Evidence-Based Practice in Social Work and Nursing

PART 1 – Evidence, professional expertise and preferences: how the concepts work together

The common thread from Module 1 – without repeating it

In Module 1 you saw how Sackett et al. (1996) define the practice of evidence-based medicine and how the Institute for Quality and Efficiency in Health Care (IQWiG) transfers this view into German. For this module, a single idea from the definition is enough: it describes practice as the integration of individual expertise with the best available external evidence. The word “integration” carries the whole weight. A study provides findings about groups under certain conditions; a decision, by contrast, always concerns a specific person in a specific situation. Anyone who reads only the study and overlooks the person has shortened the definition.

IQWiG (2025) makes this integration visible by distinguishing three elements: the evidence, a person’s condition and circumstances, and their preferences and attitudes. The professional’s expertise is the instance that brings these elements together. This module starts exactly at the seam between evidence and person: What does bringing them together look like in practice, what supports it, and where is it not enough? Figure 1 shows a mind map of the five branches along which the module unfolds: external evidence, internal evidence, self-determination, participation and the limits of the whole approach.

Four concepts, kept clearly apart

Term papers are where concepts that sit close together in everyday life often blur. Here are four working definitions. They are formulated for this course and are not literal quotations; where a source carries the concept, it is named.

Preferences are what a person favours when several paths are open: priorities, wishes, dislikes. They relate to a specific decision (“group or one-to-one conversation?”). Attitudes are, by contrast, more stable stances and convictions, for example towards help, medicine, public authorities or independence; IQWiG (2025) names both together – preferences and attitudes – as a separate element of the decision. An attitude can colour preferences without being identical to them.

Circumstances is the term IQWiG (2025) uses alongside a person’s clinical condition. For social pedagogical and nursing fields of work, this can be read as life situation : housing, income, social network, language, time, accessibility of services. This translation is a reading made by this course and not a formulation by IQWiG. By lifeworld we finally mean the everyday context of places, relationships, routines and meanings that a person experiences and lives in. This too is a working concept, not a summary of a particular theoretical approach; in your term paper you should use it only if you define it yourself or link it to the definition used in your field of study.

Internal evidence: taking the knowledge of those involved seriously

The nursing-science concept of evidence-based nursing bases nursing decisions on two kinds of knowledge. External evidence comprises methodologically secured experiences of third parties, that is, research findings. Internal evidence consists of the individual needs and experiences of the people needing care and of the nurses. Two things are noteworthy here. First, internal evidence is not an add-on for “soft” cases but an equal building block of the concept: it answers a different question from a study, namely not “What happened on average?” but “What does the measure mean for this person?”. Second, it explicitly also counts the experiences of the professionals themselves; your own experience in your field of work is therefore not mere opinion but part of the basis for decision – admittedly a part that must be open to critical reflection.

The concept comes from nursing. For social work, the transfer is a separate step of thought: service users, parents, young people, relatives and professionals have experiential knowledge that is not found in any database. Whether and how one wants to call it “evidence” is open in the professional debate; at its core the question is which knowledge is heard at all when a decision is made.

Shared decision-making: an attitude, not a form

In the sequence of steps of evidence-based nursing, shared decision-making comes first, followed by formulating the problem, searching the literature, critically appraising the studies, changing practice and evaluation. You practised how to formulate the question in Module 2; what interests us here is the start of the chain. Shared decision-making is less a document than an attitude: you do not assume that the “right” solution is already settled and only has to be conveyed. Instead, you explain in an understandable way what options there are (including doing nothing for now), ask about wishes and worries, take time for questions and agree together how you will later recognise whether the chosen path is working. These guiding questions are a practical compilation made by this course.

Table 1 summarises the four building blocks that come together in such a decision. Read it as a map: each row has its own strength and its own limit, and none replaces the others.

PART 2 – Foundations: self-determination, co-construction and bindingness

Self-determination in the professional ethics of social work

The German Professional Association for Social Work (DBSH) has presented its professional ethics in a second edition since December 2024; it is a completely revised version of the first edition of 2014. Among its supreme principles, the DBSH (2024) names autonomy, solidarity and justice. At the same time, the professional ethics link ethics and professional competence and assume that the practical competence of social work rests on scientifically secured knowledge. Both therefore stand side by side in one document: the demand to act on a sound professional basis and the demand to respect people’s autonomy.

