Elkan R, Blair M, Robinson J J
Research Fellow, School of Nursing - Postgraduate Division, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, England.
J Adv Nurs. 2000 Jun;31(6):1316-23. doi: 10.1046/j.1365-2648.2000.01423.x.
In this paper we argue that evidence-based practice, which is being introduced throughout the British National Health Service to make decisions about the allocation of limited resources, provides a welcome opportunity for health visitors to demonstrate their efficacy, skills and professionalism. However, the paper argues that to view health visiting as evidence-based is not to reduce health visiting merely to a technology through which scientific solutions are applied to social problems. Rather, health visiting needs to be viewed as a political movement, based on a particular model of society, which shapes the goals which health visitors pursue and influences the strategies they adopt to achieve their goals. The paper describes various models of health visiting as a way of showing how the goals of health visiting are always framed within a particular set of assumptions and causal explanations. The paper then turns to look at the issue of evaluating health visiting services. It is argued that evaluation should properly take account of the models which shape health visitors' goals and intervention strategies, and in turn, health visitors need to be explicit about the theoretical frameworks underpinning their interventions. Finally, it is argued that health visitors' knowledge and understanding of a range of models of society enables them to move between the various models to choose the most appropriate and effective means of intervention. Hence it is concluded that the emphasis on evidence-based practice provides health visitors with a valuable opportunity to show that their unique, professional skills and understanding are the preconditions for effective intervention.
在本文中，我们认为，循证实践正在英国国家医疗服务体系全面推行，用于做出关于有限资源分配的决策，这为健康访视员展示其功效、技能和专业素养提供了一个可喜的机会。然而，本文认为，将健康访视视为循证实践并非仅仅将其简化为一种将科学解决方案应用于社会问题的技术。相反，健康访视需要被视为一场基于特定社会模式的政治运动，这种模式塑造了健康访视员所追求的目标，并影响他们为实现目标而采取的策略。本文描述了各种健康访视模式，以此展示健康访视的目标总是如何在特定的假设和因果解释框架内形成的。接着，本文转而探讨健康访视服务的评估问题。有人认为，评估应恰当地考虑塑造健康访视员目标和干预策略的模式，反过来，健康访视员需要明确其干预措施背后的理论框架。最后，有人认为，健康访视员对一系列社会模式的了解和认识使他们能够在各种模式之间转换，以选择最合适、最有效的干预手段。因此得出结论，对循证实践的强调为健康访视员提供了一个宝贵的机会，以表明他们独特的专业技能和理解是有效干预的前提条件。
