Theory vs evidence
This paper is a presentation of the board of the hospital which will present the arguments from two committees; an evidence-based committee and theory-based committee. A summarized report of each committee's presentation is included on why the hospital should implement integrated evidenced-based practice (EBP) or theory-based practice into their clinical setting. After analysing the arguments and supporting points of both sides, merits and drawbacks of the implementation of each practice were taken into account and put forward. Finally, the rationale and recommendation for a theory-guided, evidence-based nursing approach will be asserted.
The evidence-guided committee states that by implementing an evidence-based approach into the hospital, nurses will be able to make “clinical decisions using current “best” research evidence. This is then blended with approved policies and clinical guidelines, clinical expertise and judgment, and patient preferences ().” They argue that EBP will improve clients' present and future health outcomes. The committee brought into example a study done in a hospital setting using research-based nursing intervention. The study found that 72% of the clients had 28% better outcomes physically, behaviourally, intellectually, and socio-psychologically when evidence-based practice (1988). They stressed the importance of integrating the best sound evidence of client care in the nursing profession with an aim to improve that care.
The committee also believes that EBP will help to narrow the existing gap between research and practice. When EBP is utilized, nurses will be able to use research finding to establish or guide their actions in clinical settings. They will no longer rely on fads or the advice of colleagues that may not be valid or reliable (). In addition, EBP will increase the availability and utilization of quality research that is based on randomised controlled trail designs (). This will in turn help nurses to keep up with the large amounts of continuously yield research findings and will allow them to utilize rigorous research rather than methodologically weak and unreliable research ().
The theory-guided committee argued that implementing a conceptual approach in clinical practice would “facilitate processes that significantly benefit clients, nurses, the healthcare system and the broader environment” (). Theory would provide nurses with a purpose in their clinical practice while giving them a perspective with which to view clients' situations. By implementing theory-based practice nurses, we would be able to systematize, analyse and interpret the daily experiences and information gained from providing care to clients. This in turn would help nurses better manipulate outcomes of the care provided, better communicate with clients and other health care professionals and make their practice more efficient overall.
Theory-guided nursing practice will make nursing a unique profession with its own boundaries and will help guide the direction the profession to follow in the future.
The theory-based committee also provided examples of applying major human science theories into practice and strongly urged us to designate a specific theory to guide the nursing practice within the hospital. Some examples include Parse's theory of human becoming and the formation of meaning to health and quality of life, and Newman's theory of expanding consciousness and pattern recognition through the collaboration with clients. They described a hospice setting and how such theories can be implemented to dying clients and their families. For example, if the practice is guided by Parse's theory, the nurse is able to provide an individualized care to clients, viewing each client as a unique human being and an expert of his or her own life. Another example given was towards clients with disabilities. When the practice is guided by Newman's theory, nurses are able to form relationships with their clients and find an unfolding pattern in their lives. In this way both are able to expand their consciousness; nurses and clients are able to grow, find new meanings in life, and form new and deeper relationships. Many nurses reported that when such theories were implemented in clinical settings, their job was more rewarding and professional, in turn improving both client and nurse satisfaction (). The committee argues that implementing theory based practice will help nurses understand clients better and in turn improve clients' health and well-being, as well as provide the nurses with a unique body of knowledge.
After closely listening to both committees it is clear that both EBP and theory-based practice have both advantages and disadvantages. Firstly, when EBP is used, some nurses might find it difficult to incorporate it into the clinical setting as they might simply not understand how to do so, or they may lack the knowledge and skill of interpreting research finding and applying them to practice. Whereas, when theory-guided practice is used to guide nurses thinking and actions, nurses can better comprehend and put meaning to what they are doing and why. Furthermore, time constrains can impede nurses from utilizing EBP (Canadian Nurses Association, 2004). Nurses often have heavy workloads and so can be too busy to engage in such practices. In addition, nurses may not have the appropriate access to current information and resources to support the search for new knowledge. For example, hospital libraries may not have current research journals.
Nurses may also find it difficult to implement theory-based practice into clinical settings. Nurses may have hard time to decide how and in what situations to apply theory as they may not have a clear understanding of or may not recognize the principles and concepts related to client care and needs. In fact, there is very little material in the literature relating to the application of theory to modern practice. All of the later contributes further to the already existing theory-practice gap. Moreover, nursing theory in the literature often is subjective and focuses on restricted, ideal situations. Nursing theory often describes how nursing practice should be rather than how it really is in real life situations. In fact, the knowledge of theory does not always produce good practice. As observed by Allmark (1995), practice development and progression many times lacks theoretical base. Therefore, we must be vigilant in the conscientious application of nursing theory to relevant situations.
If used effectively, both EBP and theory-based practice can greatly contribute to nursing practice. EBP is a universally applicable phenomenon which uses up-to-date top research evidences and facilitates sound judgment in clinical settings and cost-effective care. It can also promote nurses and students alike to question common clinical practice actions. Nursing theory can create new ideas and help put forward solutions to the many problems that are encountered in the experiential world of the clinical setting. Whereas nursing theory puts greater emphasis on client centered care, EBP also considers client preferences and so together they can ensure a more client centered approach. This way, clients and nurses will be able to engage in a therapeutic relationship, where trust, acceptance and mutuality are co-created by nursing and client, improving quality of care.
I believe that theory guided practice in a way allows EBP to progress by generating conceptual problems. I think that integrating both EBP and theory based practice would yield the best results for both clients and nurses alike. It would lead to improved professional autonomy and give nurses a unique identity that guides our practice by what we know rather than by delegating nursing responsibilities. Also, nurses will be able to care for clients in a way that improves their health and well being within their own environments. Nursing theory can be used to provide guidance in creating and implementing evidence-based practice.
In order to make a theory-guided, evidence-based practice possible and narrow the gap between research, theory and practice, a number of factors must be considered and addressed. Firstly, to help narrow the theory-practice gap, theory development should be targeted towards nurse educators as well as nurse practitioners. Institutions must make efforts to promote theory and practice as a whole unit rather than separate nursing actions. This in turn will help nurses apply relevance to academic knowledge in clinical practice. Students and nurses should also be exposed to theoretical principles more often. As well, effective guidelines for the application of theory in nursing practice should be developed and encouraged to be utilized. Furthermore, EBP can also be incorporated in educational faculties such as universities and within practice settings themselves.
Hospitals should incorporate programs, seminars, orientation sessions, workshops and offer nurses continuing education courses that will focus on theoretical concepts and principles as well as skills such as searching and critiquing research and applying it to practice. Other programs can also be developed that will train nurses and focus on improving their knowledge and skill to critically evaluate research findings and its effect of their practice. Moreover, hospitals should have libraries near or within the clinical setting that will include current research journals in the libraries. Hospitals should also provide internet access in the clinical setting with good databases containing theory-based and evidence-based research articles. Hospitals should also implement policies, procedures and practice guidelines that are based on current evidence.
It is also important for the theorists and researchers to directly participate in clinical settings. This will allow them to base their theories or research on real life experiences and use a language that could be easily understood by nurses. Moreover, it is essential to support information-seeking behaviours that demonstrate the use of present evidence- based and theory based practices. By promoting the benefits of EBP and theory-based practice, nurses can be the change champions who implement the best of both practices.