This is valuable for your argument in a term paper, because it shows that the tension between research knowledge and self-determination is not a marginal problem that you “unfortunately also have to bear in mind”, but lies in the professional ethics’ own self-understanding. Note, however, the type of source: the professional ethics are the position of a professional association. They serve as professional orientation, but they are not a law and do not create a legal obligation.

Self-determination and evidence-based knowledge in the professional code of conduct for nursing

For nursing – unlike for social work – there is, at one point, a legally formal regulation that touches on both topics: the professional code of conduct of the Nursing Chamber of North Rhine-Westphalia of 26 June 2025 (Pflegekammer NRW, 2025). Section 19(1) says: “Nursing practice should be based on evidence-based knowledge” (our translation). In addition, Section 3(1) commits to the generally recognised state of nursing-science, medical and other related-science knowledge, and Section 15(1) to safeguarding the right to self-determination. The statute thus names both in the same set of rules – how the two relate to each other in an individual case is a question of professional weighing-up in the team, not one that could be answered from the wording alone.

IFSW: knowledge in social work is often co-constructed

The Global Definition of Social Work was adopted by the General Meetings of the IFSW and the IASSW in July 2014. The commentary on the keyword knowledge describes social work as inter- and transdisciplinary and its research and theory as application-oriented and emancipatory. According to the commentary (IFSW, 2014), knowledge is often co-constructed together with service users; in addition, indigenous knowledge is expressly recognised. The wording is paraphrased here, because no official German translation was used for this passage.

Co-construction means in this context that knowledge is not only produced by researchers and then “applied”, but arises in the interplay of research, practice and the people concerned. This fits the idea of internal evidence from Part 1: in both cases, the knowledge of those involved counts as an independent source of insight. The recognition of indigenous knowledge additionally reminds us that scientific knowledge is not the only form of knowledge that deserves respect. How this can be spelt out concretely in Germany – for example with regard to the experiential knowledge of communities and self-help groups – is food for thought and not a statement of the commentary. This text too is a position of an international professional association, not law.

PART 3 – From recommendation to decision: a matching procedure for practice

Three questions before you adopt a recommendation

The recommendation of a guideline or a standard is an offer to the team, not an instruction for every individual case. Figure 2 translates this into a decision tree with three successive questions. You read it from top to bottom: Is there reliable evidence? Can it be transferred to the context and target group? Does it fit the person’s life situation, wishes and resources? Anyone who answers all three questions with “yes” arrives at joint implementation. Each “no” leads onto a side path of its own, and each side path has a direction for action – so the result is never “ignore the study” but “adapt the approach with good reasons”.

On the first question: according to IQWiG (2025), how reliable evidence is depends primarily on three aspects – internal validity, external validity and statistical precision. How you place these concepts you know from Module 3; for the tree, external validity is particularly important, because it corresponds to the second question on transferability. How guidelines and expert standards are built and what status they have, you learned in Module 6. On the third question: fit with the person is not the same as agreement. It asks whether the measure suits the life the person leads and whether it could reach the goal that matters to them.

Worked example: matching a recommendation with a life situation

The following example is entirely fictional. The “recommendation” is invented, comes from no real guideline and says nothing about what works in reality. It serves only to make the line of thought visible. Starting point: A fictional example recommendation states that people with a fear of falling should regularly take part in a guided exercise group. Oskar Voigt, aged 78, receives outpatient support. The professional wants to discuss the recommendation with him. Figure 3 shows the six steps; the reasoning for each step follows.

On Step 1: You read not only the recommendation but also its framework: for whom does it apply, how did it come about, is its status up to date? This is the view you practised in Module 6 with class, date and validity note. On Step 2: The life situation is the map on which the recommendation has to arrive. That Mr Voigt lives on the third floor is not a nuisance factor but part of the circumstances in the sense of IQWiG (2025). On Step 3: This is where internal evidence comes into play. The order matters: first you ask openly, then you explain the recommendation – not the other way round. Otherwise he answers a question to which you have already given him an answer.

On Step 4: Resources and obstacles work together. The daily walk is a strength that you can build on; the stairs are an obstacle that cannot be “wished away”. On Step 5: The actual integration. The aim of the recommendation remains; what is negotiated is the way. Whether an alternative does justice to the aim of the recommendation is a professional question that you do not decide alone and do not answer with a guess – which is exactly why specialist advice belongs in this step. The example expressly does not claim that guided exercises at home would be equivalent. On Step 6: Documentation is not a formality. It makes the weighing-up understandable for the team and for later questions, and it records the agreement on when you will evaluate together whether the way is working.

