As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur? In this case, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios. To Prepare
Advanced practice nurses often encounter situations where a patient’s desires for their health differ from the evidence-based guidelines or their own clinical experience. These scenarios create ethical dilemmas, as nurses must balance the patients’ autonomy and wishes with the best available evidence and their own professional judgment.
In such situations, it is crucial for advanced practice nurses to rely on evidence-based practice guidelines. Evidence-based practice involves integrating the best available research evidence with clinical expertise and patient values and preferences (Melnyk & Fineout-Overholt, 2019). By utilizing evidence-based guidelines, nurses ensure that their decisions are informed by the most up-to-date and relevant research findings.
Firstly, advanced practice nurses must thoroughly review the available evidence related to the specific scenario. This involves conducting a comprehensive literature search to identify published studies, clinical guidelines, systematic reviews, and meta-analyses that address the clinical question or dilemma at hand. Critical appraisal of the literature is then necessary to evaluate the quality and relevance of the evidence (Melnyk & Fineout-Overholt, 2019). By appraising the evidence, nurses can determine the strength and applicability of the findings to their patient’s situation.
The next step is to compare the patient’s wishes with the evidence-based guidelines. This requires a careful consideration of the available evidence and its relevance to the patient’s unique circumstances. Nurses must assess whether the evidence supports the patient’s preferences or if it suggests an alternative course of action. It is important to note that evidence-based guidelines are not prescriptive; they serve as a foundation for clinical decision-making (Melnyk & Fineout-Overholt, 2019). Nurses must exercise clinical judgment to tailor the evidence to a specific patient’s needs and values.
In situations where the patient’s wishes directly conflict with evidence-based guidelines, it is essential to have open and honest conversations with the patient and their family. Advanced practice nurses should strive to provide the patient and their family with clear and accurate information about the potential benefits, risks, and alternatives of different treatment options. By engaging the patient in a shared decision-making process, nurses can empower them to actively participate in their care and make informed choices (Muir & Palmer, 2016).
During these conversations, advanced practice nurses must also consider ethical principles that guide their practice. The four main ethical principles in healthcare are autonomy, beneficence, non-maleficence, and justice (Beauchamp & Childress, 2019). Autonomy pertains to respecting the patient’s right to make decisions about their own care, while beneficence requires promoting the patient’s well-being. Non-maleficence emphasizes the duty to do no harm, and justice relates to the equitable distribution of resources and fair treatment of patients.
Given the ethical principles, nurses should reflect on the potential consequences of the patient’s choices. If the patient’s wishes are in line with evidence-based guidelines, the nurse can support and advocate for their autonomy. However, if the patient’s wishes deviate from the evidence, the nurse should carefully consider the potential risks and benefits of the alternative course of action. In such cases, the nurse may need to engage in ethical deliberation, seeking input from colleagues, healthcare professionals, and ethics committees to make well-informed decisions (Muir & Palmer, 2016).
In conclusion, encountering situations where a patient’s wishes conflict with evidence-based guidelines or an advanced practice nurse’s own experience can create ethical dilemmas. To address these dilemmas, nurses should rely on evidence-based practice guidelines, thoroughly review the evidence, and engage in open and honest conversations with the patient and their family. During these discussions, nurses should consider the ethical principles of autonomy, beneficence, non-maleficence, and justice. By integrating evidence-based practice guidelines with ethical considerations, nurses can navigate these complex situations in a manner that upholds the highest standards of patient care.