At the end of this section, you will be able to:
‹ Discuss reasons why nurses should follow agency policies even when they conflict
with evidence15.4 Keeping It Ethical
When weighing evidence, nurses need to remember that there are no perfect
studies; therefore, there are always limitations of the evidence. Even though
systematic reviews are highly regarded, they may not provide all the answers a
researcher would like to have or that the clinician might want to know. Evidence
might support a certain treatment or intervention, but one must remember
that the literature might not report all aspects that were tested. For example,
the use of case reports might reveal harm from a pharmaceutical agent, such as
an adverse drug reaction. A systematic review might ensue to appraise harmful
consequences of the pharmaceutical agent. However, because negative trials
typically never make it to publication, the information would not be uncov-
ered during a systematic review. Similarly, the evidence derived from research
might be perceived to be ironclad, without exception or deviation. This cannot
be further from the truth. Clinicians must examine the evidence within the
context of the question, and consequently, the answer that is revealed. Nurses
must incorporate several sources of evidence at the bedside: the individual
patient experience, the clinical experience, and policy or cost considerations
(Rycroft-Malone, 2003). Questions that nurses can ask are (Straus et al., 2011):
» Are our patients enough like those in the study so that results can apply?
» Is the treatment feasible in our setting?
» What are the potential benefits and harms from the treatment for our
patients?
» What are our patients’ values and expectations about the treatment and
the outcomes?
Generalizability is always a concern when deciding how to apply evidence
to practice. Application of evidence to practice relies on findings and recom-
mendations generated from samples. Individual patients may not have the
same characteristics as study subjects, and this raises concern for nurses when
considering the adoption and application of the evidence to the point of care.
Gray (2005) suggested that the path from the evidence to utilization in practice
can be value laden and raise ethical concerns. For example, recommendations
for specific diagnostic screenings, such as routine cancer testing for specific
age groups or genders, may be scientifically justified based on incidence and
15.4 Keeping It Ethical 417