Evidence for practice, epistemology, and critical reflection

Nursing Philosophy (Impact Factor: 0.83). 09/2006; 7(4):216 - 224. DOI: 10.1111/j.1466-769X.2006.00267.x
Source: PubMed


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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Available from: Dawn Freshwater
    • "Evidence-informed healthcare has become recognized as fundamental to practice [3,4] and aims to address the large gap between what is known and what is consistently done [5]. Evidence-informed healthcare comprises the use of the best available (least biased and most trustworthy) evidence in decision making [4] in order to ensure ethical and accountable practice [3], protect patients from incompetence and other risks [4], and achieve the best patient outcomes through organizations meeting their responsibilities for the delivery of high quality care. "
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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.
    No preview · Article · Sep 2013 · Implementation Science
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    • "Its ascendancy in the field of research and practice is related to the Cochrane Collaboration in 1993 [2], and also to the efforts of Hargreaves [3] who purported that research in medicine was a model to which educational researchers should aspire. Indeed since that time evidence-based practice (EDP) has become equated with accountable, professional nursing practice [4]. Essentially, the term evidence-based practice refers to the utilization of knowledge, derived primarily from research, in practice. "
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    ABSTRACT: The term evidence-based practice refers to the utilization of knowledge derived from research. Nursing practice, however, is not limited to clinical practice but also encompasses nursing education. It is, therefore, equally important that teaching preparation is derived from evidence also. The purpose of this study was to examine whether an evidence-based approach to preceptor preparation influenced preceptors in a assuming that role. A qualitative method using semistructured interviews was used to collect data. A total of 29 preceptors were interviewed. Constant comparative analysis facilitated examination of the data. Findings indicate that preceptors were afforded an opportunity to participate in a preparatory process that was engaging, enriching, and critically reflective/reflexive. This study has generated empirical evidence that can (a) contribute substantively to effective preceptor preparation, (b) promote best teaching practices in the clinical setting, and (c) enhance the preceptorship experience for nursing students.
    Full-text · Article · Jul 2012
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    • "To minimize challenges of implementation, social workers must remain conscientiously aware of the seduction of the positivist-empirical element of the EBP model in deference to the practice wisdom and client preference elements. The former is an easy lure, since the scientific method is viewed and advocated as the most important means of evidence generation by some (Avis and Freshwater 2006), even as this power differential among the elements of the model continues to be questioned by others (Hall 2008). Similarly, with regard to social work policy concerns, the E in EBP needs to be well-defined, especially where non-scientific ideological concerns come into play (Tannenbaum 2003). "

    Full-text · Article · Jan 2009
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