The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [27]
Clinical experience and expertise play a fundamental role in terms of evidence-based nursing and practice. However, there remains some contention in relation to the terminology, role and status within the literature (Rolfe and Gardner 2006, Pearson et al. 2007). A clear distinction is apparent between experience, as a source of knowledge or evidence, and expertise, which is the application of evidence to practice, but these terms are often used interchangeably. A nurse may have many years of experience, been qualified for 20 years, but may not have developed knowledge as a result of this and thus is not able to apply this to develop expertise when making decisions related to her clinical practice. On the other hand, a nurse may have both experience and expertise but these are difficult to capture, make explicit and ensure they are verified for a wider audience (Rycroft-Malone et al. 2004b). Expert opinion does have a role both within hierarchies of evidence and within the definitions of evidence-based practice, although it is often regarded as poorer evidence compared to research (Rolfe and Gardner 2006). Guidelines and consensus practices may be informed by expert opinion. What is perhaps most important is the blending of this knowledge with research and the sharing of this with others to contribute to evidence-based decision making in practice (Rycroft-Malone et al. 2004b).
The involvement of patients in decision making about their own care and wider consultation in relation to the development of services within the NHS is a principle that has been developed and supported by the Department of Health in relation to healthcare generally and cancer care more specifically (DH 1995, 2000, 2010a). Individual experiences and preferences should be central to the practice of evidence-based healthcare and recent policy has tried to address this with a specific strategy to ensure inclusion through cancer care (DH 2010a). However, the inclusion of the patient’s values, experiences and preferences into evidence-based practice can be complicated and difficult to achieve (Rycroft-Malone et al. 2004b). For example, a patient may request a new treatment but the research evidence may not be there to support it. This is particularly contentious, with the role of the National Institute for Health and Clinical Excellence (NICE) being to appraise treatments upon which subsequent funding decisions are based. Equally, the patient may decline a treatment for which there is research evidence because in their experience, it has unwelcome side-effects. We now have a policy driver (DH 2010a) to encourage us to work towards the patient and carer having a greater role in the decision and care they receive. We must also be mindful that without patient participation, the research we use as evidence to underpin our practice would not be possible (Staley 2009).
The context within which healthcare is delivered, whilst not traditionally recognized as a base for evidence, has been suggested to contain sources of evidence that would impact upon evidence-based patient care (Rycroft-Malone et al. 2004b). This is clinical knowledge from clinical experience and professional practice. Practitioners will draw upon both local and national sources to underpin their practice and these would include, for example, policies, patient stories, cultural context and professional networks. For some, it may include the use of some of the procedures contained in this edition. Moreover, in today’s NHS in cancer and other specialties, it is evident that NICE guidance, the NHS Cancer Plan, published patient stories, patient satisfaction surveys and other sources will influence the delivery of patient