Ethics and Evidence-Based Practice

Ethics and Evidence-Based Practice

Introduction

Ethics and Evidence-based research are significant factors in healthcare institutions because all the rules and principles enshrined in them are meant to standardize and improve effective medical care services (Melnyk & Fineout-Overholt, 2015). However, the principles safeguarding the healthcare practice at times differ from the evidence-based improvement of healthcare initiatives hence leading to various consequences that mostly burden the patients. In this essay, I will discuss the principles of healthcare management based on the three parts to be addressed and elaborate on the conflicts arising from each of the factors stated.

Part 1

Ethical safeguards that are created for clinical research are mostly inapplicable for evidence-based practice and projects that are related to it due to associated effects that limit the scope of evidence collection, treatment of the subject, and decision making throughout the project. Ethical safeguards that are purposely made for clinical practice limits the application and collection of data that relates to human subjects. Evidence-based practice ensures the availability of quality and best evidence regardless of the source from which it was collected.

Clinical researchers need to adhere to the ethical safeguards that are designed for research in the healthcare industry. The researchers are required to follow the ethical safeguards throughout their study. Evidence-based practices are set to ensure that all the required evidence during the research is available for the purpose of decision-making practices (Melnyk & Fineout-Overholt, 2015). The practices mean that the process of obtaining the best evidence should not be interfered with by other clinical designed ethical safeguards. For the purposes of getting high-quality evidence, evidence-based practices may interfere with safeguards in ethical practices.

The evidence-based practices encompass the use of case studies during investigations and with the use of the subjects to obtain credible information about the history of the patient to ensure the availability of best quality evidence at all times. The safeguards in the ethical measures have guidelines for the clinical researchers and limits on the kind of data that is available. The workers in the evidence-based practices are used for the production of evidence and are responsible for any evidence collected.

The ethical safeguards stipulate the models for clinical research and have rules and regulations on the person aiming to access the information collected from a patient by obtaining access from relevant authorities. The ethical safeguards used for the purpose of clinical research might be interfered with by the workers hence the reason for having rules and restrictions when getting information on patients (Melnyk & Fineout-Overholt, 2015). The ethical safeguard measures used for purposes of clinical research have the capacity to hinder the steps on evidence-based practices. The five steps in the guidelines when obtaining information from a patient include asking questions, conducting research, clinical appraisal of the available information, implementation of the findings, and evaluation of the entire research.

The ethical safeguards for clinical research require that the human subjects must have important information for the research and must also willingly volunteer to participate in the research (Melnyk & Fineout-Overholt, 2015). The evidence-based practices, on the other hand, are mandated to collect credible information that is needed to make decisions based on the clinical findings. The ethical safeguards designed for clinical research is inappropriate or not feasible for evidence-based practices during the implementation of projects because of the conflicting objectives.

Part 2

During the implementation of initiatives for evidence-based quality practices for the improvement of clinical research, there are conflicting ethics. Firstly, attempts for improvement of quality may cause harm to some patients. Some measures that are meant to improve the quality during clinical research may be impractically applicable to all patients in the healthcare facilities (Ethical Principles in Healthcare, 2018). For example, all patients are required to obtain healthcare cover from insurance companies before receiving treatment from the hospital, a policy that aimed to ensure that everyone is insured for medical cover. However, most people are poor and unable to get health insurance coverage, and this leaves out a large group without proper access to quality healthcare services, and this worsens their conditions. The health insurance policy violates the principle of beneficence that emphasizes the importance of doing good to a patient (Melnyk & Fineout-Overholt, 2015). In this case, the majority of patients that seek medical attention, whether foreigners or citizens, conflicts the sustainable development goals of achieving global healthcare.

Secondly, strategies that have the intention of improving the quality of healthcare but eventually become ineffective in the long-run lead to loss of scarce resources that would have otherwise been utilized for other purposes such as urgent needs. The allocation of healthcare resources to one department and discriminating the others violate the principle of justice, which is an indication of an open and direct conflict between the ethical policies and principles for the improvement of practical-based quality (Ethical Principles in Healthcare, 2018).

Finally, there are clinical activities that are described as a quality improvement but are practical activities for clinical research. For example, the introduction of new dialysis machines that have not been clinically tested in institutions of public health which means that if the machines fail, the healthcare facility will be unable to provide the required healthcare services. Also, the failure will result to harm on the patients seeking to use the machines for purposes of receiving treatment. Failure of the machines violates the principle of nonmaleficence, which states that you should not harm a patient. Therefore, medical care should be provided when medical professionals have verified the equipment to be used, and when he/she can operate them efficiently and effectively.

Part 3

Ethical healthcare practices and research are guided by some guidelines that are stipulated in the American Nursing Association. Beneficence is the principle of fairness to all patients. Nonmaleficence is the ethical principle for ensuring that patients are not harmed. Autonomy is the moral principle where patients have the freedom to make their healthcare decisions. Finally, justice is the principle of equal distribution of healthcare resources for all patients. Several conflicts arise during the implementation of evidence-based practices.

Firstly, during the provision of healthcare to patients, some are harmed in the process. The principle guideline of beneficence is evidence that the nurses find themselves violating this principle together with justice. The end result is that some patients benefit from the healthcare services while others do not. Secondly, there is a conflict with the available healthcare resources. There is a wastage of a lot of resources during the implementation of evidence-based research and practices which violate the guiding principle of justice (Ethical Principles in Healthcare, 2018). Wastage and mismanagement of resources deny all patients to receive equal resources. Finally, there is a conflict between research activities and quality improvement initiatives.

Healthcare professionals must be vigilant when conducting clinical research or during quality improvement. The clinicians must have a parallel control study when there is a hint of evidence-based research. The guidelines must be followed and defined to deal with the conflicts arising during the research. Seven ethical principles guide evidence-based practices. They include: the research must be based on scientific research and social values, the research must be scientifically validated, there must be a benefit to the risk ratio, there should be an independent review, the research subjects must be respected, and finally, there must be an informed consent (Ethical Principles in Healthcare, 2018). From the above principles, there are some conflicts with ethical patient responsibilities and healthcare improvement responsibility. The ethics of consent and obtaining informed consent from patients promotes conflicts with the evidence implementation strategy (Melnyk & Fineout-Overholt, 2015). The patient’s behavior changes if they are aware of their illness hence changing the research outcomes.

The other conflict is that of a fair selection of subjects. When researching various topics, the selection of subjects becomes challenging because the subjects must willingly volunteer, but they are unwilling to participate in the research. The patients are unaware that they can participate in healthcare improvement for other patients if they get involved in the research study. It is, therefore, important for clinical researchers to create awareness on the importance of research participation.

Conclusion

The ethical practice guiding the provision of healthcare services and the improvement of evidence-based quality initiatives are critical strategies of the healthcare industry, and their alignment might lead to the actualization of the sustainable development goal on global healthcare. The various conflicts between them can be practically solved, and clinical research implemented to ensure the maximum provision of healthcare services according to the ethics and principles stipulated in the American Nursing Association.

References

Ethical Principles in Healthcare. (2018). Essential Guide to Generic Skills, 107-111. doi:10.1002/9780470757925.ch14

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing and Healthcare. A Guide to Best Practices. Second Edition.