What counts as evidence in evidence-based practice?
BACKGROUND
Considerable financial and philosophical effort has been expended on the evidence-based practice agenda. Whilst few would disagree with the notion of delivering care based on information about what works, there remain significant challenges about what evidence is, and thus how practitioners use it in decision-making in the reality of clinical practice.


OBJECTIVE
This paper continues the debate about the nature of evidence and argues for the use of a broader evidence base in the implementation of patient-centred care.


CONCLUSIONS
Against a background of financial constraints, risk reduction, increased managerialism research evidence, and more specifically research about effectiveness, have assumed pre-eminence. However, the practice of effective nursing, which is mediated through the contact and relationship between individual practitioner and patient, can only be achieved by using several sources of evidence. This paper outlines the potential contribution of four types of evidence in the delivery of care, namely research, clinical experience, patient experience and information from the local context. Fundamentally, drawing on these four sources of evidence will require the bringing together of two approaches to care: the external, scientific and the internal, intuitive.


CONCLUSIONS
Having described the characteristics of a broader evidence base for practice, the challenge remains to ensure that each is as robust as possible, and that they are melded coherently and sensibly in the real time of practice. Some of the ideas presented in this paper challenge more traditional approaches to evidence-based practice. The delivery of effective, evidence-based patient-centred care will only be realized when a broader definition of what counts as evidence is embraced.
Rycroft-Malone
Jo
J
Royal College of Nursing Institute, Radcliffe Infirmary, Oxford, Oxfordshire, UK. joanne.rycroft-malone@rcn.org.uk
Seers
Kate
K
Titchen
Angie
A
Harvey
Gill
G
Kitson
Alison
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McCormack
Brendan
B
D003657:Decision Making; D003695:Delivery of Health Care / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D009736:Nursing Process / Q000592:standards*; D015399:Nursing Research / Q000379:methods; D018802:Patient-Centered Care; D017410:Practice Guidelines as Topic