At 10:46 AM 9/5/03 +1200, Andrew Jull wrote:
>Dear John
>
>I am not so sure that this is in fact the issue for Kim Walker. In demanding
>evidence for EBP, he is placing a higher standard on EBP than he places on
>other practices mentioned, such as "narrative based practices". I believe
>that this question is simply a distraction proferred by those who would
>discount EBP (and I am not sure that engaging with such people is always
>useful debate - in accusing others of dogma, they tend entrench themselves
>deeper with every attempt at engagement).
>
>Of course I am not suggesting that evidence for EBP should not be pursued,
>but the core of Walker's objections are that nurses such as myself have
>"uncritically" adopted a dogma derived from medical practice that has little
>relevance to clinical nursing practice - as evidenced by the fact that
>advocates of EBP in Australian nursing are academics acocrding to Walker. I
>will leave that for the Ozzies to reply to.
>
>That EBP has expanded beyond medicine for good reason (ie that it is useful
>aid in decision-making) seems to have escaped Walker, as does the key
>concept that asking questions to be answered by specific research designs
>(where possible) is useful for any sort of practice profession. Personally,
>I am fascinated that teaching does not seem to have picked up on EBP even
>though it would seem to have obvious value - think of the resource
>implications for answering questions about the use of computers in
>classrooms, or the value of homework.
Walker's article is yet another example of how post-modernism has become
prevalent in the academic nursing literature. Walker's opening quote from
Foucault, one of the pantheon of post-modern pseudo-philosophical dieties,
professes extreme relativism. This notion that there is no truth out there
is profoundly anti-scientific. (Plus, would you believe anyone who starts
out by saying there is no such thing as truth?)
I agree that it will be very hard to convince Walker by any reasoned
argument that he is wrong. But I think those who believe in evidence-based
medicine, or practice, or education for that matter, need to fight against
anti-scientific postmodernism. Our patients will not be well-served if
more and more practitioners believe in such mumbo jumbo.
By the way, the slogan of the new Institute of Education Sciences in the US
Department of Education is "building evidenced-based education." See:
http://www.ed.gov/offices/IES/
...............................................................
Roy M. Poses MD
Director of Research, General Internal Medicine
Brown University Center for Primary Care and Prevention
Memorial Hospital of Rhode Island
111 Brewster St.
Pawtucket
RI 02860
USA
401 729-3400
fax 401 729-2494
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