Ethical Considerations for Evidence

Implementation and Evidence Generation

LEARNING OBJECTIVES:
AT THE END OF THE LECTURE, THE LEARNERS
WILL BE ABLE TO:
1. Explain the importance of ethics to EBP;
2. Differentiate the core ethical principles;
3. Describe the principles of ethics and how
they are imperative for all of healthcare.
 INTRODUCTION
Evidence-based practice (EBP) involves applying evidence to
practice, which should lead to improved outcomes.
The outcomes resulting from evidence implementation should
be carefully evaluated; otherwise, the confidence in applying the
evidence can be weak.
The impetus for evaluating the implementation of evidence may
arise from a commitment to EBP itself or from a commitment to
ethical practice and improving outcomes. “How evidence and
ethics interrelate is an often neglected and overlooked
dimension of evidence based approaches to health care”.
Ethical principles influence both the importance of evaluating
the impact of evidence on patients and the way those
evaluations are conducted.
 Ethical Principles
• Ethics examines issues of right and wrong, good
and bad, in any area of human interaction.
• Core Ethical Principles :
1. Beneficence: Importance of doing good for patients
2. Nonmaleficence: Importance of not harming patients
3. Autonomy: Patients’ right to make decisions about
their health, lives, and bodies
4. Principle of fidelity: Importance of trust and honesty
in ethics
5. Justice: Distribution of resources fairly among people
and without prejudice.
 Importance of Ethical Principles to ebp

1. Ethical principles influence both the importance of

evaluating the impact of evidence on patients and the way
those evaluations are conducted.
2. Ethical principles have been articulated to guide healthcare
practice.
3. Ethical principles capture the diverse range of situations in
which disagreements arise over the right thing to do or the
right way to be.
4. Ethical decision making can be seen as a method of
balancing such principles when they conflict in the complex
situations encountered in life and, particularly, in healthcare.
 ETHICAL PRINCIPLES AS APPLIED TO
RESEARCH, EBP, AND EBQI

1. Social or scientific value

2. Scientific validity
3. Fair subject selection
4. Favorable risk–benefit ratio
5. Independent review
6. Respect for potential and enrolled subjects
7. Informed consent
 ETHICAL PRINCIPLES AS APPLIED TO
RESEARCH, EBP, AND EBQI
1. Social or Scientific Value
• For research to be ethical, it should be worth doing.
EBP and EBQI activities are ethical only if they are
worth doing.
• Practitioners should identify significant clinical
outcomes that could benefit from improvements.
• The value of different proposed activities may need
to be compared to determine those that have the
potential to improve care the most, which is the
essence of EBP.
 ETHICAL PRINCIPLES AS APPLIED TO
RESEARCH, EBP, AND EBQI
2. Scientific Validity
• To be ethical, a research project must be
methodologically rigorous to ensure a well-
done study that can produce generalizable,
valid findings.
• Nonadherence to appropriate methods in the
EBP process or QI activities can result in poorly
designed or implemented projects that waste
resources and the time of those involved.
 ETHICAL PRINCIPLES AS APPLIED TO
RESEARCH, EBP, AND EBQI
3. Fair Subject Selection
• The selection of subjects for research studies should be fair so that
risks and benefits are shared equally.
• Inclusion and exclusion criteria for recruiting study participants
should be based on good scientific reasons, not convenience or
vulnerability.
• Those involved in an EBP or EBQI project should be determined
more by where the project is conducted and the population of
patients than recruitment techniques aimed at representative
sampling.
• If resources prevent improvement of care in all areas, decisions
about where to focus should be made fairly and not based on
people’s status or other irrelevant factors.
 ETHICAL PRINCIPLES AS APPLIED TO
RESEARCH, EBP, AND EBQI
4. Favorable Risk–Benefit Ratio
• Both research and EBQI should be committed
to minimizing the risks and maximizing the
gains of all studies and projects.
• Wherever possible, the risk–benefit ratio
should be improved as much as possible. This
way both beneficence and nonmaleficence are
promoted.
 ETHICAL PRINCIPLES AS APPLIED TO
RESEARCH, EBP, AND EBQI
5. Independent Review
• Independent review of research is ethically
required because of the potential conflicts of
interest. Research subjects are inherently
used as means toward the goal of new
knowledge.
• Different types of ethical review are best for
different types of EBP and EBQI activities.
 ETHICAL PRINCIPLES AS APPLIED TO
RESEARCH, EBP, AND EBQI
6. Respect for Potential and Enrolled Subjects
• Research has scientific goals, with respect for the
participants involved in the research remaining
paramount.
• In EBP and EBQI activities, respect for patients must
take precedence. Improving their outcomes is the
goal of EBQI and inherent to the nature of the
activities. As with research, it includes protecting
privacy and confidentiality, maintaining welfare, and
keeping patients informed.
 ETHICAL PRINCIPLES AS APPLIED TO
RESEARCH, EBP, AND EBQI
7. Informed Consent
• Informed consent is one of the bedrocks of clinical ethics
and research ethics.
• Participating in research is viewed as voluntary, and this
places an ethical obligation on researchers to provide
information so that people can make informed decisions to
enroll or not.
• This requirement is based on the importance of respecting
an individual’s autonomy over his or her body and health.
• Researchers must provide information about the risks and
benefits of participation and help people understand this
information.
MCQ:
1. For research to be ethical, it should be worth doing. EBP and EBQI activities are
ethical only if they are worth doing. This is?
a. Social or Scientific Value
b. Fair Subject Selection
c. Informed Consent
d. Favorable Risk–Benefit Ratio
2. The core ethical principle of nonmaleficence is?
a. Importance of trust and honesty in ethics
b. Importance of doing good for patients
c. Distribution of resources fairly among people and without prejudice
d. Importance of not harming patients
3. Participating in research is viewed as voluntary, and this places an ethical obligation on
researchers to provide information so that people can make informed decisions to
enroll or not. It is an ethical principle applied to research, EBP, and EBQI which is?
a. Respect for Potential and Enrolled Subjects
b. Favorable Risk–Benefit Ratio
c. Informed Consent
d. Fair Subject Selection