Why Ethical Safeguards Designed for Clinical Research May Not Be Appropriate For Evidence-Based Practice
Clinical research is a way to solve problems in regards to community health by arriving at the best possible decisions associated with care based on clinician observations, client reports, and research data. Research helps to improve patient outcomes while advancing the discipline and practice of providers. On that note, clinical research enables the testing of new methods in hypothetical situations that pave way for evidence-based practice. It means that the rules for clinical research are not suitable for evidence-based practice since the latter requires the use of proven methods to handle real-life situations
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The rules are different since researchers encounter challenges and ethical dilemmas as they engage in research. The first is when the researcher disrespects or does not acknowledge the culture and spiritual beliefs of the participants. The research will not be meaningful to society if it does not conform by its beliefs and values. For instance, a researcher may handle a person of a particular denomination in a disrespectful manner or subject/him to procedures that intrude on his/her religious beliefs. This lack of cultural appeal has the potential to harm the collection of accurate results. It may make the participants lie or reluctantly give responses, thus leading to wrong inferences. On that note, the lack of cultural empathy can interfere with the research process. Research must recognize the underlying spiritual beliefs of the participants to conduct ethical research.
On the other hand, evidence-based practice is based on ethical treatment. A health provider can engage in the spiritual care of individual, community, self, and colleagues by practicing the concept of ethical treatment. Ethical treatment involves an essential blend of insight into the ethnic culture, human rights, and spiritual beliefs ( Kuluski et al., 2017) . Strong recognition of ethical principles is the first step towards good decision making in natural disaster scenarios. It is crucial to consider the religious and cultural beliefs of people and communities by taking a kind and non-judgmental approach. This approach would enable one to understand their underlying views and what they are going through to help them effectively. The spiritual perspective enables social workers to consider cultural and religious beliefs when attending to people and communities; this is the basis for evidence-based practice hence the different rules from clinical research.
Ethical Controversies Related to controversies related to implementing Evidence-Based Quality Improvement (EBQI) Initiatives
The first controversy pertains to the skewing of results of clinical research to enable the EBQI initiative. To avoid skewing of results, a community organization needs a universal method for its researchers to present results without making errors. It is essential for healthcare workers to find out how they can allocate various resources to different patients by focusing more on those that need them most. All health facilities and their physicians have the responsibility of giving out accurate information to ensure the medical procedures which are conducted afterward are justified. Since skewing happens in the professional realm, researchers should be at the forefront in creating a process for reporting ethical violations to ensure practitioners uphold the best standards. The policy for reporting ethical violations is vital to ensure that such incidences are handled appropriately and to mitigate future occurrences ( Aitamaa et al., 2016 ) . Every professional nurse adheres to ethics. In the case of community health providers, they are controlled by the ACA Code of Ethics. On that note, it is the responsibility of a practitioner to ensure colleagues obey the rules of the occupation, including reporting any ethical violations. It is the moral duty of a professional to report any colleague who is violating the firm’s code of ethics by following the stipulated procedure.
Another ethical controversy pertains to the clash between a provider beliefs and a patient’s worldview. A provider should ensure they are guided by the ethical principles of utilitarianism and deontology when attending to a person with a different worldview. Utilitarianism is a moral theory through which the right choices are implemented to ensure that minimal harm is done to any involved parties. Through this theory, different courses of action, together with their consequences, have been evaluated before they are drafted into the conduct policy ( Aitamaa et al., 2016 ) . Each course of action is evaluated to determine the benefits and drawbacks. In regards to deontology, the focus of the theory is on the consequences that come with all efforts. It believes that people should operate according to their obligations and responsibilities, and this is expected in the workplace. It purports that when it comes to morality, it is as much a responsibility as it is a duty. The ACA code of conduct denotes the kind of honesty that is expected at the workplace, which is everyone’s duty to uphold. The selected courses of action are unique to the organization and only work for the benefit of the organization.
Research Planning
Community health providers are focused on the needs of a patient and the community. On that note, research should focus on the holistic needs of a patient if he/she is to provide the most effective treatment. The issue requires the implementation of evidence since health providers are at the core of a patient’s treatment plan, and there is evidence-based research that shows how nurses can take a holistic approach ( Kuluski et al., 2017) . This task begins with research certification. Certification ensures the professionals undertaking research have the needed competencies and will show ethical responsibility when performing analysis. The second thing is to justify why the research is targeting a specific population. It relates to the purpose of the study. Another essential consideration is the type of research method uses, as it ensures the results are valid and accurate.
