Nurses have the responsibility of caring for their patients and restoring their wellbeing. Usually, nursing practices are guided by the ethical principles together with the moral codes to ensure effectiveness in their practices. Often, some controversies arise from the ethical point of view, thus affecting the ability of nurses to perform their duties. This paper discusses reasons for the inapplicability of ethical safeguards in evidence-based practices, ethical conflicts that affect the application of the evidence-based initiatives for improving quality, and how these controversies relate to the core ethical codes. Finally, it discusses the ethical doctrines that may cause conflict with the moral responsibility of patients on improving healthcare.
Ethical Safeguards
One of the major reasons why ethical safeguards for clinical research may not apply to evidence-based practices is that they tend to influence the range of gathering the evidence, how treat subjects, and decision making. For that reason, the safeguards might limit the practices in the three areas. For instance, they limit the use of human beings in research and data collection. Additionally, researchers need to work following ethical safeguards and ensure the expansion of their research projects. Evidence-based practices emphasize the use of the best evidence irrespective of the source. These shreds of evidence are required for clinical decisions in society. In this case, ethical safeguards are not required to obstruct with the process of obtaining the best evidence ( Lawrence, 2019) . Among the stages of evidence-based practices include conducting investigation on-sites, the use of case studies, and the inclusion of human beings as subjects in efforts to get more accurate information on various illnesses.
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Moreover, evidence-based practices also include using the patient's medical history to help in building the research and obtain the most appropriate outcomes. This might not be catered for in the safeguards as they regulate the data that should be collected as well as individuals who should have access to a particular form of information. Nevertheless, providing evidence is crucial among evidence-based researchers. Lastly, research safeguards tend to hinder the application of the five stages used in evidence-based research ( Butts & Rich, 2019) . During the research process, evidence-based researchers engage in inquiry session where they ask the participants questions, they conduct an investigation, appraise the data collected based on their judgment, execute, and eventually conduct an evaluation.
Major Ethical Controversies
There are several implementation strategies of the Evidence-Based quality Improvement (EBQI). Leadership support, internal and external facilitation on the evaluation, feedback performance, and finally educating the patient. The ethical exemplar in the coursebook discusses the state of the American Intensive Care Units in terms of deaths through the catheter. It focuses on patient’s safety on infections and improvement ( Melnyk & Fineout-Overholt, 2015) . According to the case, healthcare should implement the evidence-based processes given by the Center for Disease Control and prevention. These procedures include washing hands, the application of full barrier protections, avoid the use of potential femoral sites for the inserting and removing of catheters.
Nevertheless, the implementation of these procedures is faced with the controversies relating to the ethical safeguard created for clinical research—the safeguards. The controversies include the fact that the ethical safeguards tend to limit the practitioners on the access to patient information and the essence of requesting consent. Additionally, it is strict on using a human being as a subject of research and using them for data collection. Lastly, these ethical safeguards may also hinder the use of the five stages of evidence-based practices.
Considering that the ethical safeguards designed for clinical research are meant to guide studies in healthcare, they influence the work of researchers within the entity. The safeguards advocates for passing information to the subjects and allowing them to decide ion being the part of the study voluntarily as opposed to being included automatically ( Stanek, 2019) . Ethics tend to hinder the ability of clinical researchers to develop evidence, which is the primary responsibility of evidence-based researchers.
These disputes relate to four principles in that they all aim at attaining the protection and wellbeing of practitioners and their patients. They ensure that patient’s rights during the healthcare process are not violated.
Conflict on Patient’s Responsibilities on Improving Healthcare
Four significant principles guide and direct health care practices. Each of these principles addresses different areas that affect the wellbeing of the patient. The first principle is beneficence. The principle emphasizes the need for practitioners to do good for the patient. On non-maleficence, it is about the importance of ensuring that practitioners do not harm their patients ( Grady, 2018) . The principle of autonomy recognizes the patient's right to decide on their health and life. The final principle is justice. This is a universal law that focuses on the need for equal distribution of resources without prejudice. The four principles are essential for nursing practices as they focus on enhancing social justice and the wellbeing of the sick.
Adequate medical care requires continuous cooperation between patients and healthcare practitioners. This partnership requires that they both take an active role in the treatment process. The ethical principles allow patients to be autonomous ( Chaiyachati & Kangovi, 2019) . Therefore, they are allowed to practice self-governance by making their choices.
The principle of autonomy is likely to cause a conflict in the patient’s responsibility for improving healthcare. For instance, it is the responsibility of patients to provide their nurses and other practitioners with a complete medical history, including their past illnesses, medication, hospitalization, family illness, and other matters that relay to their current health status. However, since it is their right to decide on their health, they might choose to provide some and leave others, thus interfering with the ability of the practitioner to fulfill their duty of ensuring their wellbeing.
It is also the responsibility of a patient to agree with their practitioners on the treatment plan. Adhering to treatment is essential for both individual and public safety, and they should always report on whether or not they are following the plan. In such a case, a patient may choose to use the autonomy principle and decide to keep the information of their adherence to the medical plan to themselves. For instance, if one decides to discontinue the medication but fails to inform their practitioners, they cause a conflict on their responsibility. Patients are required to always remain truthful and forthcoming in expressing their concerns instead of keeping their doctors in the dark ( Stanek, 2019) . Often, patients require nurses to do their best and provide them with the best services while they fail to understand their rights and balance with their responsibilities. Both patients and healthcare practitioners need to play their role well in order to ensure effective healthcare.
Solving the Conflicts
There are several techniques for relieving ethical conflicts faced by nurses in healthcare. For instance, the organization should create an environment that allows employees to air their challenges. Nursing leaders and managers can help nurses to handle the issues based on the medical rules and regulations. Another strategy is creating a supportive environment to ensure nurses are empowered and employees are well informed. Ethical experts can provide canceling for both nurses and their patients. The intervention help patients to understand the responsibility of the nurse and their need to remain ethical during their service provision.
Conclusion
One of the core principles among nurses is to ensure that they uphold the wellbeing of their patients, do good, treat all people with just, and ensure that they do no harm. However, the role of nurses is not always as easy as they face conflicts in different aspects of their work. For instance, they often face conflict on ethical principles where patients aim at playing their responsibility to improve their wellbeing. Patients tend to ignore the ethical principles, thus putting the patient at the dilemma.
References
Butts, J. B., & Rich, K. L. (2019). Nursing ethics . Jones & Bartlett Learning.
Chaiyachati, K., & Kangovi, S. (2019). Inappropriate ED visits: patient responsibility or an attribution bias?
Grady, C. (2018). Ethical principles in clinical research. In Principles and practice of clinical research (pp. 19-31). Academic Press.
Lawrence, J. (2019). The argument for Action: Ethics and Professional Conduct: Ethics and Professional Conduct . Routledge.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Box 1.3: A rating system for the hierarchy of evidence for intervention/treatment questions. Evidence-based practice in nursing & healthcare: A guide to best practice , 11.
Stanek, M. (2019). Professional ethics: the case of neonatology. Medicine, Health Care, and Philosophy , 22 (2), 231-238.
