1. Watch the Belmont Report video: Basic Ethical Principles and Their Application.
2. Review the Tuskegee Syphilis Study, 1932-1972.
3. Answer the following two prompts
- i) What aspect of this study was most impactful to you? Why?
- ii) Connect one ethical principle of human subjects research in the Belmont Report to the ethics (or, more accurately, lack thereof) of the Tuskegee Syphilis Study. For example, if you choose beneficence, explain what is meant by that per The Belmont Report, and explain how the ethical principle was violated by the experiment. Use information from the Tuskegee Syphilis Study CDC information and the Belmont Report video to support your answer.
1.In acute care, a charge nurse is assigned to oversee a unit, and a nursing supervisor oversees the nursing role across a facility. All work together to control the flow of patients in and out of the unit and facility, make staffing assignments, and assist with problems and crises.Consider this situation: A nurse is dealing with a crisis for one patient and misses a second patient crisis—a young woman who died from a postoperative hemorrhage. In this tragic situation, competing crisis events on the unit prevented a nurse from adequately monitoring other assigned patients on the unit.The charge nurse and nursing supervisor stated in the Board of Nursing’s investigation of the event that they depended on the individual nurse to alert them if help was needed.
: Describe a systems-based solution that could have prevented this event. (DO NOT state what the nurse should have done differently; you are to describe a
, not a personal, professional one.)
2.Download the HCAPHS survey and review the survey questions.
: Based on your observations in clinicals or in your job, describe a systems-based issue
a solution to that issue that has an impact of the quality of nursing care measured by at least one of the questions on the HCAPHS survey.
Ethics 1. Watch the Belmont Report video: Basic Ethical Principles and Their Application. 2. Review the Tuskegee Syphilis Study, 1932-1972. 3. Answer the following two prompts i) What aspect of this s
Nursing Research and Evidence -Based Practice Department of Nursing Services and Patient Care University of Iowa Hospitals and Clinics Attachment 1 -3: Differentiating between Quality Improvement, Evidence -Based Practice, and Research Quality Improvement Evidence -Based Practice Research Definition(s): “QI is an organizational strategy that formally involves the analysis of process and outcomes data and the application of systematic efforts to improve performance” (AHRQ, 2011 ) “The degree to which health care services for individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge” (Institute of Medicine , 2003 ) Evidence -based practice is the process of shared decision – making between practitioner, patient, and others significant to them based on research evidence, the patient’s experiences and preferences, clinical expertise or know -how, and other available robust sources of information (STTI, 2008) Health care delivery based on the integration of the best research evidence available combined with clinical expertise, in accordance with the preferences of the patient and family (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996 ; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000 ) Systemat ic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge (OHRP, 2011 ; US DHHS, 2011 ) Code of Federal Regulations: systematic investigation designed to contribute to generalizable knowledge. Intent: Who benefits Benefits expected for current: Patients/families Staff Organization Benefits likely for future: Patients/families Staff Organization Clinicians Scientific community Subjects (on occasion) Purpose Improve quality or safety of processes or patient experience within the local clinical setting Evaluate changes in efficiency or flow Improve quality and safety within the local clinical setting by applying evidence in health care decisions To contribute to and/or generate new knowledge that can be generalized Scope of interest Specific unit or patient population within an organization Specific unit or patient population within an organization Generalize to populations beyond organization Nursing Research and Evidence -Based Practice Department of Nursing Services and Patient Care University of Iowa Hospitals and Clinics Attachment 1 -3: Continued Quality Improvement Evidence -Based Practice Research Methodology: Processes or outcomes measurement Measures are simple, easy to use and administer Measures for key indicators only Measures of key indicators using tools with face validity and may be without established validity or reliability Measures include knowledge attitude, behavior/practices, and outcomes (Bick & Graham, 2010 ) Measures are complex Increased time is required to fill out the measure Measures require a detailed administration plan Estimates of reliability, validity, specificity, and/or sensitivity are required Design: Examples include: LEAN Six Sigma Plan Do Study Act (PDSA) Focus Analyze Develop Execute (FADE) Continuous Quality Improvement (CQI) Total Quality Management (TQM) Iowa Model or other EBP process model Quantitative Randomized control Qualitative Timing Rapid cycle (e.g., PDSA) Planned and timeline varies based on available clinical practice guidelines or other synthesis reports Planned and longer Extraneous variables