Report: Ethical Considerations in Evidence Based Nursing Practice

This report delves into the ethical considerations within evidence-based nursing practice, using a case study to highlight key issues. The analysis focuses on potential ethical dilemmas such as malpractice and negligence related to the use of medical equipment and the provision of care, particularly concerning patient autonomy and beneficence. The report examines current facility practices, suggesting that insufficient repositioning of patients and disregard for patient perspectives raise ethical concerns. It then presents evidence-based recommendations from Norton et al. (2018) and the Registered Nurses’ Association of Ontario (2016) regarding pressure injury prevention and management, including assessment, planning, implementation, evaluation, and education. Furthermore, the report offers suggestions for integrating these recommendations into the facility's nursing practice, emphasizing the importance of patient involvement, appropriate care plans, and ongoing evaluation of patient outcomes. References to relevant literature support the arguments and recommendations made throughout the report.

Running head: ETHICAL CONSIDERATIONS 1
Ethical Considerations in Evidence Based Nursing Practice
Student’s Name
Institution

ETHICAL CONSIDERATIONS 2
Ethical Considerations in Evidence Based Nursing Practice
Ethical Considerations of Current Facility Practices
In the facility, one probable ethical consideration that the medical practitioners need to be
wary of is malpractice. There is lacking evidence that directly link the use sheepskin in
preventing sores for stroke patients or rather, available evidence reveals that medical sheepskins
are only effective in preventing pressure ulcers in elderly orthopedic patients (McGowan et al,
2000). As such, these practitioners face litigation for using inappropriate or defective equipment
in administering care to their patients. Hence, they cause harm to the patient thereby contributing
to non-maleficence.
Given the condition that Perla is suffering from, it is anticipated that she will require
frequent hospitalization as well as various forms of medical care over lengthy periods of time if
full recovery is to be achieved. Also since this condition impairs Perla’s ability to be fully
engaged in her life, it is commendable the efforts being taken by the staff in the facility to
reposition Perla on a four hourly basis. However, given that the condition fully impacts on
Perla’s ability or capacity to function, this duration is not sufficient and as such; the nurse
practitioners could be taken to be negligent (Lesage & Portenoy, 2001).
Furthermore, since Perla has limited views in regards to the care being accorded, this
raises ethical concerns relating to autonomous decision making. They disregard the perceptions
of the patient and hence neglect patient autonomy. In this light, it can be implied that the clinical
practice impedes Perla’s autonomy to act freely and in association with a self-chosen plan
(Mackenzie & Martin, 2012). Hence, although Perla is regaining from stroke which therefore
implies that her ability to make decisions regarding the care is retained, she still faces constrains

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when attempting to act upon her abilities. This therefore raises considerable ethical concerns
regarding the medical facility and their traditions to provide care that is suited to the patient’s
needs as designated by the principal of beneficence.
Summary of Evidence and Recommendations
A recent report by Norton et al (2018) presents five recommendable steps that clinicians
should follow in their practice in a bid to prevent and manage pressure injuries. These steps
include; assess and reassessing, setting goals, assembling a team, establishing and implementing
plan of care, and evaluating the outcomes. In their recommendations pertaining to each of the
five steps, the authors denote the following key issues to be addressed. In the first step, it is
recommended that clinicians should select and use validated patient assessment tools and also
seeks out any risk factors that may hinder integrity of the skin and the ultimate healing of the
wound (Norton et al, 2018).
Nurse practitioners also need to set goals for preventing and healing wounds and these
goals should in turn be precise in the identification of quality of life and symptoms exhibited by
the patient. To the facility as a medical institution, there is need to determine the most
appropriate team comprising of health care professionals who will be entrusted with preventing
and managing pressure injuries. This process should be followed by implementation of an
identified evidence based plan to rectify the causal factors such as patient needs and
environmental challenges that influence the integrity of the skin (Australian Commission on
Safety and Quality in Health Care, 2012). Finally, this process should be concluded with a
measure system that evaluates whether the outcomes have succeeded in meeting the goals of the
care (Norton et al, 2018).