Question to think about: why does it make sense for the aim of the recommendation to remain while the way is adapted? Write down an answer in two sentences before you read on. A hint: think about what would happen if every deviation from the way automatically deleted the aim as well – and conversely, if every aim could be reached by exactly one way.

Documenting with reasons: what belongs in a decision note

A good decision note is short and answers six questions. Which recommendation or knowledge was the basis? Which life situation and which wishes of the person were known? Which alternatives were discussed? How was the weighing-up done, and who was involved? What was agreed? When and by what means will progress be evaluated? The format depends on your organisation; how you document follows its procedures. The logic behind it stays the same and is also useful for term papers: justifiability arises when someone outside the situation can follow how you reached the decision.

PART 4 – Participation: involvement in research, standards and everyday practice

Who has a say when evidence is produced?

So far we have looked at people’s involvement in decisions about them. There is also a second level: involvement in the creation of knowledge itself. The thinking behind it is simple. If the people affected are never asked which results matter to them or what a standard looks like in everyday life, there is a risk that knowledge is produced that misses their lifeworld. Participation can narrow this gap; it will not necessarily close it.

One example is the methods paper of the German Network for Quality Development in Nursing (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege, DNQP, 2025b). According to it, in the development phase of an expert standard (Expertenstandard), an expert working group works with at least one representative of the people affected. The standard is discussed at a public consensus conference, and an eight-week online consultation is planned when it is updated. You know the structure and the four phases of an expert standard from Module 6; only the participation aspect matters here. The DNQP (2025b) also states that where the evidence is weak, the judgement of the expert group carries particular weight. An interpretation can be drawn from this, which is expressly labelled as an interpretation here: the thinner the body of studies, the more it matters who helps decide in the group – and therefore also whether the people affected are represented.

Study reports can also be read for participation. CONSORT 2025 is the reporting guideline for randomised trials; it replaces CONSORT 2010 and contains 30 checklist items. Among the seven new items is one on patient and public involvement (Hopewell et al., 2025). A reporting standard does not prescribe how a study is carried out, but what should be reported transparently. In this way it shows whether and how participation took place. Important for your studies: CONSORT 2025 is a reporting guideline for publications and not a requirement for student work. It is still useful as a reading grid in a journal club, as you saw in Module 5.

Recognising participation: guiding questions for reading

Participation is a word that is quickly claimed and rarely described precisely. Table 2 gives you guiding questions you can use when reading standards, studies and methods papers to see whether and how participation is documented. The note in the third column names one anchor point from the sources of this module in each case.

Participation in everyday practice: small forms that matter

Participation here means: people can take part in decisions that affect their own lives. This ranges from understandable information through being listened to up to joint decision-making – this distinction is a working distinction of this course and not a ladder devised by a particular author. In everyday practice, participation mostly happens in small forms: you offer real choices instead of just asking for agreement. You use plain language and say what will happen next. You plan time for questions. You ask for feedback on what you decided together and pass it back to the team.

Honesty requires a look at the obstacles. Language barriers call for interpreting when information would otherwise not get across. Time pressure in organisations limits conversations. Power imbalances between professional and service user remain even when the atmosphere is friendly; people who depend on a service may be less likely to object. And in contexts of compulsion – for example when the protection of another person is at stake – there is limited room for wishes. Further duties apply there that are not negotiated in conversation; how they are to be understood in an individual case, you clarify in the team and with specialist advice. Participation is therefore not a switch that is “on” or “off”, but a quality that you have to reassess in every situation. If there are serious indications of a risk to the child's wellbeing (Kindeswohlgefährdung), inform your practice supervisor or manager immediately and follow your organisation's child protection procedure: in the youth welfare office (Jugendamt), several professionals assess the risk together (Section 8a(1) of Book VIII of the German Social Code (SGB VIII)); at non-statutory provider organisations (Träger), the assessment is made with advice from an experienced child protection specialist (insoweit erfahrene Fachkraft, InsoFa) (Section 8a(4) SGB VIII); for health professions, Section 4 of the Act on Cooperation and Information in Child Protection (KKG) applies. In acute danger: police 110, ambulance 112.