The last controversy is related to initiative planning and execution whereby the focus of health professionals may be deflected. Health providers are focused on the needs of a patient and the community. On that note, research should focus on the holistic needs of a patient if he/she is to provide the most effective treatment. The issue requires the implementation of evidence since health providers are at the core of a patient’s treatment plan, and there is evidence-based research that shows how nurses can take a holistic approach ( Kuluski et al., 2017) . This task begins with research certification. Certification ensures the professionals undertaking research have the needed competencies and will show ethical responsibility when performing analysis. The second thing is to justify why the research is targeting a specific population. It relates to the purpose of the study. Another essential consideration is the type of research method uses, as it ensures the results are valid and accurate.
Clash between Ethical Principles and Ethical Responsibility of Patients
The ethical principles that may be in conflict with the concept of “patients having an ethical responsibility in improving healthcare” include beneficence and non-maleficence. The beneficence principle means do no harm. However, due to ethical dilemmas, the beneficence must be balanced to see if the benefits outweigh the risks. Beneficence entails balancing the benefits of treatment against the costs and risk involved. The non-maleficence principle states that healthcare workers have a primary obligation to help others. More importantly, it requires the obligation to advance the legitimate interests of a patient ( Skourou et al., 2018) . Each ethical dilemma has and legal implication for a patient’s legal time. The severity of these legal implications varies significantly. , they face the risk of litigation since they would have committed harm to the patient. The basis for litigation for this case will be related to failing to show the level of care that a prudent and reasonable health professional would under the same circumstances, negligence, and disregarding the role of a health care worker ( Patuzzo & Pulice, 2017) . The litigation and review of the professional licenses of the workers involved can lead to loss of a license or reprimand of a worker’s license.
The conflicts can be resolved by availing certain key resources to patients. The first resource that can be used to make a patient’s intention clear is an advanced healthcare directive. This is a legal document in which the patient states what action should be taken in the case that he/she is no longer able to decide due to incapacity or illness ( Ogilvie, 2017) . The advanced healthcare directive should be used to clarify a patient’s position to the health care professionals. The second resource applicable in this case is the healthcare power of attorney (HCPA). The HCPA is a legal document that enables a person to empower another individual with decisions regarding his/her healthcare and medical treatment (Coleman, 2017). It is logical that for a patient to have a HCPA since it clarifies his/her wishes.
There are also certain policy recommendations that can enable resolution of the conflicts. The first policy is that the policy should require patients to have an advanced healthcare directive or HCPA. The presence of such legal documents will enable the hospital to take action in accordance with the client’s desires thus avoid an ethical dilemma. The second policy pertains placing the opinion of the medical team first. A patient’s medical team is the party that is well positioned to decide what is best for the patient. On that account, their decision should be placed above those of legal caretakers since they are acting in the best interest of the patient. The last policy is the use of substantial evidence. As such, a hospital should implement a substantive evidence policy so that actions can be based on proof rather than assumptions.
References
Aitamaa, E., Leino-Kilpi, H., Iltanen, S., & Suhonen, R. (2016). Ethical problems in nursing management: the views of nurse managers. Nursing ethics , 23 (6), 646-658.
Coleman, C. (2017). When Does Healthcare Ethics Consultation Constitute the Practice of Law. Jotwell: J. Things We Like , 1.
Kuluski, K., Ho, J. W., Hans, P. K., & Nelson, M. L. (2017). Community care for people with complex care needs: bridging the gap between health and social care. International journal of integrated care , 17 (4).
Ogilvie, W. (2017). EMS, Legal and Ethical Issues.
Patuzzo, S., & Pulice, E. (2017). Towards a European code of medical ethics. Ethical and legal issues. Journal of medical ethics , 43 (1), 41-46.
Skourou, C., Sherouse, G. W., Bahar, N., Bauer, L. A., Fairobent, L., Freedman, D. J., ... & Ozturk, N. (2018). Code of Ethics for the American Association of Physicists in Medicine (Revised): Report of Task Group 109. Medical physics .
