This paper discusses the ethical considerations in evidence-based practice and the conflicts between ethical principles and patients' responsibility in healthcare improvement.
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Running Head:ETHICS AND EVIDENCE-BASED RESEARCH1 ETHICS AND EVIDENCE-BASED RESEARCH Name Institution
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ETHICS AND EVIDENCE-BASED RESEARCH2 Introduction EBP (evidence-based practice) is a key feature in the health setting. It controls the medical practitioners in their day to day process of making decision to make sure that the decisions made are suitable for the patients (McGill, 2018). As a result, the whole process leads to better medicals services. According to McGill, (2018) clinical research is the source of medical practitioners’ evidence in their research.The study contacted medically is important in helping the establishment of important information that is transferable into nursing practice (McGill, 2018). Dang & Dearholt (2017) on the other hand explains that it is important to note that there exist various guidelines that have to be adhered to when clinical research is being carried out. The main purpose of these guidelines is to make sure that there is a mutual benefit for both the participants and the researchers (Dang & Dearholt, 2017). The purpose of this paper is to outline the manner in which moral guiding principle may not be appropriate for EBP, the moral values conflicting patients' concept in having an ethical duty in enhancing healthcare, and the ethical discrepancy connected to implementation of Evidence-Based Quality Improvement (EBQI) initiative. Why ethical safeguards designed for clinical research may not be appropriate for evidence-based practice. Regardless of the importance of ethical guidelines in medicinal investigation, they may not be appropriate for practices that are evidence-based. Good values like solitude, privilege of communication, informed permission, and patient information sheet assure that research done in clinic goes on in a suitable way to the community and those concerned (Dawson et. al 2018). The guidelines offer an appropriate way to be followed by researchers. Nevertheless, the majority of
ETHICS AND EVIDENCE-BASED RESEARCH3 these safeguards may not be suitable for practices that are evidence-based. For example, looking at privacy as a moral principle may not bound the amount of content a participant may offer. Dawson et. al (2018) explains that someone may choose to present data that is inadequate on their physical status, social network, thoughts, and health. Failure to unveil information causes imprecise information determination on the incident being studied by the researchers. In that process, those doing investigation might bring information that is not correct. Therefore the translation of pieces of evidence as such might not cause development in systems of healthcare (Dawson et. al 2018). In the same manner, informed permission principle might lower the efficacy of information gotten from medical research (Dang, & Dearholt, 2017). According toDang & Dearholt (2017),this principle states that clinical research members ought to have all the data about nature, effects of being involved in the study, risks, and the purpose. Due to this, some of the participants may avoid such kind of research because of fear of related consequences. Avoiding means that the anticipated participants' number in a certain study won’t be reached. Therefore, the outcome of the study will not have the best influence considering the number of involved participants (Dang & Dearholt, 2017). Integration of undependable facts as nursing practice evidence means that both medicinal practitioners as well as the patients won't have a chance to recognize the importance of evidence-based practice. In this regard, ethical protections for medical study may not be suitable for EBP. There is some knowledge that is never incorporated in EBP (Hepworth et. al 2016). This is because EBP downgrades some of the knowledge used by the practitioners and which are vital for good practice.Runciman, Merry & Walton (2017) further adds thatknowledge as such consists of anecdote, experience, and intuition. In health care, EBP best fits best with practice
ETHICS AND EVIDENCE-BASED RESEARCH4 areas that are firmly defined. Particularly, we have pharmacology, but it’s still suited for more areas that are cunning, for instance, the likes of nursing and surgical procedure (Hepworth, et. al 2016). Pre-publication draft copy 2 experience counts for a great deal and thus a patient would prefer being served by a practitioner who has experience than being served by the one who is well versed in current research evidence. Two ethical exemplars in section 22 review The section talks about a clinician’s research made to investigate the impact of evidence- based research introduction in order to lower the rate of infection in the ICU in Michigan (Dang et. al, 2015). In this research, more than 100-ICU were involved and the final result was that there was infection reduction of up to 66%. The study included a number of interventions targeting the ICU personnel to improve safety of patient. A nurse and a physician were selected as group leaders in each ICU. No costly technology was needed because every hospital offered enough personnel to implement the educational intervention (Dang et. al, 2015). After the study, the Office for Human Research Protection said that the team conducting the research had violated two ethics regulations (Dang et. al, 2015). The study was further submitted to the Johns Hopkins University IRB, which deemed it exempt from review. The IRB viewed the project as a realization of EBP and QI initiative and not a clinical research. Well- versed approval was not obtained from the IRB review. Large application of OHRP’s advance might imply that whole swaths of clinical work to make sure safe and effective care would either halt or shrink (Dang et. al, 2015). The situation resolutions were that both parties settled that it was a clinical investigation settled on an educational intervention. Main ethical controversies related to implementing Evidence-Based Quality Improvement
