Toward a Transdisciplinary Model of Evidence-Based Practice

Division of General Internal Medicine, University of California, 400 Parnassus Ave, A-405, San Francisco, CA 94143-0320, USA.
Milbank Quarterly (Impact Factor: 3.38). 07/2009; 87(2):368-90. DOI: 10.1111/j.1468-0009.2009.00561.x
Source: PubMed


This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal "three circles" model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines.
The core issues and challenges in EBP are identified by comparing and contrasting EBP models across various health disciplines. Then a unified, transdisciplinary EBP model is presented, drawing on the strengths and compensating for the weaknesses of each discipline.
Common challenges across disciplines include (1) how "evidence" should be defined and comparatively weighted; (2) how and when the patient's and/or other contextual factors should enter the clinical decision-making process; (3) the definition and role of the "expert"; and (4) what other variables should be considered when selecting an evidence-based practice, such as age, social class, community resources, and local expertise.
A unified, transdisciplinary EBP model would address historical shortcomings by redefining the contents of each model circle, clarifying the practitioner's expertise and competencies, emphasizing shared decision making, and adding both environmental and organizational contexts. Implications for academia, practice, and policy also are discussed.

Download full-text


Available from: Edward Mullen
    • "Evidence-based practice (EBP) is a process of making health care decisions based on the best available scientific evidence as well as the characteristics, health status, needs, values and preferences of the individual patients; the resources available; and the experience of the health professional, in a specific setting and organizational context (Satterfield et al. 2009). Although EBP is a key element in health care quality and safety, improved health outcomes and decreased health care costs (Hyrkas & Rhudy 2013), community nursing practice continues to be based more on experience, tradition and intuition than on empirical knowledge (Patelarou et al. 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to translate the community nursing version of the Developing Evidence-Based Practice questionnaire, adapt the Spanish translation to the primary care context in Spain, and evaluate its reliability and validity. Instruments available in Spanish to date are not designed to rigorously evaluate barriers and incentives associated with evidence-based practice implementation in community health nursing. Classical Test Theory approach. The 49-item Developing Evidence-Based Practice questionnaire was translated, back-translated and pilot-tested. Two items were added to assess respondents’ ability to read and understand the English language. During the first six months of 2010, 513 nurses from 255 primary health care centres in Catalunya (Spain) voluntarily participated in the study. Internal consistency and test–retest reliability were evaluated. Internal structure was analysed by principal component analysis. A randomized, controlled, parallel-design study was carried out to test scores’ sensitivity to change with two groups, intervention and control. The intervention consisted of eight hours of in-person training, provided by experts in evidence-based practice. Of 513 nurses, 445 (86·7%) nurses responded to all 51 items. Factor analysis showed six components that explained 51% of the total variance. Internal consistency and test–retest reliability were satisfactory (Cronbach α and intraclass correlation coefficients >0·70). A total of 93 nurses participated in the sensitivity-to-change tests (42 in the intervention group, 51 controls). After the training session, overall score and the ‘skills for evidence-based practice’ component score showed a medium (Cohen d = 0·69) and large effect (Cohen d = 0·86), respectively. The Developing Evidence-Based Practice questionnaire adapted to community health nursing in the primary care setting in Spain has satisfactory psychometric properties. The Developing Evidence-Based Practice questionnaire is a useful tool for planning and evaluating the implementation of evidence-based practice in community health nursing.
    No preview · Article · Feb 2016 · Journal of Clinical Nursing
  • Source
    • "Key concepts and principles from evidence-based medicine have had a substantial influence on related professions, but also in fields far beyond their medical origins (Satterfield et al. 2009). However, the labeling of the concept differs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Against the backdrop of the transformations in the entire framing of professional work, social work has come under close scrutiny in many countries, including Sweden. Doubts have been raised about practitioners’ existing know­ ledge base, and the importance of practitioners engaging in learning and the renewal and extension of professional capacities has been emphasized. The present thesis concerns knowledge use and learning in the daily practices of child investigation work. The aim is to explore processes of knowledge use and learning in practice. The study is based on a mix of qualitative approaches, basic­ ally from ethnography, comprising methods such as participant observations, interviews, reflective dialogues and documentary analysis of case data. The main findings demonstrate that investigation work is characterized mainly by the use of practice­based knowledge. Research­based knowledge is predominantly used as a means of explaining a client’s situation or to underpin and legitimize one’s own beliefs and decisions made on other grounds. Profes­ sional learning is largely adaptive in character, as the social workers learn to handle tasks in a fairly routinized way on the basis of rules or procedures that draw on existing knowledge in the practice setting. Two conclusions are drawn: First, the use of knowledge in child investigation work bears little resemblance to principles of evidence­based practice. Second, the reproduction of professional knowledge is largely implicit and taken for granted. The study offers insight into the much­discussed topic of putting knowledge into practice, which is of importance to strategies for organizing professional learning and knowledgeable practice.
    Full-text · Thesis · Jun 2015
  • Source
    • "o , because practitioners often do not embrace the scientific process , they do not use much of our published evidence ( Giluk & Rynes , 2012 ) . Although EBMgt does not solely depend on trustworthy scientific evidence , such evidence is an integral and funda - mental part of it ( Briner et al . , 2009 ; Pfeffer & Sutton , 2006 ; Rousseau , 2006 ; Satterfield et al . , 2009 ) . We note that some of our recommendations may not adequately address all potential threats to the trustworthiness of our cumulative knowl - edge and ensure that EBMgt continues to grow and be successful . Our recommendations require changes in the way we teach and conduct re - search . There are costs to many of our suggestions , but"
    [Show abstract] [Hide abstract]
    ABSTRACT: The promise of evidence-based management (EBMgt) is that educators and practitioners can access cumulative scientific information to guide their teaching and decision making. We argue that the EBMgt movement may be unable to live up to this promise to the extent that our cumulative scientific knowledge is not trustworthy. We review why the management discipline may not have trustworthy evidence and how this widens the divide among educators, practitioners, and researchers. Next, we review the implications of untrustworthy cumulative knowledge, focusing on how educators can critically assess evidence and teach this process in the classroom. We close with recommendations for improving the trustworthiness of our literature to enhance teaching and practice from an evidence-based perspective. Suggestions include increasing the reproducibility and replication of primary studies, changing the editorial review process, and focusing on the production and dissemination of practically relevant and actionable knowledge.
    Full-text · Article · Sep 2014 · Academy of Management Learning and Education, The
Show more