Question Five: Evidence-Based Practice

Hello all,

Here is question five, and a video of the question can be found here: http://www.facebook.com/pages/International-Science-Education-Partnerships-Project/265638800073

There has been a lot of discussion over the last few years over the value of evidence-based medicine (EBM) or practice (EBP)in health care.

There have been some severely critical papers on the subject posted, and mainly taking the stance that the scientific EBP approach is wrong as it has a limited view of what constitutes evidence. These arguments usually make some reference to post-modern approaches always seem to mention “ways of knowing” somewhere along the way, arguing that scientific research is not value free, evidence is really based upon individual perceptions, ways of being, intuitive knowing and that different perspectives are equally valid. A key example is the paper by  Holmes et al. here, which also suggested Archie Cochrane (one of the fathers of EBM) was an intellectual fascist.

Indeed, a growing trend is exemplified by attempts to change the terminology to evidence-informed practice McSherry (2002) argues that evidence-based practice is focused on a hierarchy of evidence whilst evidence-informed practice is focused on the practitioner knowledge.

So my question is what do you think of the concept of EBP, and is there a difference between evidence-based practice and evidence informed practice or is this merely semantics/bunk? Ok, I know that’s cheating and really two questions, but please do post your thoughts on this one. As always we look forward to your responses.

Regards Bernie

References

McSherry R., Simmons M., Abbott P.(2002) in McSherry R., Simmons M., Abbott P. Evidence-Informed Nursing: A Guide for Clinical Nurses. London: Routledge; 2002. An introduction to evidence-informed nursing; p. 1-13

Holmes D., Murray S.J., Perron A., Rail G. (2006) Deconstructing the evidence-based discourse in health sciences: truth, power and facism. International Journal of Evidence Based Healthcare, 4, 180-186.

2 thoughts on “Question Five: Evidence-Based Practice

  1. Yes, I think there is a huge difference even though there is a change in one word. For example, in my clinical rotation for med/surg, my clinical instructor told me that after we give injection, we don’t use alcohol swab because alcohol will get into the patient’s bloodstream and it could be dangerous. However, from a male perspective, we shave every morning and after we use a razor, we dab ourselves with alcohol-based solution to disinfect. Both perspectives would be equally valid and both views would be considered evidence-informed practice depending on which expert’s knowledge and rationale we choose.

    However, if we look at it from an evidence-based point of view, we would perform systemic and randomized research on patients who were swabbed with alcohol and control group who were not swabbed with alcohol after injection in order to determine the consequence of alcohol in the bloodstream. In this case, experimental research would have hierarchy over other research such as qualitative research as well as the knowledge and rationale of the experts.

    In a healthcare setting, it would be more appropriate to use evidence-informed practice because performing randomized research on every trivial practice is not feasible.

  2. Excellent points. My sense is this is just semantics and EBP is a perfectly acceptable term. Practitioner based knowledge would appear a very subjective and potentially value laden form, and poorly defined.

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