In: Nursing Issues: Psychiatric Nursing, Geriatric Nursing

ISBN: 978-1-60741-598-5
Editor: Caitriona D. McLaughlin, et al.
2009 Nova Science Publishers, Inc.

Chapter 8

Nursing Burnout in the Era of Evidence

Based Practice
1
1

Stefanos Mantzoukas and 2Mary Gouva

Assistant Professor in Nursing, Department of Nursing,

Highest Technological Educational Institute of Epirus, GREECE.
2
Assistant Professor in Mental Health Nursing, Department of Nursing,
Highest Technological Educational Institute of Epirus, GREECE.

Abstarct
Superimposed organizational demands, work overload and limited decision-making
capacities are often associated with the development of occupational stress by nurses that
eventually create a sensation of professional burnout. In the current era of evidence-based
practice, health organizations and regulatory bodies impose further demands on practicing
nurses as to implement research evidence in practice setting. Also, evidence-based
practice requires that nurses search the electronic literature as to find the best available
evidence for practice. Lastly, in accordance to the traditional view of evidence-based
practice, decisions relating to patient care are not the product of the practitioners
intellect, but the result of research findings deriving from randomized control trials that
the practicing nurses merely implement. This traditional view of evidence based practice
appears to create further organizational demands, work overload and limited decisionmaking potentials for practicing nurses that is bound to intensify the burnout feelings.
Therefore, the current chapter will conclude that the traditional view on evidence-based
practice needs to be abandoned as to avoid the perpetuation of burnout sensations in
nurses. A more radical view will be proposed that conceptualizes evidence-based practice
as an ideology of individual emancipation, where daily practice is based on the individual
nurses critical and reflexive analysis of singular situations and contexts taking into
consideration the feasibility, appropriateness, meaningfulness and effectiveness of all
types of evidence and developing a line of thought that has logical validity and
argumentative coherence. This radical view will empower individual practitioners and
enable them to undertake rational decisions based on the various types of knowledge that
they possess leading to a notion of ownership of nursing praxis and a sense of

Stefanos Mantzoukas and Mary Gouva

professional fulfillment. Finally, this radical conceptualization of evidence-based practice
not only fits in with the current trend in nursing, but also facilitates nurses to overcome
the burnout feelings.

Introduction
The concept of burnout amongst practicing nurses is a well documented phenomenon in
the nursing literature. Furthermore, a series of literature reviews and research studies have
identified a variety of underlying etiological factors that contribute to burnout sensations in
nurses. However, what appears to be missing from the relevant literature is the analysis that
links burnout and the current era of evidence based practice and how this current era of
evidence based practice can affect burnout feelings amongst nurses. The aim of the current
chapter is to provide an overview on burnout and on the underlying factors that lead to
burnout. Consequently, we will go on to develop the links between burnout and evidence
based practice as to identify potential factors of perpetuating burnout by the use of evidence
based practice and mechanisms for overcoming burnout if evidence based practice reconceptualized as to be more relevant and appropriate for nursing practice.

The Concept of Burnout in Nursing

The notion of burnout has been regarded by the literature as an occupational hazard that
exhibits multidimensional, complex and commingled characteristics with a dynamic and
developmental nature that has, when present, deleterious effects on both the individual and
the organization (Kanste et al. 2007, Jennings 2008b). The initial coiner of the term burnout
is considered to be Freudenberger (1974) and his study on frontline human service workers
and the various manifestations of chronic stress that these workers displayed due to the
numerous and direct interactions they had with large numbers of people. Consequently,
Maslach & Jackson (1981, 1982) conceptualized burnout as a syndrome typified by negative
feelings, such as emotional exhaustion, depersonalization and reduced personal
accomplishment, and went on to develop a burnout inventory as to measure the emerged and
self-reported psychological, physical and behavioral strain indicators, which amongst others
included tension, irritability, fatigue, headache, backache, extreme tiredness, sleep disorders,
indifference, cynicism and negative self-image (Duquette et al. 1994, Kilfedder, 2001).
Duquette et al. (1994) in a comprehensive review on burnout in the nursing profession
identified the work of Jenkins and Ostchega (1986), and Topf and Dillon (1988) as the first
two studies that have documented workplace stressors as contributing factors to nursing
burnout. Duquette et al. (1994) concluded that the stressful environment along with the
constant state of alertness required create conditions of physical and mental exhaustion for the
nurses that lead to burnout sensations. Since the work of Deuquette et al. a series of other
studies have similarly identified that nursing practice can significantly increase the levels of
occupational stress impacting negatively on nurses physical and psychological well-being
(Sutherland & Cooper 1992, Caplan 1994, Morita & Shima 2004, Gouva et al. 2009). The

