Evidence for practice, epistemology, and critical reflection

Nursing Philosophy (Impact Factor: 0.64). 09/2006; 7(4):216 - 224. DOI: 10.1111/j.1466-769X.2006.00267.x
Source: PubMed

ABSTRACT Abstract  Evidence-based practice (EBP) has become a critical concept for ethical, accountable professional nursing practice. However, critical analysis of the concept suggests that EBP overemphasizes the value of scientific evidence while underplaying the role of clinical judgement and individual nursing expertise. This paper explores the empiricist position that valid evidence is the basis for all knowledge claims. We argue against the positivist idea that science should be regarded as the only credible means for generating evidence on which to base knowledge claims. We propose that the process of critically reflecting on evidence is a fundamental feature of empirical epistemology. We suggest that critical reflection on evidence derived from science, arts and humanities and, in particular, nursing practice experience can provide a sound basis for knowledge claims. While we do not attempt to define what counts as evidence, it is argued that there is much to be gained by making the processes of critical reflection explicit, and that it can make a valid contribution to expert nursing practice, without recourse to irreducible concepts such as intuition.

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    ABSTRACT: Background: Dietary interventions are considered an important aspect of clinical practice, more so in the face of the rising prevalence of obesity, diabetes and cardiovascular diseases globally. Educational interventions to improve nutrition care competencies and delivery have been implemented, but with variable success. This realist review protocol therefore aims to determine what sort of educational interventions work, for whom, and in what circumstances, to improve the delivery of nutrition care by future doctors. Review questions- 1. What learning outcomes do future doctors and doctors need to attain in order to deliver nutrition care to patients? 2. What mechanisms and contextual factors lead to the attainment of those outcomes? 3. How do those mechanisms and contextual factors interplay to produce those outcomes?? 4. How could undergraduate educational interventions support an optimal interplay of those factors? Methods: This realist review will be conducted according to Pawson’s five practical steps for conducting realist review: (1) clarifying the scope of the review, (2) determining the search strategy, including adopting broad inclusion/exclusion criteria and purposive snowballing techniques, (3) ensuring proper article selection and study quality assessment using multiple methods, (4) extracting and organising data through the process of note taking, annotation and conceptualization, and (5) synthesising the evidence and drawing conclusions through a process of reasoning. Candidate programme theory The delivery of nutrition care is a complex process that is not only influenced by cognitive skills, concepts and abstract rules but the individual’s motivation as well as the social environment within which nutrition care is delivered Results: Findings will be reported according to the publication criteria outlined by the realist and meta-narrative evidence synthesis (RAMESES) group. Conclusion: The key outcome of this realist review protocol is the building and testing of a middle range theory of how educational interventions work, for whom and under what circumstances to improve the delivery of nutrition care.
    1st International Conference on Realist Approaches to Evaluation and Synthesis, UNIVERSITY OF LIVERPOOL; 11/2014
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    ABSTRACT: Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why? The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use. 24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents' function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches. This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.
    Implementation Science 09/2013; 8(1):107. DOI:10.1186/1748-5908-8-107 · 3.47 Impact Factor
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    ABSTRACT: ABSTRACT Evidence-based practice (EBP) has become a universal standard for practice among healthcare professions, but due to barriers to EBP, the most effective ways of teaching EBP are not well understood. The purpose of this study was to report students' EBP knowledge and skill gained from an entry-level Master's of Science in Occupational Therapy course in EBP. The Adapted Fresno Test of EBP was administered at the beginning and end of the course and after fieldwork experience. Results indicated that EBP knowledge and skills increased between the precourse and postcourse measurements (t = -7.98; p < 0.001), but declined between postcourse and postfieldwork measurements (t = 6.65; p < 0.001) indicating that the course improved basic EBP skills and knowledge, but was ineffective in giving the students the strategies to retain and use those skills beyond the classroom. Suggestions are made to strengthen the student retention and use of EBP skills and knowledge after graduation.
    Occupational Therapy in Health Care 07/2012; 26(2-3):138-149. DOI:10.3109/07380577.2012.694584

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