Should Practice Ever be Fully Based on Evidence and Science?
Evidence-based practice has become a buzz word these days, particularly in the healthcare system. One of the questions I would like to draw attention to is about evidence-based practice (EBP). It often compels me to reflect on whether practice can ever be fully based on evidence and science.
In my opinion, this depends on how evidence and science are defined. There are still several controversies around the definition of EBP. For instance, one of the definitions of ‘evidence’ I found stated, ‘Applying the best available research results (evidence) when making decisions about health care. Health care professionals, who perform evidence-based practice, use research evidence along with clinical expertise and patient preferences’ (Rycroft-Malone. J;2004).
There are a number of definitions, depicting variations in the meaning. The question at hand is, which one do we accept or are encouraged to accept in nursing practice? There is conflict in the definition of EBP. It is only when we clearly define the words ‘evidence’ and ‘science’, that we would be able to answer the highlighted question as a yes, no or maybe.
Furthermore, I am also wondering if the question has been worded appropriately. I can, for instance, reword the question to be: “Should practice ever be fully based on evidence and science? Is it ethical?”
This question actually opens a door to debate nursing practices in relation to evidence and science. Believers of positivist’s paradigm present the findings without 100% surety. They always keep some margin of error (% of alpha and beta error) while presenting the research findings. Selecting 5% error indicates that there is a 5% chance that the observed variation is not actually the truth, and these findings are being applied by the scientific community and healthcare professionals in practice settings.
On the contrary, this raises a serious legal and ethical issue. Have we ever considered this margin of (5%) error seriously? The error is mostly on the tail side, small enough to be ignored in contrast to the 95% of confidence interval! Have we ever thought of its implications and consequences on patients’ health and well-being? How ethical would it be to apply such findings in practical settings?
To me, one might commit a big crime by applying such knowledge in practice if findings of the study prove otherwise. Thus, it would be a serious issue on ethical grounds. For instance, what if the study proved that water from the sea is safe for drinking purposes when, in actuality, it is full of toxic materials that could endanger human lives?
If it is a valid argument, then what is the solution to this dilemma? Is the solution to not generalize at all? To not test and experiment? To keep relying on trial-and-error as we work with each patient population? The answer is obviously a resounding ‘no’. We need to investigate and explore, but in a more vigorous and ethical manner keeping the context in mind.
This might be a never-ending debate! Nevertheless, this is high time to think on the lines of how we should organize our practices.
This also depends on the goal of practice. What is the goal of nursing practice? Is it to advance science, or advance nursing knowledge? Is it to heal people and help them improve their health and should there be only one overarching goal?
In my opinion, the goal of nursing practice is to advance nursing knowledge in order to empower people to improve their health. There should be one overarching goal, and ethically, practice is responsible towards patients and profession. What I mean by that is that the nursing profession should be equally concerned with both professional survival and serving people (healing, health), and ethically it should be guided by only one reason i.e., what is best for the patient? The reason nursing practice was originally established was to take care of people, and the professional part came later.
This philosophical debate can take many shapes and turns depending upon the parties debating, scholar’s argumentation style and their biases. One can try to present ideas as objectively as possible but no argument is free from personal, societal and cultural biases. Even in our belief that a randomized control trial (case and control) is the best method, there is an inherent bias that objectivity is the best way to study something.
Additionally, what is considered to be the best method or the truth at a given time can always be refuted. That, essentially, is the beauty of science. Nothing is considered true forever.
Based on using the best scientific methods available now, research may be able to show that if a particular treatment or nursing care has significant results over and over again, it may be possible in the next decade to find some superior method to carry out studies, and using that method, we will come to learn that this treatment is not reliably effective. Therefore, scholars need to be more cognizant and cautious while undertaking any study and ensure its depth, rigor and context in full sense.
Rycroft-Malone. J; Seers. K; Titchen.A; Harvey. G; Kitson.A; McCormack.B. (2004). What counts as evidence in evidence-based practice? Nursing and health care management and policy. Vol. 47 (1).
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