Evidence Based Practice Final Actual Exam Newest Actual Exam
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Define four core ethical principles that guide healthcare practice -
ANSWERS--1. Beneficence
2. Nonmaleficence
3. Autonomy
4. Justice
Beneficence - ANSWERS--Captures the importance of doing good for
patients
Nonmaleficence - ANSWERS--Addresses the importance of not
harming patients
Autonomy - ANSWERS--Acknowledges that patients have the right to
make decisions about their health, lives, and bodies
Justice - ANSWERS--Declares that resources should be distributed
fairly among people and without prejudice
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Describe how the four core ethical principles can be seen as the
foundation for the Institute of Medicine's (IOM's) core dimensions of
quality - ANSWERS--Safety: nonmaleficence
Effectiveness: Benefience
Patient-centeredness: Autonomy
Timeliness: Beneficence and nonmaleficence
Equity: Justice
Efficiency: Beneficence and nonmaleficence
IOM Quality Dimensions - ANSWERS--Safety
Effectiveness
Patient-centeredness
Timeliness
Equity
Efficiency
Three examples of how EBP quality improvement initiatives could
conflict with ethical principles - ANSWERS--1. Attempts to improve
quality for some patients and may cause harm to others.
2. Strategies intended to improve quality that may turn out to be
ineffective and waste scarce resources
3. Activities declared to be quality improvement that may be more
accurately described as clinical research
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Clinical research - ANSWERS--Activities involving direct interaction by
investigators with human subjects or material of human origin;
generates knowledge on which practice should be based
Patient participation viewed as optional. Aim is to generalize findings
to a population wider than research subjects. Aim to disseminate
findings for use outside of the organization.
Evidence-based quality improvement (EBQI) initiatives - ANSWERS--
Systematic, evidence-based activities designed to immediately
improve healthcare delivery in specific settings
All patients receive the same evidence-based intervention as part of
routine care. Aim is to improve care of patients in a specific
organization/setting. Aim is to provide internal data to practitioners
to guide further practice changes.
Similarities between EBQI and clinical research - ANSWERS--Involve
human participants
May use similar data collection procedures to evaluate outcomes
(e.g., surveys and physiological measurements)
Both may use the same data analysis methods to manage and
process data
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Ethical implications with EBQI and clinical research - ANSWERS--If
efforts are not made to improve quality through EBQI, principles of
beneficence and nonmaleficence may be violated
If EBQI does not offer the same treatment strategies to all patients,
then the principle of justice and autonomy may be violated,
especially if patient consent is not obtained.
Three ethical controversies related to EBQI initiatives - ANSWERS--1.
Should EBQIs require the same standards of patient consent as
clinical research?
2. Is it ethical to implement EBP in one setting while continuing with
traditional (and possibly substandard) practice in another?
3. Should informed consent be obtained from the patients receiving
traditional care?
Similarities and differences among research, EBP, and QI that have
implcations for human subjects review - ANSWERS--1. research is not
an integral part of routine clinical practice
2. EBQI is an integral part of the ongoing management of clinical care
delivery (EBP)
3. Research often carries risks for patients
4. Risks with EBQI activities are usually very low; sometimes the risks
may be greater if the EBQI activities are not implemented.
5. Generally, research is focused on generating evidence for practice,
whereas EBQI is focused on implementing evidence in practice