Ethics and the evidence based research are two crucial elements of the healthcare setups, the application of the ethics are needed to maintain the quality of the healthcare standards keeping in view the human dignity, while the evidence based researches are focused on improving the quality of life, both are equally integral and undeniable. However the difference in the scope leads to some potential conflicts.
Description of why ethical safeguards designed for clinical research are not appropriate for evidence-based practice implementation projects.
Ethics have considerable significance in every profession; though ethics are not tangible entities, nonetheless they are growing as a crucial need. In research practices and evidence-based researches, the inculcation of ethics is the common debate. Precisely defining ethics is the set of philosophical terms that are applied to professional values too. The World Medical Association has explicitly devised the declaration of Helsinki as the code of conduct for the application of ethical principles in all the medical procedures carried out for research involving human bodies. The conflict between ethics and evidence-based learning has always been the subject under debate. Medical studies and clinical practices often face this objection dilemma (Agrawal, 2013). According to my observation, the ethical structure that has been proposed for clinical research conductance. The structure proposed for conducting the research significantly limits the scope of carrying out the project, as the safeguarding structure puts a boundary limit on choosing the evidence, selecting the protocol of the research, and the ways to treat the subjects for the experimentation. The ethical safeguard structure needs the medical researcher to stand up on the tripod and fulfill the three protocols, making sure that the medical research protocol, achieves the objectives of the research and ethical safeguard principles. According to the opinion of the masses, the safeguard principles put a major limiting factor on the scope of the study. While in the opinion of the experts, the researchers should carry out the work in accordance with standards set by the ethical safeguard principles (Lawrence, 2019). The idea also strengthens the unification of the international standards of research. But the central conflict arises when it comes to finding the apt pieces of evidence. The evidence-based practice guidelines the researcher about finding the pieces of evidence after carrying out immense research on the background history. Also, it suggests devising the correlation of the subject with the other case study. Thus the evidence-based practice encourages the application of the onsite and the background knowledge for collecting the data. Therefore all these requirements compel evidence to be found within the society for carrying out medical research. Here the evidence-based practice guidelines contradict the ethical safeguards policies.
Discussion of the three main ethical controversies related to implementing Evidence-Based Quality Improvement (EBQI) Initiatives
Evidence-based practices have been the subject matter under discussion for so long; in the recent past, practical steps and initiatives have been taken to include this approach in medical practices and setting healthcare standards. Evidence-based learning offers a stepwise strategical approach for the implementation of the system. The evidence-based quality improvement initiatives are the actual steps for making the method applicable. The strategies address a number of factors, including:
- Leadership support for the implementation of EBQI
- Facilitated environment for the evaluation of the initiatives
- Establishment of patient education
- A performance feedback loop
The main objective of the EBQI is to design the healthcare standards, which can immediately bring an improvement in the healthcare standards and apply them systematically. However, the clinical research is focused on taking a rationale approach, interacting directly with the subject of research, and collecting the evidence for the reasons behind the practices. Both the EBQI and clinical researchers share the same objective of bringing improvement in clinical trials. Also, both involve human participation. The data collection strategies can differ; however, the data analysis and the processing procedures are almost the same. However, the scope varies the EBQI is mainly meant for bringing improvement in the particular medical setting, most particularly addressing the specific issue in the particular subjects. However, the evidence-based clinical research is more generalized and addresses the wider population, and tries to propose a solution that can be feasibly applied within and outside the particular institute/organization under study. For instance, recent research carried out in intensive care units (ICU) highlighted the statistics of the deaths that were anyhow related to catheter insertion. The research also brought into consideration the risk factors or the probabilities of the infections that are associated with catheter insertion in ICU patients. For collecting the evidence and collecting the subjects for identifying the potential risk involved, both evidence-based clinical research and EBQI takes two different routes. Generally speaking, the EBQI approach limits information collection and subject involvement. While the evidence-based practice takes a more detailed view of the problem and involves a larger population, particularly all those having a catheter insertion history, and filling in the questionnaire, critically analyzing the collecting information, and then rationally devising the conclusion. Thus many conflicts arise while implementing the clinical research and the EBQI in the same healthcare unit, which is: EBQI focuses on the subject population under one circumstance, thus suggesting new treatment protocol under one setup cannot be proven beneficial in the other. Like analyzing the catheter insertion risk in one setting can be generalized, might be the other healthcare unit is lacking sanitization, general care, or have patients with serious illness. While devising the ethical policies, the feasibility should be the key to remember, as the clinical researches are focused on deriving the practicality and the feasibility of the proposed changes. This might be possible that the strategies intended to be implemented are either ineffective or need more resources to be implemented.
