1. Kennedy, Maureen Shawn MA, RN, FAAN


Nurses must become active in protecting science and evidence-based decision making.


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A standard practice on critical care units used to be instilling a few ccs of saline into an endotracheal tube prior to suctioning a patient. We also kept patients in bed for days following childbirth or surgery and routinely used urinary catheters in patients who were incontinent and on bedrest. These are only a few of the practices we did "just because"-there was no evidence to support them; in fact, we found out later that they resulted in worse patient outcomes.

Figure. Maureen Shaw... - Click to enlarge in new window Maureen Shawn Kennedy

Today few would argue that practice needs to be grounded in evidence-indeed, health care organizations are mandated by accrediting groups and reimbursement models to use evidence-based protocols to guide treatment. We have any number of best practice guidelines and "bundles" to guide myriad interventions-from managing basic care like oral hygiene to complex illnesses like sepsis. Agencies such as the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention, as well as various health specialty organizations, have developed practice guidelines after review and evaluation of the scientific evidence by experts. (The Agency for Healthcare Research and Quality maintains the National Guideline Clearinghouse,, which provides summaries of evidence-based practice [EBP] guidelines.) Together with using clinical judgment and acknowledging individualized patient preference, implementing EBP bundles in clinical settings has improved patient outcomes, shortened hospital stays, reduced adverse effects and hospital-acquired conditions, and lowered costs.


Because of science, we have vaccines that protect us from smallpox, typhoid, polio, tetanus, and a host of other deadly diseases. Advances in pharmaceuticals and medical technology have extended lives that would have been shortened by disease, enabled deaf people to hear, and allowed those who've lost legs to run marathons. Scientific achievements have helped each succeeding generation live longer and healthier lives.


As nurses, we know about the importance of supporting practice with evidence. We also know that the evidence needs to be "righteous"-that is, based on sound research that has been vetted by the scientific community and is unbiased and free from influence from those who stand to profit in other ways.


Unfortunately, we're at a point today where trust in science is threatened. A case in point is the continuing belief by many parents that vaccines-especially the measles-mumps-rubella vaccine-cause autism. This belief was based on flawed research that has been widely and repeatedly debunked, yet many parents still believe the original claim and refuse to have their children vaccinated. This has resulted in several outbreaks and deaths that could have been prevented.


Science is also under threat from those who create policy and control funding and who dismiss evidence and relax regulations to fit their own agenda. In a recent development reported in May by the New York Times, among others, the Environmental Protection Agency (EPA), ignoring decades of research by its own scientists, declined to ban a chemical most agreed was harmful to children. Many felt the EPA was succumbing to pressure from industry groups who lobbied against the regulations.


Science is being further undermined by the proliferation of pseudoscholarly journals, published by profit-driven "predatory publishers" who flood the scientific literature with research that lacks the expert scrutiny needed to ensure that findings are based on rigorous methods. These publications are now appearing on reference lists and not only weaken the evidence base with flawed studies, but create a lack of confidence in research.


As health care professionals, we need to be able to rely with confidence on the evidence we teach students and families, we use to build on others' research, and on which we base our practice. We need to be able to trust that what we read is true and unbiased. We all need to be critical consumers of information-to read between the lines and to know who sponsors or produces the content we read and the information we hear. We must seek the facts behind the rhetoric. While there certainly are alternative viewpoints and interpretations, there are no "alternative facts."