Clinical guidelines and the translation of texts into care: Overcoming professional conflicts concerning evidence-based practice

The difficulties of basing healthcare on literary warrant have been explained in different ways: busy practitioners have no time to read extensively, physical access is difficult, and adequate surrogates for texts like indexes, abstracts, systematic reviews are partial in their coverage. The author suggests that a deeper problem of domain conflict must be addressed. This paper reviews problems identified in previous research on evidence-based nursing practice, which indicates that there are conflicts between medical and nursing domains. EBM (evidence-based medicine, or 'text') poses challenges for nurses (proponents of 'caritas'). An additional surrogate for the medical corpus, the clinical guideline, is discussed. When based on inclusive consultation, this may prove to be a hospitable epistemological bridge for groups whose domains are in conflict. Drawing on 'social studies of science' literature, the author explores the provenance and status of the clinical guideline as a 'translation artefact' or bridging mechanism, and presents a 'snapshot' case study of the Scottish Intercollegiate Guidelines Network in 1998. She suggests that the clinical guideline is a powerful documentary genre, which links several strands of information science: information retrieval, literary warrant and the politics of classification.