Term Paper on "Nursing Philosophy"

Term Paper 14 pages (3953 words) Sources: 1+

[EXCERPT] . . . .

Nursing

Reflective Practice as Applied in Nursing Practice: Consensus between Nursing Experience and Scientific Inquiry in Evidence-Based Practice (EBP)

Nursing as both a profession and vocation in the field of medical science is considered both professionally- and emotionally-gratifying, in that the nurse, as a medical practitioner, is able to provide invaluable service not only to their profession, but most importantly, to the patients and society in general. The social relevance of nurses in the field of medical science and social services make them invaluable members of the society.

It is crucial, then, that a thorough look into nursing as a practice is conducted in order to assess the efficiency of nursing practice, based on both on its theoretical foundations and applications. Among the perspectives currently dominant and prevalent in the nursing profession is the utilization of evidence-based practice or EBP, which is defined as the "conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients" (Estabrooks, 1998:21).

EBP as one of the dominant and prevalent perspectives in nursing research and practice at present is critically analyzed by nurses who have contemplated the implications of EBP when applied on both nursing research and practice. In the section that follows, these critical discourses on EBP in the nursing profession are discussed based on how each author discussed a particular aspect of EBP. That is, each author discussed either the empirical or practical merits and disadvantages of EBP in nursing, or both.

The course of the discussion and analyses of the articles in this paper assumes the position that reflective practice be the central perspective that should govern nursing research and practice, a perspective that fuses and takes into consideration both scientific inquiry and nursing experience. Using this perspective, nurses, researchers and practitioners alike, avoid the dilemma of the lack of receptivity of the nursing community to EBP and the continuous conduct of research that cannot be translated and applied efficiently to nursing practice.

Critical discussions of Evidence-Based Practice in Nursing

The articles included in this discussion all discuss EBP in nursing; however, each author centers on specific aspect/s concerning EBP, which may be empirical, practical, or even political (macro) in nature. Carole Estabrooks' (1998) inquiry into EBP as the current and dominant perspective in nursing research questioned its applicability to nursing practice, providing us readers with both political and empirical evidence on how EBP is not a reliable framework from which nursing knowledge and practice should be based upon.

Following Estabrooks' analysis is Rolfe's (2006) short but thought-provoking analysis of what he considered the "theory-practice gap" of EBP in nursing. Rolfe centered his discussion and analysis on the empirical and practical implications of this dilemma in nursing practice, recommending later into the article measures that could be done by nurses, as researchers, in improving and developing a new nursing framework, which combines both inquiry and practice in nursing. Empirically supporting Rolfe's findings is the focus of Avis's (2006) discussion of EBP. While Estabrooks and Rolfe discussed EBP in nursing bilaterally, Avis's was centered towards establishing evidence that proved how EBP is devoid of the "reflective" nature that is needed for nursing as a profession and vocation. Lastly, McCormack primarily discussed the political issues surrounding the implementation of EBP in nursing, positing that the lack of receptivity of EBP in the nursing community was brought about by the finding that it is too theoretical and not "action research"-oriented.

Experience, not Information, is Knowledge: C. Estabrooks on the Politics and Empirical Foundations of EBP

Carole Estabrooks centered on both the political and empirical implications of EBP, specifically evidence-based decision-making, in nursing practice. In the article, the author assumed the stance that the nursing community -- researchers and practitioners alike -- still have a lot to know about EBP as a new framework, and its relatively "young" inception in the nursing practice make it a subject of critical scrutiny, especially on its empirical merits to nursing. In questioning the efficacy of EBP as the dominant framework in nursing practice, Estabrooks argued that it is not a suitable framework for nurses to work or practice under because of its being too theory-based and lack of applicability in practice.

Estabrooks' reason for questioning EBP as a nursing framework is because of the development of nursing's too much dependency on research and protocols as the basis for nursing practice per se. The author believed that EBP is not a suitable framework for nursing, a practice that depends mainly on experience as the basis of knowledge, and not just research information. Having said this, the author now posed the important question pertinent to EBP: whether "research, when used by clinicians, results in improved client/patient outcomes" or not (19). This crucial question, if positively answered, establishes the efficacy of EBP of bringing research information to nursing practice. However, this was not the case, as Estabrooks argued specific points that demonstrate the lack of applicability of EBP research to nursing practice.

In a survey she conducted to a sample of 600 staff nurses, Estabrooks sought to demonstrate whether research information is indeed a source of knowledge among nurses. More specifically and most importantly, she sought to identify what were the nurses' conceptions of knowledge, and it was fund out that "experience" came out as their primary source of knowledge, followed by "nursing school," "workplace," "physicians," "intuition," and "what has worked for years" (23) Research information did not figure to be a relevant nor significant factor in determining nurses' knowledge of their practice.

Surprisingly, though, when the nurses were asked to identify their sources of information regarding their practice, nurses cited research journals, specifically nursing journals, as their major source of nursing information (26). This discrepancy in responses when asked of source of knowledge and source of information demonstrates that nurses may use nursing journals -- generally, research -- to gain nursing information, but ultimately, when faced with decision-making tasks, they resort to their experience to make these decisions. These survey results established the fact that indeed, in the case of the nurses surveyed for the study, research does not translate to its application and implementation in nursing practice.

Another critical examination that Estabrooks conducted was to discuss how quantitative methods are applied, and continuously failed, to prove their applicability to nursing practice. She cited as an example physicians' and nurses' regard for the randomized controlled trial (RCT) method, an experimental method that is prevalently used in most nursing researches, and considered to be most reliable and the "gold standard' of evidence" (27). Estabrooks expressed her doubt over this quantitative method, asking whether data and information generated from this type of study do provide "best evidence in nursing practice." Although this was a question that cannot be answered within the article, the author only implied that RCTs are examples of how too much dependency on EBP researches have 'buried' the issue of the effectiveness and suitability of these researches when applied to nursing practice. More crucial is the question of whether these research information are even applied to nursing practice at all, or not. Empirically, Estabrooks believed that EBP does not provide the "best evidence" in nursing practice in that it did not centered on the most important aspect of the nursing profession: nursing practice (or, the conduct of nursing).

Another important facet of EBP that Estabrooks studied in the article are the political implications embedded with the implementation of this framework to nursing practice. Rooted within EBP implementation and EBP research dissemination are political maneuvers that attempt to establish this framework as the dominant and prevalent perspective to be used, both in nursing research and practice. This is a very important issue among nurses, for the establishment of EBP means a "centralization" not only of the power to 'choose' which nursing information to use, but it also gives power for EBP advocates to 'choose' what nursing practice to be implemented in the workplace and healthcare facilities.

EBP being governed mainly by physicians and researchers, Estabrooks feared that its continued prevalence and dominance in the field of nursing would result to the 'exclusion of nurses' in decision-making and important practice policy issues. The author expressed worry on the fact that while she is "not rejecting the idea of evidence-based practice," she also hoped that it should not be used as a "tool to disempower clinicians or to cause more blaming of clinicians for not doing it" (18). This concern of centralized power and exclusion of nurses once EBP becomes the dominant nursing framework is not unfounded, for major decisions are being made about patient cases that may or may not be influenced by information and data generated from the EBP framework. The implementation of nursing practice based on EBP research and information could translate directly to the patient's condition, whether this information has helped improve the nurses' practice, and ultimately, the quality of care given to patients, or not.

The "theory-practice gap" in EBP: Discrepancies between research and its application in nursing… READ MORE

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