Nursing Burnout in the Era of Evidence Based Practice

nursing literature defines burnout as the index of the dislocation between what people are and
what they have to do. Such a dislocation consequently is anticipated to create an erosion of
values, dignity, spirit and a haemorrhaging of oneself leading to depletion of both energy and
personal resources, leaving individuals helpless and with negative feelings (Gillespie &
Melby 2003, Laschinger & Leiter 2006).
Three different sources have been identified that potentially can create stress for nurses
and could lead to the development of burnout sensation. Firstly, the context in which nursing
occurs is usually intense and emotionally charged (McVicar, 2003;Yam & Shiu,
2003;Winwood & Lushington, 2006) typified by superimposed organizational demands, by
nurses lack of authority with limited decision-making capacities, and by aggressive and
violent behavior including both verbal and physical assaults (Sawatzky, 1996; Corley et al.,
2001; Bakker et al., 2005, Isaksson et al. 2009). Secondly, the nature of the nursing
profession that includes intimate involvement with individual situations, human suffering and
patient mortality, along with the development of interpersonal relationships and the use of
empathy as a caring and therapeutic technique, coupled with extended working hours and
physical work demands, such as lifting, carrying or moving weighty objects, or having to
walk extensive distances for extended periods with little rest (Freshwater 2002, Mann &
Cowburn 2005, Winwood & Lushington 2006, Jennings 2008b). Thirdly, the personality of
individual nurses, the reasons for entering the nursing profession and the educational
provision have been identified as potential factors for developing burnout sensation. Nurses
that suffer burnout usually display inadequate personal and social coping mechanisms,
dissonance between their personal ambitions and daily reality, along with a dissonance
between their education and their inability to implement the acquired knowledge in practice
(Kilfedder et al. 2001, Gillespie & Melby 2003, Gouva et al. 2009).
What is equally interesting and possibly of greater significance is that burnout sensation
not only creates a series of negative consequences for the individual nurse, but has as well a
negative effect on the professional and caring activities that the nurse conducts for the
patients. It is extensively reported in the literature that overexposure to stressful experiences
can induce maladaptive, dysfunctional and exhaustive behaviors diminishing nurses
confidence to practice nursing and reducing the sense of personal accomplishment, hence
inciting tempered and irritable reactions (Tavares, 1994, Gillespie & Melby 2003, Mrayyan
2006, Winwood & Lushington 2006). This can result to irrational thinking patterns leading to
cynical attitudes, destructive behaviors and detachment from work, which eventually breeds
feelings of ineffectiveness, routinization, depersonalization and lack of professional
autonomy and authority (Bonell 1999, Balvere 2001, Laschinger & Leiter 2006).
These attitudes can seriously compromise patient outcomes, patient safety, and quality
care (Jennings 2008). For instance, Laschinger and Leiter (2006) identified that burnout
played a major role in the relationship between nursing and patient outcomes. Jennings
(2008) expanded on this, by explicitly linking nurses high on state-anxiety and burnout to an
increase of medical errors by nurses. Moreover, a set of other authors correlated burnout with
inflexible practice, with difficulty of admitting error, with denial of failing to solve problems,
with detachment from patients, with increased falls and nosocomial infections, and with
proliferation of adverse events and patient mortality (Schmitz et al., 2000, Gillespie & Melby
2003, Laschinger & Leiter 2006). Also, feelings of burnout are associated with malpractice

Stefanos Mantzoukas and Mary Gouva

and unethical practice, with disempowerment sensation and with lack of control over the
practice setting (Laschinger & Leiter 2006, Jennings 2008, Gouva et al. 2009)
Such practice provision, renders nursing not merely problematic but questionable and
unacceptable. Unreasonable lack of skills by the nurse, omission to perform expected duties
and caring activities or perform them below the required standard, and improper conduct in
the performance of caring activities due to carelessness or ignorance are all considered cases
of nurse malpractice (Graves-Ferrell, 2007, Brooke 2008, Keian-Weld & Garmon-Bibb
2009). Malpractice is conceptualized as a type of practice that is below the standards of care
as defined by law, regulatory nursing bodies, policies and position statements by specialty
societies, health care institutions and organizations, current nursing literature, and job
descriptions. Such practice is unacceptable and entails serious consequences such as patient
physical and/or psychological injury, financial harm to both patient and nurse, defamation of
the nurse, the hospital and the profession, and even legal persecution of the nurse (KeianWeld & Garmon-Bibb 2009).

