Evidence-based Practice Evidence Research Articles

You Are Only as Good as Your Data Developing an Electronic PICC Database

The elevation of vascular access to specialty status mandates an increased responsibility for the demonstration of clinical quality and evidence of effectiveness. Although patient outcomes have always been important, the need to capture, qualify, and quantify outcomes has become essential to survival in today's competitive healthcare environment. Data collection and interpretation are integral steps in the ongoing process of outcomes analysis. Standardization in the definition of outcome indicators is imperative for accurate analysis and trending of performances that represent best practice. This article demonstrates how the development of an electronic PICC database can assist the practitioner in providing the evidence for evidence-based practice.

What counts as evidence in evidence-based practice?

Considerable financial and philosophical effort has been expended on the evidence-based practice agenda. Whilst few would disagree with the notion of delivering care based on information about what works, there remain significant challenges about what evidence is, and thus how practitioners use it in decision-making in the reality of clinical practice. This paper continues the debate about the nature of evidence and argues for the use of a broader evidence base in the implementation of patient-centred care. Against a background of financial constraints, risk reduction, increased managerialism research evidence, and more specifically research about effectiveness, have assumed pre-eminence. However, the practice of effective nursing, which is mediated through the contact and relationship between individual practitioner and patient, can only be achieved by using several sources of evidence. This paper outlines the potential contribution of four types of evidence in the delivery of care, namely research, clinical experience, patient experience and information from the local context. Fundamentally, drawing on these four sources of evidence will require the bringing together of two approaches to care: the external, scientific and the internal, intuitive. Having described the characteristics of a broader evidence base for practice, the challenge remains to ensure that each is as robust as possible, and that they are melded coherently and sensibly in the real time of practice. Some of the ideas presented in this paper challenge more traditional approaches to evidence-based practice. The delivery of effective, evidence-based patient-centred care will only be realized when a broader definition of what counts as evidence is embraced.

The notion of evidence in evidence-based practice by the Nursing Philosophy Working Group.

Questions concerning the nature of evidence in evidence-based practice have kindled debate within nursing and other health care disciplines. Such questions include the ends for which evidence is sought, the form(s) of evidence, and the values underlying evidence-based practice. In this article, some of the issues, contradictions, and tensions implicit in these questions are highlighted. It is imperative that the nursing profession continue to explore the philosophic perspectives that underscore evidence-based practice and their implications for decision making in nursing practice.

The evidence in evidence-based practice: What counts and what doesn't count?

The evidence in evidence-based practice: What counts and what doesn't count?

The psycho-social subject in 'evidence-based practice'

In this paper I provide a theoretical outline, followed by two case examples, of a qualitative method, called the free association narrative interview, which produces evidence that is congruent with the kinds and contexts of knowledge that human service professionals use in their work. Following a critique of assumptions about what constitutes evidence in evidence-based practice and an argument for the use of experiential and theoretical, as well as empirical, ways of knowing, I focus on qualitative methods and the shortcomings of semi-structured interviewing as an alternative method for evidence-based practice. In particular I argue that the theory of the research subject and the research relationship that is assumed in most qualitative methods is misguided and affects the character of the evidence that can be produced. I outline an alternative theory of the (research) subject, a psycho-social subject, drawing on psychoanalytic concepts that emphasise unconscious conflict, defences against anxiety and the centrality of unconscious intersubjective dynamics in the research, as in other, relationships. Two examples follow. The first illustrates the transference and counter-transference dynamics in one of my research interviews, showing their importance for what information was produced. The second example demonstrates the use of experiential, empirical and theoretical knowledge in the analysis of data from an interviewee with agoraphobia. It illustrates how the paradigm of a psycho-social subject can produce a more complex account of people's behaviour. I conclude by arguing that the kind of evidence illustrated here, being congruent with the vicissitudes of most human service professionals' work with clients, could provide a model for evidence-based practice that is not only more appropriate but also helpful for professional development.