Evidence-Based Practice and Ethical Nursing Care

Evidence-based practice

A problem-solving approach to clinical decision-making that integrates the best available research with clinical expertise and patient preferences.

• Best external evidence

• Clinical expertise

• Patient values and preferences

The 3 components of EBP

• Improves patient outcomes

• Standardizes care

• Optimizes cost efficiency

• Empowers nursing practice

Importance and clinical impact of EBP

PICOT

Searching literature without a structured question yields thousands of irrelevant search results. This creates a targeted search string in databases like PubMed, CINAHL, and Medline.

Patient/population, Intervention, Comparison, Outcome, and Time

PICOT framework stands for?

Ethics

Branch of philosophy addressing values relating to human conduct (rightness/wrongness of actions)

Bioethics

Applied ethics in healthcare addressing dilemmas created by medical advancements and complex client scenarios

Moral distress

Occurs when the nurse knows the ethically correct action to take but feels powerless due to institutional constraints

Autonomy

• Agreement to respect another’s right to self-determine a course of action

• e.g. Supporting a competent patient who refuses chemotherapy or requests a DNR

Beneficence

• Compassion; taking positive actions to help others

• e.g. Holding a surgical patient’s hand during spinal anesthesia; administering prescribed analgesics before wound dressing changes

Nonmaleficence

• “Do no harm”; core commitment to avoiding injury

• e.g. Double-checking high-alert medication doses before administration

Fidelity

• Agreement to keep promises; loyalty and faithfulness to professional duty

• e.g. Returning to re-assess a post-op patient’s pain within 30 minutes after promised

Veracity

• Commitment to tell the absolute truth

• e.g. Answering a patient honestly when they ask if a central line insertion will hurt, rather than lying to calm them

Justice

• Fairness in care delivery and equal allocation of resources

• e.g. Triage prioritization in emergency rooms or allocating ICU beds based on acuity, not insurance status

Negligence

[UNINTENTIONAL TORT]

• Carelessness or failure to act as a reasonably prudent person would under similar circumstances

Malpractice

[UNINTENTIONAL TORT]

• Professional negligence (failure to meet the accepted Standard of Care causing injury)

ASSAULT

[INTENTIONAL TORT]

• Action causing fear of immediate harm/battery (e.g. “If you don’t take this pill, I’ll tie you down”)

Battery

[INTENTIONAL TORT]

• Unlawful physical contact without consent (e.g. Administering blood products against a Jehovah’s Witness’s written refusal)

False imprisonment

[INTENTIONAL TORT]

• Unlawful restraint of physical movement (e.g. applying soft wrist restraints without a physician’s order or clinical rationale)

Duty owed to the patient

[4 ELEMENTS OF NURSING MALPRACTICE]

• Nurse-patient relationship established upon taking assignment

• e.g. Assigned to care for post-op bed 4

Breach of duty

[4 ELEMENTS OF NURSING MALPRACTICE]

• Nurse failed to conform to the established standard o care

• e.g. Failed to check side rails/call bell after administering IV sedatives

Causation

[4 ELEMENTS OF NURSING MALPRACTICE]

• The nurse’s breach directly resulted in the injury (proximate cause)

• e.g. Patient tried to climb out, fell, and sustained an injury

Damages/Injury

[4 ELEMENTS OF NURSING MALPRACTICE]

• Actual physical, emotional, or financial harm occurred to the patient

• e.g. Sustained a fractured femur requiring emergency revision surgery

Provider of care (surgeon/physician)

The one to explain procedure, benefits, risks, alternatives, and right to refuse

Authenticity, voluntariness, capacity

Nurse’s legal responsibility as a witness:

Patient Self-Determination Act (PSDA)

[END-OF-LIFE LEGALITIES AND PATIENT AUTONOMY]

• Federal mandate requiring healthcare facilities to inform patients of their rights to accept/refuse medical treatment

Living will

[END-OF-LIFE LEGALITIES AND PATIENT AUTONOMY]

• Written document specifying medical treatments a patient wants or rejects in end-of-life or terminal situations

Durable power of attorney for healthcare (Healthcare proxy)

[END-OF-LIFE LEGALITIES AND PATIENT AUTONOMY]

• Legal decision of a surrogate decision-maker if the patient becomes incapacitated

DNR/DNAR order

[END-OF-LIFE LEGALITIES AND PATIENT AUTONOMY]

• Physician orders specifying resuscitation limits. Must be clearly written and updated per hospital policy