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• W2784298889 abstract "It seems increasingly important in this era of ‘alternative facts’ that nursing devotes careful attention toward the ethical implications of using evidence terminology positioning its various disciplinary knowledge contributions to the health and well-being of those we serve. We inhabit a world in which the idea of ‘evidence’ has a very real and meaningful history and tradition. Evidence-based medicine was introduced in the early 1980s as a conceptual maneuver designed primarily to force medical practitioners to cease interventions that seemed convincingly beneficial based on their clinical experience despite scientific proof to the contrary (Sackett & Rosenberg, 1995; Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). The radical Halsted mastectomy for simple breast cancer is often referenced as the classic instance of a tragic harm that persisted because well-intended surgeons were confident that it was saving lives and the narrow timeframe of their clinical encounters with real patients allowed them to ignore the considerable after-effects that the intervention actually entailed (Howick, 2011). So evidence in this sense constituted an agreement that there are factual arguments, brought about by certain forms of scientifically credible investigation, that ought to take precedence over belief, prejudice, custom, social norms, and other forms of ‘knowing’ that can inadvertently compromise fairness, equity, and sound clinical decision-making. If we accept that humans are vulnerable to unconscious bias—and the evidence is pretty strong that on that front—then we have to accept that a firmly held belief in and of itself serves as a flimsy justification upon which to base a nursing action (Edwards, 2001). So, what is this thing we call evidence, and how ought we to think about it? In the archaic sense, evidence is simply the condition of being evident. However, various other definitions are actively in play in the world around us. We have the familiar scientific version—that evidence represents the available body of facts or information indicating whether a claim or proposition is true or valid. We also have the legal sense, in which evidence is something presented in a legal proceeding which bears upon or establishes a point in question. In the legal context, an entity might therefore count as evidence regardless of its own truth value, as it is being used in with respect to a position about a truth being argued. For example, the fact that someone believed something or stated something might constitute a point of evidence, regardless of that belief or statement's factual truth. An additional use of the term relies on an experiential basis, in which evidence is anything that you see, experience, read, or are told that causes you to believe that something is true or has really happened. And because the experiential version at least in part draws upon observation through the senses, it is sometimes considered as having the properties of empirical evidence. These definitional variations are important. If we were considering a matter such as whether ghosts were real, for example, the science would confirm that there is no basis for them (not, importantly, that they do not exist, but that no proof that they do has been demonstrated, despite many creative attempts). The legal context would allow belief in the presence of a ghost equal status with belief in the presence of a human being if the issue at hand were the mental state of the person with respect to that presence. And the empirical perspective would confirm that there is plenty of evidence for ghosts because so many people have reported experiences of them. It might theorize that they are a social construction, but also position that social construction to function in a real and pervasive manner shaping the lives of those who hold that construction. And while ghosts may not be the mainstay of nursing practice, there are many aspects of nursing practice for which a similar diversity of answers might ensue if we accept any definition of the term evidence (Garrett, 2014). Using this framework, a nurse might argue that the evidence seems strong that vaccination causes autism, that therapeutic touch works better than other forms of massage, or that healing is dependent upon faith. The issue for nursing is not that one cannot argue (or find citations to support) a range of possible definitions for the term evidence, but that it becomes entirely disingenuous to advocate for evidence-based or evidence-informed practice, and then accept an entirely slippery definition of what that evidence constitutes. The originators of the evidence-based medicine idea gave us a convenient way to bypass the tyranny of formal science by making it absolutely clear that effective clinical decision-making required not only a comprehensive knowledge of the available science, but also two other equally powerful perspectives—clinical wisdom and a knowledge of the preference of the patient (Sackett et al., 1996). This triumvirate of knowledge sources respects that science will often be partial, or inconclusive, or limited to specific conditions that may not apply in all cases. It also explicitly recognizes those other forms of ‘knowing’ as clinical wisdom, and the infinite human diversity that the real world presents us with as ‘patient preference’. But in our efforts to legitimize our multiplicity of knowledge sources relevant to the patient care context, nursing has all too often been guilty of extensive confusion around what ought to count as evidence. Absolutely, we ought to continue to wrestle with subjectivities and inductively derived knowledge for practice. We need to continue to advocate for better understandings of patient engagement and patient-reported outcomes. We need to draw our skill and technique for relational practice, use of touch, interpersonal communication, compassion from a vast range of sources and develop wisdom on how and when to apply them. But let us not confuse our patients and ourselves by referring to those important bodies of insight as evidence (Thorne, 2016). I believe that we need to move quickly to ensure that the next generation of nursing can clearly distinguish between an evidence claim—in the formally accepted scientific sense—and a claim that is based on a multiplicity of factors—which is what we are normally dealing with in nursing when we thoughtfully determine the best course of action when caring for any unique individual or clinical situation. When we use the term evidence-informed practice, that claim ought to be unambiguously understandable to our audience as an authentic confirmation that we have the benefit of careful consideration of the formal scientific knowledge that has relevance for the case and that it does actually provide convincing guidance to our practice decisions. It does not, however, imply that we must uncritically apply it in a standardized manner (which is the harm implied with the use of the term evidence-based). Excellent nursing will always require pattern recognition and other forms of clinical wisdom or expertise—the qualities we aspire to as we move from novice to expert (Benner, 1984). It will always depend on the capacity to look at any given clinical circumstance from a multiplicity of directions—the multiple ways of knowing that are the hallmark of our practice (Carper, 1978). And of course, it will always require our profound commitment to ‘knowing’ the patient to the best of our ability within the context available to us (Liaschenko, 1997) so that our decisions always respect the human variation we serve. Much of the work to develop these forms of knowledge will be developed through qualitative research and other forms of empirical knowledge generation that strengthen our capacity for clinical insight and action (Thorne, 2016). As a longtime proponent of qualitative inquiry, I am passionate about the contribution it can make to the quality of care and health services offered by our discipline. As an educator of nurses, I am committed to ensuring that they are able to draw upon a full spectrum of the ‘knowing’ – including emancipatory and sociopolitical knowing—that can so marvelously support our practices. But I very much hope that we can preserve our credibility as a trusted profession by avoiding the mistake of referencing such important wisdom as evidence. As the culture of alternative facts and unfounded evidence claims continues to complicate all of our lives, let us ensure that the nursing profession remains a trustworthy source of accurate claims about the valuable and multi-faceted knowledge we offer to those in need. Let us just not use the ‘e-word’ unless we mean it." @default.
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• W2784298889 title "But is it ‘evidence’?" @default.
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