Discussion post replies 7

Instructions: The response is a substantive interaction that builds on the ideas of others, delving deeper into the discussion question and course content in response to a colleague. The response includes one reference from a professional peer-reviewed scholarly journal.

(Replying to Maria SM)

Evidence-based practice (EBP) allows for many improvements in the healthcare setting. However, ethical challenges with regards to human rights and human dignity affect the subjects in which the evidence is being tested on. Informed consent and patient beneficence are a huge ethical dilemma in EBP since they affect patients directly. West et al. (2017) look at ethical challenges in dementia patients and talk about he importance of obtaining proper informed consent in order to find out the best possible outcomes in different patients with dementia. Oftentimes, there is the dilemma of doing no harm and undergoing possible risks when performing the experiment. Lee et al. (2019) talk about the importance of emotional expression for dementia patients and how those specific communication skills are most important to preserve human dignity. Many times, during randomized controlled trials, patients are unaware of the interventions being tested or whether that intervention will be an issue in the patient's health in the long run, especially since there should be no harm for the patient at all times. Since these are trials, sometimes we have no idea how the interventions will affect the patient overall.  This is why informed consent is so important in order to go over all the risks and benefits of the study at the discretion of the patient. 

 

Reference

Lee, K. H., Lee, J. Y., Boltz, M., & McConnell, E. S. (2019). Emotional expression of persons with dementia: An integrative review with implications for evidence‐based practice. Worldviews on Evidence-Based Nursing, 16(5), 344–351. https://doi.org/10.1111/wvn.12395

West, E., Stuckelberger, A., Pautex, S., Staaks, J., & Gysels, M. (2017). Operationalising ethical challenges in dementia research: A systematic review of current evidence. Age & Ageing, 46(4), 678–687. https://doi.org/10.1093/ageing/afw250

(Replying to Analuz)

Implication of Evidence-Based Practice and Human Rights

The importance of the implementation of evidence-based practice (EBP) is regarded as top priority in healthcare. EBP use can yield highly effective outcomes for patient care. However, there are times when human dignity is overlooked when implementing EBP. There have been a number of issues that disregard fairness, equality, diversity, and personal rights for implementation of preventive interventions (Leadbeater et al., 2018). Particularly related to equality, some studies may favor persons who have a higher education or someone from a specific ethnic background. Violations of ethical principles including integrity, autonomy, beneficence, and justice can occur when researchers are recruiting people to serve as study participants, attempting to convince sponsors that their research study is worth funding, and persuade editors that their findings are worth publishing (Lach et al., 2018). Adashi et al. (2018) lists three basic principles that guide the protection of human subjects; those are, respect for persons, beneficence, and justice. Every patient has the right to be treated with dignity and respect. The master’s prepared nurse must take into consideration these principles when applying EBP in order to avoid unfair patient care.  

References

Adashi, E. Y., Menikoff, J. A. & Walters, L. B. (2018). The Belmont Report at 40: Reckoning with time. American Journal of Public Health, 108(10), 1345–1348. https://doi.org/10.2105/AJPH.2018.304580

Lach, H. W., Loman, D., & Oerther, S. (2018). Scientific integrity: Avoiding the dark side of research. Western Journal of Nursing Research, 40(11), 1579–1580. https://doi.org/10.1177/0193945918793081

Leadbeater, B. J., Dishion, T., Sandler, I., Bradshaw, C. P., Dodge, K., Gottfredson, D., Graham, P. W., Lindstrom Johnson, S., Maldonado-Molina, M. M., Mauricio, A. M., & Smith, E. P. (2018). Ethical challenges in promoting the implementation of preventive interventions: Report of the SPR task force. Prevention Science, 19(7), 853–865. https://doi.org/10.1007/s11121-018-0912-7

(Replying to Liz L)

Evidence-based practice (EBP) is the highly regarded standard of care adopted by successful providers and institutions. As the transition is made from outdated practice to EBP, there is a concern for in institutional interpretation of EBP as a one one-size fits all script of care (Dreyer et al., 2017). When interpreted incorrectly, institutional authorities may promote EBP as means to discard judgement in practice. Unprecedented ethical dilemmas may arise when key aspects of EBP are left out of clinical practice, such as individual patient preferences (Dreyer et al., 2017).

     Ethical dilemmas may be encountered in the critically ill patient who does not have a good prognosis despite provided EBP care. The clinician has a practice guide to follow for the treatment of such illness, but at what point is the treatment plan deemed futile and appropriate to start the end-of life conversation? The solution to such dilemma is not an easy one, however, Berlinger and Naylor (2016) support that it is a system’s responsibility to promote ethical patient care that maintains the patient’s wishes as a priority.

References

Berlinger, N., & Naylor, M. (2016). Transition care: A priority for health care organizational ethics. Hastings Center Report. 46 39-42.  https://doi.org/10.1002/hast.631 (Links to an external site.)

Dreyer, P., Haar, A., Martinsen, B., & Norlyk, A. (2017). Lost in transformation? Reviving ethics of care in hospital cultures of evidence-based healthcare. Nursing Inquiry. 24(3).  https://doi.org/10.1111/nin.12187 (Links to an external site.)