EVIDENCE IN UNCERTAIN TIMES

Over the past couple of decades, health care disciplines have made major strides to ensure that decisions and actions are based on sound scientific evidence. Nurse scholars, those who provide direct service, administrators, and educators have joined the effort to identify the most reliable and sound scientific evidence available to inform practice. In addition, there have been discussions and debates about various meanings of "evidence"-what counts as evidence, how to deal with situations for which there is no evidence of any kind, the role of experience and clinical "know-how," and how best to determine outcomes.

Then enter the current climate of public discourse-a climate that casts doubt on science as a legitimate means of investigation and that questions the very definition of what counts as "fact." Of course, it is very difficult, often impossible, to unequivocally establish a "fact," even in the case of eyewitness accounts. But when it comes to evidence that shapes the very act of nursing care, nurses must rely on not only the conclusions but also the soundness of the methods used to arrive at those conclusions. The scholars and the practitioners of the discipline can, and should, have lively debates about the soundness of method and the conclusions reached. But ultimately in the moments of caring practice, nurses are faced with making the best choices possible, informed by knowledge of the science and by knowledge of the particular situation of the moment.

As Thorne and Sawatzky1 explained, nursing is situated in particular situations that are complex, demanding not only empiric knowledge that provide scientific evidence on which practice is based but also ethical, aesthetic, personal, and emancipatory insights. Expert practice decisions and actions rest on a complex web that brings together all forms of knowing and understanding-each element of which has similar but distinct foundations of reliability and validity. These similar foundations require dialogue and debate among members of the discipline, corroboration that unveils patterns of consistency (or lack thereof), and dogged due diligence that reveals not only consistency but also important variations in underlying patterns.

This issue of Advances in Nursing Science carries on the journal traditions of critical examination of the status quo and offering alternative approaches that might move in the direction of better informed practice based on sound and reliable scholarship. We encourage all readers to enter in discussion about the articles offered here-discussion among your own local network and beyond. These discussions lead to the next steps in the ongoing pursuit of the best evidence and insights that are so vital to the best quality of care.

-Peggy L. Chinn, PhD, RN, FAAN

Editor

REFERENCE