Unfortunately, most quantitative studies lack external validity in the research design to allow for general conclusions.
Teaching Theories and Nursing
It was Nightingale that recognized the potential of combining sound logical reflection and empirical research in the development of scientific knowledge that lead to evidence-based practices of today. She saw the need to only classify one's illness by the best possible available knowledge but to also collect patient information in the form of survey. Nightingale's work was also groundbreaking as it was the first to integrate such ideas into one method. She understood how factors such as housing and nutrition could have a direct influence on the patient's health and prognosis (McDonald, 2001, p. 68). Still many researchers to come would look at her work as primitive, inconclusive and one-sided. They would see how such details act as an extension of evidence and the attention paid to details as research of evidence (McDonald, 2001, p. 68). Many academics would argue that Nightingale served her purpose to offer a foundation for modern nursing but did not invent evidence-based nursing. Is it possible that such a foundation could grow into something broader to encompass modern research?
Many researchers argue the credit Florence Nightingale is given as the founder of modern nursing, evidence-based nursing and care. Many researchers argue that the framework in which evidence-based care is principled on did not exist prior to the 1960s and that the Nightingale method of questioning and survey also died with the matron. Simply, this is the basis of any academic dilemma, which side is right and which side is wrong? Literature suggests many points-of-view when it comes to evidence-based nursing and its evolution into a primary method of treatment in modern medicine. It is method not only used by nurses but also doctors and other medical professionals. Part of the issue and what raises evidence-based nursing and care as debated issue is the fact that it can be difficult to effectively label evidence. Depending on the professional consulted, each may have a different insight into what defines evidence and how it is collected. George Castledine believes evidence-based nursing did not start until the 1960s. Castledine (1997) writes, "research or evidence can be used in more than one way and the sue of research as a specific form of knowledge involved political, organizational, socioeconomic and attitudinal components" (p. 1).
This only opens the issue to more analysis as one contemplates the factors that make up evidence-based nursing. Is it fair for evidence to be based on guesswork? He also cites, "the problem with evidence-based approach is that it may become obsessed with the academic basis of nursing and fail to acknowledge the art of the subject" (p. 1). This creates the concept that nurses need to not only implement a fact-finding approach not just based on medical knowledge but also on humanity. Castledine (1997) believes, in order for such a method to work there must be a healthy balance (p. 1). Still this argument is just one point-of-view and does not create a framework or description of modern nursing. It, however, is advise to the nursing student in how to formulate their own approach. David Sackett, et al. (1996) understand the historical basis of such a method but are concerned with the power it presents to nurses. There is the concern that the practice while innovative may be out dated and only used to cut administrative costs to the health care system. Sackett, et al. (1996) write:
Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systemic research. (p. 71)
While clear and distinct, this definition seems conservative in nature and devoid of creative, critical thinking. There is also the concern in modern medicine that when faced with a scenario of treating a patient, two outcomes will result. One, nurses will rely too heavily on their gut instinct and passion for care or two, nurses will look to clinical explanations and medical knowledge more than actual symptoms and listening to the patient's needs. This leads to problems regarding quality of care, customer service and administrative cost benefits. In this day and age of managed health care, evidence may not play a greater role; the reality of treatment efficiently becomes the main issue for hospitals. This can lead to mistakes, lack of compassion and possibly liability. With this in mind not only is it important for nurses to use all skills available it is also important to examine the impact that evidence-based medicine has on nursing practices and the welfare of the profession.
Once the nursing student has observed the situation and gathered evidence to support his or her continuing treatment, it is important that they must follow hospital policy of a patient's bill of rights. Dr. Drane (2002) writes, "the loss of reputation for honesty in medical practice means the end of medicine as a profession" (p. 1). Clearly there is great concern for current behaviors to deviate from ethical codes of conduct and how such behaviors are influenced by outside agents. As a part of invention, one must also take into account how a person's behavior predicts future behavior. As voiced earlier, this may stem from a cultural background where it is seen that not telling the truth is acceptable behavior. Leaving a situation without taking action or voicing any information can have the same impact and cause harm but may still be seen as acceptable by that person (Drane, 2002, p. 2). As a nurse, it is part of the job responsibilities to convey the correct information to the patient about their diagnosis and treatment. This continues to challenge the nursing student and educators as they search for new ways to intervene.
Possible ways to assist the student experiencing this situation is to provide the correct advise using evidence-based nursing as a tool for analysis but also referring back to the hospital's code of ethics. With regard to truth telling, clinical judgement is always required because in some cases the patient refuses to hear the truth or only wants to hear some truths. If the patient makes such a request, this too can cause harm but at this time the family does not have a say. The nurse has three options in this scenario: (1) go along with the doctor's plan of withholding information, (2) tell the patient the truth and (3) be assigned to another case. Assigning the nurse away from the situation may solve the problem for the short-term as then their individual background cannot influence the scenario but it is a situation ever nurse will be faced with. As part of the intervention, a teacher or more experienced nurse can share with the student stories of their own experiences dealing with ethics, truth telling and over protective families. This gives the student nurse a foundation from which to formulate their own way of expressing the information, it also gives them a feeling of not being alone in difficult situations. Thew best case solution would be to allow the student to tell the truth to the patient, this will make the next experience easier having learned from the first one.
The purpose of this paper was to apply a learning theory to an actual educational case study and scenario. The situation was to be seen from the point-of-view of the nursing student scenario. The situation was presented as challenge in need of careful consideration. This included being able to identify events and critical indicators of the scenario that made the case challenging to the student. These indicators included: a student's developmental state, education level, socioeconomic standing, cultural status or any personal, family factors that influenced the situation.
Literature suggested that these indicators apply in situations of an ethical nature and the challenge remains to make the right moral decision. Nurses are faced with moral and ethical issues every day especially when it comes to building a relationship of trust with the patient. Research also suggested that the indicators above influence one's ability to make the correct choices as different views on truth telling within the medical community exist. The issue was meant to be explored from the student point-of-view is the influence of family on patient care and the patient's right know their condition and course of treatment for that condition. The scenario was described in greater detail in paragraphs above. This paper was also meant to explore the events and indictors that the student may be influenced by if such a scenario should present itself in their career. This paper presented a theory and model from which one could guide the process of intervention. Within in this theory, one could examine applicable issues involved with the…