This essay explores the ethical distinctions in clinical research and evidence based practice projects, the ethical conflicts associated with Evidence Based Quality Improvement (EBQI) Initiatives, and patients' ethical responsibilities for healthcare improvement.
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Running head: ETHICS AND EVIDENCE BASED PRACTICE ETHICS AND EVIDENCE BASED PRACTICE Name of the Student: Name of the University: Author note:
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1ETHICS AND EVIDENCE BASED PRACTICE Introduction Ethics must be followed in healthcare, not just in terms of clinical research which guide future professionalism, but also in terms of evidence based organizational quality improvement practices. However, while healthcare researchers must ensure adherence to certain ethical principles, the same set of moral rules may not be applicable for evidence based practice (EBP) implementation projects, due to possibilities of violating far greater ethical principles (Kelly et al., 2015). The following essay will hence aim to shed light on the ethical distinctions in clinical research and EBP practice projects, the ethical conflicts associated with Evidence Based Quality Improvement (EBQI) Initiatives and patients’ ethical responsibilities for healthcare improvement. Discussion Ethical Safeguards in EBQI Ethical principles and considerations must be implemented in both EBQI as well as administration of clinical research, to ensure humanitarian practices and the avoidance of harm to any of the participants or patients of the healthcare organization (Carter, Chew & Sutton, 2018). However, while both quality improvement initiatives as well as clinical research are required to follow evidence based principles for ensuring positive contributions to overall public health research and care services, conflicts continue to prevail on the need to ensure distinctions in the application of ethical principles in both fields (O'Mathúna & Siriwardhana, 2017).
2ETHICS AND EVIDENCE BASED PRACTICE Clinical research entails research procedures administered by investigators for the purpose of obtaining novel innovations and knowledge aimed at future improvement and implementation of existing and new evidence based professional practice. Clinical research requires researchers to work with human subjects or samples of human origin to ensure fulfillment of the same. EBQI initiatives on the other hand, are a set of procedures and practices implemented for the purpose of excellence in the deliverance of healthcare services (Goldstein et al., 2018). Considering that both procedures are similar in terms of recruitment of human participants, primary collection of physiological or biochemical based human data and scientific or statistical methods of data analysis, it is obvious that ethical principles apply to both. However, it must be considered that EBQUI initiatives differ in terms of their application of equal interventions throughout the patient population for improve patient care delivery as compared to clinical research which relies on the application of selective interventions on a selective group of subjects to pave the way for future practice (Califf & Sugarman, 2015). Clinical research requires adherence to certain ethical principles in terms of participant, consent and selective intervention administration as per selective patient needs, which cannot be applied on EBQI initiatives, Restrictions on the EBQI initiatives of implementing equal healthcare interventions for all patients, similar to clinical research, violates ethical principles of justice and autonomy – that is, the ethically appropriate rights of patients to receive fair treatment with respect to their autonomous needs (Bromley et al., 2015). Further, while clinical research may have ethical restrictions in terms of risks associated with administration of clinical interventions on participants, the same cannot be applied on EBQI initiatives since limitations on an organization’s attempts to enhance quality, directs them at circumstance of violation of ethical
3ETHICS AND EVIDENCE BASED PRACTICE principles of beneficence and non-maleficence – that is, the responsibility of ensuring benefit to patients and reduction of harm (Stahl & Coeckelbergh, 2016). In criticism, it must be considered that lack of patient consent and differential implementation of healthcare interventions across organization departments raise ethical violations for EBQI initiative implementation, hence necessitating the need to apply ethical principles similar to those in clinical research (Kangasniemi, Pakkanen & Korhonen, 2015). However, it must be recalled that, while clinical research is not necessitated to be performed routinely, EBQI initiative implementation is a part of an organization’s continuous professional functioning and hence, the risks of not implementing or implementing restricted EBQI initiatives outweigh the minor risks associated with implementation of EBQI devoid of stringent ethical restrictions (Baillie, 2017). Further, it must also be considered that clinical research implementation necessitate merely the assurance of methodological validity, significance and applicability – the lack of which paves the way for opportunities for future investigative improvements. However, the costs of administering inadequately formulated or excessively restrictive EBQI are far greater and not only results in wastage of organizational financial resources but also increased risk of poor healthcare deliverance, increased negative patient health outcomes and loss of patient satisfaction and quality of life (Brownson, Colditz & Proctor, 2018). Hence, considering the same, imposing ethical restrictions on EBQI initiatives, similar to those of clinical research, are unjustified and defeats the very purpose of healthcare improvement aimed by EBQI practice.
