First published – 2018
- Evidence-Based Practice
This work presents a theoretical epistemological framework for the development of nursing knowledge and practice, based on a post-positivist approach that is commensurate with contemporary concepts of evidence-based practice. As a conceptual framework, this work includes an epistemological basis for professional knowledge with a novel approach incorporating empirical (a posteriori) and intellectual knowledge (a priori) from both individual cognitive processes and group socio-cultural processes.
Nursing is both a science and an art, and requires a framework that supports the value of both in providing quality care. More importantly, the focus of care upon the individual, their family and friends, community of population is paramount. Any of these may form the client in a nursing-client relationship, and the theoretical framework used must both support this and be readily understandable by the client, so they can apprehend its value in practical terms. The following framework for the revision of care is based upon the development of existing theories and sources including the work of the World Health Organization (WHO), Madeline Leininger (1925-2012), Virginia Henderson (1897-1996), Hildegard Peplau (1909-1999), Alison Kitson, and the University of British Columbia School of Nursing Framework for Nursing Practice (UBC, 2017). The framework differs from earlier work in that it brings together a complete epistemological basis for professional knowledge, consideration of the client that incorporates both environmental and economic aspects, and a holistic model considering relational and cultural considerations within clinical assessment that is commensurate with evidence-based practice
The framework encapsulates an epistemological framework for nursing knowledge first published in 2017 (Garrett & Cutting, 2015). In this nursing knowledge is seen as both:
- Empirical Knowledge: a posteriori knowledge derived from experience, and
- Intellectual Knowledge: a priori knowledge derived from:
o Individual cognitive processes, and
o Group sociocultural processes.
This classification offers advantages in simplicity and in that it supports the principle that knowledge has both individual and subjective components that may arise from personal beliefs and as a part of sociocultural relationships. It acknowledges both the a priori and a posteriori aspect of knowing, and also provides a practical working framework for the application of knowledge within the paradigm of EBP.
Nursing is seen as the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death. Nursing encompasses the autonomous and collaborative care of individuals of all ages, families, groups, communities, and populations, sick or well.
Health is seen as extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities (WHO, 1984).
The client of nursing is the specific focus of care activities. Depending on the sphere of nursing practice or the demands of a particular situation, the client of nursing may be an individual patient, family members and friends, a community, or a specific population.
A nursing assessment framework is provided based upon physical, psychological, socio-cultural, environmental and economic indicators.
Garrett B.M. (2018) Empirical Nursing: The Art of Evidence-based Care. Emerald. Oxford. Chapter 9:An Empirical Framework for Nursing Practice 231-255 https://bit.ly/2DiIi70
Garrett, B.M. & Cutting R.L. (2015) Ways of Knowing; realism, nominalism and non-realism and a typology revisited. Nursing Inquiry 22(2). 95-105.
Henderson, V. (1982). The nursing process? Is the title right? Journal of Advanced Nursing, 7(2), 103–109.
Kitson, A. (2002). Recognising relationships: reflections on evidence-based practice. Nursing Inquiry, 9(3), 179–186.
Leninger, Madeline (2002). Transcultural nursing: concepts, theories, research and practice. New York, NY: McGraw-Hill.
Peplau, H. E. (1952). Interpersonal Relations In Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. New York. NY: Springer Publishing Company.
UBC School of Nursing. (2018). UBC Model for Nursing – School of Nursing. Retrieved December 23, 2019, from https://nursing.ubc.ca/ubc-model-nursing
World Health Organization. (2016). WHO Global Health Agenda. Retrieved December 23, 2019, from https://www.who.int/about/vision/global_health_agenda/en/
About Bernard M. Garrett
Bernie Garrett is an Associate Professor at the University of British Columbia School of Nursing. He has a range of teaching and clinical experience from medical and acute renal nursing practice in the UK where he was a renal Clinical Nurse Specialist for 15 years before becoming a nurse educator. He holds a PhD in information Science, specializing in education and artificial intelligence, and prior to his current appointment he was a Department Head at Oxford Brookes University School of Health and Social Care in the U.K.
Over most of his career Dr. Garrett’s work has been focused upon professional education and educational technologies including simulation, and his current work highlights clinical applications of emerging media (virtual and augmented reality), the philosophy of science and the use of deceptive practices in contemporary healthcare. His work is underpinned by a passion for science and evidence-based practice and he frequently writes on these subjects including his recent graduate textbook: Empirical Nursing, and the Clinical Pocket Reference for Nursing series which has sold over 70,000 copies worldwide.
He was the recipient of the 2007 at the University of British Columbia Spencer Award for Information Technology Innovation, for his work on developing a mobile e-portfolio for students, and the CRNBC Award of Excellence in Nursing Education in 2008, was the Elizabeth Kenny-McCann Nursing Education Scholar at UBC between 2013-2014, and was the National CASN Pat Griffin Nursing Education Scholar for 2014-15. He is also an Inaugural fellow of the Canadian Nurse Educator Institute.