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Insufficient evidence: the problems of evidence-based nursing
1School of Health and Social Care, University of Portsmouth, St James Hospital, UK.
Nurse Education Today
|February 29, 2000
Summary
Evidence-based nursing, prioritizing randomized controlled trials, faces criticism. This paper advocates for a shift towards reflective, quasi-legal models to justify nursing practice post-event.
Area of Science:
- Nursing
- Medical Ethics
- Research Methodology
Background:
- Evidence-based medicine (EBM) emerged in the 1990s, integrating clinical expertise with research findings.
- Evidence-based nursing (EBN) is increasingly adopted, often emphasizing randomized controlled trials (RCTs) as the primary evidence source.
- Concerns exist regarding the suitability of RCTs as the sole determinant of nursing practice.
Purpose of the Study:
- To critically evaluate the reliance on RCTs in evidence-based nursing.
- To present logical objections to the philosophy underpinning EBN and RCT dominance.
- To propose an alternative model for evidence in nursing practice.
Main Methods:
- Philosophical critique of evidence-based nursing.
- Analysis of the limitations of randomized controlled trials in nursing.
- Development of a quasi-legal model for practice justification.
Main Results:
- The current emphasis on RCTs in EBN may not adequately serve nursing's unique context.
- Significant logical and philosophical objections challenge the supremacy of RCTs in nursing.
- The proposed quasi-legal model offers a framework for retrospective practice evaluation.
Conclusions:
- Rethinking the definition of 'evidence' in nursing is crucial.
- A shift from deterministic, pre-planned practice to post-event justification through reflection is advocated.
- A quasi-legal model, emphasizing reflection, offers a viable alternative for integrating evidence into nursing practice.