Evidence, Virulence, and the Disappearance of Nursing Knowledge: A Critique of the Evidence‐Based Dogma

Abstract

We argue against the hierarchical differentiation of varied research approaches so as to allow diverse methodologies to guide research and ultimately practice. The status quo is challenged, where research agendas are currently dominated by one paradigm of knowledge development; that of post-positivism in which randomized control trials are portrayed as superior evidence. There is a hazard in excluding many other venues to build nursing knowledge and in oversimplifying the complexity of clinical nursing practice. Furthermore, we argue that this preferred path of knowledge development contradicts nursing academics' efforts to distance itself from the medical model of health care provision and research.

The effectiveness of harm reduction in preventing HIV among injecting drug users

“…16 Experimental evidence for NSPs in the form of a randomised-controlled trial, considered the highest level of evidence in the ranking scheme, has not been possible because of the logistical and ethical problems of randomly assigning NSP access to individual or groups of IDUs. 17 While the hegemony of the evidence-based medicine framework now extends into all areas of health, [18][19][20] there is increasing debate regarding its appropriateness for using these forms of evidence for assessing some public health interventions. 21,22 After two decades there is still no evidence that NSPs reduce the age of initiation, increase the frequency of injecting or prolong the duration of drug injecting careers.…”

Complexity-Based Pedagogy for E-Learning: Description of Emergence in a Graduate Nursing Program

“…This article has helped me look beyond my own thoughts and to realize that there is more then EBN to being a good nurse. One of the ideas that I really appreciated in the Holmes et al, [41] article about the way that the evidence based practice movement has a totalizing perspective that leads us all to look at the world only through that lens. This idea speaks to nurses having the ability to open their thoughts and world positions on what they think are best for the patient.…”

Discourses and practices in institutionalised nursing in South Africa: Challenges for care

“…With the exception of medicine, nursing tends to be unreceptive to knowledge coming from outside its disciplinary boundaries (Holmes, Perron and O'Byrne 2006). This is particularly problematic in South Africa, as the dominant biomedical paradigm perpetuates a Eurocentric approach to patients and results in the 'reproduction of a monolingual, English-centred approach to health care' and the 'regular exclusion [of African languages] from the hospital setting' (Deumert 2010: 59).…”

“…Nonetheless, building on the work of Barbara Carper, one way in which international nursing asserted its distinctiveness from medicine was by championing aesthetic, ethical and personal knowledge in addition to empirical medical knowledge (Archibald 2012;Holmes, Perron and O'Byrne 2006).This approach faces a threat in the recent rise of postpositivism and evidence-based nursing as the new normaive paradigm for the discipline. Given that institutional medicine's authority is rarely challenged, nursing followed suit when the former adopted evidence-based medicine as its benchmark (Holmes, Roy and Perron 2008), including terminology such as nursing diagnoses, evidence-based practice, best practices, best evidence and randomised controlled trials (Holmes, Perron and O'Byrne 2006).…”

“…Given that institutional medicine's authority is rarely challenged, nursing followed suit when the former adopted evidence-based medicine as its benchmark (Holmes, Roy and Perron 2008), including terminology such as nursing diagnoses, evidence-based practice, best practices, best evidence and randomised controlled trials (Holmes, Perron and O'Byrne 2006). This approach requires measurable, observable phenomena which thus excludes the emotional, ethical and socio-political dimensions of caring (Holmes, Perron and O'Byrne 2006;Holmes, Roy and Perron 2008). Evidence-based guidelines have also been criticised for diminishing critical thinking and professional responsibility amongst nurses (O'Halloran, Porter and Blackwood 2010).…”