Brian Baigrie

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the other pillars of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework.

Karl Popper attempted to solve what he called "the two fundamental problems of epistemology"--the problems of induction and the demarcation of science and metaphysics. The discovery of a metaphysical component in science placed his criterion of demarcation in jeopardy because it is not clear how one can evaluate this component in terms of Popper's conception of scientific progress. The theory of research programmes, offered by Lakatos and Laudan, attempts to solve this problem by marrying the views of Popper and Kuhn. On this view, paradigms consist of substantive rules which regulate scientific research. Because rules are conceptual entities, and not tacit, Lakatos and Laudan maintain that research programmes can be evaluated, thereby avoiding the charges of irrationality raised against Kuhn's conception of science. ;The difficulty with the theory of research programmes concerns the rules themselves. Commitment logically requires behavior in accordance with the rules of a research programme, but scientists constantly break rules and get away with it. Moreover, the treatment of rules by Kakatos and Laudan presupposes that rules enjoin an uncritical response from scientists; i.e., they encourage scientists to turn a blind eye to anomalies. A consideration of the pragmatic features of language, however, indicates that rules can be considered tentatively or taken as conjectures. If this is so, there is nothing compelling about rules which obliges a Kuhnian response to anomalies. The attempt to wed the views of Popper and Kuhn, therefore, must be considered a failure.

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the other pillars of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework.