Health Care and Nursing: The Ultimate Guide

Part 1: 

When it comes to improved healthcare quality, every healthcare system across the globe is geared towards this policy objective. Research implementation refers to the technical study of approaches promoting the systematic approval of findings of clinical research into a monotonous clinical practice thus reducing care which is inappropriate. It encompasses the study of healthcare influence on professionals’ methods and behavior so as to allow them to use the research findings effectively. In almost every profession, there are ethical requirements. In healthcare, ethics are considered to be well-known entities. Nursing practice which is evidence-based tends to be a global phenomenon. Its main purpose is guiding and standardizing the practice of nursing based on the exclusionary measurable scientific review. Evidence-based practice tends to be considered as a crucial element for the purposes of improving health services quality as well as achieving brilliance in patient care. This technique relies on evidence collected in the field from a report or research. The problem between ethical safeguards and evidence-based practice is that at one point one must employ ethical, safeguards 

All the same ethical safeguards designed for the purposes of clinical research may be inappropriate for evidence-based practice or evidence-based practice implementation projects. Ethical dilemmas have been faced by surgical researchers’ numerous times. Ethical dilemmas may have a negative impact on the evidence-based practice, thus making it unsuitable for healthcare needs. Ethical dilemmas tend to be health care enterprise natural part. Before evidence-based practice, ethical safeguards existed, and they are always present even if the evidence-based practice is absent. Unlike the ethical safeguards, evidence-based practice has a number of shared options which make it more appropriate on its own rather than with the combination of ethical safeguards. More so, evidence-based practice tends to be more specific due to the fact that its limitations are clearer in rehabilitation and occupational therapy. Evidence based practice with its aspect of using the present and best evidence in making decisions concerning the care of patients tend to be complex in its own way and thus not feasible with the ethical safeguards since they would make it more complex. 

Furthermore, feasibility between the evidence-based practice and ethical safeguards is impossible because of a number of things. First, there are some types of ethics which are not contained in the evidence-based practice. For instance, evidence-based practice discounts or downgrades knowledge types which practitioners use and that might be of great significance for suitable practice. They include intuition, anecdote as well as experience. Evidence-based practice in health care appropriately fits with practice areas which are tightly defined such as pharmacology in particular but still fits other areas which are skill-like such as nursing and surgery. Secondly, evidence-based practice operates “counter to patient-centered care” which is particularly concerned with continuation; a type of knowledge discounted by evidence-based practice which is usually specific to circumstances or case. Through insisting that all the practices are based upon updated research evidence wherever it is obtainable, the care which patient-centered and needs intuition and knowledge which is case-specific is undermined. Evidence-based practice may employ its guidelines and protocols which are used as a practitioners’ guide. Thirdly, there is a randomized controlled trial (RCTs) testable which is not similar the most effective. Then finally there is the decision based on evidence-based practice might be unjust. 

Part 2: 

In attempting to implement Evidence-Based Quality Improvement (EBQI) Initiatives, many controversies arise that can affect the realization of the desired outcomes and the replicability of the outcomes. Such controversies are evident in the reactions to the implementation of Evidence-Based Quality Improvement (EBQI) Initiatives during the Michigan ICU study and Spanish ICU study. Both studies focus on the use of evidence-based strategies to improve the quality of care delivered to patients and thus reduce morbidity and mortality. The main source of these controversies is the ethical concerns regarding Evidence-Based Quality Improvement (EBQI) Initiatives. 

The primary ethical issue here is the issue of informed consent. Any procedure, as well as its evidence-based variation, can only be conducted upon informed consent from the patients. It is controversial that during the introduction of any practice, the practice is considered experimental at best. As a result, the patients have to consent to the suggested evidence-based practice as being part of trials of an unsubstantiated procedure or practice. If practices are conducted without patients’ consent as it was in the Michigan ICU study, the patient’s rights are violated (Melnyk & Fineout-Overholt, 2015). However, it is challenging to have patients consent to a new practice. Without patients willing to try a process it is difficult to make it mainstream since the level of evidence required to make it mainstream is high. 

