Now is the time for evidence-generating practice in gerontological nursing.

Abstract

Evidence-based practice (EBP) holds a firm, central place in nursing. Lauded by investigators and practitioners alike, many nurses point to Florence Nightingale as the first to highlight evidence in practice (Mackey & Bassendowski, 2017). Today, most gerontological nurses value EBP, recognise unmet need for evidence in care for older people and caution against classifying evidence too rigidly (Rycroft-Malone et al., 2004). We realise older people receive our care in varied settings and at varied points in their lives, under myriad conditions. Within the plurality that is gerontological nursing practice, we guard against overly simplistic and narrowly determined understandings of the “who, what, where, when and how” that constitute EBP. Typically, EBP flows from science and investigators in the form of syntheses of single primary data sets and evidence gathered from across a set of studies. Clinicians and practitioners working in domains where that evidence is relevant benefit directly. They employ appropriate primary research findings and, more often, evidence syntheses such as systematic reviews and qualitative meta-syntheses in their practice. The plurality and multiplicity of gerontological nursing frequently outstrip available evidence, especially when empirical and quantitative terms of reference delimit evidence. Nonetheless, these unmet needs impel nurse scientists and others to continue their quests for discovery, filling reserves of necessary evidence. Our embrace of EBP parallels efforts to effect alignment between research and practice within nursing. Nursing struggles still, as in times past, in bridging a divide between research and practice. Many individual nurses and institutions display bold efforts to create relationships and build dialogue and action between research and practice. Think of the nurse researchers working in practice settings around the world to gain a sense of how far these efforts reach. Arguably, however, the divide between nursing research and practice is, when framed at the level of discipline and profession, smaller than ever before. Whether that bridge effectively reaches the many spaces where we nurse older people is less certain. Fewer long-term care institutions as opposed to acute care hospitals, for example, envision such roles and find the resources to realise them. Taking stock of the state of EBP and the amalgamation of research and practice highlights the broadly unidirectional nature of each campaign. In the same way that EBP flows from science to practice, practice is the place where research is integrated. Research teams less often include nurse clinicians than clinical programmes include a researcher or scientist. True, some research studies do incorporate team members who represent clinical and consumer or service user perspectives. The reverse relationship, like that in EBP, is far more common. The limitations of health and social care in effectively meeting the needs of older people, their families and communities warrant radical reappraisal and realignment of current structures and processes to achieve aims of improvement. Gerontological nursing, as a community of practitioners, educators and researchers, possesses knowledge, skill and perspective needed to effect such change. In a world soon to be aged and super-aged in many regions of the globe, we see phenomena—average age on a hospital ward of over 90, for instance—and contend with challenges—promoting independence at home for multimorbid yet quite functional elders—colleagues may not yet envision as even possible. To support requisite shifts in practice, education and science, I posit altering the course on which evidence flows in EBP and in the integration research and scientists into practice. Practice in care for and with the highly heterogeneous group labelled older people generates rich and varied funds of evidence. Evidence generated by practice spans the relational and aesthetic to the standardised and benchmarked along with almost everything that lies between. I suggest now, today when we contend with the possibilities held in a super-aged world, is the time for evidence-generating practice. Public health, along with a very few other disciplines, predates us here with their call for practice-based evidence (Green, 2006). Let us then lead nursing in this drive for current and nimble connections between and among practice, research and education to achieve the betterment of health and well-being at all ages for everyone around our soon to be aged world. As IJOPN Editor in Chief, I challenge gerontological nurse clinicians, scientists and educators—too often left out of debates and positions about evidence—to help define evidence-generating practice in care for older people. Foundations for this work are clear, existing in a rich and varied literature that reflects how we appraise the scope, quality and influence of our practice, collecting all of that and more as the evidence we seek. Building from those foundations to re-establish the flow of evidence as dialectic; creating platforms for nurse clinicians holding meritorious positions in research teams; and developing novel standards and standard bearers for evidence-generating practice in gerontological nursing emerge as next logical steps. Let us go forward together.