The Era of Evidence-Based Practice Nursing

Perhaps the most basic framework currently underlying and shaping nursing practice is
the concept of evidence based practice. Evidence based practice has acquired a prominent
position in the strategic planning of nursing regulatory and accreditation bodies and this
eminence is echoed in the educational, practice, policy and competence frameworks
developed by these governing bodies (Jutel, 2008; Hudson et al., 2008). Evidence-based
practice requires that nurses implement rational, moral and superior decision-making
processes that prevent clinical errors or the provision of suboptimal care (Djulbegovic 2006,
Borry et al. 2006, De Simone 2006). The current health literature asserts that clinical practice
should be based on evidence as to promote standardization, certainty and consistency in
practice that would eventually lead to high quality of care and avoidance of clinical errors
(Mantzoukas 2007, Nolan and Bradley 2008, Rolfe et al. 2008). Moreover, the literature
seems to inextricably align EBP with best practice (Walker 2003, Tolson et al. 2005), with
doing the right thing (Muir-Gray 1997), with avoiding harmful interventions (Brocklehurst &
McGuire 2005) and with transparent, accountable and legally defensible decisions (Page &
Meerabeau 2004, Parahoo 2006).
The very inception of the evidence based practice movement in the early 1990s was
based on the attempt to avoid hearsay, ritual, route and intuitive practice and base practice on
more scientific, legitimate and rational approaches, hence increasing effectiveness and
minimizing the possibility of error. One of the most quoted definition of evidence-based
medicine, which is the forerunner of the evidence based practice movement, suggests the deemphasis of intuition, unsystematic clinical experience and pathologic rationale for clinical
decision making and instead places emphasis on the examination of evidence from clinical
research (EBMWG 1992). This initial view of evidence based practice considered that
evidence primarily emerged from research finding with most eminent evidence those
emerging from randomized control trials, which they were termed as the golden standard for

Nursing Burnout in the Era of Evidence Based Practice

practice (Walker 2003, Franks 2004, Mistiaen et al. 2004, Berwick 2005, Rycroft-Malone
2006).
Furthermore, the eminence attributed to evidence emerging from randomized control
trials is mirrored in the hierarchy of evidence as developed by the proponents of this initial
view of evidence based practice. At the top of the hierarchy are the findings from systematic
reviews of randomized control trials and the next level down the hierarchy are evidence from
at least one well conducted randomized control trial. The next three levels down the pyramid
are evidence from controlled research that lack randomization, research without a control
group and opinions of respected authorities. Interestingly, the last three levels are not
recommended to inform practice, thus assuming that they are not sufficient evidence to base
practice (Sackett 1993, McKenna et al. 2000, Morse 2006). The positioning of evidence
emerging from randomized control trials at the top of the hierarchical structure of evidence
and the very language used to characterize this evidence are indicative of both the validity
and significance attributed to evidence emerging from randomized control trials. Moreover,
the significance attributed to evidence emerging from randomized control trials is portrayed
in the guidelines and clinical protocols that are developed and which are based on the most
updated randomized control trials. Furthermore, the proponents of this type of evidence
based practice have developed RCT databases (such as Cochranes database), created a series
of evidence based journals that contain primarily RCT abstracts and currently are
experimenting with computerized decision supporting systems that are based on RCT reviews
(Mistiaen et al. 2004, Brocklehurst & McGuire 2005, Haynes 2005, Walker- Dilks 2005).
In a sense, it is not at all surprising that the nursing profession has rushed to adapt the
evidence based practice discourse as it resonates with nurses long-standing calls for the
development of a research based profession and actual research-based clinical information
taking precedence over traditional modes of care (Bonell 1999, Hudson et al. 2008). More
importantly, evidence based practice evangelizes increased effectiveness in practice
provision, minimization of error and standardization of practice (Rashotte & Carnevale 2004,
Parahoo 2006). Such a promise clearly counteracts the negative outcomes that relate to
nurses burnout sensations that include adverse effects on patient safety, clinical errors,
substandard nursing care and high rates of patient mortality.
Moreover, it appears that there is no reason for burnout sensation to be present if the
evidence based practice discourse is implemented. Part of the literature anticipates evidence
based practice as a prescriptive process for making decisions, which is typified by the use of a
series of predefined steps or processes that the practitioner merely follows (Mantzoukas
2008). Such an explicit decision-making mechanism can eradicate role ambiguity and role
conflict that are primary contributing factors for nurses burnout. Also, this view of evidence
suggests that clinical decision-making and problem solving derive from objective and
generalizable sources such as research findings from randomized control trials, which purport
to provide definitive, accurate, and truthful evidences enabling nurses to practice in a
predictable, objective, and standardized manner (Mantzoukas 2007). Hence, seriously
limiting clinical unpredictability, practice complexity and context specific intricacies that are
again primary sources of stress and burnout for nurses. Also, the traditional view of evidence
based practice does not require intimate patient involvement, but merely requires that nurses
can adequately search databases as to find existing evidence on treating specific patient