Identification of the ethical principles conflicting with the concept of patients having a moral responsibility in improving healthcare
Ethics is an integral part of the coursework of nurses and other healthcare professionals. So not only do the EBQI standards ought to be implemented in the fieldwork but also healthcare professionals are advised to take into consideration the social and moral rights of their patients. Nursing ethics focuses on providing them with all the necessary knowledge to handle the socially vulnerable with their due rights, also about implementing the practices in a way that improves the quality of healthcare standards. Thus the ethical provision of the nurses focuses primarily on the ways to treat the sufferers and enhance the quality of life for the rest of the cohort. Ethical training is not only based on the ways in which the nurses should treat the patients but also tries to inculcate the essential attributes of the nursing profession into their personalities. Self-reflection, empathy, responsibility, and endurance are the critical ethics attributed to the nursing profession.
However, the responsibility of implementing these ethical standards nit only just relies on the shoulders of nurses and healthcare professionals alone. It’s always a two-way process; thus, in the recent parts, many theories have been put forward that emphasize the involvement of the patients in implementing these initiatives in the healthcare units.
The clinical procedures and the practices often try to involve the patient irrespective of their inclination, as they have been taught to save lives and bring improvement in the quality of their lives. However, ethical EBQI for patients put a contradicting stance from the patient’s perspective. Many ethical theories demand from the healthcare staff to take into consideration human dignity and respect the level of their self-determination. Nursing ethics encourage every nurse to take into account the healthcare requirement of each patient by establishing a professional relationship with every single patient. However, taking into consideration the patient’s needs according to the ethical standards might prove to be contradictory. Thus conflicts arise. This relationship of the nurses to patients plays additionally a clashing moral when the patients think to be treated in a way that is not in coherence with the severity of the illness and then can later be proven fatal. The medical caretakers, including the doctors and nurses, consistently build up their associations with the patients according to the professional standards while conveying their nursing administrations regarding human qualities without preference (Stanak, 2019) as the procedures and interventions are intended to bring improvement in the human life quality.
b) Discussion of how these conflicts may be resolved
As previously stated that the healthcare standards and the ethical principles share the same objective of bringing improvement in the health setups; however, the scope of both the initiatives might differ. This serves as the primary cause of conflict between the two. Yet, by taking a few feasible, practical steps, the issue between both can be significantly settled. In my opinion, the following approaches can resolve these conflicts: educating is the crucial step for practicing. Creating more and more awareness about the ethical practices in healthcare setups can bring more practical revolution. Specifically, conducting the seminars and training of the actual hospital staff, particularly field liners like nurses, can bring significant change. If the EBQI agencies sponsor the books and magazines regarding these ethical standards, then it can significantly contribute to educating the patients within each hospital setup. Thus the public masses will also be aware of the criteria according to which they should be dealt with in any healthcare department.
The involvement of the field workers: like the doctors and the nurses, before devising this healthcare and the ethical standards should be more encouraged. As on the call, nurses exhibit evidence-based learning. Thus they can more effectively tell about the problems they have encountered while following these practices. So this will help in setting realistic, generic, and feasible standards that could be implemented in any healthcare setup.
Agrawal K. (2013). Ethics and evidence-based research: Is there a conflict?. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 46(1), 9–10.
Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.
Lawrence, J. (2019). Argument for Action: Ethics and Professional Conduct: Ethics and Professional Conduct. Routledge.
Review the sectioned headed, Two Ethical Exemplars in Chapter 22 of the textbook (Melnyk and Fineout-Overholt, 2015, pages 518-519
Stanak, M. (2019). Professional ethics: the case of neonatology. Medicine, Health Care and Philosophy, 22(2), 231-238.