Voice thread debate: constructing counterpoint arguments with evidence

Nursing

Student 1: A matter that I consider to be of ethical importance in nursing is the use of evidence-based practice. This is an ethical issue in the sense that it is unethical not to utilize evidence in determining how to perform the duties of a nurse. The historical nurse theories, if they are not substantiated by evidence, are little more than pseudoscientific hokum. Ultimately, nursing is about helping people. You can have different approaches and philosophies, but the only approach that is truly ethical is the approach that truly works, and has been proven to do so. If you use some approach that has not been proven to work, then how are you helping?

Student 2: Are there not issues with evidence-based nursing? Is it not the case that evidence-based nursing relies heavily on randomized clinical trials, to the exclusion of all other forms of evidence, as in Ingersoll (2000).

Student 1: It\\\\\\\\\\\\'s not about dogmatic adherence to randomized clinical trials. It\\\\\\\\\\\\'s about using the best available evidence. There is a hierarchy of reliability when it comes to evidence, without question. Nursing as a field has no right to reinvent the wheels of reason here - when techniques for robust analysis have been developed by other fields, nursing has an obligation to use those best techniques. Pretending that the methods of scientific inquiry aren\\\\\\\\\\\\'t applicable to nursing practice makes no sense. The ideal is multiple, repeatable studies that all show the same thing. When you don\\\\\\\\\\\\'t have that, you use the next best thing.

Student 2: But are there not barriers to adopting evidence-based practice. Brown et al (2009) highlighted a number of these: resources available to nurses are insufficient, there aren\\\\\\\\\\\\'t enough learning opportunities, the culture doesn\\\\\\\\\\\\'t support it…there are many barriers that get in the way.

Student 1: There may well be barriers. It\\\\\\\\\\\\'s worth knowing what those barriers are, but the existence of barriers to doing the right thing doesn\\\\\\\\\\\\'t mean it\\\\\\\\\\\\'s okay to do the wrong thing. If facts exist that tell someone the most effective means of treating a patient, it does not matter what the reason is for ignoring those facts; the only thing that matters is the morality. It is wrong to ignore the facts when determining a course of treatment. I mean, if you\\\\\\\\\\\\'re not doing the best thing for the patient, what are you doing?

Student 2: Are there not other ways of learning things? Why the rigid focus on one type of learning?

Student 1: The problem with other types of learning is that they are ad hoc. They don\\\\\\\\\\\\'t adhere to a set methodology, and are not replicable. The reality is that the scientific method has established itself as the most rigorous means by which knowledge is gained, and specifically because of rhe rigor it demands. Something like Carper\\\\\\\\\\\\'s four ways of knowing is a cop-out, a way of letting people off the hook for not taking the time to learn how to research things diligently (Fawcett, et al, 2001) It\\\\\\\\\\\\'s not supported by the literature on education; it\\\\\\\\\\\\'s just somebody\\\\\\\\\\\\'s opinion, driven more by what they want to be true than what has been proven to be true. The scientific method is difficult; that nurse scholars struggle with it because historically it hasn\\\\\\\\\\\\'t been central to the study of nursing is understandable, but what is difficulty if not an opportunity for improvement? If you really want to help people, you have to use the best methods of learning possible, do the things that have the strongest support in evidence. Anything else is guessing and theorizing, but unless it\\\\\\\\\\\\'s been proven to work, you\\\\\\\\\\\\'re putting the patient at risk. It is unethical to do anything other than your very best to help the patient; you owe the patient a duty of care to do what is most likely to help, not to cater to you r own predispositions and predilections. It\\\\\\\\\\\\'s not about you – it\\\\\\\\\\\\'s about the patient, and evidence-based nursing is the only way to put the patient\\\\\\\\\\\\'s interests first. Anything else is unethical.



References

Brown, C., Wickline, M., Ecoff, L., & Glaser, D. (2009). Nursing practice, knowledge, attitudes, and perceived barriers to evidence-based practice at an academic medical center. UC San Diego. Retrieved April 6, 2018 from https://cloudfront.escholarship.org/dist/prd/content/qt47m7p92r/qt47m7p92r.pdf

Fawcett, J., Watson, J., Neuman, B., Hinton, P., Walker, J. & Fitzpatrick, J. (2001). On nursing theories and evidence. Journal of Nursing Scholarship Vol. 33 (2) 115-=119.

Ingersoll, G. (2000). Evidence-based nursing: What it is and what it isn\\\\\\\\\\\\'t. Nursing Outlook. Vol. 48 (4) 151-152.