Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two scholarly sources is required for this assignment.

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https://www.slideshare.net/stanbridge/melnyk-ppt-chapter22-76739786

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http://eprints.usq.edu.au/19602/2/Moloney_2011_whole.pdf

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 Introduction The healthcare sector is one of the most important sectors in any country. This is partly because it helps to house the different typesof challenges that are likely to arise at the place of work. One of the notable challenges is the challenge of ethical issues that may occur at the place of work when handing patients.The purpose of this paper will be to present a description of why ethical safeguards that may be designed for clinical research are likely not to be feasible for evidence-based practice or evidence-based practice implementation projects, then provide a discussion of the main ethical controversies related to implementing an evidence-based quality improvement (EBQI) initiatives and how these controversies relate to the four core ethical principles, before summing up with the identification of the ethical principles that may be in conflict with the concept of "patients having an ethical responsibilityin improving healthcare" and how such conflicts may be resolved. Ethical Safeguards for Evidence-Based Practice Evidence-based practice (EBP) was formulated to ensure that the best possible evidence is available when making clinical decisions and for the health care practice in general. Ethical safeguards are designed as a result of the need for evidence-based practice to help when it comes to clinical research to help researchers attain ethical guidelines expected from them. The process deployed to identify the best evidence should not, at any time, be interrupted by the ethical standards designed for clinical research. This implies that the ethical safeguards are likely to interfere with evidence-based practice at some point because evidence-based practice includes using on-site investigations, case studies, as well as the use of human subjects when collecting data about a disease. For example, the ethical safeguards are likely to interfere with the five steps of evidence-based practice: asking a question, searching, critically appraising the information, implementing, and evaluating by considering some of the steps as an infringement on the confidentiality and privacy of the patients, which is an ethical concern (Melnyk&Fineout- Overholt, 2015).Ethical safeguards expect the patient to be well informed of the purpose of the research and the participation to be voluntary. When such voluntary participation is not available, evidence-based practice is likely to suffer or to violate the ethical safeguards. As a result of these, ethical safeguards may not be appropriate or feasible for conducting evidence- based practice or evidence-based practice implementation projects. Furthermore, ethical safeguardsmay not be appropriate when conducting evidence-based practice or during the implementation of evidence-based practice projects because of the scope covered. According to Greenhalgh(2017), and evidence-based practice may involve identifying information about the history of the patients in order to ensure that the best-researched evidence is made available to increase the quality of life. However, the ethical safeguards are likely to place limits on the types of information that researchers are expected to collect. For example, they limit who has access to the information collected and articulates the essence of seeking consent, greatly interfering with the working of the research workers. This limits the quality of information collected by the researchers and thus limits the quality of researched evidence arrived at by the researchers. Ethical Controversies There are controversies that may manifest when implementing evidence-based quality improvement (EBQI) initiatives. These controversies include whether EBQIsrequire the same standards of patient consent as clinical research, whether it is ethical to implement evidence- based practice in one setting while continuing with traditional practice in another, and whether informed consent is obtained from the patients receiving traditional care (Melnyk&Fineout- Overholt, 2015). Controversy One The first controversy is whether EBQIs should require the same standards of patient consent as clinical research(Melnyk&Fineout-Overholt, 2015). EBQIs are generally different from clinical research. This leaves researchers in a state of dilemma when deciding whether to use the same standards for patient consent. The first controversy is related to the ethical principles in different ways. First, it expects the same standards of patient consent for both EBQIs and clinical research. This is directly connected to the ethical principle of justice that requires resources to be fairly distributed among the people without any form of prejudice (Melnyk&Fineout-Overholt, 2015). It also gives the patients the right to make their own decisions when it comes to matters of health, their lives, and bodies as per the ethical principle of autonomy. The first principle also focuses on the importance of doing good for the patients through having the same standards of patient consent and ensuring that the patients are not harmed through the ethical principles of beneficence and non-maleficence respectively (Melnyk&Fineout-Overholt, 2015). Controversy Two The second controversy is whether it is ethical to implement evidence-based practice in one setting while continuing with traditional practice in another. The evidence-based practice focuses on new and better treatments while traditional practice focuses on the use of old known practices. The evidence-based practice raises new ethical issues that traditional practice does not. A sense of ethical dilemma arises when it comes to deciding whether it is ethical to implement evidence-based practice while continuing with traditional practice. This controversy is related to the ethical principles in different ways. First, it is related to the ethical principle of benevolence as it expects the researchers to do good for the patients and non-maleficence by addressing the need for not harming the patients (Melnyk&Fineout-Overholt, 2015). By deciding whether it is ethical to implement evidence-based practice in one setting while continuing with traditional practice in another, patients have theright to make their own decisions as per the ethical principle of autonomy. Controversy Three The third controversy is whether informed consent should be obtained from the patients receiving traditional care. In traditional care, informed consent assumed that all the decisions that were made concerned the life and values of a single individual. This leaves questions regarding whether informed consent should be sought or not when it comes to informed consent for traditional care. The controversy on whether informed consent should be obtained from the patients receiving traditional care is related to the ethical principle of autonomywhich acknowledges that all patients have the right to make decisions about their lives, their health, and their bodies. The controversy is also connected to the ethical principle of beneficence and non- maleficence which address the significance of doing good for the patients and the importance of not harming the patients respectively (Melnyk&Fineout-Overholt, 2015). Ethical Responsibility of Patients "Patients have an ethical responsibility in improving healthcare". The ethical principle that may be in conflict with this concept is autonomy. Sometimes the patient may use autonomy to compromise the quality of healthcare outcomes just because they have a right in making decisions regarding their health, lives, and bodies (Melnyk&Fineout-Overholt, 2015). The conflict that arises when it comes to patients having the right when it comes to making decisions regarding their health, lives, and bodies can be addressed by allowing the parties involved to negotiate the issue through negotiating forums. Such a platform will allow the parties involved to concede or even accept autonomy as a suitable form of compromise (Maurer et al., 2017). Conclusion In conclusion, ethical safeguards may not be appropriate when conducting evidence- based practice or during the implementation of evidence-based practice projects. The three common ethical controversies are whether EBQIs require the same standards of patient consent as clinical research, whether it is ethical to implement evidence-based practice in one setting while continuing with traditional practice in another, and whether informed consent is obtained from the patients receiving traditional care. These controversies are linked to and relate to the four ethical principles, namely; beneficence, non-maleficence, justice, and autonomy. The ethical principle of autonomy seems to conflict with the concept of patients having the responsibility to improve health. References Greenhalgh, T. (2017). How to implement evidence-based healthcare. John Wiley & Sons. Maurer, M., Mangrum, R., Carman, K. L., Ginsburg, M., Gold, M. R., Sofaer, S., ...& Siegel, J. (2017). Setting boundaries: public views on limiting patient and physician autonomy in health care decisions. Journal of Health Politics, Policy, and Law, 42(4), 579-605. Melnyk, B. M., &Fineout-Overholt, E. (Eds.). (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins. 1 ETHICS AND EVIDENCE-BASED RESEARCH 2 ETHICS AND EVIDENCE-BASED RESEARCH 3 ETHICS AND EVIDENCE-BASED RESEARCH 4 ETHICS AND EVIDENCE-BASED RESEARCH 5 ETHICS AND EVIDENCE-BASED RESEARCH 6 ETHICS AND EVIDENCE-BASED RESEARCH 7