Quandaries of Autonomy and Empowerment in Evidence-Based Nursing Care

Marita Nordhaug

doi:10.7577/pp.3711

Quandaries of Autonomy and Empowerment in Evidence-Based Nursing Care

Professions and Professionalism ◽

10.7577/pp.3711 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Marita Nordhaug

Keyword(s):

Decision Making ◽

Nursing Care ◽

Patient Empowerment ◽

Professional Autonomy ◽

Evidence Based ◽

Clinical Expertise ◽

Autonomous Choice ◽

Patient’S Autonomy ◽

Research Findings ◽

Evidence Based Nursing

Empowerment and evidence-based practice represent two influential principles in nursing care: that decision-making should be based upon the patient’s autonomous choice, and the most up-to-date research findings, respectively. In this article, patient empowerment is taken to imply a transfer of control and power from the nurse to the patient through communication and care and acknowledging the patient’s perspectives and values. Empowerment-based nursing may thus be central to enhancing a patient’s autonomy. Evidence-based nursing combines up-to-date research findings, the nurse’s clinical expertise and the patient’s preferences. This article concerns some of the potential conflicts these principles may give rise to in everyday deliberations in nursing care. It is argued that patient empowerment and autonomy potentially both have paternalistic connotations. It is also questioned whether an increased emphasis on patient empowerment and autonomy may lead to a risk of diminished professional autonomy.

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Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence

Critical Care Nurse ◽

10.4037/ccn2014411 ◽

2014 ◽

Vol 34 (2) ◽

pp. 58-68 ◽

Cited By ~ 26

Author(s):

Mary H. Peterson ◽

Susan Barnason ◽

Bill Donnelly ◽

Kathleen Hill ◽

Helen Miley ◽

...

Keyword(s):

Clinical Practice ◽

Nursing Care ◽

Best Practice ◽

Clinical Decision Making ◽

Improve Patient Care ◽

Clinical Decision ◽

Evidence Based ◽

Clinical Expertise ◽

Levels Of Evidence ◽

Evidence Based Nursing

Evidence-based nursing care is informed by research findings, clinical expertise, and patients’ values, and its use can improve patients’ outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the strength of research studies, assess the findings, and evaluate the evidence for potential implementation into best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in practice.

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What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-19-00171 ◽

2020 ◽

Vol 29 (2) ◽

pp. 688-704

Author(s):

Katrina Fulcher-Rood ◽

Anny Castilla-Earls ◽

Jeff Higginbotham

Keyword(s):

Clinical Practice ◽

Research Evidence ◽

Evidence Based Practice ◽

Evidence Based ◽

Clinical Expertise ◽

Speech Language Pathologists ◽

School Based ◽

Research Findings ◽

Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

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Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

BMC Family Practice ◽

10.1186/s12875-019-1073-x ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 3

Author(s):

Lisanne S. Welink ◽

Kaatje Van Roy ◽

Roger A. M. J. Damoiseaux ◽

Hilde A. Suijker ◽

Peter Pype ◽

...

Keyword(s):

Decision Making ◽

General Practice ◽

Evidence Based Medicine ◽

Evidence Based ◽

Clinical Expertise ◽

Stimulated Recall ◽

Previous Discussion ◽

Based Medicine ◽

Stimulated Recall Interviews ◽

Gp Training

Abstract Background Evidence-based medicine (EBM) in general practice involves applying a complex combination of best-available evidence, the patient’s preferences and the general practitioner’s (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other’s consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other’s EBM behaviour through observation, and by identifying aspects that influence their recognition. Methods We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner’s consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner’s actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other’s considerations well with those who did not, we developed a model describing the aspects that influence the observer’s recognition of an actor’s EBM behaviour. Results Overall, there was moderate similarity between an actor’s EBM behaviour and the observer’s recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role. Conclusions GP trainees and supervisors do not fully recognise EBM behaviour through observing each other’s consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decision-making is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.

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Evidence-based Nursing Care for Patients With Heart Failure

AACN Advanced Critical Care ◽

10.1097/01256961-200604000-00013 ◽

2006 ◽

Vol 17 (2) ◽

pp. 170-183 ◽

Cited By ~ 12

Author(s):

Nancy M. Albert

Keyword(s):

Heart Failure ◽

Nursing Care ◽

Evidence Based ◽

Patients With Heart Failure ◽

Evidence Based Nursing

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Evidence-Based Decision-Making (Part 1): Origins and Evolution in the Health Sciences

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00007019 ◽

2009 ◽

Vol 24 (4) ◽

pp. 298-305 ◽

Cited By ~ 14

Author(s):

David A. Bradt

Keyword(s):

Public Health ◽

Decision Making ◽

Evidence Based Medicine ◽

Strategic Decision ◽

Systematic Research ◽

Evidence Based ◽

Clinical Expertise ◽

Strength Of Evidence ◽

Based Medicine ◽

Evidence Based Decision Making

AbstractEvidence is defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.

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