradient measurements enabling potential treatment and repair of cartilage degeneration. Moreover, the method proposed here will allow evaluation of cartilage implanted with tissue engineered scaffolds designed to promote chondral repair, providing valuable insight into the induced regenerative process. The Discussion section of the paper is laced with references to research significance.

How is longer term research significance measured?

Looking beyond writing impact statements within papers, sometimes you’ll want to quantify the long term research significance of your work. For instance when applying for jobs.

The most obvious measure of a study’s long term research significance is the number of citations it receives from future publications. The thinking is that a study which receives more citations will have had more research impact, and therefore significance , than a study which received less citations. Citations can give a broad indication of how useful the work is to other researchers but citations aren’t really a good measure of significance.

Bear in mind that us researchers can be lazy folks and sometimes are simply looking to cite the first paper which backs up one of our claims. You can find studies which receive a lot of citations simply for packaging up the obvious in a form which can be easily found and referenced, for instance by having a catchy or optimised title.

Likewise, research activity varies wildly between fields. Therefore a certain study may have had a big impact on a particular field but receive a modest number of citations, simply because not many other researchers are working in the field.

Nevertheless, citations are a standard measure of significance and for better or worse it remains impressive for someone to be the first author of a publication receiving lots of citations.

Other measures for the research significance of a study include:

• Accolades: best paper awards at conferences, thesis awards, “most downloaded” titles for articles, press coverage.
• How much follow-on research the study creates. For instance, part of my PhD involved a novel material initially developed by another PhD student in the lab. That PhD student’s research had unlocked lots of potential new studies and now lots of people in the group were using the same material and developing it for different applications. The initial study may not receive a high number of citations yet long term it generated a lot of research activity.

That covers research significance, but you’ll often want to consider other types of significance for your study and we’ll cover those next.

Statistical Significance

What is the statistical significance of a study.

Often as part of a study you’ll carry out statistical tests and then state the statistical significance of your findings: think p-values eg <0.05. It is useful to describe the outcome of these tests within your report or paper, to give a measure of statistical significance.

Effectively you are trying to show whether the performance of your innovation is actually better than a control or baseline and not just chance. Statistical significance deserves a whole other post so I won’t go into a huge amount of depth here.

Things that make publication in  The BMJ  impossible or unlikely Internal validity/robustness of the study • It had insufficient statistical power, making interpretation difficult; • Lack of statistical power; The British Medical Journal’s guide for authors

Calculating statistical significance isn’t always necessary (or valid) for a study, such as if you have a very small number of samples, but it is a very common requirement for scientific articles.

Writing a journal article? Check the journal’s guide for authors to see what they expect. Generally if you have approximately five or more samples or replicates it makes sense to start thinking about statistical tests. Speak to your supervisor and lab mates for advice, and look at other published articles in your field.

How is statistical significance measured?

Statistical significance is quantified using p-values . Depending on your study design you’ll choose different statistical tests to compute the p-value.

A p-value of 0.05 is a common threshold value. The 0.05 means that there is a 1/20 chance that the difference in performance you’re reporting is just down to random chance.

• p-values above 0.05 mean that the result isn’t statistically significant enough to be trusted: it is too likely that the effect you’re showing is just luck.
• p-values less than or equal to 0.05 mean that the result is statistically significant. In other words: unlikely to just be chance, which is usually considered a good outcome.

Low p-values (eg p = 0.001) mean that it is highly unlikely to be random chance (1/1000 in the case of p = 0.001), therefore more statistically significant.

It is important to clarify that, although low p-values mean that your findings are statistically significant, it doesn’t automatically mean that the result is scientifically important. More on that in the next section on research significance.

How to describe the statistical significance of your study, with examples

In the first paper from my PhD I ran some statistical tests to see if different staining techniques (basically dyes) increased how well you could see cells in cow tissue using micro-CT scanning (a 3D imaging technique).

In your methods section you should mention the statistical tests you conducted and then in the results you will have statements such as:

Between mediums for the two scan protocols C/N [contrast to noise ratio] was greater for EtOH than the PBS in both scanning methods (both  p  < 0.0001) with mean differences of 1.243 (95% CI [confidence interval] 0.709 to 1.778) for absorption contrast and 6.231 (95% CI 5.772 to 6.690) for propagation contrast. … Two repeat propagation scans were taken of samples from the PTA-stained groups. No difference in mean C/N was found with either medium: PBS had a mean difference of 0.058 ( p  = 0.852, 95% CI -0.560 to 0.676), EtOH had a mean difference of 1.183 ( p  = 0.112, 95% CI 0.281 to 2.648). From the Results section of my first paper, available here . Square brackets added for this post to aid clarity.

From this text the reader can infer from the first paragraph that there was a statistically significant difference in using EtOH compared to PBS (really small p-value of <0.0001). However, from the second paragraph, the difference between two repeat scans was statistically insignificant for both PBS (p = 0.852) and EtOH (p = 0.112).

By conducting these statistical tests you have then earned your right to make bold statements, such as these from the discussion section:

Propagation phase-contrast increases the contrast of individual chondrocytes [cartilage cells] compared to using absorption contrast. From the Discussion section from the same paper.

Without statistical tests you have no evidence that your results are not just down to random chance.

Beyond describing the statistical significance of a study in the main body text of your work, you can also show it in your figures.

In figures such as bar charts you’ll often see asterisks to represent statistical significance, and “n.s.” to show differences between groups which are not statistically significant. Here is one such figure, with some subplots, from the same paper:

In this example an asterisk (*) between two bars represents p < 0.05. Two asterisks (**) represents p < 0.001 and three asterisks (***) represents p < 0.0001. This should always be stated in the caption of your figure since the values that each asterisk refers to can vary.

Now that we know if a study is showing statistically and research significance, let’s zoom out a little and consider the potential for commercial significance.

Commercial and Industrial Significance

What are commercial and industrial significance.

Moving beyond significance in relation to academia, your research may also have commercial or economic significance.

Simply put:

• Commercial significance: could the research be commercialised as a product or service? Perhaps the underlying technology described in your study could be licensed to a company or you could even start your own business using it.
• Industrial significance: more widely than just providing a product which could be sold, does your research provide insights which may affect a whole industry? Such as: revealing insights or issues with current practices, performance gains you don’t want to commercialise (e.g. solar power efficiency), providing suggested frameworks or improvements which could be employed industry-wide.

I’ve grouped these two together because there can certainly be overlap. For instance, perhaps your new technology could be commercialised whilst providing wider improvements for the whole industry.

Commercial and industrial significance are not relevant to most studies, so only write about it if you and your supervisor can think of reasonable routes to your work having an impact in these ways.

How are commercial and industrial significance measured?

Unlike statistical and research significances, the measures of commercial and industrial significance can be much more broad.

Here are some potential measures of significance:

Commercial significance:

• How much value does your technology bring to potential customers or users?
• How big is the potential market and how much revenue could the product potentially generate?
• Is the intellectual property protectable? i.e. patentable, or if not could the novelty be protected with trade secrets: if so publish your method with caution!
• If commercialised, could the product bring employment to a geographical area?

Industrial significance:

What impact could it have on the industry? For instance if you’re revealing an issue with something, such as unintended negative consequences of a drug , what does that mean for the industry and the public? This could be:

• Reduced overhead costs
• Better safety
• Faster production methods
• Improved scaleability

How to describe the commercial and industrial significance of a study, with examples

Commercial significance.

If your technology could be commercially viable, and you’ve got an interest in commercialising it yourself, it is likely that you and your university may not want to immediately publish the study in a journal.

You’ll probably want to consider routes to exploiting the technology and your university may have a “technology transfer” team to help researchers navigate the various options.

However, if instead of publishing a paper you’re submitting a thesis or dissertation then it can be useful to highlight the commercial significance of your work. In this instance you could include statements of commercial significance such as:

The measurement technology described in this study provides state of the art performance and could enable the development of low cost devices for aerospace applications. An example of commercial significance I invented for this post

Industrial significance

First, think about the industrial sectors who could benefit from the developments described in your study.

For example if you’re working to improve battery efficiency it is easy to think of how it could lead to performance gains for certain industries, like personal electronics or electric vehicles. In these instances you can describe the industrial significance relatively easily, based off your findings.

For example:

By utilising abundant materials in the described battery fabrication process we provide a framework for battery manufacturers to reduce dependence on rare earth components. Again, an invented example

For other technologies there may well be industrial applications but they are less immediately obvious and applicable. In these scenarios the best you can do is to simply reframe your research significance statement in terms of potential commercial applications in a broad way.

As a reminder: not all studies should address industrial significance, so don’t try to invent applications just for the sake of it!

Societal Significance

What is the societal significance of a study.

The most broad category of significance is the societal impact which could stem from it.

If you’re working in an applied field it may be quite easy to see a route for your research to impact society. For others, the route to societal significance may be less immediate or clear.

Studies can help with big issues facing society such as:

• Medical applications : vaccines, surgical implants, drugs, improving patient safety. For instance this medical device and drug combination I worked on which has a very direct route to societal significance.
• Political significance : Your research may provide insights which could contribute towards potential changes in policy or better understanding of issues facing society.
• Public health : for instance COVID-19 transmission and related decisions.
• Climate change : mitigation such as more efficient solar panels and lower cost battery solutions, and studying required adaptation efforts and technologies. Also, better understanding around related societal issues, for instance this study on the effects of temperature on hate speech.

How is societal significance measured?

Societal significance at a high level can be quantified by the size of its potential societal effect. Just like a lab risk assessment, you can think of it in terms of probability (or how many people it could help) and impact magnitude.

Societal impact = How many people it could help x the magnitude of the impact

Think about how widely applicable the findings are: for instance does it affect only certain people? Then think about the potential size of the impact: what kind of difference could it make to those people?

Between these two metrics you can get a pretty good overview of the potential societal significance of your research study.

How to describe the societal significance of a study, with examples

Quite often the broad societal significance of your study is what you’re setting the scene for in your Introduction. In addition to describing the existing literature, it is common to for the study’s motivation to touch on its wider impact for society.

For those of us working in healthcare research it is usually pretty easy to see a path towards societal significance.

Our CLOUT model has state-of-the-art performance in mortality prediction, surpassing other competitive NN models and a logistic regression model … Our results show that the risk factors identified by the CLOUT model agree with physicians’ assessment, suggesting that CLOUT could be used in real-world clinicalsettings. Our results strongly support that CLOUT may be a useful tool to generate clinical prediction models, especially among hospitalized and critically ill patient populations. Learning Latent Space Representations to Predict Patient Outcomes: Model Development and Validation

In other domains the societal significance may either take longer or be more indirect, meaning that it can be more difficult to describe the societal impact.

Even so, here are some examples I’ve found from studies in non-healthcare domains:

We examined food waste as an initial investigation and test of this methodology, and there is clear potential for the examination of not only other policy texts related to food waste (e.g., liability protection, tax incentives, etc.; Broad Leib et al., 2020) but related to sustainable fishing (Worm et al., 2006) and energy use (Hawken, 2017). These other areas are of obvious relevance to climate change… AI-Based Text Analysis for Evaluating Food Waste Policies

The continued development of state-of-the art NLP tools tailored to climate policy will allow climate researchers and policy makers to extract meaningful information from this growing body of text, to monitor trends over time and administrative units, and to identify potential policy improvements. BERT Classification of Paris Agreement Climate Action Plans

Top Tips For Identifying & Writing About the Significance of Your Study

• Writing a thesis? Describe the significance of your study in the Introduction and the Conclusion .
• Submitting a paper? Read the journal’s guidelines. If you’re writing a statement of significance for a journal, make sure you read any guidance they give for what they’re expecting.
• Take a step back from your research and consider your study’s main contributions.
• Read previously published studies in your field . Use this for inspiration and ideas on how to describe the significance of your own study
• Discuss the study with your supervisor and potential co-authors or collaborators and brainstorm potential types of significance for it.

Now you’ve finished reading up on the significance of a study you may also like my how-to guide for all aspects of writing your first research paper .

Writing an academic journal paper

I hope that you’ve learned something useful from this article about the significance of a study. If you have any more research-related questions let me know, I’m here to help.

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How To Write a Significance Statement for Your Research

A significance statement is an essential part of a research paper. It explains the importance and relevance of the study to the academic community and the world at large. To write a compelling significance statement, identify the research problem, explain why it is significant, provide evidence of its importance, and highlight its potential impact on future research, policy, or practice. A well-crafted significance statement should effectively communicate the value of the research to readers and help them understand why it matters.

Updated on May 4, 2023

A significance statement is a clearly stated, non-technical paragraph that explains why your research matters. It’s central in making the public aware of and gaining support for your research.

Write it in jargon-free language that a reader from any field can understand. Well-crafted, easily readable significance statements can improve your chances for citation and impact and make it easier for readers outside your field to find and understand your work.

Read on for more details on what a significance statement is, how it can enhance the impact of your research, and, of course, how to write one.

What is a significance statement in research?

A significance statement answers the question: How will your research advance scientific knowledge and impact society at large (as well as specific populations)? 

You might also see it called a “Significance of the study” statement. Some professional organizations in the STEM sciences and social sciences now recommended that journals in their disciplines make such statements a standard feature of each published article. Funding agencies also consider “significance” a key criterion for their awards.

Read some examples of significance statements from the Proceedings of the National Academy of Sciences (PNAS) here .

Depending upon the specific journal or funding agency’s requirements, your statement may be around 100 words and answer these questions:

1. What’s the purpose of this research?

2. What are its key findings?

3. Why do they matter?

4. Who benefits from the research results?

Readers will want to know: “What is interesting or important about this research?” Keep asking yourself that question.

Where to place the significance statement in your manuscript

Most journals ask you to place the significance statement before or after the abstract, so check with each journal’s guide. 

This article is focused on the formal significance statement, even though you’ll naturally highlight your project’s significance elsewhere in your manuscript. (In the introduction, you’ll set out your research aims, and in the conclusion, you’ll explain the potential applications of your research and recommend areas for future research. You’re building an overall case for the value of your work.)

Developing the significance statement

The main steps in planning and developing your statement are to assess the gaps to which your study contributes, and then define your work’s implications and impact.

Identify what gaps your study fills and what it contributes

Your literature review was a big part of how you planned your study. To develop your research aims and objectives, you identified gaps or unanswered questions in the preceding research and designed your study to address them.

Go back to that lit review and look at those gaps again. Review your research proposal to refresh your memory. Ask:

• How have my research findings advanced knowledge or provided notable new insights?
• How has my research helped to prove (or disprove) a hypothesis or answer a research question?
• Why are those results important?

Consider your study’s potential impact at two levels: 

• What contribution does my research make to my field?
• How does it specifically contribute to knowledge; that is, who will benefit the most from it?

Define the implications and potential impact

As you make notes, keep the reasons in mind for why you are writing this statement. Whom will it impact, and why?

The first audience for your significance statement will be journal reviewers when you submit your article for publishing. Many journals require one for manuscript submissions. Study the author’s guide of your desired journal to see its criteria ( here’s an example ). Peer reviewers who can clearly understand the value of your research will be more likely to recommend publication. 

Second, when you apply for funding, your significance statement will help justify why your research deserves a grant from a funding agency . The U.S. National Institutes of Health (NIH), for example, wants to see that a project will “exert a sustained, powerful influence on the research field(s) involved.” Clear, simple language is always valuable because not all reviewers will be specialists in your field.

Third, this concise statement about your study’s importance can affect how potential readers engage with your work. Science journalists and interested readers can promote and spread your work, enhancing your reputation and influence. Help them understand your work.

You’re now ready to express the importance of your research clearly and concisely. Time to start writing.

How to write a significance statement: Key elements 

When drafting your statement, focus on both the content and writing style.

• In terms of content, emphasize the importance, timeliness, and relevance of your research results. 
• Write the statement in plain, clear language rather than scientific or technical jargon. Your audience will include not just your fellow scientists but also non-specialists like journalists, funding reviewers, and members of the public. 

Follow the process we outline below to build a solid, well-crafted, and informative statement. 

Get started

Some suggested opening lines to help you get started might be:

• The implications of this study are… 
• Building upon previous contributions, our study moves the field forward because…
• Our study furthers previous understanding about…

Alternatively, you may start with a statement about the phenomenon you’re studying, leading to the problem statement.

Include these components

Next, draft some sentences that include the following elements. A good example, which we’ll use here, is a significance statement by Rogers et al. (2022) published in the Journal of Climate .

