To the editor:

I am writing in response to Dr Dzurec's article entitled "Certainly, leaps of faith and tradition: Rethinking clinical interventions." Dr Dzurec uses a research study reported by myself and Dr Marguerite Kinney, 1 to support her points regarding paradigmatic assumptions and how clinical traditions may not always be the most appropriate means for making clinical intervention decisions. I was pleased that Dr Dzurec correctly analyzed the grounding of our study and that she accurately reported the conclusion "the practice of utilizing the abdomen as the only or preferred site for subcutaneous heparin injections was not supported." 2

The tenacity of tradition, so aptly described by Dr Dzurec, should be questioned if nurses are to view their interventions within a scientifically based practice. What disturbs me, as a researcher, is that 8 years after the initial study regarding alternate sites for subcutaneous heparin injections, there have been no reports (to my knowledge) of research that has attempted to replicate these findings. Through replication with extension to correct the limitations, the study of alternative sites for the administration of subcutaneous heparin could bring valuable insight into a common clinical practice in nursing. The statements Kirchoff 3 made over a decade ago, regarding the heavy reliance on tradition and the lack of replication, validation, and dissemination of research into clinical practice seems to be continuing today. This "state of the science" leads me to several questions. How long will we as a discipline continue to practice and teach "traditions" as the way to intervene versus developing a research-based practice? Which traditions in nursing practice would be supported under careful and systematic scrutiny? Is there room in our science for replication and validation? Where are the funds to support replication studies and research utilization? Who will disseminate information on replication studies? Are we moving toward a solid scientific basis for our practice without replication and validation? Can we encourage research utilization based on single studies? Will tradition be the primary guiding force of the discipline in the next century or can we move the discipline to utilization of a scientific-based practice, thus creating new supportable traditions?

I believe there is value in tradition and that science and tradition can co-exist in a practice discipline. Indeed, if traditional interventions have merit, scientific analysis will support the tradition. To assure our clients have the best possible care, we need to develop traditions based on empirical evidence. I believe we need a science that encourages replication, validation and research utilization.

- Pamela Stewart Fahs, DSN

Assistant Professor; Decker School of Nursing; Binghamton University; Binghamton, New York

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