Evidence and expertise

Citation

Paley J (2006) Evidence and expertise. Nursing Inquiry, 13 (2), pp. 82-93. https://doi.org/10.1111/j.1440-1800.2006.00307.x

Abstract
This paper evaluates attempts to defend established concepts of expertise and clinical judgement against the incursions of evidence-based practice. Two related arguments are considered. The first suggests that standard accounts of evidence-based practice imply an overly narrow view of 'evidence', and that a more inclusive concept, incorporating 'patterns of knowing' not recognised by the familiar evidence hierarchies, should be adopted. The second suggests that statistical generalisations cannot be applied non-problematically to individual patients in specific contexts, and points out that this is why we need clinical judgement. In evaluating the first argument, I propose a criterion for what counts as evidence. It is a minimalist criterion but the 'patterns of knowing', referred to in the literature, still fail to meet it. In evaluating the second argument, I will outline the powerful empirical reasons we have for thinking that decisions based on research evidence are usually better than decisions based on clinical judgement; and show that current efforts to rehabilitate clinical judgement seriously underestimate the strength of these reasons. By way of conclusion, I will sketch the ways in which the concept of expertise will have to be modified if we accept evidence-based practice as a template for health-care.

Keywords
decision-making; evidence-based practice; expertise; judgement; research; Nursing Philosophy; Nursing Research; Qualitative research; Clinical competence

Journal
Nursing Inquiry: Volume 13, Issue 2