Nova Southeastern University Evidence Base Practice Discussion

I HAVE TO REPLY TO 3 DIFFERENT POST WITH 150-200 WORDS

FIRST POST

I CAN MAKE IT 3 DAYS, BUT THE FIRST POST HAS TO BE AVAILBLE BY THURSDAY

Different ethical principles can be challenged when implementing evidence-based practice. Abu-Baker et al. (2021) explains that evidence-based practice combines the greatest research evidence with clinical expertise as a guide for nurses to intervene and treat their patients. The ethical principle of non-maleficence is one that can be challenged when implementing evidence-based practice. Mentzelopoulos et al. (2018) defines non-maleficence as avoiding harm or causing the least amount of harm when trying to treat and help a patient. If a nurse is implementing evidence-based practice on his or her patient who needs to be resuscitated the nurse may put evidence-based practice before the ethical principle of non-maleficence when treating the patient. If the patient is very old and frail the nurse may be doing more harm when trying to resuscitate the patient but the nurse is simply following the evidence-based standards of emergency care. Mentzelopoulos et al. (2018) notes the principle of non-maleficence can be challenged during cardiac arrest when the issue of when to stop CPR is questioned. The nurse can be following evidence-base practice standards on CPR instead of considering that continuing CPR is causing more harm than good to the patient. Darmon et al. (2019) explains that non-maleficence suggests more than do no harm. A healthcare provider can perform a benefit/risk ratio and put a patient’s wishes first to follow this ethical principle. When implementing evidence-based practice in the intensive care unit the ethical principle of non-maleficence can be challenged. Instead of putting the patient’s wishes first as well as weighing the benefit/risk ratio a nurse can be more focused on implementing evidence-based practice to treat the critically injured patient.

References

Abu-Baker, N., AbuAlrub, S., Obeidat, R., & Assmairan, K. (2021). Evidence-based practice beliefs and implementations: A cross-sectional study among undergraduate nursing students. BMC Nursing, 20(1), 1–8. https://doi-org./10.1186/s12912-020-00522-x (Links to an external site.)

Darmon, M., Benoit, D., & Ostermann, M. (2019). Less is more: Ten reasons for considering to discontinue unproven interventions. Intensive Care Medicine, 45(11), 1626–1628. https://doi-org./10.1007/s00134-019-05740-9 (Links to an external site.)

Mentzelopoulos, S., Slowther, A., Fritz, Z., Sandroni, C., Xanthos, T., Callaway, C., Perkins, G., Newgard, C., Ischaki, E., Greif, R., Kompanje, E., & Bossaert, L. (2018). Ethical challenges in resuscitation. Intensive Care Medicine, 44(6), 703–716. https://doi-org./10.1007/s00134-018-5202-0

SECOND POST

Discuss one (1) ethical challenge of human dignity and/or human rights related to the implementation of evidence-based practice.

The purpose of evidence-based practice (EBP) is to improve quality of care; however, implementation of EBP raises important ethical issues when human participants are involved. For example, controversy exists between EBP implementation compared to clinical research. Although EBP implementation and clinical research use similar methods to evaluate outcomes, they can be differentiated based upon the generalizability of their findings (O’Mathuna, 2019). One ethical challenge of human dignity and/or human rights related to the implementation of EBP is autonomy. According to O’Mathuna (2019), the ethical principle of autonomy “acknowledges that patients have the right to make decisions about their health, lives, and bodies” (p. 681). Therefore, the ethical requirement of informed consent applies to EBP implementation activities that take on the form of clinical research. In fact, nurses are legally obligated to obtain informed consent from patients prior to carrying out an intervention or treatment (Taylor, 2018). Furthermore, implementation of EBP requires ethical consideration by healthcare professionals. Opsahl et al. (2020) describes how a mock hospital ethics committee (MHEC) impacted students’ learning about the use of evidence to support ethical decision-making in health care. The MHEC was an effective teaching strategy to help students understand the importance of ethical evidence-based decision-making for promoting optimal care and outcomes (Opsahl et al., 2020).

References

O’Mathuna, D. P. (2019). Ethical considerations for evidence implementation and evidence generation. In B. M. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed., p. 681-699). Wolters Kluwer.

Opsahl, A., Nelson, T., Madeira, J., & Wonder, A. H. (2020). Evidence?based, ethical decision?making: Using simulation to teach the application of evidence and ethics in practice. Worldviews on Evidence-Based Nursing, 17(6), 412–417. https://doi-org. /10.1111/wvn.12465

Taylor, H. (2018). Informed consent 1: legal basis and implications for practice. Nursing Times, 114(6), 25–28.

THIRD POST

Ethical Challenges of Evidence-Based Practice Implementation

When health care professionals (HCP) implement evidence-based practice (EBP), the patient’s best interests are placed front and center. Using science and research to improve patient outcomes is at the fundamental core of all healthcare professions. However, a number of ethical issues may present themselves when trying to implement EBP such as the conflict of autonomy versus beneficence. How does the HCP find the right balance between respecting a patient’s wishes while trying to guide them in making the best decision for their health? (Forte et al., 2018). Upholding the highest degree of beneficence is difficult when EBP does not align with the patient’s own values and desires or when it ends up doing more harm than good. Letting a patient decide their own course of treatment can be a harrowing experience. For example, agreeing to let a patient refuse a life-saving treatment/procedure violates the principle of beneficence. Similarly, insisting on treatment can violate patient autonomy. Vallgarda (2016) presents another perspective on these ethical dilemmas and states that, in the case of early detection of obesity, swift intervention is intended to decrease weight gain and prevent future complications. However, if the intervention ends up failing, it can lead to stigmatization and further marginalization of disadvantaged populations and end up doing more harm than good (Vallgarda, 2016. Therefore, the HCP must approach each patient’s situation with an open, empathetic mind and consider all variables. Using a framework can also help guide decision making for both patient and provider in these kinds of situations. Forte et al. (2018) outline a conceptual model that takes into account the ethics of accuracy focusing on the facts and reality of the disease, ethics of comprehension and understanding focusing on the patient experience, ethics of situational awareness focusing on the healthcare team, and the ethics of deliberation focusing on the patient-provider relationship. This conceptual model, among others, has the potential to help guide HCP in helping preserve patients’ dignity and rights while optimizing patient outcomes.

Reference

Forte, D. N., Kawai, F., Cohen, C. (2018, August). A bioethical framework to guide the decision-making process in the care of seriously ill patients. BMC Medical Ethics, 19(1), 1-8. https://doi.org/10.1186/s12910-018-0317-y (Links to an external site.)

Vallgarda, S. (2016, August). Ethics dilemmas of early detection of obesity. Scandinavian Journal of Public Health, 44(6), 543-545. https://doi.org/10.1177/1403494816652538