Evidence-based practice involves the incorporation of scientific research evidence that has been newly discovered into health care practice. Medical doctors have adopted this method fully and use it to offer patient care. Its implementation in the nursing profession has, however, drawn a lot of critics, who argue that this mode of practice harbors many assumptions, which, unless addressed, will undermine the role of nurses in health care provision .
Evidence based practice in nursing is a result of the shift to the use of research in the medical profession. Initially, nurses carried out their roles independently from the medical profession. However, the formalization of the nursing profession made them subjects to physicians. Nurses were forced to adopt evidence based practice in order to maintain authenticity in their profession. Evidence based practice uses relevant and valid scientific research evidence to provide quality nursing care. However, it fails to acknowledge the understanding of use of knowledge in good nursing practice.It has been suggested that nurses should adopt evidence based practice only after fully understanding the rules of this practice, which favor diagnosis, experimental research and clinical interventions, so as to avoid exclusion from the movement. Factor that determine the use of research by individuals include; attitude, level of education, nurses involvement in research activities and time spent reading professional journals. The key factors, however, are belief suspension, attitude and the frequency of attending educational sessions.
It has been discovered that the ability of individual nurses to adopt research findings is high. Those who fail to do so are called laggards and account for factors out of their control. The discourse assumes that nurses, who are mostly women, way of knowing is not important in practice. It also assumes that scientific knowledge is the most superior of all forms of knowledge. Many critiques also argue that the issues involving evidence based practice are not adequately explored. They claim that there are more fundamental issues that require attention to address the assumptions in evidence based practice. Post-structuralism theory explains that nurses find it difficult to abandon a system they are used to replacing it with a new and an untested system.
Majority of nurses are caring women who cultivate and value different ways of acquiring knowledge. Scientific based practice neither offers this knowledge to them nor shows them how to support a patient emotionally. The four ways of knowing in nursing are esthetics, ethics, personal knowing and empirics. Empirical knowledge is knowledge about observable world. Esthetics involves knowledge of the practice of nursing. Personal knowing allows the nurse to understand the patient as a person. Ethical knowing involves knowledge of what is good, right or wrong. Nurses learn and become knowledgeable more effectively through listening to their peers or physicians.Their confidence and decision making improves with experience and practice. Scientific based evidence is assumed to be right and obvious discouraging arguments against it. Evidence based practice is biased towards non evidence forms of practice. For instance, opposing evidence in making a clinical decision is compared to witchcraft. This leaves the use of evidence as the only approach viable to practice.
Scientific research is financed by powerful individuals who structure the research questions to meet their own interests. This has facilitated blocking of alternative ways of dealing with ailments. Surveillance has risen as a result of the use of evidence based practice. Medical records of patients and records and error reports have been used to scrutinize nurses unfairly. Traditional medical practice supported medical science knowledge while evidence based practice emphasizes more on research.
When we focus on individual nurses, and judge their ability to take up research evidence, they feel unconnected. Post structuralism analysis allows for things to be understood at a social level enhancing social change. In order to be taken seriously, nurses must speak out of their values and knowledge. They have to do this with zeal and persistence to gain respect and freedom to do their job.
WALL, S. (2008). A Critique of Evidence-Based Practice in Nursing: Challenging the Assumptions. Palgrave Macmillan Journals, 1-17.