Recognising relationships: reflections on evidence-based practice.

This paper argues for a broadening of the way evidence is developed and used in health-care. It contends that the current political and policy imperatives and the evidence-based practice movement are in direct tension with the other major ideological movements that promote patient-centred healthcare services. Nursing is affected by this tension because it is more naturally focused on relationships with clients to achieve health outcomes. The unresolved and mounting tension could be alleviated by embracing a broader definition of what counts as evidence and by focusing more on patient-centred healthcare methodologies and acknowledging the interdependency of distinct ways of generating new knowledge. A number of case studies are used to illustrate how research focusing on patient perspectives and nurses' response to patient experiences can improve the evidence base for nursing.