Disciplinary Boundaries and Professional Expectations: an Ordinary Search

Healthcare professionals (e.g., nurses, physiotherapists, paramedics etc.) use evidence to justify and underpin the activity or performance of practitioners. That is, evidence is deployed to defend practice and/or it sanctions change aimed at improving practice. Colloquially, the term “evidence based practice” (EBP) summaries and describes these activities or objectives. And the idea that professionals can practice in the absence of evidence is, today, difficult to sustain. EBP involves, among much else, the location and appraisal of literature. Thus, searches locate literature, and review or appraisal processes determine whether what has been found is robust enough to fulfil the role allotted to evidence. EBP works well for technical and ‘treatment option’ questions (e.g., “is this dressing more absorbent than that dressing in these circumstances?”). However, healthcare professionals legitimately and persistently interest themselves in, for example, normative and/or ethical questions. These can be addressed but not be answered using traditional scientific and/or biomedical knowledge (i.e., research report findings) and, faced with such questions, EBP, as commonly conceived, falters. In this presentation I use an example drawn from personal experience to highlight just a few of the problematic issues that are thrown up for professionals when an ‘everyday’ search transgresses (as many potentially do) disciplinary boundaries and professional expectations. My presentation focuses on the nebulous quality of ‘relevance’ and ‘evidence’ for practitioners. I conclude by proposing that substantive interdisciplinary and cross-disciplinary understanding is difficult and sometimes impossible to achieve for professionals working within social and cultural structures that underscore and maintain disciplinary boundaries.