1. Briefly situate your research study in its larger context . Start by introducing the topic, leading to a problem statement. Here’s an example:

‘Heatwaves pose a major threat to human health, ecosystems, and human systems.”

2. State the research problem.

“Simultaneous heatwaves affecting multiple regions can exacerbate such threats. For example, multiple food-producing regions simultaneously undergoing heat-related crop damage could drive global food shortages.”

3. Tell what your study does to address it.

“We assess recent changes in the occurrence of simultaneous large heatwaves.”

4. Provide brief but powerful evidence to support the claims your statement is making , Use quantifiable terms rather than vague ones (e.g., instead of “This phenomenon is happening now more than ever,” see below how Rogers et al. (2022) explained it). This evidence intensifies and illustrates the problem more vividly:

“Such simultaneous heatwaves are 7 times more likely now than 40 years ago. They are also hotter and affect a larger area. Their increasing occurrence is mainly driven by warming baseline temperatures due to global heating, but changes in weather patterns contribute to disproportionate increases over parts of Europe, the eastern United States, and Asia.

5. Relate your study’s impact to the broader context , starting with its general significance to society—then, when possible, move to the particular as you name specific applications of your research findings. (Our example lacks this second level of application.) 

“Better understanding the drivers of weather pattern changes is therefore important for understanding future concurrent heatwave characteristics and their impacts.”

Refine your English

Don’t understate or overstate your findings – just make clear what your study contributes. When you have all the elements in place, review your draft to simplify and polish your language. Even better, get an expert AJE edit . Be sure to use “plain” language rather than academic jargon.

• Avoid acronyms, scientific jargon, and technical terms 
• Use active verbs in your sentence structure rather than passive voice (e.g., instead of “It was found that...”, use “We found...”)
• Make sentence structures short, easy to understand – readable
• Try to address only one idea in each sentence and keep sentences within 25 words (15 words is even better)
• Eliminate nonessential words and phrases (“fluff” and wordiness)

Enhance your significance statement’s impact

Always take time to review your draft multiple times. Make sure that you:

• Keep your language focused
• Provide evidence to support your claims
• Relate the significance to the broader research context in your field

After revising your significance statement, request feedback from a reading mentor about how to make it even clearer. If you’re not a native English speaker, seek help from a native-English-speaking colleague or use an editing service like AJE to make sure your work is at a native level.

Understanding the significance of your study

Your readers may have much less interest than you do in the specific details of your research methods and measures. Many readers will scan your article to learn how your findings might apply to them and their own research. 

Different types of significance

Your findings may have different types of significance, relevant to different populations or fields of study for different reasons. You can emphasize your work’s statistical, clinical, or practical significance. Editors or reviewers in the social sciences might also evaluate your work’s social or political significance.

Statistical significance means that the results are unlikely to have occurred randomly. Instead, it implies a true cause-and-effect relationship.

Clinical significance means that your findings are applicable for treating patients and improving quality of life.

Practical significance is when your research outcomes are meaningful to society at large, in the “real world.” Practical significance is usually measured by the study’s  effect size . Similarly, evaluators may attribute social or political significance to research that addresses “real and immediate” social problems.

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• Writing Tips

How to Discuss the Significance of Your Research

• 6-minute read
• 10th April 2023

Introduction

Research papers can be a real headache for college students . As a student, your research needs to be credible enough to support your thesis statement. You must also ensure you’ve discussed the literature review, findings, and results.

However, it’s also important to discuss the significance of your research . Your potential audience will care deeply about this. It will also help you conduct your research. By knowing the impact of your research, you’ll understand what important questions to answer.

If you’d like to know more about the impact of your research, read on! We’ll talk about why it’s important and how to discuss it in your paper.

What Is the Significance of Research?

This is the potential impact of your research on the field of study. It includes contributions from new knowledge from the research and those who would benefit from it. You should present this before conducting research, so you need to be aware of current issues associated with the thesis before discussing the significance of the research.

Why Does the Significance of Research Matter?

Potential readers need to know why your research is worth pursuing. Discussing the significance of research answers the following questions:

●  Why should people read your research paper ?

●  How will your research contribute to the current knowledge related to your topic?

●  What potential impact will it have on the community and professionals in the field?

Not including the significance of research in your paper would be like a knight trying to fight a dragon without weapons.

Where Do I Discuss the Significance of Research in My Paper?

As previously mentioned, the significance of research comes before you conduct it. Therefore, you should discuss the significance of your research in the Introduction section. Your reader should know the problem statement and hypothesis beforehand.

Steps to Discussing the Significance of Your Research

Discussing the significance of research might seem like a loaded question, so we’ve outlined some steps to help you tackle it.

Step 1: The Research Problem

The problem statement can reveal clues about the outcome of your research. Your research should provide answers to the problem, which is beneficial to all those concerned. For example, imagine the problem statement is, “To what extent do elementary and high school teachers believe cyberbullying affects student performance?”

Learning teachers’ opinions on the effects of cyberbullying on student performance could result in the following:

●  Increased public awareness of cyberbullying in elementary and high schools

●  Teachers’ perceptions of cyberbullying negatively affecting student performance

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●  Whether cyberbullying is more prevalent in elementary or high schools

The research problem will steer your research in the right direction, so it’s best to start with the problem statement.

Step 2: Existing Literature in the Field

Think about current information on your topic, and then find out what information is missing. Are there any areas that haven’t been explored? Your research should add new information to the literature, so be sure to state this in your discussion. You’ll need to know the current literature on your topic anyway, as this is part of your literature review section .

Step 3: Your Research’s Impact on Society

Inform your readers about the impact on society your research could have on it. For example, in the study about teachers’ opinions on cyberbullying, you could mention that your research will educate the community about teachers’ perceptions of cyberbullying as it affects student performance. As a result, the community will know how many teachers believe cyberbullying affects student performance.

You can also mention specific individuals and institutions that would benefit from your study. In the example of cyberbullying, you might indicate that school principals and superintendents would benefit from your research.

Step 4: Future Studies in the Field

Next, discuss how the significance of your research will benefit future studies, which is especially helpful for future researchers in your field. In the example of cyberbullying affecting student performance, your research could provide further opportunities to assess teacher perceptions of cyberbullying and its effects on students from larger populations. This prepares future researchers for data collection and analysis.

Discussing the significance of your research may sound daunting when you haven’t conducted it yet. However, an audience might not read your paper if they don’t know the significance of the research. By focusing on the problem statement and the research benefits to society and future studies, you can convince your audience of the value of your research.

Remember that everything you write doesn’t have to be set in stone. You can go back and tweak the significance of your research after conducting it. At first, you might only include general contributions of your study, but as you research, your contributions will become more specific.

You should have a solid understanding of your topic in general, its associated problems, and the literature review before tackling the significance of your research. However, you’re not trying to prove your thesis statement at this point. The significance of research just convinces the audience that your study is worth reading.

Finally, we always recommend seeking help from your research advisor whenever you’re struggling with ideas. For a more visual idea of how to discuss the significance of your research, we suggest checking out this video .

1. Do I need to do my research before discussing its significance?

No, you’re discussing the significance of your research before you conduct it. However, you should be knowledgeable about your topic and the related literature.

2. Is the significance of research the same as its implications?

No, the research implications are potential questions from your study that justify further exploration, which comes after conducting the research.

 3. Discussing the significance of research seems overwhelming. Where should I start?

We recommend the problem statement as a starting point, which reveals clues to the potential outcome of your research.

4. How can I get feedback on my discussion of the significance of my research?

Our proofreading experts can help. They’ll check your writing for grammar, punctuation errors, spelling, and concision. Submit a 500-word document for free today!

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How To Write Significance of the Study (With Examples) 

Whether you’re writing a research paper or thesis, a portion called Significance of the Study ensures your readers understand the impact of your work. Learn how to effectively write this vital part of your research paper or thesis through our detailed steps, guidelines, and examples.

Related: How to Write a Concept Paper for Academic Research

Table of Contents

What is the significance of the study.

The Significance of the Study presents the importance of your research. It allows you to prove the study’s impact on your field of research, the new knowledge it contributes, and the people who will benefit from it.

Related: How To Write Scope and Delimitation of a Research Paper (With Examples)

Where Should I Put the Significance of the Study?

The Significance of the Study is part of the first chapter or the Introduction. It comes after the research’s rationale, problem statement, and hypothesis.

Related: How to Make Conceptual Framework (with Examples and Templates)

Why Should I Include the Significance of the Study?

The purpose of the Significance of the Study is to give you space to explain to your readers how exactly your research will be contributing to the literature of the field you are studying 1 . It’s where you explain why your research is worth conducting and its significance to the community, the people, and various institutions.

How To Write Significance of the Study: 5 Steps

Below are the steps and guidelines for writing your research’s Significance of the Study.

1. Use Your Research Problem as a Starting Point

Your problem statement can provide clues to your research study’s outcome and who will benefit from it 2 .

Ask yourself, “How will the answers to my research problem be beneficial?”. In this manner, you will know how valuable it is to conduct your study. 

Let’s say your research problem is “What is the level of effectiveness of the lemongrass (Cymbopogon citratus) in lowering the blood glucose level of Swiss mice (Mus musculus)?”

Discovering a positive correlation between the use of lemongrass and lower blood glucose level may lead to the following results:

• Increased public understanding of the plant’s medical properties;
• Higher appreciation of the importance of lemongrass  by the community;
• Adoption of lemongrass tea as a cheap, readily available, and natural remedy to lower their blood glucose level.

Once you’ve zeroed in on the general benefits of your study, it’s time to break it down into specific beneficiaries.

2. State How Your Research Will Contribute to the Existing Literature in the Field

Think of the things that were not explored by previous studies. Then, write how your research tackles those unexplored areas. Through this, you can convince your readers that you are studying something new and adding value to the field.

3. Explain How Your Research Will Benefit Society

In this part, tell how your research will impact society. Think of how the results of your study will change something in your community. 

For example, in the study about using lemongrass tea to lower blood glucose levels, you may indicate that through your research, the community will realize the significance of lemongrass and other herbal plants. As a result, the community will be encouraged to promote the cultivation and use of medicinal plants.

4. Mention the Specific Persons or Institutions Who Will Benefit From Your Study

Using the same example above, you may indicate that this research’s results will benefit those seeking an alternative supplement to prevent high blood glucose levels.

5. Indicate How Your Study May Help Future Studies in the Field

You must also specifically indicate how your research will be part of the literature of your field and how it will benefit future researchers. In our example above, you may indicate that through the data and analysis your research will provide, future researchers may explore other capabilities of herbal plants in preventing different diseases.

Tips and Warnings

• Think ahead . By visualizing your study in its complete form, it will be easier for you to connect the dots and identify the beneficiaries of your research.
• Write concisely. Make it straightforward, clear, and easy to understand so that the readers will appreciate the benefits of your research. Avoid making it too long and wordy.
• Go from general to specific . Like an inverted pyramid, you start from above by discussing the general contribution of your study and become more specific as you go along. For instance, if your research is about the effect of remote learning setup on the mental health of college students of a specific university , you may start by discussing the benefits of the research to society, to the educational institution, to the learning facilitators, and finally, to the students.
• Seek help . For example, you may ask your research adviser for insights on how your research may contribute to the existing literature. If you ask the right questions, your research adviser can point you in the right direction.
• Revise, revise, revise. Be ready to apply necessary changes to your research on the fly. Unexpected things require adaptability, whether it’s the respondents or variables involved in your study. There’s always room for improvement, so never assume your work is done until you have reached the finish line.

Significance of the Study Examples

This section presents examples of the Significance of the Study using the steps and guidelines presented above.

Example 1: STEM-Related Research

Research Topic: Level of Effectiveness of the Lemongrass ( Cymbopogon citratus ) Tea in Lowering the Blood Glucose Level of Swiss Mice ( Mus musculus ).

Significance of the Study .

This research will provide new insights into the medicinal benefit of lemongrass ( Cymbopogon citratus ), specifically on its hypoglycemic ability.

Through this research, the community will further realize promoting medicinal plants, especially lemongrass, as a preventive measure against various diseases. People and medical institutions may also consider lemongrass tea as an alternative supplement against hyperglycemia. 

Moreover, the analysis presented in this study will convey valuable information for future research exploring the medicinal benefits of lemongrass and other medicinal plants.  

Example 2: Business and Management-Related Research

Research Topic: A Comparative Analysis of Traditional and Social Media Marketing of Small Clothing Enterprises.

Significance of the Study:

By comparing the two marketing strategies presented by this research, there will be an expansion on the current understanding of the firms on these marketing strategies in terms of cost, acceptability, and sustainability. This study presents these marketing strategies for small clothing enterprises, giving them insights into which method is more appropriate and valuable for them. 

Specifically, this research will benefit start-up clothing enterprises in deciding which marketing strategy they should employ. Long-time clothing enterprises may also consider the result of this research to review their current marketing strategy.

Furthermore, a detailed presentation on the comparison of the marketing strategies involved in this research may serve as a tool for further studies to innovate the current method employed in the clothing Industry.

Example 3: Social Science -Related Research.

Research Topic:  Divide Et Impera : An Overview of How the Divide-and-Conquer Strategy Prevailed on Philippine Political History.

Significance of the Study :

Through the comprehensive exploration of this study on Philippine political history, the influence of the Divide et Impera, or political decentralization, on the political discernment across the history of the Philippines will be unraveled, emphasized, and scrutinized. Moreover, this research will elucidate how this principle prevailed until the current political theatre of the Philippines.

In this regard, this study will give awareness to society on how this principle might affect the current political context. Moreover, through the analysis made by this study, political entities and institutions will have a new approach to how to deal with this principle by learning about its influence in the past.

In addition, the overview presented in this research will push for new paradigms, which will be helpful for future discussion of the Divide et Impera principle and may lead to a more in-depth analysis.

Example 4: Humanities-Related Research

Research Topic: Effectiveness of Meditation on Reducing the Anxiety Levels of College Students.

Significance of the Study: 

This research will provide new perspectives in approaching anxiety issues of college students through meditation. 

Specifically, this research will benefit the following:

 Community – this study spreads awareness on recognizing anxiety as a mental health concern and how meditation can be a valuable approach to alleviating it.

Academic Institutions and Administrators – through this research, educational institutions and administrators may promote programs and advocacies regarding meditation to help students deal with their anxiety issues.

Mental health advocates – the result of this research will provide valuable information for the advocates to further their campaign on spreading awareness on dealing with various mental health issues, including anxiety, and how to stop stigmatizing those with mental health disorders.

Parents – this research may convince parents to consider programs involving meditation that may help the students deal with their anxiety issues.

Students will benefit directly from this research as its findings may encourage them to consider meditation to lower anxiety levels.

Future researchers – this study covers information involving meditation as an approach to reducing anxiety levels. Thus, the result of this study can be used for future discussions on the capabilities of meditation in alleviating other mental health concerns.

Frequently Asked Questions

1. what is the difference between the significance of the study and the rationale of the study.

Both aim to justify the conduct of the research. However, the Significance of the Study focuses on the specific benefits of your research in the field, society, and various people and institutions. On the other hand, the Rationale of the Study gives context on why the researcher initiated the conduct of the study.

Let’s take the research about the Effectiveness of Meditation in Reducing Anxiety Levels of College Students as an example. Suppose you are writing about the Significance of the Study. In that case, you must explain how your research will help society, the academic institution, and students deal with anxiety issues through meditation. Meanwhile, for the Rationale of the Study, you may state that due to the prevalence of anxiety attacks among college students, you’ve decided to make it the focal point of your research work.

2. What is the difference between Justification and the Significance of the Study?

In Justification, you express the logical reasoning behind the conduct of the study. On the other hand, the Significance of the Study aims to present to your readers the specific benefits your research will contribute to the field you are studying, community, people, and institutions.

Suppose again that your research is about the Effectiveness of Meditation in Reducing the Anxiety Levels of College Students. Suppose you are writing the Significance of the Study. In that case, you may state that your research will provide new insights and evidence regarding meditation’s ability to reduce college students’ anxiety levels. Meanwhile, you may note in the Justification that studies are saying how people used meditation in dealing with their mental health concerns. You may also indicate how meditation is a feasible approach to managing anxiety using the analysis presented by previous literature.

3. How should I start my research’s Significance of the Study section?

– This research will contribute… – The findings of this research… – This study aims to… – This study will provide… – Through the analysis presented in this study… – This study will benefit…

Moreover, you may start the Significance of the Study by elaborating on the contribution of your research in the field you are studying.

4. What is the difference between the Purpose of the Study and the Significance of the Study?

The Purpose of the Study focuses on why your research was conducted, while the Significance of the Study tells how the results of your research will benefit anyone.