Acknowledged but not measured Acknowledged but not measured Controlled and/or measured Tight protocol control Sample Small convenience sample Small convenience sample Sampling varies based on study question; may include an established process to improve generalizability of results Sample size Small but large enough to observe changes Feasible for data collection Small but large enough to observe changes Feasible for data collection Size based on estimates of adequate power or saturation Data collection Minimal time, resources, cost Minimal time, resources, cost Complex, tightly controlled, plan for resources constructed Nursing Research and Evidence -Based Practice Department of Nursing Services and Patient Care University of Iowa Hospitals and Clinics Attachment 1 -3: Continued Data analysis Descriptive statistics or statistical process control charts for trended data Descriptive statistics or statistical process control charts for trended data Complex with inferential statistics to promote generalizability of results Regulating bodies: Organization Influenced by: The Joint Commission Centers for Medicare and Medicaid Services Organization Organization, OHRP, FDA, state, and local laws Additional burden or risks: Patient and/or population expected to benefit directly from improved flow or process Risk of participation is same as receiving usual clinical care If risk or burden is higher than with usual care, consider research and IRB Patient and/or population expected to benefit directly from observations Risk of participation is same as receiving usual clinical care If risk or burden is higher than with usual care, consider research and IRB Subject may or may not benefit from participation in study Participant is aware of risks Informed consent required IRB: Not required unless as per organizational policy Not required unless as per organizational policy Required Dissemination: Expected to disseminate within the organization, may be expected for public accountability and transparency based on CMS regulations; may be published “The intent to publish is an insufficient criterion for determining whether a quality improvement activity involves research. Planning to publish an account of a quality improvement project does not necessarily mean that the project fits the definition of research; people seek to publish Expected to disseminate within the organization; publication is increasingly becoming an expectation Does not indicate generalizability of findings or research (see disseminating quality improvement data) Expected Nursing Research and Evidence -Based Practice Department of Nursing Services and Patient Care University of Iowa Hospitals and Clinics Attachment 1 -3: Continued descriptions of nonresearch activities for a variety of reasons, if they believe others may be interested in learning about those activities.” (US DHHS, 2011 ) REFERENCES AHRQ. (2011). Closing the quality gap: Revisiting the state of the science Retrieved September 1, 2011, from http://www.ahrq.gov/clinic/tp/gaprevistp.htm Bick, D., & Graham, I. (2010). Evaluati ng the impact of implementing evidence -based practice . United Kingdom: Wiley -Blackwell Publishing and Sigma Theta Tau International. Cacchione, P. Z. (2011). When is institutional review board approval necessary for quality improvement projects? Clinical Nursing Research, 20 (1), 3 -6. Cullen, L., Tucker, S., Hanrahan, K., Rempel, G., & Jordan, K. (2012). Evidence -based practice building blocks: Comprehensive strategies, tools, and tips. Iowa City, IA: Nursing Research and Evidence -Based Practice Division, Department of Nursing Services and Patient Care, University of Iowa Hospital s and Clinics. Institute of Medicine. (2003). Patient safety: Achieving a new standard of care . Washington, DC: National Academies Press. Nasby, D. (2009). Nursing Research Grand Rounds, Differentiating research and quality improvement . Rochester, MN: Mayo Clinic. OHRP. (2011). Title 45 Public welfare DHHS, Part 46: Protection of human subjects Retrieved September 8, 2011, from http://ohsr.od.nih.gov/guidelines/45cfr46.html OHSR. (2005). Office of Human Subjects Retrieved September 8, 2011, from http://ohsr.od.nih.gov/index.html Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence based medicine : What it is and what it isn’t. British Medical Journal, 312 , 71 -72. Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence -based medicine: how to practice and teach EBM . London: Churchill Livingstone. Selker, H. , Grossmann, C., Adams, A., Goldmann, D., Dezii, C., Meyer, G. S., Roger, V., Savitz, L., & Platt, R. (2011). The common rule and continuous improvement in health care: A learning health system perspective . Washington, DC: Institute of Medicine. Shirey, M. R., Hauck, S. L., Embree, J. L., Kinner, T. J., Schaar, G. L., Phillips, L. A. A., S.R., Swenty, C. F., & McCool, I. A. (2011 ). Showcasing differences between quality improvement, evidence -based practice, and research. Journal of Continuing Education in N ursing, 42 (2), 57 -68, quiz 69 -70. Sigma Theta Tau International Research and Scholarship Advisory Committee. (2008). Sigma Theta Tau International Position Sta tement on Evidence -Based Practice February 2007 Summary. Worldviews on Evidence -Based Nursing, 5 (2), 57 -59. US DHHS. (2011). Quality improvement activities – FAQs Retrieved September 8, 2011, from http://answers.hhs.gov/ohrp/categories/1569