Introduction

Evidence-based practice (EBP) is essential in the improvement of health care quality and delivery. It involves the use of research evidence, models, and clinical expertise to inform clinical decision-making. While the ‘evidence-based practice’ is emphasized in the nursing field, the proliferation of perspectives on EBP seems to erode the original intent and framework underpinning this model. In particular, identifying or determining what constitutes ‘best evidence’ is often problematic. This paper reviews a qualitative study (article) that reports on the implications of the competing EBP perspectives for the current nursing practice environment.

Study Purpose

The aim of the study by Thorne and Sawatzky (2014) is to unravel the multiple “theoretical discourses around the notion of evidence” through a review of the different conceptualizations of evidence in nursing literature (p. 6). This will improve nursing theory development, enhance the use of research evidence, and promote clinical reasoning in nursing practice.

Research Question/Hypothesis

The authors hypothesize that there is a discrepancy between the current definitions of ‘evidence’ within nursing practice and the frameworks underpinning this concept in other disciplines. This has affected the dissemination of nursing knowledge in clinical settings. The study’s hypothesis is not easily identifiable. Moreover, no research question is provided.

Method

Study Design

The study examines the intricacies related to the use of ‘evidence’ in specialized practice settings. The authors use a phenomenological approach to identify the competing bodies of knowledge and assumptions related to evidence-based practice in the nursing discipline. The research method used involves an analysis of nursing texts and literature to gain insights into the frameworks, scholarly discourses, and assumptions surrounding the conventional use of evidence in nursing and develop a new perspective. The study does not use primary data and thus, it does not involve a selection of a sample (participants) from a population.

Setting

The study involves a discussion of bodies of knowledge in nursing scholarship relating to the conceptual frameworks and models that inform clinical reasoning. The authors analyze scholarly texts to give a clear picture of the perspectives underpinning evidence-based practice. In this regard, since the study does not involve data collection from a specific population, it is not possible to describe the characteristics of the study’s setting. Nevertheless, a broad range of nursing texts and articles on evidence-based practice is reviewed in this study.

Population/Sample

The researchers did not use primary data in their analysis. They only relied on secondary sources (texts and peer-reviewed journal articles) in their analysis. In this regard, there was no target population/sample for this study. The analysis involved 48 sources. However, the article does not specify the inclusion criteria used to select the sources used in this study. Moreover, it is not clear whether data saturation was reached in order to identify common themes in literature.

Ethical Considerations

Studies involving human subjects must obtain approval from the Institutional Review Board (IRB). In general, the benefits of a qualitative study must exceed the risks to the participants for it to gain IRB’s approval. In the study by Thorne and Sawatzky (2014), the focus is on evidentiary knowledge that guides nursing practice. Thus, the study relies on scholarly literature to analyze the perspectives surrounding systematic theorizing and philosophizing in a nursing context. Since there are no human subjects involved, the study does not pose any risk that may require it to seek IRB’s approval.

Data Collection

Instrument /Observation/Interview/Artifacts/Documents

Data collection instruments such as questionnaires help researchers to collect relevant data from the target population or sample. However, Thorne and Sawatzky (2014) did not use questionnaires or interviews to obtain data because the study relied on secondary sources (books and articles). Additionally, the authors did not use participant observation to collect qualitative data. The authors only rely on theoretical and empirical research on “conceptualizations of the clinical evidence” to develop a framework for theorizing a ‘generalized’ evidence-based practice (Thorne & Sawatzky, 2014).

Validity and Reliability

Validity in research describes the truthfulness of a study’s conclusion or inference. Thorne and Sawatzky (2014), based on a detailed analysis of the scientific frameworks and perspectives on evidence-based practice, conclude that it is only through a change of the current frameworks, which guide the application of specific nursing evidence that a wholesome way of theorizing can be developed in nursing practice. However, the study’s reliance on secondary data as the only source of information (lack of data triangulation) affects the validity of this conclusion. Moreover, data from in-depth interviews with the key stakeholders such as nurses and other health care professionals would have enhanced the validity of this study.

Reliability refers to the repeatability of the measures by another study. In Thorne and Sawatzky’s (2014) study, the authors reflect on the current bodies of knowledge relating to the use of research evidence in nursing. In this regard, the study does not involve any specific measures. Thus, the same results or conclusions may not be arrived at in other similar studies.

Results

Data Analysis

The study utilizes a descriptive data analysis approach to appraise previous studies and clinical scenarios. Typically, this approach entails data preparation, description, and hypothesis testing. In their analysis, Thorne and Sawatzky (2004) did not follow these phases to analyze the qualitative data and make inferences. The authors analyze various studies that focus on knowing and use of evidence, true beliefs, ideologies, nursing knowledge, evidence conceptualizations, and critical reflection, among others (Thorne & Sawatzky, 2004).

Significant Findings

The study brings to the fore the perspectives on the use of evidence in nursing practice. The authors find a discrepancy in the identification and application of evidence within the nursing discipline. The study revealed identified common themes in literature as ideologies, beliefs, knowledge, and conceptualizations that guide the use of evidence in nursing practice. In this regard, they recommend that nurses should not merely adhere to specific theoretical evidence; instead, they should develop a general (fulsome) way of theorizing within the nursing discipline.

Testing the Null Hypothesis

The authors have not put forward a null hypothesis at the beginning of the article. In this regard, the study does not involve the testing of the null hypothesis. If the null hypothesis is rejected, it means that the results are significant.

Discussion

One of the major strengths of this study is the use of the phenomenological approach. It elucidates the issue of selecting evidence in nursing practice. The study also exposes the challenges of specific theoretical perspectives in nursing practice and recommends a fulsome approach to guide nurses in selecting the best evidence for use. However, the failure to use primary data sources affects the validity of the study’s conclusions.

The study’s findings have implications for practice. There is increasing pressure for health care professionals, including nurses, to justify their clinical decisions with research evidence. The study recommends that nursing, as a discipline, should adopt a framework for identifying significant evidence with clinical applications. However, the study did not use specific inclusion criteria in selecting the secondary data sources. This presents a threat to the study’s external validity (generalizability) and credibility.

Reference

Thorne, S. & Sawatzky, R. (2014). Particularizing the General Sustaining Theoretical Integrity in the Context of an Evidence-Based Practice Agenda. Advances in Nursing Science, 37(1), 5–18.