Suppose your research is about the Effectiveness of Lemongrass Tea in Lowering the Blood Glucose Level of Swiss Mice . You may include in your Significance of the Study that the research results will provide new information and analysis on the medical ability of lemongrass to solve hyperglycemia. Meanwhile, you may include in your Purpose of the Study that your research wants to provide a cheaper and natural way to lower blood glucose levels since commercial supplements are expensive.

5. What is the Significance of the Study in Tagalog?

In Filipino research, the Significance of the Study is referred to as Kahalagahan ng Pag-aaral.

• Draft your Significance of the Study. Retrieved 18 April 2021, from http://dissertationedd.usc.edu/draft-your-significance-of-the-study.html
• Regoniel, P. (2015). Two Tips on How to Write the Significance of the Study. Retrieved 18 April 2021, from https://simplyeducate.me/2015/02/09/significance-of-the-study/

Written by Jewel Kyle Fabula

in Career and Education , Juander How

Jewel Kyle Fabula

Jewel Kyle Fabula is a Bachelor of Science in Economics student at the University of the Philippines Diliman. His passion for learning mathematics developed as he competed in some mathematics competitions during his Junior High School years. He loves cats, playing video games, and listening to music.

Browse all articles written by Jewel Kyle Fabula

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11.1 The Purpose of Research Writing

Learning objectives.

• Identify reasons to research writing projects.
• Outline the steps of the research writing process.

Why was the Great Wall of China built? What have scientists learned about the possibility of life on Mars? What roles did women play in the American Revolution? How does the human brain create, store, and retrieve memories? Who invented the game of football, and how has it changed over the years?

You may know the answers to these questions off the top of your head. If you are like most people, however, you find answers to tough questions like these by searching the Internet, visiting the library, or asking others for information. To put it simply, you perform research.

Whether you are a scientist, an artist, a paralegal, or a parent, you probably perform research in your everyday life. When your boss, your instructor, or a family member asks you a question that you do not know the answer to, you locate relevant information, analyze your findings, and share your results. Locating, analyzing, and sharing information are key steps in the research process, and in this chapter, you will learn more about each step. By developing your research writing skills, you will prepare yourself to answer any question no matter how challenging.

Reasons for Research

When you perform research, you are essentially trying to solve a mystery—you want to know how something works or why something happened. In other words, you want to answer a question that you (and other people) have about the world. This is one of the most basic reasons for performing research.

But the research process does not end when you have solved your mystery. Imagine what would happen if a detective collected enough evidence to solve a criminal case, but she never shared her solution with the authorities. Presenting what you have learned from research can be just as important as performing the research. Research results can be presented in a variety of ways, but one of the most popular—and effective—presentation forms is the research paper . A research paper presents an original thesis, or purpose statement, about a topic and develops that thesis with information gathered from a variety of sources.

If you are curious about the possibility of life on Mars, for example, you might choose to research the topic. What will you do, though, when your research is complete? You will need a way to put your thoughts together in a logical, coherent manner. You may want to use the facts you have learned to create a narrative or to support an argument. And you may want to show the results of your research to your friends, your teachers, or even the editors of magazines and journals. Writing a research paper is an ideal way to organize thoughts, craft narratives or make arguments based on research, and share your newfound knowledge with the world.

Write a paragraph about a time when you used research in your everyday life. Did you look for the cheapest way to travel from Houston to Denver? Did you search for a way to remove gum from the bottom of your shoe? In your paragraph, explain what you wanted to research, how you performed the research, and what you learned as a result.

Research Writing and the Academic Paper

No matter what field of study you are interested in, you will most likely be asked to write a research paper during your academic career. For example, a student in an art history course might write a research paper about an artist’s work. Similarly, a student in a psychology course might write a research paper about current findings in childhood development.

Having to write a research paper may feel intimidating at first. After all, researching and writing a long paper requires a lot of time, effort, and organization. However, writing a research paper can also be a great opportunity to explore a topic that is particularly interesting to you. The research process allows you to gain expertise on a topic of your choice, and the writing process helps you remember what you have learned and understand it on a deeper level.

Research Writing at Work

Knowing how to write a good research paper is a valuable skill that will serve you well throughout your career. Whether you are developing a new product, studying the best way to perform a procedure, or learning about challenges and opportunities in your field of employment, you will use research techniques to guide your exploration. You may even need to create a written report of your findings. And because effective communication is essential to any company, employers seek to hire people who can write clearly and professionally.

Writing at Work

Take a few minutes to think about each of the following careers. How might each of these professionals use researching and research writing skills on the job?

• Medical laboratory technician
• Small business owner
• Information technology professional
• Freelance magazine writer

A medical laboratory technician or information technology professional might do research to learn about the latest technological developments in either of these fields. A small business owner might conduct research to learn about the latest trends in his or her industry. A freelance magazine writer may need to research a given topic to write an informed, up-to-date article.

Think about the job of your dreams. How might you use research writing skills to perform that job? Create a list of ways in which strong researching, organizing, writing, and critical thinking skills could help you succeed at your dream job. How might these skills help you obtain that job?

Steps of the Research Writing Process

How does a research paper grow from a folder of brainstormed notes to a polished final draft? No two projects are identical, but most projects follow a series of six basic steps.

These are the steps in the research writing process:

• Choose a topic.
• Plan and schedule time to research and write.
• Conduct research.
• Organize research and ideas.
• Draft your paper.
• Revise and edit your paper.

Each of these steps will be discussed in more detail later in this chapter. For now, though, we will take a brief look at what each step involves.

Step 1: Choosing a Topic

As you may recall from Chapter 8 “The Writing Process: How Do I Begin?” , to narrow the focus of your topic, you may try freewriting exercises, such as brainstorming. You may also need to ask a specific research question —a broad, open-ended question that will guide your research—as well as propose a possible answer, or a working thesis . You may use your research question and your working thesis to create a research proposal . In a research proposal, you present your main research question, any related subquestions you plan to explore, and your working thesis.

Step 2: Planning and Scheduling

Before you start researching your topic, take time to plan your researching and writing schedule. Research projects can take days, weeks, or even months to complete. Creating a schedule is a good way to ensure that you do not end up being overwhelmed by all the work you have to do as the deadline approaches.

During this step of the process, it is also a good idea to plan the resources and organizational tools you will use to keep yourself on track throughout the project. Flowcharts, calendars, and checklists can all help you stick to your schedule. See Chapter 11 “Writing from Research: What Will I Learn?” , Section 11.2 “Steps in Developing a Research Proposal” for an example of a research schedule.

Step 3: Conducting Research

When going about your research, you will likely use a variety of sources—anything from books and periodicals to video presentations and in-person interviews.

Your sources will include both primary sources and secondary sources . Primary sources provide firsthand information or raw data. For example, surveys, in-person interviews, and historical documents are primary sources. Secondary sources, such as biographies, literary reviews, or magazine articles, include some analysis or interpretation of the information presented. As you conduct research, you will take detailed, careful notes about your discoveries. You will also evaluate the reliability of each source you find.

Step 4: Organizing Research and the Writer’s Ideas

When your research is complete, you will organize your findings and decide which sources to cite in your paper. You will also have an opportunity to evaluate the evidence you have collected and determine whether it supports your thesis, or the focus of your paper. You may decide to adjust your thesis or conduct additional research to ensure that your thesis is well supported.

Remember, your working thesis is not set in stone. You can and should change your working thesis throughout the research writing process if the evidence you find does not support your original thesis. Never try to force evidence to fit your argument. For example, your working thesis is “Mars cannot support life-forms.” Yet, a week into researching your topic, you find an article in the New York Times detailing new findings of bacteria under the Martian surface. Instead of trying to argue that bacteria are not life forms, you might instead alter your thesis to “Mars cannot support complex life-forms.”

Step 5: Drafting Your Paper

Now you are ready to combine your research findings with your critical analysis of the results in a rough draft. You will incorporate source materials into your paper and discuss each source thoughtfully in relation to your thesis or purpose statement.

When you cite your reference sources, it is important to pay close attention to standard conventions for citing sources in order to avoid plagiarism , or the practice of using someone else’s words without acknowledging the source. Later in this chapter, you will learn how to incorporate sources in your paper and avoid some of the most common pitfalls of attributing information.

Step 6: Revising and Editing Your Paper

In the final step of the research writing process, you will revise and polish your paper. You might reorganize your paper’s structure or revise for unity and cohesion, ensuring that each element in your paper flows into the next logically and naturally. You will also make sure that your paper uses an appropriate and consistent tone.

Once you feel confident in the strength of your writing, you will edit your paper for proper spelling, grammar, punctuation, mechanics, and formatting. When you complete this final step, you will have transformed a simple idea or question into a thoroughly researched and well-written paper you can be proud of!

Review the steps of the research writing process. Then answer the questions on your own sheet of paper.

• In which steps of the research writing process are you allowed to change your thesis?
• In step 2, which types of information should you include in your project schedule?
• What might happen if you eliminated step 4 from the research writing process?

Key Takeaways

• People undertake research projects throughout their academic and professional careers in order to answer specific questions, share their findings with others, increase their understanding of challenging topics, and strengthen their researching, writing, and analytical skills.
• The research writing process generally comprises six steps: choosing a topic, scheduling and planning time for research and writing, conducting research, organizing research and ideas, drafting a paper, and revising and editing the paper.

Writing for Success Copyright © 2015 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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The importance of determining the clinical significance of research results in physical therapy clinical research

Susan armijo-olivo.

a University of Alberta, Faculty of Rehabilitation Medicine, Faculty of Medicine and Dentistry, Edmonton, Canada

b Institute of Health Economics, Edmonton, Canada

Clinical research in physical therapy is fundamental to generate new knowledge and validate our therapies. The evaluation of research findings is crucial to help clinical decision making and to comply with the principles of evidence based-practice. Statistical significance testing has dominated the way researchers typically report their results and evaluate their significance. 1 , 2 This approach has been commonly used to determine the importance and generalizability of research results and to demonstrate the effect of an intervention in health research. However, this approach has limited use for clinicians and decision makers trying to offer the best possible treatment to patients.

Statistical significance is based on hypothesis testing (i.e. null hypothesis vs. alternative hypothesis). 3 The decision to accept or reject the null hypothesis is based on predetermined levels of probability (i.e. p  < 0.05 or 0.01) used to test the strength of the evidence against the null hypothesis. 4 The dichotomous choice that emerges from the hypothesis testing procedure (i.e. null hypothesis rejected or accepted) does not provide any insights whether the results of the study are important for different stakeholders such as patients, clinicians, and decision makers. 5 , 6

Statistical significance does not assure that the results are clinically relevant. Indeed, the use of null hypothesis significance testing rarely determines the practical importance or clinical relevance of findings. 1 , 7 In addition, statistical significance can also provide misleading results to the clinical community since a statistical difference between groups could be found if the sample size was large and/or if the inter-subject variability was low, even though the difference between groups was small to be considered clinically important by the patients or clinicians. 5 This has been exemplified in one of our studies, where a difference between subjects with TMD and healthy controls on head and cervical posture was statistically significant but that difference was only 3.3°, [95%CI 0.15, 6.41], which according to any clinician working on the field, would not be clinically relevant since clinicians generally use clinical observation or in some cases, photographs to evaluate posture and it is unlikely that this assessment would allow to consistently detect such a small difference.

Given the limitations of statistical significance, it is relevant for physical therapy practice that results of clinical research are analyzed having in mind the clinical relevance of the results. The question whether a patient has improved in a meaningful way is fundamental to improve clinical decision making regarding treatment management. Since clinicians are interested in whether or not the intervention had an impact on clinical outcomes and also in the magnitude of such impact, relying solely on statistical significance to conclude about relevance of results seems to be limited and insufficient.

Clinical relevance (also known as clinical significance) indicates whether the results of a study are meaningful or not for several stakeholders. 7 A clinically relevant intervention is the one whose effects are large enough to make the associated costs, inconveniences, and harms worthwhile. 8 Clinical relevance facilitates the understanding and interpretation of results for clinicians. In physical therapy, the assessment of this approach has become a popular method to assist the transfer of knowledge into clinical practice. 1 , 7 , 9

Diverse methodologies have been developed in the attempt to determine the clinical significance of an intervention. The most common methods are the “distribution-based methods” and the “anchor-based methods”. The calculation of the effect size (ES), the minimum detectable change (MDC)/difference (MDD), 10 and the standard error of measurement (SEM) are examples of the distribution-based methods. 1 , 7 Anchor-based methods involve the client's perspective using an anchor, commonly the use of the Global Rating Scale of Change (GRSC) 2 to define the minimal important difference (MID). Researchers and clinicians interested in these methods are encouraged to see Jaeschke et al., 2 Armijo-Olivo et al., 7 Musselman, 1 as well as De Vet et al., 10 for a complete description.

Researchers conducting clinical trials in the field of physical therapy have the obligation to report the clinical relevance of results to the clinical community to adhere to the principles of evidence based practice. This will help disseminate evidence in a useful and understandable way for end-users such as patients, health care clinicians, and policy/decision-makers. The information of “ p ” values is insufficient to achieve these requirements and because it provides insufficient and limited information, clinical researchers needed to present the clinical relevance of their results to help busy clinicians with interpretation and easy uptake of research results in clinical practice.

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BSA’s Zahra Zamani on the Importance of Research

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May 17, 2024

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For nearly 50 years, BSA has sought to create inspired solutions that improve lives. We specialize in the markets of healing, learning, and discovery, meaningfully impacting the communities of our projects. Changing lives happens through solving real problems that healthcare and higher education facilities face, and we seek to partner with clients whose vision aligns with that quest.

Zahra Zamani, Ph.D, EDAC, LSSYB, is the Director of Research for BSA. Her primary focus is investigating the impact of physical environments and planning decisions on various aspects of the human experience.  In our conversation, Zahra shared how BSA leverages evidence-based design across Healing, Learning, and Discovery, what she’s working on, and her favorite part of working at BSA.

What was your background before joining BSA in 2021?

Before joining BSA, I worked as a postdoctoral researcher in academia. My research projects covered diverse topics such as tourism, childcare development, and healthcare design. However, I transitioned to the industry because I found applied research more fulfilling than theoretical research. Consequently, in 2017, I began working at EwingCole as a design researcher.

How do you define evidence-based design?

Evidence-based design (EBD) is an approach to designing environments—such as buildings, landscapes, or interiors—based on credible research evidence and data. It integrates findings from various fields, including architecture, psychology, sociology, and medicine, to inform design decisions. Evidence-based design aims to create spaces that promote health, well-being, productivity, and safety by considering the impact of design elements on human behavior, performance, and experience. This approach emphasizes the importance of empirical research, observational studies, and user feedback in guiding design choices, ultimately aiming to optimize the functionality and effectiveness of built environments.

How does BSA leverage evidence-based design in our Healing, Learning, and Discovery projects?

BSA leverages evidence-based design (EBD) principles across our projects in Healing, Learning, and Discovery to create environments that prioritize the well-being and effectiveness of the users. In Healing spaces, such as hospitals and healthcare facilities, we integrate research findings on patient outcomes, staff efficiency, and therapeutic environments to design spaces that promote healing, reduce stress, and enhance patient comfort. This may involve considerations such as access to natural light, views of nature, noise reduction, and flexible layouts to accommodate evolving medical practices.

In Learning environments such as schools and educational institutions, we apply EBD principles to support optimal learning outcomes and student well-being. This includes designing classrooms, libraries, and common areas, facilitating collaboration, concentration, and engagement. We incorporate research on educational pedagogy, environmental psychology, and ergonomic design to create environments conducive to effective teaching and learning.

Similarly, in Discovery spaces such as research laboratories and innovation hubs, we utilize EBD to foster creativity, productivity, and collaboration among researchers and innovators. We design environments that encourage experimentation, knowledge sharing, and breakthrough discoveries by integrating evidence from workplace psychology, ergonomics, and organizational behavior.

What are you currently working on?

Currently, my focus is on developing two discrete event simulation models for a hospital system in Texas. These models aim to predict future processes to enhance patient flow and overall experience. I’m exploring various scenarios, which include determining the optimal number of kiosks needed, assessing the adequacy of exam rooms, and optimizing patient flow processes. Using FlexSim Software, I evaluate how design and operational modifications impact different outcomes, such as patient wait times, length of stay, and resource utilization. This approach helps identify potential bottlenecks, optimize workflows, and ultimately improve the efficiency of these healthcare facilities for future patients.

What is your favorite aspect of working at BSA?