Another controversy is that the low level of evidence to support the evidence base practice may sometimes hinder the justification of the adoption of the practices. As a result, healthcare workers in most cases adopt the practices on the benefits of beneficence and non-maleficence (Melnyk & Fineout-Overholt, 2015). The trust they are ethically doing the best for the patients as well as protecting the patients from harm. They are doing their duty, yet they risk being called out for sanctioning experimental procedures that do not have the interest of the patient catered for. 

In a nutshell, adoption of Evidence-Based Quality Improvement (EBQI) Initiatives faces controversies and ethical challenges. The controversies and challenges indicate a need for reviewing research ethics and having appropriate ethical standards to guide evidence-based research and Evidence-Based Quality Improvement (EBQI) Initiatives. 

Part 3: 

Ethics refers to the principle describing whatever that is usually expected in terms of correct and wrong and right in the basis of conduct. For instance, nurses in most cases are usually held to the ethical principles which are embodied in the American Nurses Association Code of Ethics. Ethical and ethics practice are combined into all facets of nursing care. Ethical thoughts and principles are classified into two major parts; these are deontology and utilitarianism. “Deontology is the ethical school of thought that requires that both the means and the end goal must be moral and ethical, and the utilitarian school of ethical thought states that the end goal justifies the means even when the means are not moral” (Registered Nursing.Org, n.d.). Deontology is usually focused on the wrongness or rightness of an action while utilitarianism ignores individual privileges thus considering the greatest majorities welfare as the most important factor. 

There are a number of general ethical principles which all the nurses are required to adhere to, these general principles include justice, accountability, informed consent and autonomy, nonmaleficence, veracity, fidelity and confidentiality, and beneficence (Williamson 2014). 

Fidelity and Confidentiality 

These are concepts which are faced in the daily operations and duties of nurses and healthcare systems. Fidelity is about being honest and loyal to the patients, telling them the truth and what they need to know. For example, after conducting a certain test like HIV test telling the patients the truth about the results is mandatory and an obligation that every nurse has. Confidentiality is also fundamental, and every nurse and healthcare system must embrace it and therefore keep the patient’s information to them alone. For instance, after conducting the test, it is a must that the result of the test remains with the healthcare facility as well as the nurse only and not passed out to other parties. 

Autonomy 

This ethical principle refers to the rights of an individual to freedom, independence, and self-determination in making their individual decisions. Nurses and healthcare systems are expected to respect the rights of their clients to decide on matters concerning their own health. Even if not in agreement with the client, this principle must be respected by the healthcare system as well as the nurses. 

Beneficence 

This principle has it that all health care practitioners must do everything within their power to ensure that their clients benefit in all situations. All the recommended procedures, as well as treatment, must b for the purposes of doing good to the clients. To maintain this, it is a requirement for the medical teams to maintain and keep on developing high-level knowledge and skills and also ensure that they are equipped with the best and current medical practices. 

Non-maleficence 

This principle is for the purposes of ensuring that no harm is done to the clients. The principle ensures that medical practitioners do more good than harm to their clients. 

Justice 

This principle states that at no points should there be unfairness in the medical decision; fairness should be evident in every aspect in the healthcare system. Medical practitioner must uphold justice in all their operations. 

Informed Consent 

This principle means that for any procedure to be done on a client, the client must have given the go-ahead to the medical facility or heal care practitioners for the procedure to be carried on. 

Accountability 

This principle is about accepting the responsibility of individuals’ actions. Healthcare practitioners are accountable for all their actions in nursing care 

Nurses understanding these ethical principles and put them into practice in their daily duties have the power to influence others behaviors successfully. Ethical principles should be put in practice in an open and clear environment and be founded on a complete ethical decision-making model employing the suitable guidelines of evidence-based practice available (Parker, 2007). 

References 

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice . Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. 

Parker, F., (Nov. 26, 2007) Ethics Column: "The Power of One" OJIN: Online Journal of Issues in Nursing. Vol. 13 , No. 1. 

Registered Nursing.(n.d). Ethical Practice: NCLEX-RN . Retrieved from https://www.registerednursing.org/nclex/ethical-practice/ 

Williamson, L. (2014, June 3). Patient and Citizen Participation in Health: The Need for Improved Ethical Support American Journal of Bioethics 2014 Jun 3; 14(6): 4–16. DOI: 10.1080/15265161.2014.900139