PART 5 – Critical appraisal: limits, tensions, open questions

Context dependence and transferability

A study is carried out somewhere and with particular people. Whether its results can be transferred to your residential group, your ward or your neighbourhood is the question of external validity that you know from Module 3. In Germany there are additional particularities that should not be underestimated: provider and funding structures, responsibilities, regional services and differences between town and country. A service that was studied abroad in a different structure meets different conditions here. The reporting guideline CONSORT 2025 also takes up the question: the earlier separate item on generalisability was removed, and it is now dealt with under limitations (Hopewell et al., 2025). This shift is a sign that transferability is not settled with a tick in a box.

At the same time, “That is different for us” must not become a blanket excuse for fending off inconvenient evidence. A sound argument says specifically how the setting, target group or conditions differ and why this difference could matter for the result.

Values and questions of power

What counts as a desired outcome is never purely technical. Outcomes such as those you chose in Module 2 when formulating your practice question reflect decisions made by researchers, providers or funders. What does not count as an outcome there does not appear in the studies, even if it matters to those involved. Added to this is the power imbalance: professionals have specialist knowledge, access to services and control over documentation. Even when they take participation seriously, service users may hold back wishes because they fear disadvantages.

Both hold true, without a simple order of priority being possible: preferences do not automatically override professional standards, and professional standards do not automatically override preferences. It is the team’s task to bear this tension and work on it rather than resolve it one-sidedly. Table 3 collects the most important tensions of this module with questions for practice and possible ways of handling them.

When studies are missing

For many social pedagogical questions there are no or only a few reliable studies of effectiveness. This is no surprise when you consider how complex the settings, target groups and forms of help are and how hard some questions are to study. Two false conclusions suggest themselves. The first is: “If there is no study, the measure is ineffective.” That is not true, because missing evidence is not proof of missing effect. The second is: “If there is no study, I can decide however I like.” That is not true either. For expert standards, the DNQP (2025b) shows how this can be handled: where the evidence is weak, the judgement of the expert group carries particular weight – that is, a structured professional judgement, not an arbitrary one. In your own practice this means: state the gap openly, combine professional knowledge with the person’s wishes, proceed carefully and evaluate how things go, so that experience becomes knowledge others can follow.

The debate about evidence-based social work

In German-language social work, evidence-based practice is discussed controversially. Three basic positions can be distinguished, which Figure 4 sets side by side: supportive voices that emphasise randomised studies of effectiveness; critical voices that point to a technology deficit of social interaction, the limited transferability of causal models and concern about professional autonomy; and mediating voices that lie between the two lines. For your work, the rule of this course applies: you assign arguments to positions, not to individual authors, unless you have read the contribution in question yourself and can support it with evidence.

How does this help with the topic of this module? The technology deficit-type argument can be understood in general terms to mean that social interaction cannot be planned like a technical process, because service users take part and the same measure lands differently in different life situations. This is exactly the point where preferences, life situation and participation come into play. The position of the mediating voices is the working basis in this module – not because the criticism is unjustified, but because it helps to use study knowledge without narrowing it. The reference to the position is a reading made by this course and not an attribution to any person. The question of professional autonomy remains: who decides when study knowledge is enough to base a decision on?

Consequences for practice: four constellations

A model for thinking can be derived from the considerations so far, which you can use as a guide. Figure 5 arranges situations by two questions – Is there evidence? Does it fit the person? – and gives four fields. Field A is the ideal case: the evidence is there and fits, you implement the recommendation together and evaluate how things go. In field B there is a tension that has to be worked on: ask for reasons, clarify adjustments or alternatives in the team, record the weighing-up. In field C the evidence is thin but the person is open; here you proceed carefully, state the gap openly and evaluate how things go systematically. In field D both evidence and fit are missing; here it is worth clarifying aims and wishes anew, involving specialist advice and not carrying on out of mere habit. This recalls the sentence “We have always done it this way” from Module 1: habit is not a reason, but not an opponent either – it is an occasion to clarify the reasons.

The four-field matrix is a model for thinking and not a classification of people. It describes how you can place a situation, not what a person “is”. A case can move between fields over time – for example when a conversation changes the fit or when new studies appear. To be clear about the limits: the model says nothing about the effectiveness of specific programmes; it only sorts how to deal with the situation.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you judge your own understanding.