Stefanos Mantzoukas and Mary Gouva

problems and implement that evidence, therefore removing another element that contributes
to creation of burnout (Kessenich 1997, Thompson et al. 2005). In summation, the traditional
view of evidence based practice via objectification and standardization of practice not only
secures efficient, effective and safe practice, but also eradicates clinical complexity, practice
ambiguity, role conflict and nurses intimate involvement with singular patient situations, thus
removing all those contributing factors that have been identified as responsible for developing
nursing burnout.

Critique of Traditional Evidence-Based Practice

and its Role in Perpetuating Burnout
Whilst the above traditional view on evidence based practice seem to be able to deal with
nursing burnout, nonetheless the nursing literature is replete with a continuum of authors that
on one end of the spectrum raise cautionary voices with regards the usefulness of the
traditional view of evidence based practice (Bonell, 1999) and on the other end of the
spectrum a set of authors that are waging a polemic against the fascist attitude of evidence
based practice (Walker 2003, Holmes et al. 2006). This criticism leveled against evidence
based practice and its relevance and usefulness in nursing has direct implications with the
development of burnout sensation for nurses. If evidence based practice is unable to achieve
the goals in nursing as explicated above, than it is appropriate to assume that it would be very
unlikely that it would be able to extricate the burnout sensation for nurse professionals.
The critique that evidence based practice has attracted from nurse authors relate to its
basic premises and aims that are considered to be incongruent with nurses and nursing
practice. The notion of objective, detached and generalisable evidence as propounded by the
traditional view of evidence based practice via the use of research findings emerging from
randomized control trials is considered a simplistic, questionable and superficial approach
unable to achieve efficiency and optimum care (Geanellos 2004, Mantzoukas 2008, 2009). In
fact, evidence based practice is accused of discounting the importance and complexity of
human encounters in the provision of services (Geanellos 2004).
Moreover, it is argued that evidence-based practice does not increase objectivity but
rather obscures the subjective elements that inescapably enter all forms of human inquiry
(Goldenberg 2006). Thus, the problem with evidence based practice is that, at best, it
downplays, and at worst, it utterly disavows the subjective elements operating at the heart of
nursing (Holmes et al. 2007). In other words, nursing is the practice of the unique that
requires personal knowing of the individual, with contextual knowledge and the ability to
carry out specific and unique activities as to care and cater for specific patient needs (Carper
1978, Edwards 2001, Rolfe 2006, Mantzoukas & Jasper 2008). The fact that the traditional
view of evidence based practice does not consider these essential types of nursing knowledge
as valid forms of knowledge creates for nurse practitioners conflicting messages where the
practice requirements of evidence based practice become incompatible with professional
values and demands.
Furthermore, the use of evidence emerging from randomized control trials has as well
practical limitations. Practitioners are busy professionals dealing with complex and unique