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ETHICS AND EVIDENCE-BASED RESEARCH5 Various arguments are linked to the Evidence-Based Practice Quality Improvement initiative. To begin with, some people might say that (EBQI) may be thought to be clinical research. As such, the same levels of patient ability while carrying out medical research ought to be held in the implementation of EBQIs (Merriam & Grenier, 2019). Secondly, views may come up that the efforts to proceed with quality for some patients may be dangerous to others. Such kind of argument might indicate that support directed to EBQIs would be small. Third, the patients in receipt of traditional care ought to be given an opportunity for well-versed consent to conclude that they possess full knowledge in regard to the EBQIs being set off. The moral arguments above relate to the four core ethical principles. Particularly, the purpose of these controversies is meant to provide protection to the patients and only allowed persons to share their data (McGill, 2018). To add to this, pushing for the need for informed consent is the goal of the concerns discussed in regard to EBQIs. Informed approval feature is important for the understanding of the patients about the advantages together with the disadvantages linked to the EBQIs and clinical research. In addition, the discussion makes sure that patients do not suffer from exploitation for the wrong reasons that could risk their health, which is a non-exploitation principle. For that reason, arguments relating to EBQIs are in relation to the four core ethical principles (Weimer & Vining, 2017). Ethical principles conflicting with the concept of “patients having an ethical responsibility in improving healthcare A number of ethical issues come out differing with the plan of patients having a moral duty in enhancing healthcare (Pozgar, 2019). Some of these issues are privacy and informed consent. The previous research reveals that patients might be pushed to hide important
ETHICS AND EVIDENCE-BASED RESEARCH6 information from the medical practitioners controlling them. In such kind of scenario, a lot of information that could have been gathered by the nurses to help them in engaging the best practices to improve healthcare is not gotten. With reference to the well-versed permission, providing the information needed to the patients ahead of healthcare practice possibly will frighten the patients from participating in evidence-based practice. For example, a patient might build feelings of focusing on the possible unattractive outcome, opposite to the medical cover benefits of medical endeavor. Therefore, the patient does not play a part in healthcare improvement. Finding a solution to these disagreements will need an institution of an educational plan that aims at informing the patients on the advantages of contributing to the improvement of healthcare. Personal positions of patients need to be expounding to find out what is publicly needed. The program may also deal with the patients on how serious they are in improving medical performance. There is also a conflict that exists amid the principle of the beneficiary and the concept of the patients having an ethical responsibility in healthcare improvement can be solved through giving an opportunity to the patient to choose he/she may prefer the medical practitioners to do. According toPozgar (2019)having the principle of practitioners is good but giving a chance to the patients to choose what they prefer most upholds the concept of having an ethical responsibility in health care improvement. Conclusion There is a need for ethical guidelines to be adhered to in clinical research (Walker et. al 2019). People doing research have a role to play in ensuring that the rights of patients are not violated. Nevertheless, these principles should not have a negative impact on evidence-based
ETHICS AND EVIDENCE-BASED RESEARCH7 practice. Additionally, there is an ethical responsibility by the patients themselves to participate in the improvement of healthcare. Thus they ought to understand that improvement of healthcare section benefits the whole nation as well as the patients themselves. This becomes an encouragement to lift their efforts so that they can increase their involvement in healthcare sector.
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ETHICS AND EVIDENCE-BASED RESEARCH8 References Brownson, R. C., Baker, E. A., Deshpande, A. D., & Gillespie, K. N. (2017).Evidence-based public health. Oxford University Press. Dang, D., & Dearholt, S. L. (2017).Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau. Dang, D., Melnyk, B. M., Fineout-Overholt, E., Ciliska, D., DiCenso, A., Cullen, L., & Stevens, K. R. (2015). Models to guide implementation and sustainability of evidence-based practice.Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 3rd ed. Philadelphia, PA: Wolters Kluwer Health, 274-315. Dawson, L., Strathdee, S. A., London, A. J., Lancaster, K. E., Klitzman, R., Hoffman, I., ... & Sugarman, J. (2018). Addressing ethical challenges in HIV prevention research with people who inject drugs.Journal of medical ethics,44(3), 149-158. Hepworth, D. H., Rooney, R. H., Rooney, G. D., & Strom-Gottfried, K. (2016).Empowerment series: Direct social work practice: Theory and skills. Nelson Education. Merriam, S. B., & Grenier, R. S. (Eds.). (2019).Qualitative research in practice: Examples for discussion and analysis. Jossey-Bass. McGill, S. M. (2018).Low back disorders: evidence-based prevention and rehabilitation. Human Kinetics. Pozgar, G. D. (2019).Legal and ethical issues for health professionals. Jones & Bartlett Learning.
ETHICS AND EVIDENCE-BASED RESEARCH9 Runciman, B., Merry, A., & Walton, M. (2017).Safety and ethics in healthcare: a guide to getting it right. CRC Press. Walker, S. C., Sedlar, G., Berliner, L., Rodriguez, F. I., Davis, P. A., Johnson, S., & Leith, J. (2019). Advancing the state-level tracking of evidence-based practices: a case study.International journal of mental health systems,13(1), 25. Weimer, D. L., & Vining, A. R. (2017).Policy analysis: Concepts and practice. Routledge.