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In a similar report provided by Registered Nurses’ Association of Ontario (2016), five
notable procedures were provided including; assessment, planning, implementation, evaluation
and education. Assessment primarily involves conducting health history of the patient as well as
the risk of developing additional pressure injuries. Planning comprises the development of
pressure injury plan of care but in this case, the plan should ideally make an inclusion of the
patient and a team of inter-professionals. During implementation, the patient should be
repositioned at regular intervals. Other notable activities during implementation include;
developing a nutritional plan for the patient and positioning the patient on a pressure
redistribution support surface. Evaluation entails the reassessment of the likelihood of the patient
to develop additional pressure injuries (Australian Commission on Safety and Quality in Health
Care, 2012; RNAO, 2016). Finally, it is also recommended that the facility could implement an
education program for clinicians as well as new health professionals who will focus on educating
these individuals on the measures for prevention and management of pressure injuries.
Other studies also reveal that the assessment of skin integrity is crucial in preventing and
managing pressure injuries. For instance, prior to administering skin care such as dressing,
medical practitioners are required to evaluate the integrity of the skin. Assessment tools such as
waterlow risk tools as well as body maps may come in handy. Moreover, it is advisable to
emphasize on the patient’s preventive care practices which may involve good hygiene and
nutrition, and hydration in order to alleviate the integrity of the skin. Alternatively, medical
practitioners should be flexible in their willingness to reposition patients especially those that are
deemed to be at the highest risk of pressure ulcers (Allen et al, 2017).
Suggestions for Facility to Embed Evidence into their Nursing Practice

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In regards to the five steps identified by Norton et al, there are a number of suggestions
that can help the facility in the inclusion of these recommendations within their practice
domains. For instance, to identify the causal factors that can impact the skin integrity, the facility
may focus on the patient’s physical and emotional well-being and the lifestyle as well. In
assembling the team for management and prevention, it will be worthwhile for the facility to
enlist the patient as well as the family or relatives as vital members of the team. Ideally, this will
give the patient autonomy and further enhance self-care (Arnold, 2003). It is also critical for the
plan of care to incorporate certain practices such as cleansing, managing bacterial and moisture
balance, and debriding (Norton et al, 2018).
In addition, depending on the outcomes that are measured, it is essential that the facility
reassesses the patient and the wound, and evaluate the environment in which the patient is
situated. This action could be pivotal in ensuring that the set goals have been achieved thereby
managing to successfully heal the pressure injuries. Also, the facility can do well in conducting
initial physical exams prior to administering care and this should be followed up by subsequent
examinations whenever a change is observed in the wound.

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References
Allen, T., Cordiner, C., Hardman, M., & Revill, S. (2017). Examples of Good Practice in
Pressure Ulcer Prevention in Norfolk Care Homes. Retrieved from
https://www.healthwatchnorfolk.co.uk/wp-content/uploads/2016/07/Pressure-Ulcers-
Equipment-Final-Report-Jan-2017.pdf
Arnold, M. C. (2003). Pressure Ulcer Prevention and Management: The Current Evidence for
Care. AACN Clinical Issues, 14(4), 11-28. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/14595201
Australian Commission on Safety and Quality in Health Care. (2012). National Safety and
Quality Health Service Standards. Retrieved from
https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-
Sept-2012.pdf
Lesage, P., & Portenoy, R. K. (2001). Ethical Challenges in the Care of Patients with Serious
Illnesses. Pain Medicine, 2(2), 121-130. Retrieved from
https://academic.oup.com/painmedicine/article/2/2/121/1859252
McGowan, S., Montgomery, K., Jolley, D., & Wright, R. (2000). The Role of Sheepskins in
Preventing Pressure Ulcers in Elderly Orthopedic Patients. Primary intention, 7(2), 127-
134. Retrieved from https://www.lanamed.de/data/file/McGowan_The%20role%20of
%20sheepskin___%202000.pdf

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Mackenzie, C. R., & Martin, I. M. (2015). Ethical Considerations in Chronic Musculoskeletal
Disease. Current Reviews in Musculoskeletal Medicine, 8(2), 128-133. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596179/
Norton, L., Parslow, N., Johnston, D., Ho, C., Afalavi, A., Mark, M., & Moffat, S. (2018). Best
Practice Recommendations for the Prevention and Management of Pressure Injuries.
Retrieved from https://www.woundscanada.ca/docman/public/health-care-professional/
bpr-workshop/172-bpr-prevention-and-management-of-pressure-injuries-2/file
Registered Nurses’ Association of Ontario (RNAO). (2016). Assessment and Management of
Pressure Injuries for the Inter-professional Team. Retrieved from
http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf