The research basis of health care decision making

Evidence-based nursing: a stereotyped view of quantitative and experimental research could work against professional autonomy and authority

In recent years, there have been calls within the United Kingdom's National Health Service (NHS) for evidence-based health care. These resonate with long-standing calls for nursing to become a research-based profession. Evidence-based practice could enable nurses to demonstrate their unique contribution to health care outcomes, and support their seeking greater professionalization, in terms of enhanced authority and autonomy. Nursing's professionalization project, and, within this, various practices comprising the 'new nursing', whilst sometimes not delivering all that was hoped of them, have been important in developing certain conditions conducive to developing evidence-based practice, notably a critical perspective on practice and a reluctance merely to follow physicians' orders. However, nursing has often been hesitant in its adoption of quantitative and experimental research. This hesitancy, it is argued, has been influenced by the propounding by some authors within the new nursing of a stereotyped view of quantitative/experimental methods which equates them with a number of methodological and philosophical points which are deemed, by at least some of these authors, as inimical to, or problematic within, nursing research. It is argued that, not only is the logic on which the various stereotyped views are based flawed, but further, that the wider influence of these viewpoints on nurses could lead to a greater marginalization of nurses in research and evidence-based practice initiatives, thus perhaps leading to evidence-based nursing being led by other groups. In the longer term, this might result in a form of evidence-based nursing emphasizing routinization, thus--ironically--working against strategies of professional authority and autonomy embedded in the new nursing. Nursing research should instead follow the example of nurse researchers who already embrace multiple methods. While the paper describes United Kingdom experiences and debates, points raised about the importance of questioning stereotyped views of research should have international relevance.

Family health and health services utilisation in Belmont, Western Australia: a community case study

This case study was designed to examine the self-defined health needs of families in one urban Western Australian community. We conducted 157 family interviews to examine the relationship between family sociodemographic variables and patterns of use of health services, which included services used within the previous 12 months, and what the family needed and wanted from these services. Questions covered perceptions of health, family health concerns and the role of the family health guardian. Quantitative analysis included frequencies, cross-tabulations, chi-squared tests and multiple regression analysis. Open-ended responses were categorised and analysed for common themes. Approximately 80 per cent of participants had used one or more health services during the previous 12 months and, despite 35.9 per cent of families having at least one family member with a long-standing illness, disability or infirmity, most (82.1 per cent) considered the family healthy. The correlational analysis revealed several associations. Predictably, younger persons reported higher health ratings and older persons had more health concerns. Larger families reported better perceived levels of health. Higher utilisation rates were recorded for families with children, who tended to use the general practitioner for general care and medication, whereas one-parent families used hospital and specialist care more often, and 98.7 per cent reported satisfaction with services. What they needed and wanted from their health service providers was 'full disclosure' and 'not being talked down to', and for specialists especially to be approachable and impart information simply and honestly.