My favorite aspect of working at BSA is the collaborative environment that fosters a sense of empowerment and a shared vision to improve lives. At BSA, I’m surrounded by talented individuals who are passionate about their work and dedicated to making a positive impact. There’s a genuine spirit of collaboration where ideas are freely exchanged, and everyone’s input is valued regardless of their role or background. This collaborative approach empowers each team member to contribute their unique perspective and expertise, allowing us to tackle complex challenges more effectively and innovate together.

Favorite thing you’ve read recently?

Recently, we had a presentation focusing on strategies to alleviate staff burnout and stress within the A/E/C and healthcare industries. I delved into several articles proposing interventions to address staff stress and burnout during this process. This topic is critical as a US survey revealed that 41%, 23%, and 19% of physicians cope with burnout by isolating themselves, drinking alcohol, and binge eating, respectively (Kane, 2019). An insightful literature review by Kerlin et al. (2020) explored the epidemiology of burnout syndrome among ICU clinicians and its effects on clinicians, patients, and healthcare services. This article highlighted the importance of adequate sleep, exercise, and engaging in mindfulness and meditation practices to enhance resilience and mitigate staff burnout. Simple strategies such as providing spaces and resources for mindfulness activities like meditation or yoga can equip healthcare professionals to respond with detachment to stressful situations, thereby reducing stress reactions. For instance, recent research conducted a randomized controlled trial involving 80 healthcare professionals assigned to either a mindfulness-based yoga intervention or a control group. The study found that participants completing the yoga intervention experienced statistically significant improvements in health and well-being, particularly in measures of stress, perceived stress, burnout, vitality, sleep quality, serenity, and mindfulness (Hilcove et al., 2020).

What new skill have you recently learned unrelated to work that you’ve enjoyed?

Recently, I’ve been enjoying taking yoga and Pilates classes, which have been a fantastic way to unwind and stay active outside of work. Learning the various poses and techniques has improved my flexibility and strength and helped me cultivate mindfulness and relaxation. It’s been refreshing to explore these practices and discover how they contribute to my overall well-being, providing a nice balance to the demands of everyday life. Plus, it’s a great opportunity to meet new people and connect with a community focused on health and wellness.

Kane: Kane L. Medscape national physician burnout, depression & suicide report

Kerlin, m. p., mcpeake, j., & mikkelsen, m. e. (2020). burnout and joy in the profession of critical care medicine. annual update in intensive care and emergency medicine 2020 , 633-642. https://www. medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056. accessed 5 sept 2019., hilcove, k., marceau, c., thekdi, p., larkey, l., brewer, m. a., & jones, k. (2021). holistic nursing in practice: mindfulness-based yoga as an intervention to manage stress and burnout. journal of holistic nursing , 39 (1), 29-42..

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Social Cognitive and Addiction Neuroscience Lab at the University of Iowa

Research in the scanlab.

Research projects in the UIOWA Social Cognitive and Addiction Neuroscience Lab generally focus on one of the following areas:

The role of cognitive control in social behavior

Effects of alcohol on cognitive control 

Individual differences in neurobiologically based risks for addiction, primarily alcohol use disorder

Effects of incidental stimulus exposure on cognition and behavior (i.e., priming effects). 

The common theme around which these lines of work are integrated is the interplay between salience (i.e., motivational significance) and cognitive control (see Inzlicht, Bartholow, & Hirsch, 2015 ).

Salience, Cognitive Control, and Social Behavior

The interaction of salience and cognitive control is an enduring area of interest in the SCANlab, going back to Dr. Bartholow’s undergraduate days. In his undergraduate senior honors thesis, Dr. Bartholow found that participants asked to read résumés later recalled more gender-inconsistent information about job candidates. This general theme carried through to Dr. Bartholow’s dissertation research, in which he used event-related brain potentials (ERPs) to examine the neurocognitive consequences of expectancy violations. In that study, expectancy-violating behaviors elicited a larger P3-like positivity in the ERP and were recalled better compared to expectancy-consistent behaviors ( Bartholow et al., 2001 , 2003 ). Back then, we interpreted this effect as evidence for context updating (the dominant P3 theory at the time). As theoretical understanding of the P3 has evolved, we now believe this finding reflects the fact that unexpected information is salient, prompting engagement of controlled processing (see Nieuwenhuis et al., 2005 ).

Our research has been heavily influenced by cognitive neuroscience models of the structure of information processing, especially the continuous flow model ( Coles et al., 1985 ; Eriksen & Schultz, 1979) and various conflict monitoring theories (e.g., Botvinick et al., 2001 ; Shenhav et al., 2016 ). In essence, these models posit (a) that information about a stimulus accumulates gradually as processing unfolds, and (b) as a consequence, various stimulus properties or contextual features can energize multiple, often competing responses simultaneously, leading to a need to engage cognitive control to maintain adequate performance. This set of basic principles has influenced much of our research across numerous domains of interest (see Bartholow, 2010 ).

Applied to social cognition, these models imply that responses often classified as “automatic” (e.g., measures of implicit attitudes) might be influenced by control. We first tested this idea in the context of a racial categorization task in which faces were flanked by stereotype-relevant words ( Bartholow & Dickter, 2008 ). In two experiments, we found that race categorizations were faster when faces appeared with stereotype-congruent versus –incongruent words, especially when stereotype-congruent trials were more probable. Further, the ERP data showed that that this effect was not due to differences in the evaluative categorization of the faces (P3 latency), but instead reflected increased response conflict (N2 amplitude) due to partial activation of competing responses (lateralized readiness potential; LRP) on stereotype-incongruent trials. A more recent, multisite investigation (funded by the National Science Foundation ) extended this work by testing the role of executive cognitive function (EF) in the expression of implicit bias. Participants (N = 485) completed a battery of EF measures and, a week later, a battery of implicit bias measures. As predicted, we found that expression of implicit race bias was heavily influenced by individual differences in EF ability ( Ito et al., 2015 ). Specifically, the extent to which bias expression reflected automatic processes was reduced as a function of increases in general EF ability.

Another study demonstrating the role of conflict and control in “implicit” social cognition was designed to identify the locus of the affective congruency effect ( Bartholow et al., 2009 ), wherein people are faster to categorize the valence of a target if it is preceded by a valence-congruent (vs. incongruent) prime. This finding traditionally has been explained in terms of automatic spreading of activation in working memory (e.g., Fazio et al., 1986 ). By measuring ERPs while participants completed a standard evaluative priming task, we showed (a) that incongruent targets elicit response conflict; (b) that the degree of this conflict varies along with the probability of congruent targets, such that (c) when incongruent targets are highly probable, congruent targets elicit more conflict (also see Bartholow et al., 2005 ); and (d) that this conflict is localized to response generation processes, not stimulus evaluation.

Salience, Cognitive Control, and Alcohol

Drinking alcohol is inherently a social behavior. Alcohol commonly is consumed in social settings, possibly because it facilitates social bonding and group cohesion ( Sayette et al., 2012 ). Many of the most devastating negative consequences of alcohol use and chronic heavy drinking also occur in the social domain. Theorists have long posited that alcohol’s deleterious effects on social behavior stem from impaired cognitive control. Several of our experiments have shown evidence consistent with this idea, in that alcohol increases expression of race bias due to its impairment of control-related processes ( Bartholow et al., 2006 , 2012 ).

But exactly how does this occur? One answer, we believe, is that alcohol reduces the salience of events, such as a control failure (i.e., an error), that normally spur efforts at increased control. Interestingly, we found ( Bartholow et al., 2012 ) that alcohol does not reduce awareness of errors, as others had suggested ( Ridderinkhof et al., 2002 ), but rather reduces the salience or motivational significance of errors. This, in turn, hinders typical efforts at post-error control adjustment. Later work further indicated that alcohol’s control-impairing effects are limited to situations in which control has already failed, and that recovery of control following errors takes much longer when people are drunk ( Bailey et al., 2014 ). Thus, the adverse consequences people often experience when intoxicated might stem from alcohol’s dampening of the typical “affect alarm,” seated in the brain’s salience network (anterior insula and dorsal anterior cingulate cortex), which alerts us when control is failing and needs to be bolstered ( Inzlicht et al., 2015 ).

Incidental Stimulus Exposure Effects

A fundamental tenet of social psychology is that situational factors strongly affect behavior. Despite recent controversies related to some specific effects, we remain interested in the power of priming, or incidental stimulus exposure, to demonstrate this basic premise. We have studied priming effects in numerous domains, including studies showing that exposure to alcohol-related images or words can elicit behaviors often associated with alcohol consumption, such as aggression and general disinhibition.

Based on the idea that exposure to stimuli increases accessibility of relevant mental content ( Higgins, 2011 ), we reasoned that seeing alcohol-related stimuli might not only bring to mind thoughts linked in memory with alcohol, but also might instigate behaviors that often result from alcohol consumption. As an initial test of this idea, in the guise of a study on advertising effectiveness we randomly assigned participants to view magazine ads for alcoholic beverages or for other grocery items and asked them to rate the ads on various dimensions. Next, we asked participants if they would help us pilot test material for a future study on impression formation by reading a paragraph describing a person and rating him on various traits, including hostility. We reasoned that the common association between alcohol and aggression might lead to a sort of hostile perception bias when evaluating this individual. As predicted, participants who had seen ads for alcohol rated the individual as more hostile than did participants who had seen ads for other products, and this effect was larger among people who had endorsed (weeks previously) the notion that alcohol increases aggression ( Bartholow & Heinz, 2006 ). Subsequently, this finding has been extended to participants’ own aggression in verbal ( Friedman et al., 2007 ) and physical domains ( Pedersen et al., 2014 ), and has been replicated in other labs (e.g., Bègue et al., 2009 ; Subra et al., 2010 ).

Of course, aggression is not the only behavior commonly assumed to increase with alcohol. Hence, we have tested whether this basic phenomenon extends into other behavioral domains, and found similar effects with social disinhibition ( Freeman et al., 2010 ), tension-reduction (Friedman et al., 2007), race bias ( Stepanova et al., 2012 , 2018 a, 2018 b), and risky decision-making (Carter et al., in prep.). Additionally, it could be that participants are savvy enough to recognize the hypotheses in studies of this kind when alcohol-related stimuli are presented overtly (i.e., experimental demand). Thus, we have also tested the generality of the effect by varying alcohol cue exposure procedures, including the use of so-called “sub-optimal” exposures (i.e., when prime stimuli are presented too quickly to be consciously recognized). Here again, similar effects have emerged (e.g., Friedman et al., 2007; Loersch & Bartholow, 2011 ; Pedersen et al., 2014).

Taken together, these findings highlight the power of situational cues to affect behavior in theoretically meaningful ways. On a practical level, they point to the conclusion that alcohol can affect social behavior even when it is not consumed, suggesting, ironically, that even nondrinkers can experience its effects.

Aberrant Salience and Control as Risk Factors for Addiction

Salience is central to a prominent theory of addiction known as incentive sensitization theory (IST; e.g., Robinson & Berridge, 1993 ). Briefly, IST posits that, through use of addictive drugs, including alcohol, people learn to pair the rewarding feelings they experience (relaxation, stimulation) with various cues present during drug use. Eventually, repeated pairing of drug-related cues with reward leads those cues to take on the rewarding properties of the drug itself. That is, the cues become infused with incentive salience, triggering craving, approach and consummatory behavior.

Research has shown critical individual differences in vulnerability to attributing incentive salience to drug cues, and that vulnerable individuals are at much higher risk for addiction. Moreover, combining incentive sensitization with poor cognitive control (e.g., during a drinking episode) makes for a “potentially disastrous combination” ( Robinson & Berridge, 2003 , p. 44). To date, IST has been tested primarily in preclinical animal models. Part of our work aims to translate IST to a human model.

In a number of studies over the past decade, we have discovered that a low sensitivity to the effects of alcohol (i.e., needing more drinks to feel alcohol’s effects), known to be a potent risk factor for alcoholism, is associated with heightened incentive salience for alcohol cues. Compared with their higher-sensitivity (HS) peers, among low-sensitivity (LS) drinkers alcohol-related cues (a) elicit much larger neurophysiological responses ( Bartholow et al., 2007 , 2010 ; Fleming & Bartholow, in prep.); (b) capture selective attention ( Shin et al., 2010 ); (c) trigger approach-motivated behavior ( Fleming & Bartholow, 2014 ); (d) produce response conflict when relevant behaviors must be inhibited or overridden by alternative responses ( Bailey & Bartholow, 2016 ; Fleming & Bartholow, 2014), and (e) elicit greater feelings of craving (Fleming & Bartholow, in prep.; Piasecki et al., 2017 ; Trela et al., in press). These findings suggest that LS could be a human phenotype related to sign-tracking , a conditioned response reflecting susceptibility to incentive sensitization and addiction ( Robinson et al., 2014 ).

Recently, our lab has conducted two major projects designed to examine how the incentive salience of alcohol-related cues is associated with underage drinking. One such project, funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA; R01-AA020970 ), examined the extent to which pairing beer brands with major U.S. universities enhances the incentive salience of those brands for underage students. Major brewers routinely associate their brands with U.S. universities through direct marketing and by advertising during university-related programming (e.g., college sports). We tested whether affiliating a beer brand with students’ university increases the incentive salience of the brand, and whether individual differences in the magnitude of this effect predict changes in underage students’ alcohol use. We found (a) that P3 amplitude elicited by a beer brand increased when that brand was affiliated with students’ university, either in a contrived laboratory task or by ads presented during university-related sports broadcasts; (b) that stronger personal identification with the university increased this effect; and (c) that variability in this effect predicted changes in alcohol use over one month, controlling for baseline levels of use ( Bartholow et al., 2018 ).

A current project, also funded by the NIAAA ( R01-AA025451 ), aims to connect multiple laboratory-based measures of the incentive salience of alcohol-related cues to underage drinkers’ reports of craving, alcohol use, and alcohol-related consequences as they occur in their natural environments. This project will help us to better understand the extent to which changes in drinking lead to changes in alcohol sensitivity and to corresponding changes in the incentive salience of alcohol-related cues.

• Open access
• Published: 18 May 2024

How prehospital emergency personnel manage ethical challenges: the importance of confidence, trust, and safety

• Henriette Bruun   ORCID: orcid.org/0000-0003-3955-269X 1 , 5 ,
• Louise Milling   ORCID: orcid.org/0000-0001-8320-5391 1 ,
• Daniel Wittrock   ORCID: orcid.org/0000-0003-0034-0876 2 ,
• Søren Mikkelsen   ORCID: orcid.org/0000-0002-5187-7027 1 , 3 &
• Lotte Huniche   ORCID: orcid.org/0000-0002-7294-4815 1 , 4  

BMC Medical Ethics volume  25 , Article number:  58 ( 2024 ) Cite this article

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Ethical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. Ethical challenges are associated with moral distress that can lead to burnout. Clinical ethics support has proven useful to address and manage such challenges. This paper explores how prehospital emergency personnel manage ethical challenges. The study is part of a larger action research project to develop and test an approach to clinical ethics support that is sensitive to the context of emergency medicine.

We explored ethical challenges and management strategies in three focus groups, with 15 participants in total, each attended by emergency medical technicians, paramedics, and prehospital anaesthesiologists. Focus groups were audio-recorded and transcribed verbatim. The approach to data analysis was systematic text condensation approach.

We stratified the management of ethical challenges into actions before, during, and after incidents. Before incidents, participants stressed the importance of mutual understandings, shared worldviews, and a supportive approach to managing emotions. During an incident, the participants employed moral perception, moral judgments, and moral actions. After an incident, the participants described sharing ethical challenges only to a limited extent as sharing was emotionally challenging, and not actively supported by workplace culture, or organisational procedures. The participants primarily managed ethical challenges informally, often using humour to cope.

Our analysis supports and clarifies that confidence, trust, and safety in relation to colleagues, management, and the wider organisation are essential for prehospital emergency personnel to share ethical challenges and preventing moral distress turning into burnout.

