Ethical conduct in healthcare constitutes an essential ingredient in upholding patient advocacy rights and ensuring the best outcomes for patients' health status. Ethical principles of doing good and avoiding harm act as a control guide when providing healthcare after evidence-based research. The research involves scientific findings that act as evidence towards solving patient's problem. However, there exists instances when ethical safeguards may contradict the evidence-based research, especially with research involving human subjects (Melnyk & Fineout, 2015). Such cases entail lack of informed consent and confidentiality issues. Some situations may force researchers to expose someone health condition and act without seeking permission particularly when it is an emergency that requires a rapid clinical trial to address it.
Part 1: Describe why ethical safeguards designed for clinical research may not be feasible or appropriate for evidence-based practice or evidence-based practice implementation projects.
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Cases of biased and undocumented findings have been reported regarding following clinical trials that question the authenticity of report given. Every research involves thorough investigations and case studies done to give evidence. However, it can be marred by personal opinion, especially when there is no sufficient evidence to make a sound conclusion hence making ethical safeguards not feasible. Most likely, the person involved in research might not be competent enough. The ethical guidelines require information to be disclosed fully after evidence-based research (Rousseau & Olivas, 2015). However, it may violate a patient's confidentiality if the report reveals that a particular patient has a rare condition that is easily identifiable.
The guidelines require publication of all evidence-based report whether positive or negative. Schmidt and Brown (2017) asserted that such a report presents an ethical dilemma, especially to surgical researchers who are bound to abide by ethical practice in the course of their research. Thus, it becomes difficult to balance research methodology with healthcare ethics. There are high chances where DOH guidelines have been compromised at one point. Further, issues related to patient's informed consent, confidentiality, or harm could result due to human error. The ethical safeguards may also not be feasible since healthcare research is associated with multiple unethical problems, which are of profound harm to individual participants. In evidence-based medicine, some ethical guidelines are bureaucratic and inflexible in practice.
Part 2: Discuss three main ethical controversies related to implementing Evidence-Based Quality Improvement (EBQI) Initiatives.
The first entails attempts made to change quality of health regarding selected category of patients which results in harm to others by failing to make active consultation. The clinicians researched reduction of catheter-related infection in Michigan ICU (Melnyk & Fineout, 2015). The research team was informed that there was violation of ethical regulations. Another controversy involves failure by clinicians to seek informed consent following the assumption that the research was not meant to be reviewed by IRB. The body in charge of protecting human participants in research declared that the study was a clinical study aimed at reducing morbidity and costs of treatment. An additional controversy include involvement of human participants who were physicians, nurses, and patients. Formal consent was necessary as required by the OHRP. The efforts that were done to improve catheter related infections could turn out a waste of resources if there was no agreement by clinicians at Michigan and OHRP.
Describe how these controversies relate to the four core ethical principles
In seeking consent or approval, significant controversies exists when OHRP realizes that no permission was granted to carry out the research. Failure to seek consent from parties concerned leads to harm, violation of personal rights, and confidentiality issues concerning the report released. The mistake is taken seriously with severe penalties on researchers who violate the laid down regulations. Attempts made to improve healthcare quality of the patients become a controversy when several patients are not favored. Most likely, the guidelines were circumvented, the report biased and not accurate to be relied upon (Schmidt & Brown, 2017). Evidence-based research and quality initiatives require all information to be published in the public domain, whether positive or negative though this might violate confidentiality when the report is sensitive or specific.
Social value, scientific validity of research and EBQ are taken as ethical where the goal is to improve healthcare without generalizing knowledge under different methods. Fair selection while spreading risk-benefit ratio for both research and evidence-based quality improvements might conflict with ethical standards. Melnyk (2015) noted that differing independent review exists between EBQI and clinical research and associated with ethical controversy as well as respect for potential enrolled participants.
Part 3: Identify which ethical principles may be in conflict with the concept of “patients having an ethical responsibility in improving healthcare.”
Respect for autonomy and informed consent may be in conflict with the ethical responsibility of patients in improving their healthcare. Some patients may object decisions made at improving their healthcare on account that they were not involved or consulted. Physicians should respect the autonomy and decisions made by patients about their health as part of patient advocacy. Principle of independent review may also conflict when different standards are applied between evidence-based practice and clinical research involving patient’s outcomes (Rousseau & Olivas, 2015). Notably, it is recommended that questions of scientific validity, social and scientific value be used with equal measure to arrive at the best clinical decision aimed at improving patients' healthcare.
Discuss how these conflicts may be resolved
Conflicts related to autonomy and informed consent may be solved by respecting individual rights and decisions made about their healthcare. Healthcare providers should follow the will of patients and listen to their opinion regarding their health before giving out professional advice on the same. Acting against the patient wish results in conflicts and diminished trust of patient-doctor relationship (Schmidt & Brown, 2017). The medical personnel should seek the permission of the patients before executing any medical checkups to avoid unnecessary conflicts. Under independent review, any clinical research carried out is meant for the well-being of the patients. It is based on scientific findings which are not subjective to any patient’s decision. Setting equal standards in every research methodology would help reconcile possible differences and controversies that may arise from evidence-based report (Melnyk & Fineout, 2015). Severe measures put on organizations that go contrary to guidelines of evidence-based research have made research organizations more careful with their report. Cases of conflict have declined owing to strict adherence of research phases.
Conclusively, an appropriate balance between group responsibility and individual autonomy is requisite. Patients are entitled to cooperate to realize quality improvement initiatives which are justified by benefits of shared ideas. Informed consent is essential in medical research. However, for each patient, it may not be feasible where physicians use questionable professionalism in healthcare practice. Evidence-based quality improvements have a minimal risk and should always be evaluated in clinical evidence based research.
References
Melnyk, B., & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing: A Guide to Best Practice.
Rousseau, D. M., & Olivas‐Luján, M. R. (2015). Ethics and Evidence‐Based Management. Wiley Encyclopedia of Management , 1-3.
Schmidt, N. A., & Brown, J. M. (2017). Evidence-based practice for nurses . Jones & Bartlett Learning.
