Evidence-based healthcare as it is contemporarily conceived is based on the view that clinical decisions should be based on the best available scientific evidence but recognising patient preferences, the context of healthcare and the judgement of the clinician. The ongoing debate on the nature of evidence for practice across all of the health professions is influenced by the experience of clinicians in everyday practice who, in using the evidence, assert that there are diverse sources of research-based and non-research-based evidence and that the process of evidence-based practice should be placed within a broader context that is grounded in practice; recognises different evidentiary bases; and is directed towards improving global health across vasty different practice contexts. We present a developmental framework of evidence-based practice that builds and expands on the work of leaders in the field of evidence-based healthcare; is contextualised; is inclusive of diverse forms of evidence; and incorporates understandings of knowledge transfer and utilisation. The conceptual model attempts to situate healthcare evidence and its role and use within the complexity of practice settings globally.
The dominant discourses surrounding the debate on evidence-based healthcare takes for granted that the concept evidence is exclusively derived from randomized controlled trials. However, influenced by the experience of practicing clinicians, who assert that there are diverse sources of evidence, we contend that evidence-based practice can properly be inclusive of diverse forms of evidence including the results of all forms of rigorous research, expert opinion, and experience. The Joanna Briggs Institute model illustrates this broader definition of what counts as evidence which is seen as critical to developing the role and use of evidence-based healthcare within the complexity of practice settings globally.
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