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Introduction

Patients affected by acute and severe illness are dependent on emergency services manned with physically and mentally well-functioning personnel. Thus far, there has been focus on the fact that critical incidents, defined as illness or injury that threatens the patient´s survival [ 1 ], can have short-term as well as long-term negative effects on the mental health and emotional well-being of the prehospital emergency personnel [ 2 ]. In addition, several studies with focus on ethical challenges in emergency medicine [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ] have recently elucidated the complex and challenging clinical context in which the work of prehospital emergency personnel takes place. In this context, moral distress has received increased attention during the past decades. In 1984 Jameton introduced the concept of moral distress in nursing as resulting from situations “when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” [ 13 ]. Later studies including other health care professionals [ 14 ] have contributed to a broader understanding of moral distress. Morley et al. [ 15 ], in their narrative synthesis of the literature, defined moral distress as the presence of a causal relationship between the experience of a moral event and the experience of psychological distress. Psychological distress is described as the presence of psychological and/or physical reactions. These may include feelings like anxiety, frustration, guilt, anger, sadness, psychological exhaustion, helplessness, and depression. Physical symptoms may include insomnia, nausea, migraines, abdominal pain, tearfulness, and physical exhaustion. As in other areas of healthcare moral distress has been described in emergency medicine [ 16 ]. Moral distress is recognised as a serious problem among nurses, physicians, and other healthcare professionals as it negatively affects them as individuals, as well as affecting their relations with patients, relatives, colleagues, and external collaborators. Moral distress is associated with burnout and the inclination to leave employment in healthcare [ 15 , 17 ].

To meet these challenges some health care institutions provide clinical ethics support services to assist healthcare professionals in managing ethical challenges and reduce the risk of burnout from moral distress. Although research into clinical ethics support is relatively new, literature reviews evaluating specific ethics support services like clinical ethics committees [ 18 ], moral case deliberation [ 19 , 20 ] and clinical ethics consultation [ 21 ] have been published. To our knowledge, little is known of clinical ethics support in prehospital emergency medicine.

The purpose of the research project

This study is part of a larger action research project carried out in collaboration with prehospital emergency personnel in the region of Southern Denmark [ 3 ]. The overall purpose is to develop and test an approach to clinical ethics support that considers the context of emergency medicine and the local settings. This purpose is supported by a grounding in practice philosophy and empirical ethics [ 22 , 23 ]. In this paper, we report on how prehospital emergency personnel manage day to day ethical challenges. In a previous paper [ 3 ], we reported on how ethical challenges were experienced by prehospital emergency personnel.

The Danish emergency services

The prehospital system in Denmark is three-tiered. The basic resource is an ambulance manned by two emergency medical technicians (EMT) or paramedics (PM) [ 3 , 24 ]. Following a caller’s contact with the emergency dispatch centre, the healthcare dispatcher, commonly a nurse, a PM, or an EMT, manages the call and dispatches one or more of the following units: an ambulance, an ambulance and a rapid response paramedic unit, an ambulance and an anaesthesiologist-manned mobile emergency care unit (MECU), or an anaesthesiogist-manned helicopter service. MECUs are dispatched in approximately one case in four alongside an ambulance using a rendezvous model [ 11 ]. The dispatchers’ choice of ground-based or helicopter-based supplementary unit depends on the geographical location of the incident or patient and is primarily based on the estimated response time of the unit in question. In the region of Southern Denmark ground-based rapid response units carry out the vast majority of missions requiring a supplemental unit.

Research design

Action research pertaining to interventions in health care constitutes the overall methodological approach of this research project [ 25 , 26 ]. Action research is practice-based, sensitive to organisational context, and offers a relevant research strategy when aiming to identify, develop, and test context-sensitive forms of clinical ethics support in prehospital emergency medicine. By actively involving prehospital emergency personnel throughout the process, it is likely that barriers to the development of clinical ethics support can be identified and addressed. The research project [ 3 ] is divided into three parts:

Identification of experiences with and management of ethical challenges in emergency medicine.

Collaborative development of an approach to clinical ethics support in emergency medicine.

Testing of the approach.

The authors of this paper formed the core research group. For the investigation of ethical challenges, and the development and testing of various forms of clinical ethics support the researchers were affiliated with the regional prehospital research group, and collaborated with anaesthesiologists, EMTs and PMs from the emergency medical system of the Region of Southern Denmark. Further, ad hoc collaboration was established with a prehospital communications officer and prehospital educators in discussions of research activities, data analysis, communication, and the planning and testing of a context-sensitive approach to clinical ethics support [ 3 ].

Data collection

The results reported in this paper are based on three semi-structured focus groups conducted with EMTs, PMs, and anaesthesiologists [ 3 ]. Focus groups were chosen to elicit narrative data based on social interaction amongst participants. The aim was to gain insight into a variety of ethically challenging situations along with clinical reasoning and social negotiations around the best course of action for the patient [ 27 , 28 ]. During focus groups, participants compared and commented on statements prepared to facilitate discussion. The focus groups generated insights into experiences, management strategies, reflections, and contrasting views among colleagues on the topic of ethical challenges [ 3 ]. The participants were recruited through an internal information network. In this local setting, most ambulance crew teamed up with the same partner during most shifts. The majority of the anaesthesiologists had been manned the local MECUs since the inception in 2006 and on average their prehospital workload amounted to two to five monthly 24-hour shifts. In total, 15 EMTs, PMs, and MECU physicians participated in the three focus groups [ 3 ].

Table  1 [ 3 ] shows the distribution of professional background and gender of the participants in the focus groups. On average the nine EMTs and PMs had been employed in a prehospital services for 15.3 years, ranging from 6 to 28 years. The six MECU physicians had been employed in a prehospital service for an average of 13.9 years, ranging from 4 to 30 years.

Each focus group lasted two hours and were conducted in a meeting room at the prehospital unit [ 3 ]. Participants and facilitators were all facing each other. The focus groups took place during the late hours of the afternoon and sandwiches and soft drinks were provided. Authors HB and LH facilitated all three focus groups, while author LM participated as an observer and assisted by collecting written consent forms and managing audio recordings. As part of the focus group process one facilitator took notes on a flip chart in plain view for all to comment on. Authors SM and DW did not participate in the focus groups in any capacity due to their respective positions as lead consultant of the MECU and head of the department of quality and education. Three overall questions guided the focus groups [ 3 ]:

When and what kind of ethical challenges do you experience in your work?

How do you manage these ethical challenges?

In what ways does your workplace provide support for managing ethical challenges?

Audio files were transcribed verbatim. During transcription and further processing of data, any names of persons and places mentioned during the focus groups were anonymised. Interview transcripts and photographs of the flip charts were stored on a secure server.

Data analyses

Data was transferred to and systematised in NVivo (QSR International, Burlington, Massachusetts, USA). The analytic procedure was guided by systematic text condensation [ 29 ]. As data proved rich in descriptions of both experience with and management of ethical challenges, the research team decided to focus on each separately. First, the analysis emphasised the experience of ethical challenges in day to day work [ 3 ]. Second, the analysis was focussed on the management of ethical challenges and how personnel interact with colleagues and external collaborators in the context of the emergency services.

The process of analysis was iterative involving meaning condensation of each transcript followed by moving back and forth between the condensed meaning units and theoretical concepts. To analyse how prehospital emergency personnel managed ethical challenges during incidents, we drew on the concept of moral conduct coined by Vetlesens and Nortvedt [ 30 , 31 ]. In particular, we drew on the idea of a three-part sequence of moral conduct initiated by moral perception , followed by moral judgment , leading to moral action . According to Vetlesens and Nortvedt [ 30 , 31 ], moral perception is a precondition for moral judgement and rests on the individual being open to the world, and receptive to the events that take place in it. Moral judgement encompasses the interpretation, understanding, and balancing of the welfare, interests, and rights of the parties concerned. The ability to perceive what is morally significant and to feel affected by a situation that affects the well-being of others is an expression of the individual’s capacity for empathy. Empathy is thus an important aspect of moral conduct.

Inspired by Avraham et al. [ 1 ] the analysis of prehospital emergency personnel´s management of ethical challenges are divided into activities before, during and after specific incidents. Interview extracts are presented avoiding redundant utterances.

Before incidents.

Mutual understandings and shared worldviews

The interpersonal environment of the local ambulance station is important to how prehospital emergency personnel engage in specific incidents and how they manage ethical challenges. The participants in the focus groups discussed the development of “mutual understandings” and “shared worldviews” as a basis for working together in ethically challenging situations. Several participants described how they distanced themselves from prehospital emergency personnel at other stations for example if these seemed more concerned with “getting home to bed” than doing what was best for the patient. Another example would be if colleagues spoke or acted disrespectful when dealing with patients.

Managing emotions

The way emotions are viewed and handled is important not just to the personal wellbeing, but also in relation to how difficult situations may be handled. Prehospital emergency personnel engage in emotionally demanding jobs and face human suffering, tragedy, and death daily. Having to pay attention, make decisions, and act in ethically challenging situations adds emotional strain. Several participants in the focus groups described how their attitudes towards the mutual expectations of “the right way” to deal with their emotions at work had changed over time.

In the old days, [ ] we were told if you can’t handle the sight of someone smashed in a traffic accident, then you shouldn’t be here [ ]. It’s not like that today. We can say I actually cannot handle this. I think that was terrible, I would really just like some help to get past it. (Text example 1)

EMTs and PMs pointed to more training and the employment of more female personnel as reasons for these changes. Several participants explained how they routinely talked with colleagues about emotional reactions to incidents nowadays. They also conveyed generally caring about the well-being of each other and being involved in each other’s private lives more so now than they used to. These changes in attitudes towards emotions at work were described as related to changes in how the job was now perceived and recognised as emotionally demanding.

My father often said, he could not understand how I could remain in this job, because as he said, you are so soft. [ ] I thought a lot about that, [ ] my answer has become that I can remain in this job because and not in spite of me being as soft as I am. So, in essence,, [ ] if I need to cry over something, well then I just do it. (Text example 2)

Some pointed out that this changed perception and recognition of their job as emotionally demanding would sometimes be at odds with the public expectation of swift and unaffected action in any situation, as well as with the public perception of them as heroes setting aside their safety to help patients. From the perspective of EMTs, PMs, and MECU physicians, heroes are unsafe and foolhardy. Conversely, they view themselves as well-considered professionals who pay attention to guidelines and struggle with what to do when the guidelines are contrary to what they consider to be in the best interest of the patient.

During incidents.

Moral perception

The focus groups offer many examples of the moral perceptions involved in end-of-life incidents. In the example below, a PM conveys his awareness of signs that indicate the patient’s state of health relative to the consequences of further professional action.

Now, we are not the ones to make the final decision [concerning resuscitation], but it may take ten minutes for the MECU to arrive, and until then you try to get as good a picture of this patient [ ] as possible. It may be the nursing home resident with all kinds of ailments, who is still warm [without obvious signs of death], and where you [according to legislations] should actually start [resuscitation]. It may well be that you quickly manage to call [the MECU to have the physician order you to refrain from resuscitation], (Text example 3)

Another PM explained trying to gather as much information about the patient as possible to aid decision-making further down the line, including decisions that would prove ethically challenging. Several participants described how they would try to get an understanding of the patient, for example by looking for clues around the house, e.g. a pre-packed box of palliative medication. Discovering and developing an understanding of the patient is part of what it means to perceive morally relevant aspects of a situation.

Moral judgment

The focus group participants reported bringing various resources into play when they reflect on what would be the best possible action in specific situations. The physicians in particular referred to bioethical concepts such as paternalism and autonomy, e.g. when considering whether an individual patient was competent to make their own decisions. One physician said he acted largely in accordance with ontological ethics based on the idea of human interdependence [ 32 , 33 , 34 ], while other colleagues reported being guided by utilitarian principles.

Several participants referred to non-specific gut feelings. Such sensory-emotional evaluations receive little attention and are not recognised as valuable resources for moral judgement the way cognitive-linguistic evaluations are. In one focus group, a PM explained how he relied on his gut feeling to guide his classification of a patient as either competent or incompetent, and from that decided on relevant actions in the specific situation.

It is very much up to one’s individual gut feeling. And I mean, it’s just nice to have the instructions and the legislation too, and I also think it’s nice to have the MECU to back you up. I may have a gut feeling but then you can always just call the MECU and be either confirmed or be told, no, we will just transport him [to hospital]. (Text example 4)

A physician drew attention to his personal moral judgement of particular patients such as rapists or violent offenders and reflected on his difficulties in empathising with all patients equally.

One is not that empathetic. That is, it’s not necessarily substandard, but it may well be that [the patient] doesn’t get the whole package of empathy. Sometimes you can be challenged by someone who is so unsympathetic or outright repulsive that you have a difficult time delivering what you really ought to. (Text example 5)

Further, participants discussed how their moral judgment changed through their work with different patients over time.

Who really decides whether a life is worth living. I have personally had my boundaries moved a lot after I started working at the centre for chronic respiratory insufficiency. We treat people who may be paralysed from head to toe but still insists that life is good and worth living. (Text example 6)

Moral action

The focus groups convey that EMTs, PMs, and physicians have different tasks and roles, and therefore different room for manoeuvring when faced with ethical challenges.

Moral action – EMTs and PMs

EMTs and PMs commonly work independently at the scene and engage in moral perception, judgement, and action on many occasions. Amongst the EMTs and PMs of the focus groups, it is not uncommon to request support from a physician. Sometimes the physicians are consulted because EMTs or PMs “need their backs covered”, sometimes they look for “an assessment of available options”, or “help to settle a disagreement”. In the following example, a PM contacted a physician because he wanted to test his gut feeling.

My partner [in the ambulance] and I are faced with some decisions to make… We do not always agree on the decisions and sometimes we agree to disagree and need the extra support or the extra point of view [ ]. We need to call and discuss a patient [with the MECU]. (Text example 7)

Sometimes EMTs and PMs expect physicians to contribute to their moral actions in decisive ways. As they are subject to the physicians’ decisions, it is important for them to have confidence in the physicians´ professional competences, whether they agree with them or not. Asked how he feels if a physician interrupts his treatment of a patient with cardiac arrest and orders it stopped, an EMT replied:

It depends on the situation, but [ ] in the cases I’ve been involved in, it has really helped a lot. Especially when we’re dealing with old people with dementia and [ ] cancer [ ] fortunately sometimes “an adult”, a physician, arrives, who can say stop, stop, stop [the futile treatment]. That, to me, is terrific. (Text example 8)

However, sometimes EMTs and PMs feel overruled. Particularly if the physicians do not make their reasons explicit or do not take the considerations of EMTs or PMs into account before taking action.

EMT 7: It’s obvious, if you’ve made a decision and you’re going one way, and then the MECU arrives, for example, and turn your decision around. To some extent, it is OK, but it can make you feel a little bit inadequate, feel that I didn’t do it well enough. MECU 6: Yes, the issue of over-ruling [is not nice]. EMT 7: Yes, and that’s exactly why it’s important to be open and say, well, based on this and that, we’ll make this decision, it is about including each other’s opinion (Text example 9).

One EMT explained how various strategies were employed to influence the physicians to take the kinds of actions that a paramedic would prefer. Moreover, both EMTs, PMs and physicians mentioned how collaboration depended upon good working relations. Therefore, working with familiar staff is important. Several EMTs and PMs mentioned that if disagreements arise, they would try to point it out and initiate a conversation about it. Asked how they do this, they replied:

EMT1: In plain Danish. MECU2: Hands off! [the patient] EMT1: Is it worth it? [to treat this patient] MECU2: Are you sure that’s a good idea? EMT1: Yes, don’t you t’ink it’s a good idea? MECU1: No, I’m discarding the adrenaline from the syringe (Text example 10).

Sometimes the EMTs and PMs do not find it appropriate to question or attempt to influence a physician’s decision in front of a patient or their relative as this can potentially undermine the patient’s feeling of being safe and well taken care of. On occasions, EMTs or PMs disagree with a physician to an extent where they see no other option than to withdraw from the situation altogether. They do so by turning to legitimate practical tasks unrelated to the treatment of the patient, e.g. “turning the ambulance around in the driveway”.

Moral action – medical physicians

Although knowing the thoughts and considerations of EMTs and PMs are generally not the physicians’ top priority, some are conscious of actively involving EMTs and PMs in the decision-making process.

If you must terminate cardiopulmonary resuscitation and make the call that this is futile treatment, I usually look around at the team and then ask, do we agree that this is futile? I know that the final decision rests on my shoulders, so to speak, but still, there may be someone in the team who either finds it very surprising that we should stop or have some information, which might change my position [towards continued treatment]. (Text example 11)

In addition, physicians are aware that their decisions and actions, including their personal conduct, has an impact on how an incident is managed overall. If a physician is considered acting in an unprofessional, unreasonable, or ethically questionable manner, it could affect the entire team and their actions. During the focus groups physicians commonly staged their professional competencies as the starting point for assessing the optimal action in a specific situation.

Professionalism is hugely important because it provides a firm standpoint. It should not be necessary to talk about whether what we are doing out there is good enough because we are acting optimally according to the present conditions (Text example 12).

