Your profile reflects your reputation, it will build itself as you create new debates, write arguments and form new relationships.
Make it even more personal by adding your own picture and updating your basics.
JoeOConnor
| Reward Points: | 4 |
| Efficiency:
Efficiency is a measure of the effectiveness of your arguments. It is the number of up votes divided by the total number of votes you have (percentage of votes that are positive). Choose your words carefully so your efficiency score will remain high. | 100% |
| Arguments: | 4 |
| Debates: | 0 |
Lindsey, I see your point regarding consent needing to be obtained when the patient is part of a study, but I think I disagree with the assertion that EBQI's are all in the form of research studies that need additional consent. In some instances, EBQI's are obtained through the review of a patient's data from previous care that brings no harm or additional intervention to a patient. In this case, why should informed consent be obtained?
Most often, informed consent is obtained when a patient is to undergo a specific intervention or to be included as part of a research study. In these instances, the risks and benefits of receiving or not receiving these interventions are discussed and the patient is given the ability to decide for themselves whether or not they choose to participate. With EBQI's, no additional interventions may be needed, making informed consent unnecessary.
Your argument about EBP and the health care worker having ethical obligations to do right by their patients is noted, but aren't EBP interventions and any subsequent quality initiatives that come from them the right thing to do for them? Technically, when a patient comes to the ED willingly and of their own accord and volition, their actions constitute implied consent. If we are to agree as health care providers that a patient's presence constitutes implied consent, then we should also agree that they consent to us performing needed medical assessments and interventions to keep them safe and to prevent any subsequent harm? Is this not the definition of beneficence and nonmaleficence?
The issue of informed consent in research-related healthcare practices is one that has spawned debate for decades. Informed consent, as its name implies, refers to the ability of a person to agree or disagree to participate in any activity, based on information given to them regarding the proposed activity. It allows the person, after consideration of all options, including the benefits and risks of all, to decide for his or herself whether they wish to participate in the proposed treatment or not. At the core of informed consent are the concepts of autonomy and self-determination, whereby a patient possesses the right to make decisions for his or herself based on wants and desires.
While most research in healthcare requires the consent of a patient to participate, it is difficult to find a reason as to why additional informed consent would be necessary for EBP and EBQI. In most hospitals and care settings, general consent is obtained upfront for routine care and general testing. Additional informed consent is therefore only needed when more invasive testing, administration of blood products, or surgical/medical procedures are deemed necessary. Having to obtain informed consent with all EBP and EBQI initiatives has the potential to delay patient care and needed interventions. Due to the fact that only MD’s can obtain informed consent, time to intervention may be increased if informed consent must be obtained by patients or their families. This, in turn, has the potential to negatively impact patient outcomes.
When further considering EBQI’s, the need to obtain additional informed consent is unnecessary, due to the fact that quality improvement initiatives are developed with data and care that the patient has already consented to and received. In addition, if a review of data is being performed in order to develop EBQI’s, informed consent should not be necessary, owing to the fact that there is no direct patient contact or intervention being performed.
Miller, F. G., & Emanuel, E. J. (2008). Quality improvement research and informed consent. New
England Journal of Medicine, 358, 765-767. Retrieved from:
The argument of whether nursing theory has provided the profession with the tools to enhance patient care is one that has existed for decades. Every theory from Dorothea Orem to Hildegard Peplau has undergone intense scrutiny to determine what, if any, impact their thoughts and frameworks have had on nursing practice. Despite multiple published articles arguing for the use of theory as a guide for nursing practice, this debate has proven that nursing theory is a thing of the past, and that evidence-based-practice (EBP) has become the new framework for nursing practice.
Theory is often recognized by nursing scholars as the foundation of the nursing profession. With the development of theory, it was thought that the nursing profession had found a way to legitimize its existence in the medical world. This, however, is no longer the case. Nursing has long been considered a necessary, academically and clinically sound profession, whose practice is built on evidenced based and scientifically studied interventions and care processes. Daily nursing practice, therefore, determines the necessity for research and patient care protocols, and not theory. Stevens (2013) argues that “the entry of EBP onto the healthcare improvement scene constituted a major paradigm shift” (The EBP movement, para. 7). Gone are the days of development of nursing theories. Nursing theory proves ineffective in defining nursing practice and directing patient care at this point in its history, as theory lends itself too much to interpretation. In today’s nursing world, evidenced-based practices “standardize healthcare practices to science and best evidence and to reduce illogical variation in care, which is known to produce unpredictable health outcomes” (The EBP movement, para. 7).
As has been stated, objective, measurement based outcomes have replaced abstract theories in the development of care. Thus, again, evidenced-based practice becomes the focus of nursing practice to enhance patient outcomes. It has been found that “EBP goes beyond research use and includes clinical expertise as well as patient preferences and values” (Conner, 2014, understanding EBP, para. 1). Considering this definition, using evidenced-based practices provides a holistic view to nursing by considering the patient’s own preferences for their care. This widely known, evidenced-based, patient-centered care, in turn, has the direct ability to improve patient outcomes. Theories, in contrast, only provide overarching themes or concepts, and provide no definitive, objective data to influence best practices or for development of best practice protocols.
Overall, nursing theories, while at one time a measure of success of nursing and framework for nursing practices, are no longer the gold standard in the development best practices. Nor should they be, as evidenced-based practices are much more definitive, objective, and measurable in nature, providing more legitimacy to the nursing profession than outdated theoretical ideas.
Conner, B.T. (2014). Differentiating research, evidence-based practice, and quality improvement. American Nurse Today, 9(6). Retrieved from: https://www.americannursetoday.com/
Stevens, K.R. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2). Retrieved from: http://www.nursingworld.org/
|
I am probably a good person but I haven't taken the time to fill out my profile, so you'll never know! |
