Evidence-Based Practice in Nursing: Understanding Science and Pseudoscience

1. Chapter 4Evidence-Based Practice

2. Nursing: An Art and a Science • Nursing arts • The simple acts of nursing (e.g., wound care, feeding) • Nursing science • Rooted in an understanding of anatomy, physiology, and chemistry and the quest for knowledge • Based on the scientific method

3. Science • Applies formal and informal reasoning methods to understand and predict the world in which humans live • Emphasizes what can be observed, measured, and publicly verified

4. Scientific Processes • Controlled observation • Experimentation • Analysis • Synthesis • Prediction • Confirmation

5. Science Is Rooted in the Objective Study of Phenomena

6. Principles of the Scientific Method • Systematic empiricism • Publicly verifiable knowledge • Empirically solvable problems and testable theories

7. Question Tell whether the following statement is true or false. Empiricism is a philosophical position that all knowledge and all ideas derive from experience. A. True B. False

8. Answer Answer: A. True Empiricism is a philosophical position that all knowledge and all ideas derive from experience.

9. Evidence-Based Care • The conscientious, explicit, and judicious use of current best evidence to provide services for clients • Integrates the best available research findings with clinical expertise to enhance decision making

10. Pseudoscience • Therapies and treatments for physical or mental health problems • Used without empirical or theoretical support

11. Multiple Outlets Communicating Extraordinary Medical Claims

12. Types of Scientific Evidence • Sham treatments • Placebos • Clinical trials

13. Types of Clinical Trials • Double-blind approach • The treatment a subject is receiving is unknown to him and the recorder • Case-control study • Researchers use specific criteria to identify participants and then interview them retrospectively • Secondary data analysis • The analyst was not responsible for collecting data or collected data for a different reason

14. Question A researcher conducting a clinical trial uses a specific disease process to identify participants and then interviews them after the study to provide data. This is an example of: A. Double-blind approach B. Case-control study C. Secondary data analysis D. Type VI studies

15. Answer Answer: B. Case-control study Rationale: In case-control study, researchers use specific criteria to identify participants and then interview them retrospectively. In the double-blind approach, the treatment a subject is receiving is unknown to him and the recorder. With secondary data analysis, the analyst was not responsible for collecting data or collected data for a different reason. Type VI studies involve uncontrolled case reports and are of questionable value.

16. Pseudoscience • Therapies and treatments without empirical or theoretical support • May lead to myths and distortions that influence mainstream practices • Methods described as “unconventional” or “unorthodox”

17. Recognizing Pseudoscientific Therapies

18. Pseudoscience Versus Science • Perhaps the most important characteristic that separates pseudoscience from genuine science is the lack of concern with valid evidence (Lilienfeld et al., 2004) • Practitioners of pseudoscience rely on eyewitness testimonies and personal anecdotes rather than well-controlled, publicly verifiable studies • The foundations of science are evidence and logical argumentation

19. Question Tell whether the following statement is true or false. Pseudoscientists operate from assumptions, or assertions taken for granted or supposed, that may be either explicit or hidden. A. True B. False

20. Answer Answer: A. True Pseudoscientists operate from assumptions, or assertions taken for granted or supposed, that may be either explicit or hidden.

21. Quackery • Treatment that entails methods not scientifically accepted and involves fraudulent medical practices • Usually practiced for money, ego gratification, and power • Those who practice quackery give false hope to genuinely suffering people

22. Distinguishing Quackery from Unproved Interventions • Unproved treatments consistent with established scientific concepts are considered experimental • Researchers studying them are engaged in properly designed studies • Treatments promoted without established scientific methodology, replication, and peer review are not experimental • They are either nonvalidated or unproved

23. Junk Science • Faulty data collection and analysis used to further a special agenda • The media may use junk science for sensational headlines and programming to attract viewers and advertisers • Some use junk science to advance their own or their employers’ social and political agendas • In some cases, problems with junk science have wreaked havoc in health care

24. Two Types of Attachment Disorders • An emotionally withdrawn, unresponsive pattern in which absence of attachment behaviors predominates (inhibited subtype) • A pattern in which attachment behaviors are evident but directed nonselectively or indiscriminately, even at relative or complete strangers (disinhibited subtype)

25. The Dangers of Pseudoscience: Attachment Therapy • Attachment therapy has many variations, but most involve subjecting the client to physical confrontation and restraint to release repressed anger over abandonment • The process is repeated until the child is exhausted and emotionally reduced to an “infantile” state • Then, parents cradle, rock, and bottle-feed the child, implementing an “attachment” (Mercer, 2001; Mercer et al., 2003)

26. Question Tell whether the following statement is true or false. A study funded by the National Center on Child Abuse and Neglect found allegations of satanic ritual abuse (SRA) of children to be true. A. True B. False

27. Answer Answer: B. False A study funded by the National Center on Child Abuse and Neglect found allegations of satanic ritual abuse (SRA) of children to be without merit.

28. Patterning: An Example of Quackery • Doman and Delacato asserted that mental retardation represents a person’s failure to develop through proper “phylogenetic” (evolutionary) stages • The modality is a time-consuming treatment involving passive physical manipulation of the limbs and body to stimulate proper phylogenetic development • According to patterning, the person must master each stage before progressing to the next • The exercises intend to impose the proper “pattern” on the central nervous system

29. Question Which of the following is the term for the quackery practice that uses methods to assist nonverbal people to type letters, words, phrases, or sentences with a typewriter, computer keyboard, or alphabet facsimile? A. Facilitated communication B. Patterning C. Junk science D. Sham treatments

30. Answer Answer: A. Facilitated communication Rationale: In facilitated communication, nonverbal clients are assisted to communicate using modern technology. Patterning is a treatment involving passive physical manipulation of the limbs and body to stimulate proper phylogenetic development. Junk science refers to faulty data collection and analysis used to further a special agenda. Sham treatments refer to counterfeit forms of therapy.

31. Implications for Professional Nurses • Ethics • Knowledge • Research • Advocacy • Education

32. Using the Internet for Information • Sites touting unproved remedies for serious are exploding, putting consumers at risk • Nurses have individual and collective ethical obligations to protect the public from such excesses • Nurses must educate themselves and others about the differences between legitimate and fraudulent treatments