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4ETHICS AND EVIDENCE BASED PRACTICE Chapter 22 Review Upon reading and reviewing the findings discussed by Melnyk and Fineout-Overholt (2015), it can be implied that the implementation of EBQI initiatives can result in the emergence of major ethical controversies. Firstly, one of the major ethical controversies associated with the same is a question of whether the same standards of obtaining consent during clinical research be applicable in terms of implementation of EBQI initiatives. The second controversy entails the question of whether the application of evidence based practice in one organizational department is justified when traditional, poor quality practices are continued in other departments. Thirdly, another ethical controversy which must also be considered is whether obtaining consent from patients receiving traditional healthcare services is necessary prior to the implementation of novel EBQI initiatives (Melnyk & Fineout-Overholt, 2015). The emergence of such ethical controversies must be addressed with immediate importance since the same relate to major ethical considerations. The lack of implementation of adequate and well designed EBQI initiatives, due to the imposition of excessive ethical restrictions similar to those in clinical research are a direct violation of ethical principles of beneficence and non-maleficence (Nicholls, Newson & Ashcroft, 2016). Beneficence entails the need the ensure benefit to the patient whereas non-maleficence dictates the need to ensure least possible harm to patients by healthcare professionals. Hence, it is like that the administration of poorly designed EBQI initiatives increases the risk of greater harm to patients as well as reduced possibilities of achieving beneficial positive health outcomes (Walker, 2016). However, it must be also be noted that presence of disparities in the implementation of EBQI initiatives across the departments of an organization, violates the ethical principles of justice – which necessitates fair and equal healthcare services for all. Further, the lack of
5ETHICS AND EVIDENCE BASED PRACTICE obtaining consent from patients prior to implementation of EBQI results in violation patient autonomy – the rights of patients to put forward their needs and preferences. Hence, to address such controversies, healthcare organizations must seek to maintain a delicate balance between ethics of beneficence, non-maleficence, justice and autonomy, and if needed, practice patient centered discussion with the concerned patients to ensure consideration of patient needs (Yıldız, 2017). Patient care Ethical Conflict The concept of “patients having an ethical responsibility in improving healthcare” necessitates the direct participation of citizens and patients in healthcare decision making at the organizational level for the purpose of informing their opinions on healthcare interventions and treatment services (Townsend et al., 2015). While such concepts successfully address acceptable standards of patient centered practice as well as ethical concepts of patient autonomy and justice, it must also be remembered that patients and citizens hail from non-clinical backgrounds and may possess reduced health literacy and evidence based knowledge in comparison to health professionals. Hence, uninformed and inadequately constructed patient participation procedures may result in implementation of risky or poorly evidenced healthcare interventions resulting in violation of ethical principles of beneficence and non-maleficence (Kelley et al., 2015). To combat the same, healthcare organizations must consider educating and increasing the health literacy of patients and citizens on the need to practice evidence based practice and scientifically valid healthcare interventions. Further, establishments of accredited or internationally acceptable standards on the need to consider evidence based research prior to implementation of interventions, above any opinion, irrespective to be those of patients or professionals, may be beneficial in mitigating such conflicts (Runciman, Merry & Walton, 2017).
6ETHICS AND EVIDENCE BASED PRACTICE Conclusion Hence, it can be observed that conflicts and controversies continue to plague present day ethical standards in EBQI and clinical research, as well regarding the role of patient participation in healthcare improvement. To conclude, there is need to prioritize patient and community benefit, reduction of healthcare errors as well as evidence based practice prior to implementation of any form healthcare intervention.
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