Disregard the science behind the practice

  1. Why is it that some nurses,maybe those who have been in the field a long time,believe that there clinical experience is more reliable than evidenced based practice and the procedures generated from this evidence?
    For example this experienced nurse doesnt deem it neccessary to follow the steps of a procedure because she believes her vast experience is more reliable than the research in which the procedure was created from.
    I get this impression from certain old timers.
    Any one else ran into this?
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  2. 16 Comments

  3. by   researchrabbit
    I think this is true in any profession. Because "it's always been that way" some folks are reluctant to change.

    And with age, some people gain wisdom and some get glued into their ruts...sometimes it's a bit of both.

    Sometimes people are threatened by change, as well; age doesn't help that, just makes it worse.

    Arrogance might also play a role. Or fear that s/he won't be able to do the task in a different way.

    It is very diffcult for the person to change (can be done but it'll take a lot of griping and moaning and someone is going to have to be very stern that it's going to be the new way or the highway).
  4. by   purplemania
    they just don't want to admit they are not keeping up with the literature. Some think the literature is academic fantasy. Others just are too lazy to change their habits.
  5. by   JohnnyGage
    I used to run into this every now and then. My solution was to join my unit's clinical practice committee, which not only constantly reviews nursing literature, but writes and updates policies. Granted, writing procedures and policies is not my favorite thing, but now I can talk to these resistant nurses and say, "I know you've done it your way many times in the past, but after reviewing the literature our committee has developed such and such. Please look it over as soon as you can."

    Thanks to the committee and a lot of educational efforts on our parts, our unit is much more eager to learn and put research into practice.
  6. by   llg
    While I agree with the posts above, I want to add 2 thoughts that temper the discussion a bit.

    1. Never discount experience. Scientific research is continually validating that the judgement of an experienced, expert practitioner is often "ahead of" the current literature and/or scientifically based protocols. Sometimes, the "old fogey" has learned a few things that are quite valuable, but just not in the literature yet.

    2. What is considered "scientifically correct" is always changing as more information becomes available. This is particularly true of intervention studies that show that a certain treatment is better than another. The long-term consequences are often not known until long after the articles have been published and practices have changed.

    That's one of the wonderful (and frustrating) things about science and knowledge. Much of what you think of as scientifically correct today will be considered out-of-date tomorrow.

    llg
  7. by   prmenrs
    Been there, done that, both sides. HOWEVER, I can change practise, IF I'm not "ordered" to. Some docs will discuss what the research shows, how the change is beneficial to the pt (that's always the bottom line for me). But if some researcher comes in and says, change because I, the demi-god, decrees it so, I really dig my heals in.

    I guess it's about collegial respect--I'll respect you if you respect me. I may not always keep up with all the literature, but I am a great observer, and if I see that a change in practise results in less misery for the baby, I'm all for it.

    The best example is early extubation for really small premies. The philosophy USED to be to keep them on a vent and "let them grow", now they're intubated to get their surfactant, and extubated. They get Nasal SIMV or CPAP instead--hard on the nose, but MUCH, MUCH better for the lungs. Plus, without the ETTube, there's less barotrauma, less chance for an iatrogenic event, like plugging or dislodging, less trauma to the cords, etc... And the babies do fine with that. So, I'm happy. And more willing to listen to the Docs that started that trend. And because I am willing to change, the Docs listen to me as well, esp when it comes to one of "my" babies.

    My advice is to find a way to tap into her knowledge, and let her see WHY this change is good. You may not convince the old fogies, after all, they've seen the pendulum swing for longer than you, but learning how to handle adult learners is an art all its own, and a good one to learn.
  8. by   ohbet
    Experience is obviously good and Ive learned and hope to continue to learn from those nurses with more experience than mine BUT ...A nurses own experience or that of her colleagues is less reliable than research because a single person can be influenced as much by preconceptions as by objective observaions.
  9. by   globalRN
    I agree with ohbet, what we may be able to see in our clinical practice may not be representative. What nursing needs is to understand and to appreciate good clinical research and its application to current practice.

    All nurses may not understand how to interpret/analyse or critique research studies but that is why most institutions have nurse educators and CNSs.....facilitate understanding, support
    and implementation of research based clinical practice.

    Practicing nurses really do need to be more open to questioning 'sacred cows' of nursing tradition and supportive of the clinical application of good research findings.
  10. by   globalRN
    Um....I may get flamed for this but perhaps older nurses are 'resistant' or scornful of research because they don't understand research...the majority of older nurses probably graduated from diploma programs where the emphasis was on
    'doing'...an apprenticeship form of nursing education.
  11. by   mario_ragucci
    You will not get flamed; This isn't a furnace! There will always be generation gaps. I don't know where the older nurses come from. At 38 yo, i see myself as old. I'll feel young when I'm in my 50's. It's hard to tell a person how to think and move. Discipline is everything. I can't fault anyone w/o discipline because it's not really a requirement for nusing, but it's a plus to have in terms of mental wealth.
    If you tried to tell me how to do something, I can always apply scientific method and nursing assessment tools. Some folks don't go for it. Remember! Luke Skywalker trusted the force and won in the end. That set up our society to acceptance of quackery. Lol!
  12. by   caroladybelle
    Please also remember the limitations of research.

    In regards to meds, frequently are researched with limits on other meds (pt taking the research med and no more than two other meds), or limitations regarding gender or pt health status. Then when the drug is introduced to the general population, it fails to show the same results or worse, does harm (How many pts are on no more than three meds, are of the test group type, or have the same co-morbidity status?). Research is not always the be all and end all for facts.

    Personal experience: I had a resistant respiratory infection (about 10 years ago). My physician prescribed me a brand new drug, Omniflox (not sure of the spelling). Within about 2 weeks, I turned a wretched shade of yellow - lab draws showed liver problems. Omniflox (?) was pulled from the market shortly thereafter, due to some deathes. Yet, research had shown it to be a safe drug.

    Thalidomide passed a number of animal safety tests, but its use in humans proved diasterous, yet may still prove useful for myeloma.

    Propulsid was in use for years, before many problems were found with it.

    Xanax was at one time thought to be benign and nonaddictive.

    Research is a wonderful tool but needs to be tempered with caution and common sense.
  13. by   researchrabbit
    It's not just drugs, either. If the researcher is determined to prove his/her point, you wouldn't believe the hoops they make the statistics jump through to make it work.

    Plus some studies are done with very small numbers, thus are suspect.
  14. by   llg
    I didn't mean to imply that we should disregard the research -- just that we need to maintain a healthy skepticism toward what we find in the literature similar to the skepticism we should maintain in relation to knowledge developed through experience. It's a bad thing when the pendulum swings too far in EITHER direction.

    Sometimes, "old fogeys" rely too much on their personal experience and are too resistent to change in spite of solid scientific evidence supporting the change. However sometimes, people newly out of school and/or overly infatuated with the lieterature, believe everything they read and race to implement every suggestion they find. Both groups need to moderate their behavior a bit and introduce a little skepticism into their thinking.

    The best result comes when scientific knowledge (or "book learning") is combined with the knowledge gained from experience -- and that takes "wisdom" as opposed to mere "knowledge."

    llg -- who has worked in 2 academic research centers and worked on many, many research projects.

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