THERE IS A CATCH phrase that dominates the clinical landscape of medical and psychiatric mental health care-evidence-based practice (EBP). Indeed, on any given day these phrases can be heard to be uttered in the hallways of our academic institutions as well as our clinical institutions; and are often narrowly interpreted to mean practices that have a proven efficacy based on empirical study and data. Certainly, in this era of EBP, research dissemination and utilization have been given deserved emphasis in the context of clinical practice. Yet, at the risk of seeming antiscience (which I am not), I wonder whether we have taken EBP and Best Practices so far down the research path that we have lost sight of the role of clinical judgment and forgotten that research outcomes cannot always be translated down to the particulars of an individual clinical case. And, perhaps we have become so enamored with EBP and Best Practices that, especially among our colleagues in academic settings, we no longer value clinical scholarship that is narrative, reflective, or otherwise nonempirical in nature-witness the increased emphasis on databased manuscripts in appointments and promotions criteria in our academic institutions and the emphasis on EBP in the classroom, clinical, and written assignments of our graduate psychiatric mental health nursing programs.

Surely I can’t be opposed to evidence in the context of psychiatric mental health nursing practice! Of course not! But, I have witnessed the disappearance of certain types of evidence that concerns me. I have watched it disappear from these pages as well as from our academic programs and our practice dialogues. It is sadly rare that authors submit clinical narratives, think pieces or substantive case discussions to this journal. I have had people tell me that because Archives of Psychiatric Nursing is a research journal they would not think of submitting “softer” manuscripts for our consideration. Yet it is these “softer” pieces that will likely illuminate the important variations from the empirical norm-the clinical case that defies the evidence; or the untoward response to tried and tested pharmacological interventions. I have also had psychiatric mental health nurses tell me that they don’t read Archives of Psychiatric Nursing because it is about research not practice! It seems pretty obvious to me that one cannot be about clinical research without being about practice. It is equally obvious that research alone does not and cannot define the entire domain of practice.

So, just what is the evidence in EBP? I think it is the carefully considered combination of research evidence, clinical evidence based on assessment and observation, inputs from the individual patient, and expert clinical judgment based on all of these things. Our science is not nearly so refined that there is only one best practice or intervention for a given clinical problem. For the most part we are faced with choices among practices for which there is competing evidence that must be fit to the individual clinical situation.

How do we inform the choices we make in practice? In real life we consult with our practice colleagues who are experts in the area in question; read the research literature; and consult with our patients who are, afterall, the experts in their own personal preferences, values and reactions to treatment. And, how will we refine our capacity to evaluate such evidence if we don’t write about it and share it in public forums that might allow for examination and discourse?

When is the last time you made a clinical decision that did not follow the linear path of the “evidence”? What were the factors that made you choose a different path? How did things turn out for that patient? How do you explain the outcome given the deviation from the evidence? This is the stuff of an intriguing manuscript and it belongs in a journal like Archives of Psychiatric Nursing precisely because we are about clinical research and practice and the only way we can fulfill this mission is with all the evidence, not just the empirical evidence.

I encourage you to think about your practice and the types of evidence that inform your clinical judgments. I particularly encourage you to think about those contrary cases that seem to defy the empirical evidence. Don’t restrict your thoughts to late-night private musings or discourse with a few trusted colleagues. Put it on paper and dare to expose it to review and dissemination so that we can begin to recapture the evidence of clinical judgment and clinical narrative alongside the evidence of research-only then will we have all the stuff we need for EBP and only then will Archives of Psychiatric Nursing fulfill its commitment to shape psychiatric mental health nursing practice.