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Assignment: Dissemination Of EBP And Research

Dissemination of EBP and research, such as presenting results at a conference or writing an article for a journal, is an important part of professional practice. Identify one professional journal and one nursing or health care conference where you might present your project. Discuss why each of your choices is the best option for you to disseminate your new knowledge. one page

Further, the Halacha considers oxygen, food and fluids to be essential components of life

to which every human being is entitled. Accordingly, a dying patient cannot be denied

these basic needs, and withdrawal of artificial nutrition and hydration is not allowed as it is

seen as an act leading to death. However, in cases where the continuance of artificial

nutrition and hydration cause suffering and complications to a patient who is approaching

death, such support may be withdrawn upon the request of the patient or if it can be

ascertained that that was the patient’s wish (Bülow et al. 2008). The Conservative

Movement’s Committee on Jewish Law and Standards adopted a somewhat dissimilar

view in classifying artificial nutrition and hydration as medicine, permitting their removal

where there is not likely to be any reasonable prospect for recovery at the end of life

(Zahedi et al. 2007). It is suggested that when the decision is made to discontinue artificial

nutrition and hydration, the focus of communication should be on ‘‘what will be done to

demonstrate respect for the patient, rather than on emphasising what will be withdrawn or

withheld’’ (Gillick 2001; Loike et al. 2010). With regard to palliative sedation, there is a

general agreement in Jewish law that this is permitted in spite of the risk that the

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administration of such drugs may shorten life, based on the principle of double effect

(Bülow et al. 2008; Loike et al. 2010).

The Buddhist Perspective

The two most fundamental values in Buddhism are compassion and respect for life (Keown

2005). According to the Buddhist faith, life ‘‘begins at conception and ends at death: in the

interval between these events, the individual is entitled to full moral respect, regardless of

J Relig Health (2016) 55:119–134 127

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the stage of psycho-physical development attained or the mental capacities enjoyed’’

(Keown 2005). The manner of dying and death is of particular significance in Buddhism;

death with an unclouded mind is believed to lead to a better rebirth in the next life (Keown

2005; Zahedi et al. 2007), and death is an experience that will recur many times. Con-

sequently, this concept has significant bearing on end-of-life issues such as palliative

sedation and pain management, as the concern would be to maintain a mental and sensory

clarity at all times. In terms of artificial nutrition and hydration, the Buddhist perspective

maintains that such life-sustaining support cannot be discontinued, even from patients in a

persistent vegetative state (Keown 2005; Zahedi et al. 2007). This stems from the notion

that in Buddhism, damage to the brain is not differentiated from injury to any other part of

the human body when considering the ethics of treatment (Keown 2005).

The above does not, however, mean that there is a moral obligation in Buddhism that

life must be preserved at all costs. The ethical validity of an act or omission in Buddhism is

measured against the aim or motive of such conduct. If a patient ‘‘makes death his aim’’,

then the refusal of medical care is considered to be an offence; declining further treatment

due to the patient’s acceptance that recovery is grim and death is inevitable, is on the other

hand legitimate (Keown 2005). It follows that proceeding with futile treatment goes against

the teachings of Buddhism; ‘‘to seek to prolong life beyond its natural span by recourse to

increasingly elaborate technology when no cure or recovery is in sight is a denial of the

reality of human mortality, and would be seen by Buddhism as arising from delusion and

excessive attachment’’ (Keown 2005).

The Islamic Perspective

The Shari‘ah or Islamic law is based on two primary sources, the Holy Qur‘an (the Holy Book

which Muslims believe to be the word of God Almighty) (Al-Qur’an 2:2) and the Sunnah of

Prophet Muhammad (peace be upon him) (his words, conduct and tacit approval) (Al-Qur’an

4:59). The secondary source of the Shari‘ah is found in ijtihad (deductive reasoning) (Su-

laiman 2008, Sunan Abu Dawud, Book 24, Hadith no. 3585). The guiding principles, rules

and regulations in the main sources govern the Islamic way of life and, together with ijtihad,

provide a comprehensive moral and juridical framework to address and accommodate issues

relating to human conditions (Gatrad and Sheikh 2001). In Islamic jurisprudence, each

deliberation towards resolving any given issue must observe the following five fundamental

principles which are known as maqasid al-shari‘ah: preservation of life, protection of an

individual’s freedom or belief, maintenance of intellect, preservation of honour and integrity,

and protection of property. Congruently, end-of-life issues in Islamic bioethics involve

ethical considerations on the sanctity of human life. This ruling is ordained in the Holy Qur’an

in the following verse: ‘‘Do not take life which God has made sacred except in the course of

Justice’’ (Al-Qur’an 6:151). It is accordingly forbidden for anyone to deliberately end a life:

‘‘Whosoever takes a human life, for other than murder or corruption in the earth, it is as if he

has taken the life of all of mankind’’ (Al-Qur’an: 5:32).

Overview of Evidence-Based Practice

Evidence-based health care practices are available for a number of conditions such as asthma, heart failure, and diabetes. However, these practices are not always implemented in care delivery, and variation in practices abound. Traditionally, patient safety research has focused on data analyses to identify patient safety issues and to demonstrate that a new practice will lead to improved quality and patient safety. Much less research attention has been paid to how to implement practices. Yet, only by putting into practice what is learned from research will care be made safer. Implementing evidence-based safety practices are difficult and need strategies that address the complexity of systems of care, individual practitioners, senior leadership, and—ultimately—changing health care cultures to be evidence-based safety practice environments.

Nursing has a rich history of using research in practice, pioneered by Florence Nightingale. Although during the early and mid-1900s, few nurses contributed to this foundation initiated by Nightingale, the nursing profession has more recently provided major leadership for improving care through application of research findings in practice.

Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions. Best evidence includes empirical evidence from randomized controlled trials; evidence from other scientific methods such as descriptive and qualitative research; as well as use of information from case reports, scientific principles, and expert opinion. When enough research evidence is available, the practice should be guided by research evidence in conjunction with clinical expertise and patient values. In some cases, however, a sufficient research base may not be available, and health care decision making is derived principally from nonresearch evidence sources such as expert opinion and scientific principles. As more research is done in a specific area, the research evidence must be incorporated into the EBP.

Models of Evidence-Based Practice

Multiple models of EBP are available and have been used in a variety of clinical settings. Although review of these models is beyond the scope of this chapter, common elements of these models are selecting a practice topic (e.g., discharge instructions for individuals with heart failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient care and provider performance, and consideration of the context/setting in which the practice is implemented., The learning that occurs during the process of translating research into practice is valuable information to capture and feed back into the process, so that others can adapt the evidence-based guideline and/or the implementation strategies.

A recent conceptual framework for maximizing and accelerating the transfer of research results from the Agency for Healthcare Research and Quality (AHRQ) patient safety research portfolio to health care delivery was developed by the dissemination subcommittee of the AHRQ Patient Safety Research Coordinating Committee. This model is a synthesis of concepts from scientific information on knowledge transfer, social marketing, social and organizational innovation, and behavior change (see Figure 1). Although the framework is portrayed as a series of stages, the authors of this framework do not believe that the knowledge transfer process is linear; rather, activities occur simultaneously or in different sequences, with implementation of EBPs being a multifaceted process with many actors and systems.

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