Ethics and Evidence-based Practice
Introduction
Ethics and evidence-based research are crucial aspects of healthcare organizations since the principles and rules enclosed in them are meant to improve and standardize effective medical care services. Ethics is the code of conduct that guides a person on how to behave in certain situations. During the research, ethics helps a researcher to ensure that the interests of all the participants are put into considerations. The code of ethics for researchers requires them to obtain written consent indicating their willingness to participate in the study. Additionally, researchers must inform all authorities and organization involved in the regulation of research before the commencement of research. Thus, ethics plays an important role in evidence-based research.
Why Ethical Safeguards designed for Clinical Research may not be Feasible or Appropriate for Evidence-based Practice
Often, clinical research uses ethical safeguards that do not apply to evidence-based practice due to certain reasons. First, the ethical safeguards reduce the scope of treatment of the participants, gathering of evidence, as well as making decisions. The safeguards designed for clinical research reduce the use and gathering of information relating to human subjects. However, the primary goal of evidence-based practice is to ensure availability of information regardless of the source. Clinical researchers normally ensure they follow the ethical safeguards, which help them to expand their research projects (Guraya, London & Guraya, 2014). Since EBP aims to obtain evidence for clinical practice and decision-making, the application of these ethical safeguards may obstruct the process of collecting sufficient evidence.
Further, there are a series of steps involved in EBP to help in making a clinical decision and obtaining information. Consequently, ethical safeguards could be violated in clinical practice since some of the information may not be shared. For this reason, it may not be appropriate to use ethical safeguards in EBP projects since the objectives could lead to a conflict. Ethical safeguards may be a hindrance to EBP, which means that the use of case studies, on-site investigations, and human subjects to gather data may be limited. Additionally, EBP involves a process of obtaining information concerning the history of the patient and using it for clinical research. In the context where EBP is used to manage chronic constipation among the elderly, healthcare organizations are in an emergency that requires action. Essentially, ethical safeguards may restrict the collection of evidence from patients’ history, which means a lower quality of care. Following these guidelines may also making decision making slower, which then affects the facility negatively.
Ethical Controversies Related to Implementing Evidence-Based Quality Improvement (EBQI) Initiatives and how these Controversies Relate to the Four Core Ethical Principles.
Lack of effort to upgrade quality through evidence-based quality improvement (EBQI) leads to violations of principles of beneficence and nonmaleficence. Additionally, if EBQI fails to provide similar treatment to all patients, there might breach in the principle of autonomous decision-making and justice, especially where consent is not granted. One of the controversies that surround EBQI is where a similar process of consent should be applied in clinical research. Another controversy arises when assessing whether it is ethical to perform EBP in one context and use conventional and deficient practice in another context. The third controversy roots from the informed consent, which may not be given by the patient using traditional care.
EBQI may be performed using certain strategies some of which are external and internal facilitation in providing an assessment of patient education, performance feedback, and leadership support. Some of the ethical examples outlined by Melnyk, & Fineout-Overholt (2015) are deaths that happen in various intensive care units in the United States annually due to catheter-related infections. The exemplar discusses the need to enhance patients’ safety. Additionally, the authors emphasize the need to use EBP procedures as recommended by the Center for Disease Control and Prevention (CDC).
As previously mentioned, the application of ethical standards in clinical research restricts the involvement of human subjects in research. Therefore, it limits the amount and quality of information gathered. In EBP, researchers produce evidence, but ethical safeguards limit the individuals who should access the information regarding the patient as well as obtaining their consent. In other words, ethical safeguards influence how researchers behave within a practice. Additionally, the use of application ethical safeguards in clinical studies can hinder the five steps involved in evidence-based practice (Leadbeater et al., 2018). Bypassing these steps signifies that quality healthcare will not be attained.
The decapitations are connected to the ethical principles of beneficence, nonmaleficence, justice and self-direction. In a clinical situation where a health organization wants to reduce chronic constipation among the elderly, it might sound controversial to get consent from patients who are already obtaining care and facings risks related to constipation. Moreover, it may be controversial to use ethical principles in regards to autonomy since the patients may need stabilization before making a significant decision.
Ethical Principles may be in Conflict with the Concept of “Patients having an Ethical Responsibility in Improving Healthcare
In some situations, strategies designed to ensure the quality of care might end up ineffectual and waste of scarce resources. Melnyk and Fineout-Overholt (2015) believe that EBQI is likely to contrast ethical principles. Efforts made to enhance care quality for one patient may harm other patients. In nursing, ethical principles are critical since they ensure the improvement of welfare for the sick, vulnerable, and injured. Additionally, nursing ethics are crucial in providing effective care and preventing disease. Nurses play an important role in addressing issues like social structures that hinder the provision of high-quality care and patients welfare.
Moreover, the principles that influence ethical responsibility resolving conflict include respect to human dignity, relationship with patients, type of health issue, and the right for self-determination. It is important to respect human dignity since it reduces the chances of harm. Nurses need to maintain values of patients in professional relationships. Although the provision of universal care is essential, patients have diverse needs, which may lead to ethical conflict. There is also a need to maintain a balance between the needs of the patients and those of the care providers.
Ways of Resolving the Conflict
In a healthcare setting, several strategies can be used to resolve ethical conflicts. One of the ways of resolving ethical conflict is by establishing a setting that promotes the ability of the nurse to present their opinions on care improvement. When it comes to clinical research, it is significant to have a fair way of selecting the subjects, by specifying the exclusion and inclusion criteria. The criteria should be presents in a way that can be scientifically proven rather than for convenience. Melnykand and Fineout-Overholt (2015) cite that patients used in EBQI projects need to be selected from a population served by the healthcare organization rather than the ability to generalize outcome findings. Additionally, it is crucial to maintain a promising risk-benefit ratio in EBP. The EBP projects and research should seek to maximize the gains while minimizing the risks of all studies.
Furthermore, there is a need to perform an independent review in the course of the study. The reviews can help to identify the potential conflicts of interests as well as the violations of human rights. The researchers also need to respect both the potential and already enrolled participants. According to Melnykand and Fineout-Overholt (2015), the most basic requirement of EBQI and research is to ensure the well-being of human subjects. The patients have the right to refuse EBP treatment and the nurses need to respect those decisions.
Conclusion
In the context of the healthcare organization wants to make changes to reduce chronic constipation among the elderly, it is vital to empower the nurses in their attempt to resolve the challenges. Giving support to the nurses can help them resolve the conflicts as well as ethical issues present. Moreover, in a healthcare environment, there is an increased need to have an ethical specialist to provide direction to the patients and nursing professionals. Another way of resolving conflicts is by implementing ethical principles while ensuring that ethical responsibility is offering journals and books that help in understanding the issues and addressing the conflict. For the nurse who wants to prevent constipation among the elderly patients, they will use these resources to know how they can make ethical decisions. However, they should focus on the welfare of the patients while implementing these measures.
References
Guraya, S., London, N., & Guraya, S. (2014). Ethics in medical research. Journal of Microscopy and Ultrastructure, 2(3), 121. doi: 10.1016/j.jmau.2014.03.003
Leadbeater, B., Dishion, T., Sandler, I., Bradshaw, C., Dodge, K., & Gottfredson, D. et al. (2018). Ethical Challenges in Promoting the Implementation of Preventive Interventions: Report of the SPR Task Force. Prevention Science, 19(7), 853-865. doi: 10.1007/s11121-018-0912-7
Melnyk, B., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare. Philadelphia: Lippincott Williams & Wilkins.
