Mitchell D
University of Nottingham, UK.
J Nurs Manag. 1998 Sep;6(5):275-80. doi: 10.1046/j.1365-2834.1998.00080.x.
This paper addresses the issues of evidence-based practice (EBP) in relation to power, professionalism and the British National Health Service reforms.
There has been little discussion at organizational level over issues of professional boundaries, roles and tensions, which are inextricably linked with the drive for an evidence-based culture.
The paper is a reflection on the findings of a recent case study, which examined the management and organization of an independent sector provider of mental health services in its drive to address issues of EBP.
New managerial hegemony had altered the balance of power within the organization, there was an extension of managerial surveillance, competing political relationships and a general decline in medical dominance.
Organizations should avoid 'personalizing' the debate on establishing a research-based culture. EBP requires structures to support it and groups representing the health care professions within the organization should be involved in identifying and making recommendations on EBP issues.
本文探讨了循证实践（EBP）与权力、专业主义及英国国民医疗服务体系改革相关的问题。
在组织层面，对于与循证文化驱动力紧密相连的专业界限、角色及矛盾等问题，几乎没有进行过讨论。
本文是对近期一项案例研究结果的反思，该研究调查了一家独立部门心理健康服务提供商在推动循证实践问题解决过程中的管理与组织情况。
新的管理霸权改变了组织内部的权力平衡，管理监督范围扩大，政治关系相互竞争，医疗主导地位普遍下降。
组织应避免将建立基于研究的文化的辩论“个人化”。循证实践需要有相应结构来支持，组织内代表医疗保健专业的团体应参与识别循证实践问题并提出相关建议。
