The EBP controversy: misconception, misunderstanding, or myth.

Two recent articles prompted us to step up on our soapbox instead of our step aerobics box today. In the first, "Aesthetics and Evidence-Based Practice in Nursing: An Oxymoron?" Freshwater (2004) proposes that the current trend toward evidence-based practice (EBP) in nursing is somehow at odds with the art of nursing. In the second, an editorial by Hasnain-Wynia (2006), the author discusses the perception by some that evidence-based medicine (EBM) is at odds with the cultural competence in medicine (CCM) movement. Although HasnainWynia does say in her editorial that EBM and CCM may be considered complementary approaches to improving the quality of health care, both of these articles contain what we believe are misconceptions, misunderstandings, or myths about an evidence-based approach to practice. MYTH 1. EVIDENCE IS ONLY QUANTITATIVE IN NATURE AND IS THUS A TRADITIONAL REDUCTIONIST APPROACH TO PRACTICE Evidence in the EBP movement in nursing refers to any information that addresses a clinical question of interest. Evidence may be qualitative as well as quantitative. In fact, it is not possible to answer a quantitative question with qualitative evidence or a qualitative question with quantitative evidence. For nursing, understanding patients' experience is just as important as providing interventions that will achieve desired outcomes (for the patient). In either case, however, one needs to be able to formulate a focused question and use the best available evidence to answer that question-the process is the same. An example of a quantitative question would be: In older adult women experiencing pain after hip replacement surgery, does the administration of analgesics a half-hour prior walking decrease patients' pain and increase mobility? This quantitative question can best be answered with data from randomized controlled trials (RCTs). On the other hand, if the question is: What is the experience of hip replacement like for older adult women, then indepth, open-ended interviews with these women are appropriate in order to obtain an answer to the question. We cannot separate the art and science of nursing. Why do we even want to try? We must integrate them in order to provide the best possible care to our patients. MYTH 2. EBP DOES NOT RESPECT THE INDIVIDUALITY OF THE PATIENT, PARTICULARLY THE INDIVIDUAL'S HEALTH BELIEFS, VALUES, AND BEHAVIORS Even before nurses began writing prodigiously about EBP, Sackett, Strauss, Richardson, Rosenberg, and Haynes (2000) in discussing the components of EBM, included patients' values and preferences as important for the clinician to consider when applying evidence in practice. All the nursing literature we have read makes a strong statement about the necessity of applying evidence flexibly depending on patients' values, beliefs, and treatment preferences. When Levin teaches EBP to nurses and nursing students she always discusses the need for patient self-determination in making health care decisions. One example Levin uses is a meta-analysis on interventions for nocturnal enuresis in children (GIazener, Evans, & Peto, 2005). The study concluded that an alarm system compared to other treatment alternatives was an effective remedy for this condition. If, however, the child lived with a single parent who worked two jobs and slept maybe 4 hours a night, would an alarm system, which would involve the parent awakening with the child during that 4-hour rest time, be the best treatment approach for all concerned? Perhaps in this case the parent would choose a medication that has been shown to be an effective treatment for bedwetting. The point here is that the clinician, nurse, physician or any other health care provider involves the patient in treatment decisions, presenting available options and looking at the pros and cons of each in relation to the individual. MYTH 3. EBP IS AT ODDS WITH AESTHETICS AND THE CARING ASPECT OF NURSING We always thought that the art of nursing was the integration of generalizable evidence about health and illness, with knowledge about the individual person for whom we are caring, which includes his or her particular values and beliefs, and the intuitive perceptions of the expert clinician. …