Norlyk Annelise, Haahr Anita, Dreyer Pia, Martinsen Bente
Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark.
Faculty of Health Sciences, VIA University College, Skejby, Denmark.
Nurs Inq. 2017 Jul;24(3). doi: 10.1111/nin.12187. Epub 2017 Jan 12.
Drawing on previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence-based fast-track programmes. The aim of this paper was to analyse and discuss if and how it is possible to include patients' individual perspectives in an evidence-based practice as seen from the point of view of nursing theory. The paper highlights two conflicting courses of development. One is a course of standardization founded on evidence-based recommendations, which specify a set of rules that the patient must follow rigorously. The other is a course of democratization based on patients' involvement in care. Referring to the analysis of the narrative, we argue that, in the current implementation of evidence-based practice, the proposed involvement of patients resembles empty rhetoric. We argue that the principles and values from evidence-based medicine are being lost in the transformation into the current evidence-based hospital culture which potentially leads to a McDonaldization of nursing practice reflected as 'one best way'. We argue for reviving ethics of care perspectives in today's evidence practice as the fundamental values of nursing may potentially bridge conflicts between evidence-based practice and the ideals of patient participation thus preventing a practice of 'McNursing'.
借鉴以往的实证研究，我们提供了一个典型的叙述，以说明患者在按照循证快速通道方案组织的医院护理中的体验。本文的目的是从护理理论的角度分析和讨论是否以及如何将患者的个人观点纳入循证实践。本文突出了两个相互冲突的发展方向。一个是基于循证建议的标准化方向，这些建议规定了患者必须严格遵守的一套规则。另一个是基于患者参与护理的民主化方向。参考对该叙述的分析，我们认为，在当前循证实践的实施中，所提议的患者参与类似于空洞的言辞。我们认为，循证医学的原则和价值观在向当前循证医院文化的转变过程中正在丧失，这可能导致护理实践的麦当劳化，表现为“一种最佳方式”。我们主张在当今的循证实践中复兴关怀伦理视角，因为护理的基本价值观可能潜在地弥合循证实践与患者参与理想之间的冲突，从而防止“麦当劳式护理”的做法。
