Evidence-Based Practice for Nurses

FYI

When nurses are involved in testing proto-

cols, ethical dilemmas can arise. Issues can

concern the selection of the sample, data

collection, and reporting.

At the end of this section, you will be able to:

‹ List three dilemmas that can arise when nurses are involved in testing protocols

18.4 Keeping It Ethical

As a staff nurse, it is likely that you will be involved at some point in evaluating

patient care outcomes. At the very least, your documentation will be a source

of data. There are other ways for you to become involved in evaluation. When

nurses are involved in testing protocols, ethical dilemmas can arise. Issues can

concern the selection of the sample, data collection, and reporting.

When considering the recruitment of patients to participate in protocol

testing, you must make certain that they fit the criteria and are not included

simply to reach the sample size needed. You are obligated to collect data as

directed by the protocol. Reflect back to the example of reducing the number

of hours on bed rest following cardiac catheterization. Suppose you were to

assess for bleeding in one of your patients but were unable to do that assess-

ment because of an emergency on the unit. You might be tempted to guess

or enter data collected at a later time. But for the integrity of the process,

it would be preferable to indicate that the data are missing. Another issue

that can arise is that sometimes nurses have a tendency to change behaviors

when they are aware that data are being collected. For example, a hospital is

implementing a smoking cessation program. Because the nursing staff know

that their unit is being compared to other units in the

facility, they are very careful to follow the program exactly

as outlined. However, after data collection is concluded

and the protocol is found to be effective, it would not

be in the best interest of patients for nurses to return to

using former protocols.

True/False

1. Baseline data are unimportant in outcome measurement.


2. Precise description of indicators is essential.


3. For complex analyses, the assistance of a statistician may be needed.


4. Input from staff can help clarify outcome measurement.

TEST YOUR KNOWLEDGE 18-3

How did you do? 1. F; 2. T; 3. T; 4. T

482 CHAPTER 18 Evaluating Outcomes of Innovations