Victoria Min-Yi Wang

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.

How ought scarce health research resources be allocated, where health research spans basic, translational, clinical, health systems and public health research? In this article, I first outline a previously suggested answer to this question: the ‘fair-share principle’ stipulates that total health research funding ought to be allocated in direct proportion with suffering caused by each disease. Second, I highlight a variety of problems the fair-share principle faces. Like other resource allocation frameworks, the principle needs to address the aggregation and distribution of harms and consider cost-effectiveness. Moreover, to make resource allocation recommendations, the principle has to be used in conjunction with real-world estimates of ‘suffering’, usually provided by the Global Burden of Disease Study. These estimates are disease-centric and only take ‘proximal’ causes of health loss into account. Applying the principle based on such estimates disregards ‘distal’ causes, including social determinants of health, thus skewing resource allocation towards biomedical research and away from public health research. Since public health research aims at improving population health while reducing health inequalities, the principle leads to inequitable priority-setting. The fair-share principle can only become equitable when due consideration is also given to ‘distal’ causes that are amenable to public health research and interventions.

Robert Northcott, at the beginning of his highly readable Science for a Fragile World, asks us to imagine a world “in which laws and causal relations are fragile, winking in and out like bubbles in a boiling soup” (1) or like the mud bubbles rising and popping on the cover image. Northcott has two aims in this philosophy of science book, written mainly for an academic audience. First, to defend the claim that many of the relations studied by and of interest to the sciences are indeed fragile. And second, to suggest that when relations are fragile, scientific investigations should be carried out in the manner of a ‘Case-Worker’ rather than a ‘Stability-Theorist’, methodological approaches the book sets out to define. Despite being relatively short, the book makes a convincing case for these two claims. It also opens avenues for further research, as well as inviting scientists from a range of disciplines and “science funders, planners, and educators” (15) to reflect on, and potentially change, some of their practices.

Numerous societal issues, from climate change to pandemics, require public engagement with scientific research. Such engagement reveals challenges that can arise when experts communicate with laypeople. One of the most common frameworks for framing these communicative interactions is the deficit model of science communication, which holds that laypeople lack scientific knowledge and/or positive attitudes towards science, and that imparting knowledge will fill knowledge gaps, lead to desirable attitude/behavior changes, and increase trust in science. §1 introduces the deficit model in more detail and shows that adhering to this model often fails to achieve its aims, which motivates the main question of this chapter: how can Ludwik Fleck’s theory of thinking collectives address the persistent problem of deficit approaches in science communication? I suggest that it can do so by exposing the deficit model’s implicit assumption of an expert-lay divide. Accordingly, §2 lays out Fleck’s theory and §3 contrasts it with contemporary debates about science communication. Following this descriptive work, §4 draws on Fleck’s ideas to make four concrete suggestions for further questioning the expert-lay divide.

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.