Several physicians stressed that it was important to them to be busy with treatment-related tasks such as intubation or peripheral intravenous cannulation at the scene and to manage the technical aspects well. However, as the following text example illustrates, some physicians recognised that their “obsession” with technical solutions did not always bring about the best possible result.

I was summoned to an old woman who had a foreign body in her throat [ ]. We carry with us something called a Magill forceps, which we can use to pry out foreign bodies from the throat and then we save lives. The relatives were standing outside crying, and I thought, wow, that patient is someone’s lovely grandmother. We must do everything we can to help her. I removed the foreign body that had caused the cardiac arrest. It was relatively simple. I then went outside the room and told the relatives that now we had saved the life of the patient. Then they cried even louder. It turned out to be the nursing staff who were crying with relief that this tormented person had now finally found peace. And then you think, oops, that it would have been nice if you had known that in advance, and maybe you had “hurried slowly”, right? (Text example 13)

Moreover, physicians are aware of and pay attention to the legal implications of specific clinical assessments.

After all, it is a medical assessment whether you think the person is competent or not competent, and if you have decided that the patient is competent, then it is straightforward in terms of legislation, you cannot grab him and abduct him into an ambulance. And then you might have some thoughts that it would be best if he went to the hospital and stuff like that, but you just can’t do that. (Text example 14)

In addition to having the patient’s best interest at heart, physicians’ actions are shaped by legal requirements. Physicians are quite aware that what is legally warranted may not always be what is best for the patient, and the risk of a complaint plays a role in their decision-making.

If you’re a [prehospital] physician and [ ] you admit everyone, your ass is never on the line. There will never be a complaint. No relatives complain that their relative has been admitted to hospital. Isn’t that just fantastic! But they don’t understand what it means to be hospitalised when you are 90 years old, confused, and has dementia [ ] I sometimes have a bad taste in my mouth about some of the things I do. [ ] Not because I’m lazy, but it just… maybe I’m a bit lazy, I don’t want any complaints, I am not interested in sticking my neck out like that (Text example 15).

After incidents.

Ethical challenges are difficult to share

The focus group participants recognise that they encounter a wide array of ethical challenges on the job [ 3 ]. They pointed out that the medical implications and practicalities of an incident is often discussed, whereas ethical implications for several reasons are not.

First, ethical challenges are emotionally taxing . As described above, moral perception, judgement, and action engage health professionals not just reflectively but also emotionally. Participants explained that ethically challenging situations can trigger thoughts and emotions for a long time after the incident. Some conveyed that doubt and uncertainty can linger about whether they have done the right thing in a given situation. Others described a sense of frustration in situations where they cannot do what they consider right. Several participants pointed out that ethical challenges can evoke feelings of incompetence and guilt . To share and discuss ethical challenges can be emotionally as well as morally unsettling. Furthermore, in the context of modern-day healthcare, some participants expressed fear of repercussions should they be found “guilty” of acting in ways considered unethical. Some participants conveyed a general awareness of the possibility of having errors exposed publicly in the press or on social media. For one participant this awareness has turned into a fear that his “whole life could disintegrate” if he does not act appropriately in an ethically challenging situation. He referred to a specific situation where a colleague risked overlooking a broken leg of a woman covered head to toe in religious clothing out of respect for her integrity. It would amount to medical misconduct not to find and treat the leg.

Let’s take the example that “X” brought up about some burka-clad woman sitting in a car involved in an accident. There are rules and regulations that we can’t talk our way around. If I don’t discover that the patient has a broken leg, then I can lose my livelihood, I can lose my reputation, and my well-being… my whole life can be dissolved. (Text example 16)

This description points to how the fear of mismanaging an ethically challenging situation is linked to the fear of not just compromising your personal and professional integrity, but of being publicly exposed, and risking your job. Such fears and worries are not conducive to sharing thoughts or emotions related to ethical challenges in the workplace.

Second, participants reported examples of organisational barriers . One such is the experience of EMTs and PMs of being corrected by someone in charge if they “bend the rules slightly” in the best interest of the patient and to be able to live with their own actions.

EMT1: In the past we could, well, say there’s rigor, that’s fine, we’ll stop right here. MECU: Well, the legislation has been the same all these years. We just had a practice of bending the rules a little so that we could live with it. However, every time someone [up higher] discovered it, it was like [audible smack of hands] only doctors are allowed to terminate treatment [when there are no obvious signs of death], but you just think the patient is dead, by all means [terminate treatment]. Nevertheless, it’s got something to do with people’s sense of security. (Text example 17)

Another barrier is the lack of a forum with “ organisational impunity ” for EMTs and PMs to discuss difficult ethical challenges. All participants recognised that the use of debriefing after critical incidents has become more common in recent times and offers an occasional chance to touch on emotional reactions to ethically challenging situations. However, this is coincidental rather than intended. Likewise, turning to psychological treatment after traumatic events or to address mental health issues has become more widespread and acceptable, but is still the exception rather than the rule.

But I’ve been there, where I received some psychological treatment and stuff like that. It is fantastic. And it probably also means that you can manage a little longer, if you can look a little inwards and say, stop, I guess I need a little help here. (Text example 18)

Rather than sharing, a widespread way of processing ethically and hence emotionally, challenging incidents is the use of dark humour amongst colleagues, “when no one else is around”.

We really have a sick sense of humor, and I was glad we were absolved from our sins by a crisis psychologist, who once said, that he recommended dehumanisation sometimes. That the use of grotesque words to talk about grotesque experiences is actually okay. And not a sign that we are emotionally detached as long as we are able to act professionally and with empathy. (Text example 19)

A few participants shared ethical challenges with a partner, close relative, or friend, in particular if these were also healthcare professionals. Several commented that they would never burden their private relations with the horrors of work.

Now that my partner is not a healthcare professional, I cannot come and share these considerations [with her]. She would think I was part of a crazy world where people die and there are bombs, explosions everywhere, and things like that. At times when I’ve had a girlfriend or a partner who was a nurse, I could also share considerations [at home] within the family. (Text example 20)

One participant conveyed that he finds relief in a religious belief when faced with the ethical challenges of working with life and death on a daily basis.

If we can help the patient and the patient survives, then his number wasn’t up. Should the patient die even though we did everything we could, well then it was his turn, his number had been drawn and that’s how it is. (Text example 21)

Professional confidence, interpersonal trust, and organisational safety

The focus group participants gave examples of how they share and discuss ethical challenges with colleagues. They pointed out that sharing is important in maintaining long-term mental health.

But I think those of us who make it, we are good at talking to colleagues at work too. It is not always conscious; it’s just a need we have to talk. (Text example 22)

Several focus group members said that ethically sensitive conversations mostly take place in informal settings , such as in the ambulance or MECU on route back to the station after an assignment. It was important to the participants that they had confidence in their conversational partner. Confidence was inspired by medical skills and experience. Newly educated or newly recruited colleagues were not the first choice for sharing thoughts or emotions around ethically challenging incidents. In addition, it was of utmost importance that participants felt they could trust the person to respond with care and integrity. This was raised in the context of physicians discussing ethical challenges with EMTs or PMs.

Yes, but the better you know your paramedic at the MECU [ ] the better the communication. You dare to stand up for yourself, but you also dare to articulate what the problems are, dare to articulate that you may need some help. You should not underestimate the possibilities that working 24-hour shifts with the same man gives you. In other words, if you open up yourself, you get something back. (Text example 23)

Equally, confidence and trust were important for EMTs and PMs, who discussed ethical challenges with physicians.

Then you also dare to ask afterwards, that was really weird. What was this about? In other words, we use our doctors a lot [ ]. You [the physicians] are asked about both large and small matters subsequently, right, [ ] and it is usually to learn something for the next time you find yourself in a similar situation. (Text example 24)

Additionally, physicians pointed out that they have the opportunity to discuss ethical challenges at mandatory monthly group meetings for the MECU physicians.

So we talk about it at the monthly meeting for MECU physicians. There we have a forum [ ] and opportunity to report cases where, I for example, had been clumsy, or what have you, or: What would you have done in a similar case? (Text example 25)

This forum was portrayed as providing confidentiality and a safe space for discussing actions that could classify as mistakes.

Yes, yes, exactly, but then opting out of treatment is discussed and made explicit, it becomes like, legitimate. Sometimes we even have it in writing that this patient should not receive standard treatment because the person in question has abused the system any number of times. (Text example 26)

Professional confidence, interpersonal trust, and organizational safety

Faced with ethical challenges, the moral conduct of prehospital emergency personnel requires moral perception and moral judgment to arrive at moral action. Further, the management of ethical challenges hinges on taking the requirements and demands of the prehospital emergency services and, when applicable, the external collaborators into account. When ethical challenges arise, they are often accompanied by emotions such as doubt, insecurity, inadequacy, and guilt. One participant expressed fear of losing his livelihood, reputation, and well-being in certain circumstances (text example 16). Some participants talked of individual management strategies, such as turning to religious or spiritual thought (text example 21) or sharing with a partner, close relative, or friend (text example 20). The use of dark humour is an integral part of how colleagues generally interact when outsiders are not present (text example 19). When prehospital emergency personnel involve colleagues in a dialogue on ethical challenges, confidence in their professional experience and competence is fundamental, just as interpersonal trust is a prerequisite for sharing. Professional confidence and interpersonal trust is built up over time and through regular collaboration (text examples 23 and 24).

The literature on inter-collegial trust in healthcare is limited. One example is Calnan and Rowe who, in their book “Trust Matters in Healthcare” [ 35 ], write about trust among clinicians. The authors find that medical competence is central when clinicians build trust in each other. However, being technically skilled is not sufficient. Interpersonal values like confidentiality, honesty, reliability, and good manners are equally important. In addition, the clinician must act in the patient’s best interest. Earlier trust among clinicians was achieved through hierarchical systems, but today, so the authors claim, trust is built and maintained over time. The assessment of confidentiality, honesty, reliability, and medical competence is an ongoing process. Further, the authors describe how clinicians can lose confidence in a colleague if their medical competencies are brought into serious question. Minor flaws are accepted. More importantly, confidence can be jeopardised if someone fails to show respect for a colleague. The authors find that a low level of trust causes a lack of confidence and increased criticism that in turn perpetuates the lack of trust within a team. A high level of trust leads to openness, better communication, and effective working relationships.

In our study, the prehospital emergency personnel predominantly point to informal forums as the context were ethical challenges are discussed. They report that they deliberate on ethically challenging situations in the ambulance or MECU on route back to the unit´s base. There are several reasons why prehospital emergency personnel do not discuss ethical challenges more broadly in the organisation. EMTs and PMs do not appreciate a sense of being publicly corrected (text example 17) and they do not have a forum with organisational impunity. Medical physicians are invited to present and deliberate on incidents that turned out in unwanted or unintended ways at monthly group meetings (text example 25). Although a younger physician expressed hesitation, as he did not feel confident enough to present his ethical challenges, several other physicians voiced their appreciation of this organisational opportunity to share and found it useful (text example 26).

Our study indicates that prehospital emergency personnel need to feel confident in and to trust their colleagues and managers if they are to share the ethical challenges they experience at work. French et al. [ 8 ] describe that emergency medical service professionals prefer to discuss ethical conflicts with peers, friends, family, and union delegates rather than following the formal organisational procedures (turning to a superior). This is because people who are not representatives of the organisation are viewed as more empathetic and can be consulted without fear of the legal repercussions that could follow from a formal process. Thus, a lack of trust is the primary reason for them not to engage with organisational processes or supporting committees. Calnan and Rowe [ 36 ] provide a general description of what characterises trust relations between clinicians and managers. In contrast to trust between clinicians, which is largely based on medical competence, trust in managers is driven by honesty and accessibility, but also to the extent to which they act in the interests of the clinical practice. Clinicians lose confidence in their managers if they appear to prioritise meeting government targets over clinical needs. Clinicians distrust managers “if their involvement in running service was seen as interference with clinical decision-making and indicated a lack of respect for clinicians’ professional judgement and autonomy. “Distrust was created particularly when clinicians felt managers were interfering to save money but this results in poorer patient care” [ 36 ]p137. Trust, on the other hand, is reflected in clinicians’ desire to share confidential ethical challenges related to patient care with their managers.

Professional background, moral judgement, and possibilities of action

In addition to legal requirements, medical guidelines, and demands from external collaborators, the professional background of prehospital emergency personnel influence moral perception, judgement, and action in specific incidents. Although the purpose of our study was not to investigate differences between physicians, EMTs, and PMs we found that physicians pay attention to what they can and must do medically and technically (text example 12, 13), to avoid complaints and court cases more so than EMTs and PMs. Further, physicians include theoretical perspectives to a larger extent when they reason about their actions.

Several studies indicate that there are differences in the ethical reasoning of different healthcare professionals. A survey based on 2129 respondents conducted by Telleus et al. [ 37 ] showed that caregivers like nurses more often assess ethical challenges in a relational position while physicians more often take a deontological position. Concurrently, Telleus et al. [ 37 ] discuss that although some empirical studies have been conducted on ethical decision-making processes among healthcare professionals most studies are theory driven. One exception is a study by Agledahl et al. [ 38 ] based on participant observation among 15 physicians from different medical specialities. The authors describe how physicians handle ethical challenges in clinical settings. Across medical specialities, physicians approach ethical challenges in a relatively uniform way. They break down the patient’s history, amplify the patient’s complaints, and categorise them according to medical symptoms. Focus is directed at the patient’s functional level and existential aspects remain unexplored.

Another exception is an interview study conducted by Hurst et al. [ 39 ] investigating physicians’ handling of ethical challenges. The authors interviewed internal medicine physicians, oncologists, and physicians in intensive care units about the ethical challenges they had experienced and how they acted. The authors found that when physicians are confronted with an ethical challenge, they seek assistance and try to avoid a conflict, protect their own integrity, conscience and reputation, and protect the group of people involved in the decision and their integrity.

In our study, we found that prehospital emergency personnel base moral judgment on the perception of morally relevant information and clues in the environment. EMTs and PMs described relying on their gut feeling (what we have termed sensory-emotional evaluation) and on physicians’ assessment of the situation. Further, physicians pointed to clinical guidelines, legislation, and bioethical concepts. To our knowledge, there is no literature analysing the process of moral judgment among EMTs and PMs. Goethals et al. [ 40 ] have described moral reasoning and behaviour among nurses in a literature review. Nurses’ ethical reasoning is a complex process based on moral theories, ethical principles, and situational aspects embedded in the specific context of the nurse-patient relationship. Ethical reasoning emerges from the patient’s need for care and is influenced by the nurse’s relationship with the patient’s relatives and the team in the clinical context. The authors conclude that the ethical behaviour of nurses is closely tied to relational and contextual aspects of care.

In our study, EMTs and PMs are legally obliged to answer to physicians’ decisions. It can prove difficult for EMTs and PMs to act against their own moral judgement when they do not agree with physicians. Some try to indirectly influence the physicians towards the desired sequence of events or comment directly on physicians’ choices (text example 10). Sometimes EMTs and PMs refrain from getting involved if overt disagreement is deemed irreconcilable with good patient care. For some EMTs and PMs, at times, the only solution can, be to leave the scene in order not to take on responsibility for actions they disagree with and to demonstrate their disapproval. Physicians, on the other hand, are aware that they are accountable to medical guidelines and legislation, as well as being responsible for the team collaboration to achieve the best possible outcome for the patient.

Our and other studies describe how the considerations of healthcare professionals are influenced by their working conditions and medical disciplines (somatic [ 41 , 42 ], psychiatry [ 43 , 44 ], primary health care [ 45 , 46 ]), as well as their position and responsibility (nurses [ 14 ], physicians [ 47 , 48 ]). However, our study clarifies an interdisciplinary perspective in moral conduct that stresses the asymmetrical power relationship between physicians, EMTs and PMs. Consequently, EMTs and PMs discreetly try to influence physicians’ decisions. If that is not possible, they may withdraw from direct engagement in patient care. EMTs and PMs convey that this is motivated by their commitment to protect patients and relatives from experiencing disagreement or conflict between the prehospital emergency personnel in a distressing situation. Further, they do not want to jeopardize their own professional reputation or risk hampering future interdisciplinary collaboration. Overall, the EMTs and PMs weigh their professional integrity against protecting patients and securing future working relations with physicians. Articulating ethical challenges that bring the asymmetric power relations into question may have major personal and professional consequences for the individual EMT or PM. Therefore, these cases are delicate, and those who articulate them are vulnerable. Paradoxically, asymmetric power relations is one key barrier to clinical ethics support [ 49 ], while at the same time offering a framework for structured dialogue on the consequences of power relations amongst prehospital emergency personnel [ 19 ].

