Clinical Governance tells nurses to base our practice on evidence; but in Clinical Governance the government is really saying “We think you should do this because it’s what we want you to do.” This is not evidence, it is policy. Throughout history those in power have had the privilege of defining reality for everybody else, and this is what Clinical Governance is.
I have always been told that “evidence” can change practice; in reality I have found that the best way to change practice is to point out government policy and guidelines to my manager and the Trust that employs me. After all if a health care organisation doesn’t do what the government tells it to then its funding will be pulled. The rest of us are told this decision was based on ‘evidence’, in order to keep us quiet.
Much of the “evidence” nurses are told to work to comes from medicine. In fact medicine was where evidence-based practices began. All nurses would say that we see the patient and we see caring from a very different perspective than doctors do; so adopting the same idea as medicine of “evidence” shows how nursing is still subject to medicine. Evidence-based practice is an attempt by a paternalistic profession (Medicine) to reign in the stray child that nursing with its own ideas and values represents.
This brings me to my second point regarding evidence. Does evidence come from research; is it government policy; is it the opinion of a noteworthy person; is it something that I have read in an article about nursing? I always thought that evidence is something that has been researched and is scientific; but a lot of evidence doesn’t agree with government policy. I think that ideally practice should be based on all these different versions of what ‘evidence’ is, and not just limited to what an authority - whose motives for doing so can sometimes be questioned (such as the government) - says ‘evidence’ is. The problem with evidence is that it automatically limits you in what you can do because you have to stick to the boundaries that the evidence sets. Relying on evidence for practice means that if you want to do something that does not have a basis in evidence then you can’t do it. This stifles creativity at a time when nursing is trying to find a place for itself in the world of modern healthcare. Some nurses are trying to forge this place by saying that the old ways of relying on science to provide evidence that inspires practice is no longer valid. Other nurses say you have to use evidence in a scientific way because you need to talk with those authorities in the same language they use.
This is why nursing is in a unique position in using and talking about evidence. Nurses are able to consider from all sides what they do, so long as they understand the bigger picture.
