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Posts tagged ‘Evidence based practice’

What’s the Point of the Evidence Debate?


We have just published ahead of print an article that will be published in the first issue of 2014!  The article is titled “Particularizing the General: Sustaining Theoretical Integrity in the Context of an Evidence-Based Practice Agenda” by Sally Thorne, PhD, RN, FAAN, FCAHS and Richard Sawatzky, PhD, RN.  Dr. Thorne and Dr. Sawatzky have extended their discussion of the “evidence” debate with this message for ANS blog readers:

Although we realize that “the evidence debate” may seem like a tired topic for some readers, we think it remains one of the most important avenues through which nurses can find their grounding in why the philosophy of science really matters to our discipline. Health and public policy get made on the basis of a complex and highly

Dr. Sally Thorne

Sally Thorne, PhD, RN, FAAN, FCAHS

politicized combination of ideology and science. We tend to think about ideology as if it exists in the world of “the other” and not in our own disciplinary knowledge. And yet, we must recognize that nursing has always been driven by so much more than just empirical science or philosophy, even if we sometimes struggle with how to name, conceptualize and justify those other forms of knowledge that influence our practice.

For us, the history of theoretical and philosophical knowledge-building in nursing is quite fascinating. Although it has taken a lot of twists and turns along the way (some of them sufficiently awkward as to be downright embarrassing), once you clear away the “noise” and reflect on what many of the founding nurse theorists and scholars were struggling with, you realize that they were grappling with incredible complexities. The language they used was sometimes a bit convoluted or misleading, and the competitiveness among the individual theorists and their disciples was at times unseemly. Nevertheless they were trying to work out ways of conceptualizing the rather marvelous constellation of intellectual and behavioral competencies that characterize the practice of nursing when it is done at its best, in order that we could improve our capacity to help nurses achieve that.

Of course if nursing were derived from a simple skillset, then that theorizing and philosophizing would have been

Dr. Sawatzky

Richard Sawatzky, PhD, RN

easy.  But it is not. And that’s what makes the story so fascinating. Patients are complex and adaptive, and so are we. The social and ideational worlds within which people experience health and illness are dynamic, multilayered, and fraught with uncertainties and complexities.  The thinking nurse – that nurse we refer to as “expert” within his or her population group or setting – is always skillfully navigating that great chasm between science (which represents the general past) and context (which represents the particular moment), not to mention looking forward to considerations of possible implications for the future.

In re-entering the “evidence debate” in this manner, we wanted to juxtapose ideas about how we make sense of knowledge that comes from certain kinds of formally derived scientific processes with those that have to do with nursing’s inherent interest in the individual case. We believe that the trend towards standardized practice in health care during recent decades (e.g., reliance on general clinical practice guidelines) is increasingly at odds with notions of heterogeneity and individual differences (or “anti-standardization”), such as those prompted by field of personalized medicine. Just as many forms of medical management are moving away from population-based science (i.e., reliance on population averages) toward novel targeted and individualized therapies arising from genomics, proteomics and pharmacogenomics, we believe that nurses will need systems and structures through which to focus and strengthen individualized care and patient-centered approaches. These are not simply vague abstractions, but complex and challenging dimensions of the intellectual approach that nurses must always bring to their practice.

So for us, it seems useful to really push nurses toward clarity in what does and does not constitute evidence in the conventional sense. Slippage with how we frame the basis of what we think we know will only serve to discredit our profession as a credible contributor to the larger world that is wrestling with these evolving ideas. We are concerned that the tendency to reconceptualize certain forms of knowledge as “evidence,” in an attempt to obtain credibility, will not serve the nursing well. Nursing practice and theories are unavoidably influenced by many valuable forms of nursing knowledge that do not necessarily conform to conventional notions of “evidence.” Rather than “branding” all nursing knowledge as “evidence,” nurses are challenged to articulate what these “non-evidential” forms of knowledge are and what the basis is of their justification. We want to remobilize an enthusiasm for why nurses ought to care about the nursing theory world by bringing into focus the relevance that disciplinary thought has in the larger world of contested practices and influence upon futures.

We keep returning to this idea that the dialectic between the general and the particular is really the essential element in the uniqueness of nursing knowledge, our defining characteristic, the idea best captures what we are.  As we continue to develop our collective expertise and wisdom with regard to evidence generation and interpretation – figuring out how we learn about the patients of the future through systematic and rigorous exploration of the past – it will be imperative that we not forget the “artform” of individualized holistic care, enacting relational practice, and taking an intersectional lens on the social determinants that may be shaping the health and illness experience of the patient who is before us in the moment.

Thanks for taking this journey with us, and we look forward to a lively debate!

You can download this article at no charge now on the ANS web site!  Get it, read it, and come back here to engage in this very important, and interesting debate!

Designing Evidence-based Practice


If you are interested in a model for designing approaches in practice that are evidence-based, this is the article for you!  The article is titled Development and Testing of an Intervention to Improve Outcomes for Partners Following Receipt of an Implantable Cardioverter Defibrillator in the Patient” and is authored by Cynthia M. Dougherty, PhD, FAHA, FAAN, ARNP; Elaine A. Thompson, PhD, RN; and Peter J. Kudenchuk, MD, FACC, FAHA.  Go to the ANS web site while this article is featured, and you can download a copy of the article free of charge!

This “Editor’s Pick” article describes how the authors used the results of three research studies to design and test a “patient and partner” nursing intervention for patients in the time after they return home from receiving an implantable cardioverter defibrillator. Dr. Dougherty has shared this photograph of the team that worked on this project, and a brief description description of their work:

team

P+P Research Team, University of Washington, School of Nursing, 2012

Back Row:  Dr. Elaine Thompson (Author), Lisa Foley, Susanne Steffes, Chayna Davis, Lisa Hales, Mary Strasser.

Front Row:  Pagna Prom, Seieun Oh, Caylene Castagno, Dr. Cynthia Dougherty (Author).

Since 1990, Dr. Dougherty has been working with patients who suffer cardiac arrest and receive an ICD and their families.  This research program spans numerous iterations in the technological development of the implantable defibrillator (ICD) as well ever changing patient populations who are eligible to receive the ICD.  The paper outlines a series of investigations that have lead to the formal testing of the patient and partner (P+P) intervention after ICD study, currently funded by the National Heart, Lung, and Blood Institute of the NIH.

 

April-June issue now available – Practice-Based Evidence


This is a terrific issue of ANS that you will not want to miss!  The Table of Contents is on the ANS web site, where you can go directly to details about each article.  This issue focuses on the topic “Practice-Based Evidence” but also features commentaries about two previously published articles that raised quite a bit of reader response!  These commentaries are available as free downloads in the “Featured Articles” section of the Home Page.

Here is some background on the commentaries.  The article by David Keepnews titled Lesbian, Gay, Bisexual, and Transgender Health Issues and Nursing: Moving Toward an Agenda is a thoughtful response to the article published last fall in ANS 33:3.  That article, titled Nursing’s Silence on Lesbian, Gay, Bisexual, and Transgender Issues: The Need for Emancipatory Efforts is based on an analysis by Eliason, Dibble and DeJoseph examining content in nurse journals with high impact-factor scores.  Their analysis revealed Read more

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