Personal capacity for empathy as essential for moral conduct

According to Vetlesen and Nordvedt [ 30 ], moral conduct is a result of the emotional-cognitive process of moral perception and judgement resulting in action. Fundamental to any moral conduct is the ability to be receptive to the moral significance of a specific situation, and how the situation affects the well-being of the people involved. “Emotions are active and indeed indispensable in disclosing to us that others’ weal and woe is somehow at stake in a given situation” [ 31 ]. The individual’s emotional life resonates with his or her ability to empathise with others. The ability to empathise is developed exactly through growing up with others. Moral conduct in emergency services, as elsewhere, is based on the perception of what is morally significant, which is ultimately a result of the entire personal biography, including experiences at work. The personally developed capacity for empathy is a foundation for doing the job and is challenged, developed, or hampered on the job. The growing acceptance of psychological treatment (text example 18) may come with the risk that challenges associated with moral behaviour are privatised and individualised. The relevant and natural psychological reactions prehospital emergency personnel experience because ethical challenges may even be seen as pathological. Even if individual psychological treatment can provide an opportunity to reflect on work-related ethical challenges, it does not support organisationally grounded and collective ways of developing strategies for managing ethical challenges. This contrasts with generalising and normalising the emotional ability that forms the basis of moral perception, which is fundamental for prehospital emergency personnel to make decisions based on a moral assessment of a specific situation. Privatisation hinders an important dialogue about the psychological protection and well-being of personnel who are expected - and consider it an important part of the job - to empathise with their patients.

Establishing clinical ethics support

Moral case deliberation [ 50 ]is one of several different ways of organising clinical ethics support. In a literature review, Haan et al. [ 19 ] describe the impact of moral case deliberation in healthcare settings. The authors identify four thematic clusters: (a) changes that are brought about on a personal and inter-professional level, concerning the healthcare professional’s feelings of relief, relatedness and confidence; understanding of the perspectives of colleagues, one’s own perspective and the moral issue at stake; and awareness of the moral dimension of one’s work and of the importance of reflection; (b) changes that are brought about in caring for patients and families; and (c) changes that are brought about on an organizational level. Moreover, the authors identify a cluster of themes concerning (d) facilitators and barriers in the preparation and context of MCD, i.e., a safe and open atmosphere created by a facilitator, a concrete case, commitment of participants, a focus on the moral dimension, and a supportive organisation.

Traditionally, professionals embedded in a medical culture are reluctant to share ethical challenges with outsiders, as they can be seen as being disloyal to colleagues [ 51 ]. The inclination to share ethical challenges differs between various healthcare professionals. While nurses find it very important to share their ethical dilemmas and decisions with other nurses and to receive support [ 40 ], physicians are more reluctant to do so [ 49 ]. Yet our analysis supports other studies [ 14 ] showing that moral conduct – involving moral perception, judgement, and action – is rarely understood or acted on by health professionals as a simple matter of right or wrong. By contrast, ethical challenges are commonly staged as complex situations involving decisions and actions dependent on legal, medical, and organisational demands [ 3 , 8 ]. For these reasons, individual coping strategies are not enough to address moral distress. The development and testing of context sensitive forms of clinical ethics support in the prehospital emergency services of the region of Southern Denmark will be discussed elsewhere.

Strength and limitations

The results of the study are based on data generated using mixed focus groups with the participation of both MECU physicians, EMTs and PMs. Focus groups may offer a safe place for participants to reflect on topics that are difficult to talk about, e.g. because of stigmatization or taboo. By including MECU physicians, EMTs and PMs we have ensured sufficient dynamics in the focus group for different experiences, perspectives and coping strategies to be articulated. However, the presence of MECU physicians in the focus group could have had the consequence that not all EMTs and PMs experienced the focus group as a safe place, which is why they may have withheld important and relevant perspectives. Nevertheless, a rich and diverse data material was collected and it became clear that there were different areas of responsibility and opportunities for moral action depending on whether it was MECU physicians or EMTs and PMs who experienced ethical challenges.

A limitation concerning external validation to other healthcare branches is that generally, in healthcare services, female employees are overrepresented. In Denmark, however, in the prehospital emergency system, the personnel traditionally consists mostly of male employees. Although this trend is slowly changing, the gender distribution in the focus groups reflects the gender distribution at present.

Moreover, the participants were recruited through information about the purpose of the study. This may have resulted in an overrepresentation of prehospital emergency personal who were particularly interested in ethical challenges. By not necessarily forming a representative sample of prehospital personnel, this study cannot quantify the overall incidence of ethical challenges among prehospital emergency personnel.

Despite the limitations described above, our comprehensive descriptions of the context of the research project may enable readers from other parts of the healthcare system to assess differences and apply our findings with relation to their clinical practice. We thus have sought to enhance the transferability of the study´s results through a reader-based analytical validity.

Ethical challenges were accompanied by emotions such as doubt, insecurity, inadequacy, and guilt. The prehospital emergency personnel employed informal management strategies, such as talk on route back to the station or during breaks, sharing with a partner, close relative, or friend, but mainly if they were health professionals, or in many cases, the use of dark humour. Our analysis supports and clarifies that confidence, trust, and safety in relation to both colleagues and management are essential for prehospital emergency personnel to share ethical challenges. Thus, preventing moral distress turning into burnout or the inclination to leave employment in healthcare is closely associated with skills and experience of colleagues, the extent of interpersonal trust, and with organisational support and safety.

Data availability

Individuals may be identified from audio files. In adherence with the regulations of the Danish Data Protection Agency they are thus not available for public distribution. The pseudonomised transcriptions of the audio files (in Danish) are available from the corresponding author on reasonable request.

Abbreviations

Emergency medical technician

Mobile emergency care unit

Avraham N, Goldblatt H, Yafe E. Paramedics’ experiences and coping strategies when encountering critical incidents. Qual Health Res. 2014;24(2):194–208.

Article   Google Scholar  

Oliveira AC et al. Working in prehospital emergency contexts: stress, coping and support from the perspective of ambulance personnel. Int J Workplace Health Manage, 2019.

Bruun H, et al. Author correction: ethical challenges experienced by prehospital emergency personnel: a practice-based model of analysis. BMC Med Ethics. 2022;23(1):120.

Milling L, et al. Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests. BMC Med Ethics. 2021;22(1):82.

Milling L, Lassen AT, Mikkelsen S. Transparency in out-of-hospital cardiac arrest resuscitation: decision-making when patients are in the grey area between treatment and futility. Eur J Emerg Med. 2021;28(6):414–5.

Brochner AC et al. Does the morning morality effect apply to Prehospital anaesthesiologists? An investigation into diurnal changes in ethical Behaviour. Healthc (Basel), 2020. 8(2).

Bijani M, et al. Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis. BMC Emerg Med. 2021;21(1):11.

French E, Casali GL. Ethics in emergency medical services–who cares? An exploratory analysis from Australia. EJBO Electron J Bus Ethics Organ Stud, 2008. 13.

Torabi M, et al. Barriers to ethical decision-making for pre-hospital care professionals. Nurs Ethics. 2020;27(2):407–18.

Torabi M, et al. Ethical decision-making based on field assessment: the experiences of prehospital personnel. Nurs Ethics. 2019;26(4):1075–86.

Mikkelsen S, et al. Characteristics and prognoses of patients treated by an anaesthesiologist-manned prehospital emergency care unit. A retrospective cohort study. BMJ open. 2017;7(2):e014383.

Sandman L, Nordmark A. Ethical conflicts in prehospital emergency care. Nurs Ethics. 2006;13(6):592–607.

Jameton A. What Moral distress in nursing history could suggest about the future of Health Care. AMA J Ethics. 2017;19(6):617–28.

Kälvemark S, et al. Living with conflicts-ethical dilemmas and moral distress in the health care system. Volume 58. Social science & medicine; 2004. pp. 1075–84. 6.

Morley G, et al. What is ‘moral distress’? A narrative synthesis of the literature. Nurs Ethics. 2019;26(3):646–62.

Trautmann J, et al. Relationships among moral distress, level of practice independence, and intent to leave of nurse practitioners in emergency departments: results from a national survey. Adv Emerg Nurs J. 2015;37(2):134–45.

Burston AS, Tuckett AG. Moral distress in nursing: contributing factors, outcomes and interventions. Nurs Ethics. 2013;20(3):312–24.

Crico C, et al. Evaluating the effectiveness of clinical ethics committees: a systematic review. Med Health Care Philos. 2021;24(1):135–51.

Haan MM, et al. Impact of moral case deliberation in healthcare settings: a literature review. BMC Med Ethics. 2018;19(1):85.

Kok N, et al. Effect of Structural Moral Case Deliberation on burnout symptoms, Moral Distress, and Team Climate in ICU professionals: a parallel cluster Randomized Trial. Crit Care Med. 2023. https://doi.org/10.1097/CCM.0000000000005940 .

Bell JAH, et al. Clinical ethics consultations: a scoping review of reported outcomes. BMC Med Ethics. 2022;23(1):99.

Vogel S. What is the philosophy of Praxis? Crit Theory Thought Andrew Feenberg, 2017: p. 17–45.

Musschenga AW. Empirical ethics, context-sensitivity, and contextualism. J Med Philos. 2005;30(5):467–90.

Mikkelsen S, Lassen AT. The Danish prehospital system. Eur J Emerg Med. 2020;27(6):394–5.

McCormack B. Action research for the implementation of complex interventions , in Complex interventions in health . Routledge; 2015. pp. 326–37.

Malterud K. Action research–a strategy for evaluation of medical interventions. Fam Pract. 1995;12(4):476–81.

Halkier B. Focus groups as social enactments: integrating interaction and content in the analysis of focus group data. Qualitative Res. 2010;10(1):71–89.

Halkier B. Practice theoretically inspired focus groups: Socially recognizable performativity? A New Era in Focus Group Research: Challenges, Innovation and Practice, 2017: pp. 389–410.

Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health. 2012;40(8):795–805.

Vetlesen A, Nortvedt P. Følelser Og moral. (sensitivity and moral). Hans Reitzels forlag; 1997.

Vetlesen AJ. The perseption of the Moral , in perception, empathy, and judgment: an inquiry into the preconditions of moral performance . Penn State; 2012.

Løgstrup KE. Den etiske fordring (English translation: Løgstrup, K.E. 1997) . Vol. 2. 1956, 1991, Denmark: Gyldendal.

Løgstrup KE. The ethical demand. Volume 2. Notre Dame: University of Notre Dame; 1997.

Book   Google Scholar  

Rabjerg B. Løgstrup´s Ontological Ethics An analysis of human interdependent existence. Res Cogitans. 2017;2017(1):93–110.

Google Scholar  

Calnan M, Rowe R. Trust between clinicians , in Trust Matters in Health Care . 2008, McGraw-Hill Education (UK). pp. 84–119.

Calnan M, Rowe R. Trust relations between clinicians, managers and patients , in Trust Matters in Health Care . 2008, McGraw-Hill Education (UK). pp. 122–147.

Telléus PK, Holdgaard DM, Thørring B. Physicians and caregivers do differ in ethical attitudes to daily clinical practice. Clin Ethics. 2018;13(4):209–19.

Agledahl KM, Forde R, Wifstad A. Clinical essentialising: a qualitative study of doctors’ medical and moral practice. Med Health Care Philos. 2010;13(2):107–13.

Hurst SA, Hull SC, DuVal G, Danis M. How physicians face ethical difficulties: a qualitative analysis. J Med Ethics. 2005;31(1):7–14.

Goethals S, Gastmans C, de Casterle BD. Nurses’ ethical reasoning and behaviour: a literature review. Int J Nurs Stud. 2010;47(5):635–50.

Reiter-Theil S, Schürmann. The big five in 100 clinical Ethics Consultation cases. Bioethica Forum, 2016. 9.

Forde R, Vandvik IH. Clinical ethics, information, and communication: review of 31 cases from a clinical ethics committee. J Med Ethics. 2005;31(2):73–7.

Molewijk B, Engerdahl IS, Pedersen R. Two years of moral case deliberation on the use of coercion in mental health care: which ethical challenges are being discussed by health care professionals? Clin Ethics, 2016. 11.

Bruun H, et al. Ethical challenges assessed in the clinical ethics Committee of Psychiatry in the region of Southern Denmark in 2010–2015: a qualitative content analyses. BMC Med Ethics. 2018;19(1):62.

Lillemoen L, Pedersen R. Ethical challenges and how to develop ethics support in primary health care. Nurs Ethics. 2013;20(1):96–108.

van der Dam S, et al. Ethics support in institutional elderly care: a review of the literature. J Med Ethics. 2014;40(9):625–31.

Bringedal B, et al. Between professional values, social regulations and patient preferences: medical doctors’ perceptions of ethical dilemmas. J Med Ethics. 2018;44(4):239–43.

Hurst SA, et al. Ethical difficulties in clinical practice: experiences of European doctors. J Med Ethics. 2007;33(1):51–7.

Bruun H, et al. Implementing ethics reflection groups in hospitals: an action research study evaluating barriers and promotors. BMC Med Ethics. 2019;20(1):49.

Molewijk B. R Ahlzen 2011 Clinical Ethics Committee Case 13: should the school doctor contact the mother of a 17-year-old girl who has expressed suicidal thoughts? Clin Ethics 6 1 5–10.

Pedersen R, Akre V, Forde R. Barriers and challenges in clinical ethics consultations: the experiences of nine clinical ethics committees. Bioethics. 2009;23(8):460–9.

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Acknowledgements

We acknowledge the time and engagement of the prehospital emergency personnel who took part in this study. We recognise that speaking up on sensitive issues can take courage even in organisational contexts where participants feel safe to do so.

No external funding was obtained.

Open access funding provided by University of Southern Denmark

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The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark

Henriette Bruun, Louise Milling, Søren Mikkelsen & Lotte Huniche

Department of Quality and Education, Ambulance Syd, the Region of Southern Denmark, Odense, Denmark

Daniel Wittrock

The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark

Søren Mikkelsen

Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

Lotte Huniche

Department of Regional Health Research, Faculty of Health Science, Forensic Mental Health Research Unit Middelfart (RFM), University of Southern Denmark & Psychiatric dept, Middelfart, Denmark

Henriette Bruun

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Contributions

H.B. and S.M. conceived the study. H.B., L.H. and S.M. participated in the design of the study and in considerations and decisions concerning methodology. In collaboration with L.M., H.B. and L.H. carried out the focus groups. Data acquisition was carried out by H.B., L.M., and L.H. Data analysis was performed by H.B. and L.H. All authors participated in discussions of results. The manuscript was drafted by H.B. and L.H. D.W., L.M. and S.M. revised the manuscript and further participated in the writing process with comments and remarks. All authors have read and approved the final manuscript.

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Correspondence to Henriette Bruun .

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In accordance with the Helsinki declaration, the research project was conducted in respect of informed consent, respect for personal integrity, the right to privacy and respect for personal integrity and dignity. All participants gave informed written consent, after receiving both oral and written information about the project, including their right to withdraw their consent at any time. The project is registered with the Danish Data Protection Agency (20/63051). In accordance with Danish law; interview-based studies need no further approval by a research ethics committee. This was confirmed in an email from The National Committee on Health Research Ethics in Denmark (20202000-205) received by the author HB on March 8, 2021.

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Bruun, H., Milling, L., Wittrock, D. et al. How prehospital emergency personnel manage ethical challenges: the importance of confidence, trust, and safety. BMC Med Ethics 25 , 58 (2024). https://doi.org/10.1186/s12910-024-01061-9

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Why Market Research Is Important

2022-06-02 Market Research

A consumer sees an ad for a product that seems perfect for them and rejoices over their luck, but this scenario likely didn’t (and shouldn’t) come down to luck. Companies make these scenarios possible through strategic market research. Equipped with valuable information about its target market, a company can develop products and create marketing campaigns that appeal directly to consumers. And the benefits don’t stop there. You can leverage the data procured through market research to propel your company to success in a variety of ways.

We’ll break down the basics of market research below to show how companies use it and explore some of the key benefits. If you’re not taking full advantage of market research to make data-driven decisions, you should start considering the ways it could help your company grow.

What Is Market Research in Business?

Market research involves gathering data to learn more about target demographics and consumers so a business can market itself more effectively and, ultimately, succeed in the market. Market research is a vital part of any business strategy, whether that business is B2B or B2C, big or small, new or old. It provides the answers companies need to make decisions that will move them forward instead of back by empowering them to base decisions on data.

