title: Lost in transformation? Reviving ethics of care in hospital cultures of evidence-based healthcare.
abstract: Drawing on previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence-based fast-track programmes. The aim of this paper was to analyse and discuss if and how it is possible to include patients' individual perspectives in an evidence-based practice as seen from the point of view of nursing theory. The paper highlights two conflicting courses of development. One is a course of standardization founded on evidence-based recommendations, which specify a set of rules that the patient must follow rigorously. The other is a course of democratization based on patients' involvement in care. Referring to the analysis of the narrative, we argue that, in the current implementation of evidence-based practice, the proposed involvement of patients resembles empty rhetoric. We argue that the principles and values from evidence-based medicine are being lost in the transformation into the current evidence-based hospital culture which potentially leads to a McDonaldization of nursing practice reflected as 'one best way'. We argue for reviving ethics of care perspectives in today's evidence practice as the fundamental values of nursing may potentially bridge conflicts between evidence-based practice and the ideals of patient participation thus preventing a practice of 'McNursing'.
authors.affiliation: Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark.|Faculty of Health Sciences, VIA University College, Skejby, Denmark.
authors.forename: Annelise
authors.identifier: 0000-0002-8512-228X
authors.initials: A
authors.lastname: Norlyk
authors.affiliation: Faculty of Health Sciences, VIA University College, Skejby, Denmark.
authors.forename: Anita
authors.initials: A
authors.lastname: Haahr
authors.affiliation: Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark.|Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Pia
authors.initials: P
authors.lastname: Dreyer
authors.affiliation: Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Bente
authors.initials: B
authors.lastname: Martinsen
mesh_terms: D004993:Ethics, Nursing; D055317:Evidence-Based Practice / Q000592:standards*; D006761:Hospitals / Q000639:trends*; D006801:Humans; D009723:Nurse-Patient Relations; D009742:Nursing Theory; D015279:Organizational Culture; D018802:Patient-Centered Care; D010687:Philosophy, Nursing
keywords: ethics of care; evidence-based practice; fast-track programme; hospital culture; nursing practice; nursing theorists; nursing theory; patient participation