Governing nursing conduct: The rise of evidence based practice

Abstract

Drawing on the Foucauldian concept of 'governmentality' to analyse the evidence-based movement in nursing, we argue that it is possible to identify the governance of nursing practice and hence nurses across two distinct axes; that of the political (governance through political and economic means) and the personal (governance of the self through the cultivation of the practices required by nurses to put evidence into practice). The evaluation of nursing work through evidence-based reviews provides detailed information that may enable governments to target and instruct nurses regarding their work in the interest of preserving the health of the population as a whole. Political governance of the nursing population becomes possible through centralised discursive mechanisms, such as evidence-based reviews that present nursing practice as an intelligible field whose elements are connected in a more or less systematic manner. The identity of the evidence-based nurse requires the modern nurse to develop new skills and attitudes. Evidence-based nursing is an emerging technology of government that judges nursing research and knowledge and has the capacity to direct nursing practice at both the political and personal level. Since 1994 a plethora of Foucauldian governmentality studies have emerged in Australia across a range of topics, although very few have been concerned with or even touched upon nursing practice. Our purpose with this discussion is to present a beginning analysis that provides a space for critical reflection upon the implementation of the evidence-based practice principles into nursing using Foucault's concept of governmentality. We argue that certain processes involved in evidence-based nursing have the ability to govern the practice of nursing through broader political, economic and personal means. This represents a new capacity for the system of social control and regulation of nursing practice that is an unintended consequence of the evidence-based practice movement.