Nursing Burnout in the Era of Evidence Based Practice

clinical problems that require on the spot decisions to be made. It is, therefore, virtually
impossible for practitioners to stop before every decision is to be made and retreat back to the
library to retrieve all relevant evidence emerging from randomized control trials (Rolfe 2005,
Mantzoukas 2008). Also, the limited number of experimental studies conducted by nurses
and the antitrial cultural permeating the nursing discipline further limits the numbers of
evidence deriving from randomized control trials available to clinical nurses (Cullum, 1997;
Droogan and Cullum, 1998, Mantzoukas 2009). Additionally, the notion of singular and
absolute evidence that randomized control trials evangelize cannot solve daily clinical
problems because answers and solutions for daily practice need to be constructed or
fabricated as to fit individual cases (Forbes et al. 1999, Edwards 2001, Weaver & Olson
2006). Hence, if nurses base their practice only on evidence from randomized control trials
they will be running the serious risk of being unable to deal and solve daily patient problems.
Finally, basing practice on evidence emerging from randomized control trials can make
practice appear as a cookbook activity with the restrictive effect that this has on practitioners
initiative and autonomy (McKenna et al. 2000, Lorenz et al. 2005). In fact, it is argued by
parts of the literature that the value attributed to evidence emerging from randomized control
trials is an intentional distortion by highly established researchers, nurse academics, nurses
with authoritative positions in governmental posts, economical imperatives, other professional
groups, and the epistemology of positivism (Forbes et al., 1999; Walker, 2003; Freshwater &
Rolfe, 2004; Mantzoukas, 2007). The fundamental explanation for such a distortion appears
to be the need of powerful groups, which base their status on their ability to develop, conduct,
and disseminate randomized control trials, to maintain and increase their powerful and
hegemonic positions (Rolfe, 2000; Murray et al., 2007, Mantzoukas 2007). Moreover,
evidence developed by groups far removed from the clinical environment pre-packaged in the
form of evidence-based practice guidelines has a silencing effect on practitioners intellectual
and critical voices on methodology, philosophy, theory and practice issues transforming
practitioners into mute, docile, unaccountable and without autonomy professionals
(Freshwater and Rolfe, 2004; Holmes et al., 2008; Rolfe et al., 2008).
In summation, the critique of the traditional view of evidence based practice is developed
on the dissonance that exists between the professional ideals of the nursing profession that
advocate for unique and singular patient care, and the practice requirements of evidence
based practice that strive for objective and generalisable evidence and practice. Consequently,
this dissonance is furthered by the impracticality of acquiring evidence deriving from
randomized control trials and the inappropriateness of this evidence in solving daily clinical
problems. The result of implementing evidence in practice that is both impractical and
inappropriate often leads to patient dissatisfaction and reduces patients confidence in nursing
care. Finally, the critique of the traditional view of evidence based practice concludes that the
preponderance of standardized practice as developed by individuals removed from the ward
context can lead to routinization of practice and seriously curtail nurse autonomy.
The dissonance between the ideal and the real, the depersonalization of practice, the
inability to implement learned practices in the clinical context, patient dissatisfaction and
anger for not solving their problems, routinazation of practice and lack of autonomy in the
clinical environment make up not only a critique towards the traditional view of evidence
based practice, but also constitute the foundational blocks for developing burnout sensation.

Stefanos Mantzoukas and Mary Gouva

While the rhetoric of the traditional view of evidence based practice as already demonstrated
appear to be removing all those contributing factors that have been identified as responsible
for developing nursing burnout, nevertheless its actual implementation perpetuates and
further cultivates nursing burnout.

Radical Conceptualization of Evidence-Based

Practice as Means of Overcoming Burnout
From the heretofore analysis the answer begging question is if there is hope in the current
era of evidence based practice for nurses to avoid or overcome burnout feelings. Whilst the
traditional view of evidence based practice seems to perpetuate burnout feelings in nurses,
nonetheless this is not to suggest that there is no hope. Indeed, if evidence based practice is
re-conceptualized or re-described in a radical, but more useful manner, then burnout would
not be an issue for nursing. This re-conceptualization entails what the Kant termed as sapere
aude, which freely translates as dare to think for yourself (Critchley 2001, Mantzoukas &
Watkinson 2008). In other words, nurses cannot expect of others to think for them and
provide them with ready made answers for their own practice, but each nurse practitioner
needs to think for their own self.
This radical view of evidence based practice does not imply that the nurse will know a lot
of evidence or indeed even be proficient in finding evidence, but that s/he would be able to
think about the value of evidence, critique the evidence and reason on the conditions of the
possibility of implementing specific evidence in specific cases in specific contexts (Murray et
al 2007, Mantzoukas 2007). Hence, the radical re-conceptualization of evidence based
practice entails the identification of the potentials and limitations through reflexive and
critical analysis of singular situations and contexts taking into consideration the feasibility,
appropriateness, meaningfulness and effectiveness of all types of evidence and developing a
line of thought that has logical validity and argumentative coherence (Avis & Freshwater,
2006; Pearson et al., 2007; Mantzoukas, 2007).
Furthermore, such critical and reflexive approach does not only identify the limits and
usefulness of the available evidence, but also critiques the potentials and limits of the
individual and the context within which s/he operates. Murray et al. (2007) suggest that
practical application of knowledge will always be inadequate or in bad faith if the
practitioner does not avow the political and ethical dimensions of his or her own
power/knowledge (p. 515). Eventually, evidence based practice is not a product that can be
passed from knower to would be knower, but a process involving well-reasoned and justified
sets of action that relate logically and coherently to previous actions and signify in a
contingent manner the actions that would follow. The greater the sophistication of the
justified actions and the more critical the reasoning of the implemented practice, the greater
their value and validity becomes. Finally, evidence that emerge from the reflexive, critical and
reasoned faculties of individual practitioners will be more applicable and relevant to specific
patient cases and practice contexts. Even in the cases that the practice context may not be
conducive to the suggested evidence, the practitioner using reflexive, critical and reasoned
approaches is appropriately positioned as to change the context of her or his practice.