Most companies know what market research is and acknowledge its importance in a general sense, but they may not realize just how crucial market research is to the success of their business. When you need to identify market trends, understand your core customer better, or achieve a long list of other important goals, market research is the answer.

Types of Market Research

Market research is a broad category. In fact, there are many varieties of market research that you can use to meet the specific goals of your business. Below, we’ll explore the different benefits of each type of market research.

• Brand research:  Brand research is focused on creating or refining your company brand to make a bold and favorable impression on your target market. You could look into the level of brand awareness among your target audience, how loyal customers are to your brand, what sorts of qualities people associate with your brand, and other aspects of customers’ relationship with your brand.
• Marketing campaign evaluation:  Some market research focuses specifically on  marketing campaign effectiveness . You can evaluate how many people have seen your online ads and what the click-through rate has been, for example. This type of information can help you make adjustments if needed and inform future campaigns so you reach consumers effectively and keep customer-acquisition costs down.
• Competitor research:  Competitor research focuses on the competition to help you gain insights into how your company can pull ahead. Looking into a competitor’s marketing campaigns, brand reputation, revenue or sales volume, and other important data points can help you learn from their strengths and weaknesses.
• Customer segmentation research:  An important type of market research, especially for new businesses, is customer segmentation. These studies divide your larger consumer base into different groups or personas. Understanding the different types of consumers you want to connect with can help you create individualized campaigns tailored for each group.
• Consumer research:  Nearly all market research involves the consumer in some fashion, but some research is focused specifically on understanding consumers within a certain segment better. You may want to learn about their purchasing habits, interests, motivations, and more. The better you understand your consumers, the more effectively you can appeal to them.
• Product development:  Developing products calls for market research first to ensure the concept has value and then to refine the product over time. For example, you may see sales dipping on a flagship product and discover that customers’ needs have shifted and this product should offer a new feature to be more useful or convenient.
• Usability testing:  Similar to product development research, usability testing is focused on products. However, the focus here is on how consumers use your product. You may release a beta version of your mobile app, for example, and get feedback from users to find out if there are any bugs or other problems you need to work out.

The Benefits of Market Research

Market research can deliver valuable benefits to companies like yours. Let’s look at some of the most impactful ways market research can empower your company to succeed.

1. Maintain a Customer-Centric Approach

Market research is all about understanding your consumer base better, and that is an essential step to creating a customer-centric business. Customer-centric companies keep the customer experience at the forefront of all they do. Research has shown that customer-centric  businesses are 60% more profitable . It’s easy to see why prioritizing the customer’s needs and desires is a recipe for success.

Market research is how you come to understand those needs and desires in the first place, along with other important aspects of your target customers. You can’t effectively build a customer-centric business unless you understand your customers. Conducting market research allows you to appeal more specifically to your customers’ pain points and preferences. It’s a win-win for your customers and your business.

One of the most effective ways to be customer-centric in your market research is by using a segmentation-targeting-positioning (STP) model. This marketing model involves:

• Segmentation:  Brainstorm the possible segments your product or service may appeal to. These segments can be defined geographically, demographically, or otherwise.
• Targeting:  Determine which segment or segments offer the most profitable opportunities for your company so you can focus on marketing to these segments.
• Positioning:  Develop a strategy for addressing your target segment’s needs and do it better than your competitors. You can also consider the best way to promote your solution to the target segment.

2. Connect With Your Audience More Effectively

When you understand your target customers better, that means you’ll be able to more effectively reach them. When it comes to your marketing campaign, you don’t want to waste time and money on trial and error — you want to have an informed marketing strategy. There are two main elements of effectively connecting with your audience: the marketing channels you use and the content you share.

Using a one-size-fits-all approach, regardless of your audience, can be a costly mistake when it comes to marketing channels. The print publications your audience reads, the television shows they watch, and the websites they spend time on can dramatically differ from those of the target audience for your last product.

For instance, you can reach  close to half of the urban population  by advertising or marketing on Instagram, but you’ll only reach approximately a fifth of the rural population this way. So advertising your farm equipment on Instagram is likely a poor choice.

Choosing the right marketing channels is an important first step to reach your audience, but to truly connect with them, you also need to tailor the content of your marketing materials. Everything from the features of your product you advertise to the tone and visuals you use should be crafted to speak to your target audience. When customers feel you’re “speaking their language,” they’re more likely to pay attention to what you have to say.

3. Identify Opportunities for Growth

Market research isn’t just an important step for new companies or companies launching new products. Conducting market research periodically can help you discover new opportunities to improve and grow. For example, you may discover:

• Unreached segments:  You may come across unreached segments that, like your current customers, could benefit from your products or services. Perhaps they just don’t know about your brand yet, or they think your products are intended for someone else. This segment could be consumers of a different age, gender, income level, or geographical region, for example. A simple modification in your product or marketing strategy may be all it takes to unlock a whole new customer base.
• Business partnerships:  Through market research, you may also discover opportunities to partner with other businesses that already have an established connection with your target audience. Joint promotions can be mutually beneficial for you and the partner company. Essentially, you can combine the power of both your brands to expand and strengthen your reach.
• Product improvements:  Market research can reveal possible shortcomings in your product or services that, if remedied, would allow you to appeal to more customers and improve customer satisfaction. You may also discover opportunities for add-ons, product bundles, or other upsells that appeal to customers’ preferences and help you increase profits.

4. Reduce Risks by Testing Concepts

Risk is a necessary part of any business venture. If businesses didn’t take on risks, they would also limit the potential for reward. However, successful businesses tend to mitigate their risks in strategic ways. The way to avoid risk is not to avoid doing anything. Instead, businesses should use market research to minimize risks and maximize rewards.

A major way you can minimize risks is by ensuring there’s demand for a product. The reality is that many products fail. Some experts place the  failure rate as high as 95% . While that estimate is likely too high, it remains true that many new products fail to connect with consumers and end up in clearance bins. One study found that, of the 9,000 new products that were broadly distributed at a national retailer,  60% were no longer sold  within three years.

Because of the high risk involved, you should never create a product based on a mere hunch. Use thorough market research to predict whether a product concept has real potential for success. Will your product meet a need or desire your customers have, and will it do so more effectively than your competitors are doing? When you have proof of concept, you can be more confident in your efforts and more effectively attract investors.

After you’ve created your product, whether it’s a prototype or a limited run, you can employ market research again to help you refine your strategy before an official product launch. For example, you could give samples of a new food product to passersby in exchange for their feedback. You can also use market research to test reactions to a new logo, new packaging, or any number of other business decisions.

5. Make More Informed Decisions

Market research empowers companies to make more informed decisions that are backed by data. Gut feelings are not reliable means of making decisions. For instance, you may think releasing a luxury version of your product at a higher price point is a great business idea, but consumers willing to pay that price may associate your brand with budget-friendly products and opt for luxury products from luxury brands instead. The only way to know for sure is to conduct market research.

Market research data can serve as a compass, steering each choice a company makes to take them one step closer to their goal of successfully converting and retaining their target customers.

Here are some examples of decisions you can make more accurately with the help of market research:

• Choosing a different consumer base to target through a new marketing campaign
• Determining which channels to include in your advertising campaign
• Selecting design and personality elements to form a brand persona that will connect with your audience
• Choosing whether to open a new retail location
• Deciding whether a product should be discontinued or modified
• Pricing products in a way that maintains margins and appeals to customers

Through market research, you can make these and other decisions based on data rather than guesses and, as a result, boost your chances of getting it right the first time.

6. Compete More Effectively

Solid market research can be the difference that gives you a competitive edge in the marketplace. For one, by understanding your customers better, you may be able to engage them more effectively than your competitor is doing. Additionally, competitor research can give you direct insight into your competitors so you can understand how you fit into the marketplace.

If you’re a newcomer and want to know the best ways to draw customers away from legacy brands, market research can help you find out where consumers are dissatisfied with these brands and their offerings. By pinpointing these gaps, you can appeal directly to consumers’ desires and market yourself as a disruptive company with a superior solution.

You can also use market research to help you discover underserved segments of the market. By targeting these underserved consumers, you can carve out a place in the market for yourself where you’ll excel. For example,  the founder of War Paint, a cosmetic company  marketed to men, said, “Growing up, I never felt there was a brand for me, that spoke to me.” War Paint and some other emerging cosmetic brands target male consumers who were previously not part of the equation in the makeup market.

7. Stay on Top of Trends

Market research isn’t just important for new businesses. As consumers evolve, companies must also evolve to optimize the way they connect with customers. Market research is a valuable means of staying up on relevant trends. Researching trends can often be done through secondary research. Industry reports or research from your competitors, for example, can reveal what new product features consumers are interested in.

Today’s culture changes rapidly, and market research is essential if you want to keep up. You need to stay aware of trends regarding your consumers’ purchasing behavior, the most popular advertising channels, packaging preferences, product features, relevant messaging, and much more. Mimicking what your competitor did last year isn’t a good strategy.

Trends are especially important and cycle more frequently in some industries, such as fashion and design. If your company sells light fixtures, for example, you need to conduct research frequently to see what styles appeal to modern interior designers and homeowners. You also need to be aware of any new technology you can incorporate into your product to help you stay at the cutting edge and deliver the latest and greatest products to your consumers.

How to Conduct Market Research

Companies can conduct market research through various means. First, it’s helpful to understand the difference between two main categories of sourcing market research data — primary and secondary research:

• Primary research  is the data a company collects or an expert collects on the company’s behalf for their market research purposes. In other words, it’s field research. Some primary research is exploratory, meaning it’s more open-ended, and other forms of primary research aim to provide insight into specific questions or issues.
• Secondary research  involves using data that already exists and is at your disposal for market research purposes. For example, you could consult government census data, industry data reports or statistics on market trends. This type of research can provide a good starting point for understanding the market more broadly and learning about the competition.

Secondary research tends to be a starting point before conducting primary research.

There are several methods of primary research companies use to learn from consumers. Some of the most popular methods include:

• Surveys:  Surveys involve asking consumers questions they can quickly answer. Survey questions can be multiple choice or more open-ended. Surveys can be conducted in-person, over the phone, through the mail or  online . They provide a fast and simple way of reaching a large audience and getting their feedback.
• Focus groups:  Focus groups tend not to involve as many participants as a survey. Instead, a market researcher leads a small group of consumers in a discussion to get a window into consumers’ thoughts. Because the groups are small, most companies will assemble multiple focus groups and take all the results into account. They may observe through a one-way mirror or watch a recording.
• Interviews:  Interviews are similar to focus groups but may involve even fewer people. A one-on-one interview can be a valuable way of gaining detailed insight from one customer. These insights can be helpful, but they don’t provide statistically reliable data as you can get with a large survey.
• Observation:  Market observation involves watching consumers to see how they behave under natural conditions, such as a retail store. These consumers may or may not know they are being observed. For example, researchers may watch security footage taken from a store to see which departments customers tend to go to first and whether they stop to look at point-of-purchase displays.
• Field trials:  Field trials involve making a business move but doing so on a smaller scale and observing the results. For example, a restaurant chain may try a new menu item at a handful of locations and see how popular it is. If it’s a success, the company can feel more confident about adding the item to their menus throughout the region.

Companies can conduct their own market research in-house, but many choose to share their goals with a third-party expert who can create a market research strategy and execute it. By outsourcing your market research, you can streamline the process, focus on your core competencies, and receive valuable data from the experts that you can then leverage to drive your business forward.

Does Market Research Work?

Market research takes time, effort, and finances to complete, so it makes sense to spend these resources only if you’re going to get a positive return. The reality is that market research remains a crucial part of running a successful business because it is indeed worth the investment. Of course, market research alone won’t cause your business to succeed — but it will give you the information you need to make strategic decisions that will steer your company to success.

We looked at several benefits of market research but consider the inverse reality. Without market research, you could fail to connect with customers, miss out on growth opportunities, be vulnerable to risks, make poor business decisions, and ultimately lose your customers to your competitors. Some businesses get lucky without doing their research, but these instances are rare. Market research can help you avoid common pitfalls and grow your business.

Learn More About Our Market Research Tools

Market research should be a key part of your company’s recipe for success. Surveys are one of the most popular and effective means of reaching consumers and gaining insight into their values, preferences, opinions, and more. At Cint, we help brands and agencies conduct online studies that can empower them with the market research data they need. We can connect your company with millions of consumers, deliver fast results, and ensure those results are accurate through robust quality checks. Cint can help you produce the primary data you need on a tight timetable so you can make informed decisions to help you connect with customers and grow your business. To learn more about our market research tools, contact our team today.

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Bee Research Questions for Kids

How much do you know about bees? Did you know they have five eyes and four wings? Did you know that not all bees live in hives? Did you know that not all bees are black and white? Encourage students to engage with all sorts of fascinating facts about bees with a research project, using this handy, printable list of Bee Research Questions to get them started!

You can find the instructions for downloading a printable version of this list of Bee Research Questions below.

A bee research project would be a great way to raise awareness about World Bee Day with school age children. It would also tie in nicely with Earth Day celebrations, or an Environmental Science unit.

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With more than 20,000 identified bee species in the world, and the importance of bees to the world’s environment – not least to the production of both food and oxygen – bees are kind of a big deal! World Bee Day was initiated on May 20th, 2017 by the United Nations as a means of raising awareness of the significant contribution that bees make to the world. It is now celebrated on May 20 each year.

What’s the big deal about bees? In one word – pollination. Bees collect nectar and pollen from flowers. Nectar and pollen are food sources for bees. As bees move from flower to flower collecting the nectar and pollen that they need, they transfer pollen from plant to plant and enable pollination.

When animals and insects pick up the pollen of flowers and spread them to other flowers, they enable the plant to reproduce. Importantly to humans, this includes many food crops and trees for oxygen production. When pollination occurs, the fertilized flowers of the plant enable it to reproduce or form fruit. Whilst other animals, including birds and rodents, can act as pollinators, the most common (and important) pollinators are insects, especially bees.

Bees also produce food for humans directly in the form of honey. And there is a lot of interest in the medicinal properties of honey and the many other products bees make.

Unfortunately, many bee species are at risk. Their habitats are disappearing as green spaces are cleared and replaced with buildings, and the use of pesticides on crops and flowers is harmful to them.

The printable includes the following questions about bees to be used as prompts to get students researching these wonderful, essential insects;

• Honey bees are not the only bees in the world. How many other bee species are in your local area?
• Not all bees sting, what sting-less bees do you have in your local area?
• Can all honey bees sting? Or only males? Or only females?
• Can bumblebees sting once or multiple times?
• What makes honey bees so noisy when they fly? Are all bees noisy when they fly?
• Do all bees live in a beehive? If they don’t, where do they live?
• Do all bees make honey and honeycomb?
• Does a bee have two eyes or more?
• How fast do bees fly and do all bees fly as fast as each other?
• Do all bees have a queen bee or only the honey bee?
• Why are honey bees so important that they are now found all round the world?
• Do all bees swam?
• Can honey be used as an antiseptic?
• Does a honey bee have more than one stomach? What about other bees?
• What threats are facing honey bee populations?
• How can we help bees survive?
• Are all species of bee the same size? If not, what is the smallest and what is the largest?
• How long is a honey bees life span? Do other bees live for longer?
• Do bees sleep at night?
• Can bees see at night?
• Can bees see in colors or do they see in black and white?

More Fun Bee Activities for Kids

• Hear students buzz with laughter with this fun Bee Jokes for Kids Fortune Teller printable.
• Sing an action song about bees with preschool or kindergarten age children. You can find two in our collection of insect action songs and rhymes .
• Students will be positively buzzing as they search for bee words in these fun bee word search puzzles – two with an extra special bee facts challenge.

Tips for Download & Printing : Bee Research Prompts for Kids

Click here to download: Bee Research Questions . Save the PDF to your computer.

Printing Tips

• Open the PDF to print the pages you require.
• When printing, select “Fit to printable area” (or similar) to ensure the page fits with your printer type and local paper size.

Having trouble accessing or downloading the file? Please try a different internet browser. Please note: All Childhood 101 printables are for personal use only, you may not use any part of this content for commercial purposes-that includes selling the document, giving it away to promote your business or website, or printing the file to sell. You may not share, loan or redistribute these documents. Teachers may use multiple copies for students in their own classroom.

Christie Burnett is a teacher, presenter, writer and the mother of two. She created Childhood 101 as a place for teachers and parents to access engaging, high quality learning ideas.

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