Nursing Theorists' Critique of Evidence-Based Practice

This paper considers the critique of evidence-based practice by Fawcett et al. (2001), which is grounded in Carper’s (1978) seminal paper on patterns of knowing in nursing. Carper identified four patterns: empirics, ethics, personal and aesthetics. Using her typology, Fawcett et al. argue that the adoption of EBP entails a reduction of valid nursing knowledge to empirics. They go on to argue that this reductionism is inimical to the ethos of nursing. For them, ethics is needed to ensure the development and maintenance of appropriate moral values. Personal knowing is needed to ensure the authenticity of individual relationships between nurse and client. Aesthetic knowledge is required for nurses to appreciate the human experiences involved in health, illness and care.
We argue that one of the reasons for the dominance of empirics lies in the fact that it is ‘discursively formulated and publicly verifiable’ (Carper 1978, 16), while the other aspects of nursing knowledge are, to greater or lesser degrees, esoteric. We contend that, if the balance between empirics and other forms of knowledge is to be addressed, those forms of knowledge need to be presented in such a way that they are amenable to public discourse. One reason for this is that simply laying claim to them as attributes of nursing knowledge will not wash with a laity that is skeptical about the altruistic claims made by professionals. Public verifiability entails judging nurses by their deeds – the actions that result from their ways of knowing, as experienced by those in their care. This, in turn, entails strengthening systems of accountability.
Carper, B., 1978. Fundamental patterns of knowing in nursing. Advances in Nursing Science 1 (1), 13-23.

Fawcett, J., Watson, J., Neuman, B. Walker, P., Fitzpatrick, J., 2001. On nursing theories and evidence. Journal of Nursing Scholarship 33 (2), 115-119.