Nursing Burnout in the Era of Evidence Based Practice

Of course this requires a different kind of practitioner and a different kind of educational
provision. In this radical conception of evidence based practice the educational system needs
to prepare nurses not with ready made knowledge prepackaged in the form of theories and
definitive evidence, but instead needs to have a developmental nature where the practitioner is
enabled to ask questions, to critically scrutinize theories and evidence for their logical
coherence, to look at practice with a questioning mode as to identify how things are, why they
are as such and imagine how they can be different. Such a questioning, critical and reflective
mode of practice allows and requires a culture of freedom. A thinking-culture where there is
no right answer or correct practice. In other words, everything is possible and anything goes
as long as it is rationally argued, logically justified and critical reflected upon.
This radical view of evidence based practice can become the means for overcoming the
burnout sensation. The practitioners that base their practice on this radical view of evidence
will not be entrapped in the dissonance between ideal and real because there is no ideal or
even real for that matter. Both the ideal and real will be a creation each time of the individual
practitioner that will be based and developed on critical reflexivity. Furthermore, such a
practitioner has a sense of ownership of his/her practice as each time the practitioner creates a
new micro-theory as to fit the specific needs of a specific patient. Even if the organizational
environment is not conducive to such practices this new type of practitioner that implements a
radical version of evidence based practice will be able to use his/her skills as to change the
conditions of the context and function as a change agent. Finally, this radical view of
evidence based practice has an emancipatory role for the nurse as it provides a sense of
freedom and autonomy in the decision making of patient care. Furthermore, such practice
allows for the constant development of practitioner as it is required that s/he constantly has to
logically justify all choices made.

Conclusion
In conclusion this chapter has summarized the detrimental effects that burnout has for
both the practitioner and the patient. Moreover, it has identified as primary contributors to
burnout sensation the dissonance between the ideal notion of nursing and the reality of daily
practice, practitioners lack of authority and limited decision-making capacity, and the
limitations of nurses professional autonomy. Furthermore, the current era of evidence based
practice further perpetuates nurses burnout sensation, since the traditional view of evidence
based practice contributes to the disillusionment of practitioners and to the delimitation of
nurse autonomy in the practice setting. The objective and generalisable evidence produced by
researchers far removed from the reality of the clinical setting, along with the alleged
catholicity of this evidence and its projection as the most effective and optimal knowledge for
patient treatment creates a greater sense of dissonance to practitioners that are educated and
cultured in caring for individuals as unique and singular beings existing in unique and
specific contexts, and require each time to develop personal knowledge and understanding of
their caring needs. Also, superimposing evidence in practice that are the result of electronic
searches in various evidence based practice databases transforms practitioners from decision
makers to mere technicians capable only of finding ready made solutions to practice

10

Stefanos Mantzoukas and Mary Gouva

situations. However, if evidence based practice is re-described as a critical, reflexive and

reasoned approach to practice and re-conceptualized as a process that the practitioner
undertakes as to shape practice, rather than a product that is imposed on practice, than the
notion of dissonance, the lack of ownership of practice and the limitation of autonomy would
cease to be an issue and therefore evidence based practice will become a mechanism for
overcoming burnout in nursing.

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