At the end of this section, you will be able to:

‹ List the 5 Ss

‹ Discuss the types and purposes of other sources of evidence

Other Sources of Evidence

Cynthia L. Russell

12.1 The Pyramid of the 5 Ss

Nursing is both an art and a science. We learn and practice nursing by using both propositional knowledge
and nonpropositional knowledge. Propositional knowledge is the science of nursing, or knowledge that
is “formal, explicit, derived from research and scholarship and concerned with generalisability” (Rycroft-
Malone et al., 2004, p. 83). For example, the knowledge we gain from research studies is propositional
knowledge. Nonpropositional knowledge is the art of nursing, or knowledge that is “informal, implicit
and derived primarily through practice” (Rycroft-Malone et al., 2004, p. 83). When we learn to prepare
adhesive tape before dressing a wound, we are gaining nonpropositional knowledge. Both of these ways
of knowing must come from many sources, be critically evaluated by experts, and be integrated into the
evidence that guides nursing practice.

An organizing framework to explain the importance and contribution of various levels of information
to evidence-based healthcare delivery has been developed (Haynes, 2006). The framework is organized in a
pyramid with five levels, including studies, syntheses, synopses, summaries, and systems (see Figure 12-1).
These levels are known as the 5 Ss (Haynes, 2006). Research studies form the base of the pyramid. The use

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CHAPTER 12