Nursing based evidence: moving beyond evidence‐based practice in mental health nursing

Abstract

Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplines favour knowledge developed using quantitative methodologies so they and evidence-based practice (EBP) and evidence-based nursing (EBN), increasingly called for in mental health nursing, fit seamlessly together. Nevertheless, as these movements dismiss qualitative approaches to knowledge (evidence) development, I argue against the move toward EBP/EBN in mental health nursing. This is because the specialty's primary interests - human experiences of illness/health care and human relationships, often do not lend themselves to being quantitatively researched. Using nursing examples, I demonstrate how qualitative research, wholly unacceptable in relation to EBP/EBN quality of evidence scales, is indispensable to mental health nursing. The need for evidence arising from qualitative research in no way precludes the need for quantitatively derived evidence. Indeed, the specialty's twofold interest - the work of nurses with clients and the explication of phenomena which inform practice, require diverse knowledge and thus, diverse research approaches. This twofold interest defines the area of mental health nursing practice, and knowledge informing it is referred to as nursing based evidence (NBE). Because it values multiple approaches to knowledge development, NBE provides a way to articulate the specialty's distinct contribution to the health care of people experiencing mental illness and advances mental health nursing.

‘I know it is only exercise, but to me it is something that keeps me going’: A qualitative approach to understanding mental health service users' experiences of sports therapy

“…This perspective accepts that participants' experiences and perceptions need to be explored to make sense of their perspectives of their treatment, and of the effect that participation can have, on a person's life. Adopting such an approach is supported by a client‐centred National Health Service that encourages and supports the inclusion of service users' perspectives (Department of Health 1999), through the adoption of participatory research (Tilford 2000), to develop knowledge about situation‐specific experiences (Geanellos 2004).…”

“…The nature of this research (i.e. situation‐specific and participatory), aimed to develop and enhance the current evidence base in this area of research (Geanellos 2004; Tilford 2000) and supports national government policy recommendations for the use of exercise in the treatment of people with mental health problems (Department of Health 1999, 2006). In doing so, it adds value to the current body of knowledge by providing a conduit for service users' voices to be heard within the literature.…”

“…Findings from such research could feed into developing Grant's (2000) practitioner guidelines further, which are currently based on positivist research studies. The inclusion of research with service users' perspectives would go some way to developing a more eclectic nursing based evidence base, which according to Geanellos (2004), has a critical contribution to the development of effective mental health services. As a consequence then, it is important to emphasize that although the conclusions from this study cannot be generalized, the findings enrich previous research through the inclusion both of service users' voices and of a service user as a co‐researcher.…”

Developments in the evidence‐based health care debate – 2004

“…In the paper which follows Geanellos (2004), writing from the University of Western Sydney, Australia, is concerned with the concept of nursing‐based evidence as a means of moving beyond ‘evidence‐based practice’ in mental health nursing. As she points out, a significant body of knowledge and practice in this field is derived from the disciplines of psychiatry, pharmacology and the behavioural sciences which favour knowledge developed using quantitative methodologies and which thus ‘fit’ more easily within the concept of evidence‐based clinical practice.…”

Methodologies à la carte: an examination of emerging qualitative methodologies in social research

“…The NHMRC, on the other hand, is known to marginalise, if not outright reject, qualitative methodologies. In 1995, the NHMRC rated evidence from qualitative research at the lowest level; this was soon followed by the removal of qualitative evidence from its quality of evidence scale 2 altogether (Geanellos, 2004). In essence, rather than a broadening of acceptance and inclusion of qualitative methodologies, it can be argued that based on the context presented Australian social scientists are excluded from one of the two peak funding bodies and marginalised from the other.…”