Nursing & Evidence-Based Practice
Evidence-Based Practice (EBP)
Evidence-based practice (EBP) is a method for critically appraising and adapting research findings for clinical practice. The purpose is to help medical personnel make better judgments about patient care by rapidly incorporating the results of the most recent studies, clinical experience, and patient preference into daily practice (Albarqouni et al., 2018). EBP strongly emphasizes using the most recent and pertinent research to make clinical decisions.
Although EPB is beneficial when implemented successfully, it encounters several barriers. These barriers can be divided into three distinct categories: organizational, clinical, and personal (Albarqouni et al., 2018). Lack of resources and insufficient organizational support are examples of organizational impediments. Clinical barriers include the complexity of clinical decision-making and a lack of clinical expertise. Finally, individual barriers include not knowing about or being unfamiliar with evidence-based practice, needing to be more resistant to implementing change in clinical practice, and relying more on one’s own experience or gut instinct than on the research.
The American Association of Critical-Care Nurses (AACN) has categorized the levels of EBP from level A to level E (Armola et al., 2009). They are Level A – Analyzing the outcomes of several randomized controlled trials or synthesizing the findings of qualitative investigations that all point in the same direction to support a particular action, intervention, or treatment. Level B – regulated, well-designed, non-randomized trials that yield consistent results in favor of a particular action, intervention, or treatment. Level C – Techniques other than randomized controlled trials (RCTs) that yield inconclusive results, such as descriptive, qualitative, or correlational studies. Level D – Recommendations based on clinical studies and peer assessment from respected professional organizations. Level E – Expert opinion or several case reports supporting a theoretical conclusion.
When delivering the highest quality treatment, all relevant evidence must be considered when making clinical choices (Armola et al., 2009). There are a variety of sources of evidence that can be used to inform decision-making. Examples of the highest quality evidence include results from randomized controlled trials, findings from other scientific approaches, including descriptive and qualitative research, and data gleaned from case reports, scientific concepts, and the opinions of experts. Evidence from studies should be considered with professional expertise and patient values when making decisions about patient care. In addition to these sources of evidence, various other sources can be used when making clinical decisions. Among these are patient-reported outcomes, which offer insightful details regarding the patient’s condition and the efficacy of any therapies they may have received.
Ethical Issues in Research
The United States Public Health Service (USPHS) launched the Tuskegee Experiment. It is the longest nontherapeutic experiment on humans in medicine to observe how African American males’ syphilis progresses if left untreated (Baker, 2014). Without their knowledge or agreement, individuals were enlisted in the study of the neurological effects of syphilis under the pretence that they would receive “special free treatment,” which turned out to be spinal taps performed without anaesthetic. Permission to participate in an experiment must be voluntary and devoid of compulsion. Unfortunately, the participants in the Tuskegee Experiment were not informed of the nature of the experiment, the hazards involved, or the fact that their syphilis was not being treated. This violation of the informed consent principle was highly troublesome. In all medical research, informed consent is a fundamental ethical principle.
Informed consent is the first important ethical concern that must be considered. It means providing all possible study participants with all the information about the research that could plausibly affect their decision to participate. The scope of researchers’ responsibilities for their subjects is an important open question. Worry also arises because a person may feel compelled to agree or not fully comprehend the nature of the commitment to which he or she agrees. Although it was with medical professionals, such as doctors and nurses, and qualified researchers who are respected in society, the Tuskegee Experiment benefited from participants with low levels of caring due to their socioeconomic status.
Throughout the Tuskegee Experiment, there was no respect for the ethical principle of informed consent. Without free and informed permission from participants, the USPHS did not do its job as a professional. The public’s trust in the medical community has been severely dented due to inadequate informed consent, prompting the introduction of stricter ethical norms for research.
Albarqouni, L., Hoffmann, T., & Glasziou, P. (2018). Evidence-based practice educational intervention studies: a systematic review of what is taught and how it is measured. BMC medical education, 18(1), 1-8.
Armola, R. R., Bourgault, A. M., Halm, M., Board, R. M., Bucher, L., Harrington, L., & Medina, J. (2009). AACN levels of evidence. What’s new? Critical Care Nurse, 29(4), 70-73. doi:10.4037/ccn2009969
Baker, A. (2014, May 3). State Version Tuskegee Syphilis Experiment [Video]. YouTube. https://www.youtube.com/watch?v=hCabkEbpM5Q