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DNP Bound - Using the Library/Searching for the Evidence

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DNP Bound - Using the Library/Searching for the Evidence

  1. 1. Using the Library<br />DNP Bound<br />Frontier School of Midwifery and Family Nursing<br />
  2. 2. Alice Whitman Memorial Library<br />
  3. 3. Alice Whitman Memorial Library<br />Library Home Page<br />Library 101 in ANGEL<br />
  4. 4. Evidence Based Practice<br />Searching for the evidence<br />
  5. 5. Evidence Based Practice<br />What is EBP?<br />Most commonly cited definition is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”<br />Sackett, et al.<br />
  6. 6. Evidence Based Practice<br />The EBP Cycle<br />Identify/define the problem<br />Formulate a focused clinical question<br />Identify the appropriate resources<br />Search for valid and relevant information<br />Critically appraise/review this information<br />Implement in practice<br />Clinical audit<br />
  7. 7. Formulate a Question<br />Ask a focused, answerable question:<br /> NOT<br />Are febrile seizures in babies dangerous?<br />INSTEAD<br />Does a febrile seizure in a 6-month old infant increase the likelihood that s/he will develop epilepsy?<br />
  8. 8. Formulate a Question<br />What is the effect of [the Intervention or predictor variable]<br />On [the Outcome or given characteristic]<br />For [the group or patient characteristics]<br />
  9. 9. Formulate a Question<br />Use the PICO framework:<br />P – patient/problem<br /> I – intervention<br /> C – comparison<br /> O – outcome<br />
  10. 10. P<br />Population<br />Disease or condition<br />Stage of disease<br />Gender<br />Age group<br />Socioeconomic group<br />Healthcare setting<br />
  11. 11. I<br />Intervention<br />What is being done?<br />Drug therapy, surgery, radiotherapy<br />Level of intervention: frequency, dosage<br />Stage of intervention: prevention, secondary prevention; advanced<br />Delivery of intervention: self-medication, etc.<br />
  12. 12. C<br />Comparison<br />What could be done instead?<br />
  13. 13. O<br />Outcome<br />What happened to P as a result of I?<br />Patient oriented: quality of life; reduction in severity of symptoms; adverse effects<br />Provider oriented: cost-effectiveness<br />
  14. 14. Medical vs. Nursing Concerns<br />Medical <br />Abnormalities of joint ( Xrays, tests)<br />Medication <br />Surgical intervention<br />Nursing<br />Prevention<br />ADLs<br />Pain <br />Sleep problems<br />
  15. 15. Is acupuncture effective in inducing labor?<br />
  16. 16. Exercise or antidepressants for depression?<br />
  17. 17. What is Evidence?<br />Hierarchy of research evidence:<br />Systematic reviews<br />Randomized controlled trials<br />Non-randomized controlled trials<br /> e.g. cohort studies, case-control studies<br />Consensus statements from respected authorities<br />Individual/expert knowledge<br />Anecdotal evidence<br />
  18. 18. Where is the Evidence?<br />Traditional bibliographic databases<br />MEDLINE, CINAHL<br />Point of care/clinical resources<br />DynaMed, Essential Evidence Plus<br />
  19. 19. Finding the Evidence<br />Use functions of the database to narrow searches:<br />Subject Headings<br />Limiters<br />Filters<br />
  20. 20. Subject Headings<br />Specific words or phrases selected from a controlled vocabulary that describe a work<br />MEDLINE = MeSH<br />CINAHL = CINAHL Headings<br />
  21. 21. Limiters<br />Parameters for your search <br />MEDLINE limiters include:<br />Age group<br />Publication type<br />Language<br />Dates<br />
  22. 22. Research Filters<br />Research filters are pre-designed search strategies<br />Clinical Queries<br />PubMed page: http://www.ncbi.nlm.nih.gov/pubmed/clinical<br />Limiter in MEDLINE (EBSCOhost)<br />((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials[MeSH Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading])<br />
  23. 23. Searching for the Evidence<br />Search Example:<br />What should the NP do to prevent pressure ulcers in the elderly?<br />
  24. 24. Searching for the Evidence<br />Forming a Question<br />What is the effect of Nursing Care/Intervention –Intervention is the predictor variable<br />On – Preventing pressure ulcers – this is the given characteristic or outcome<br />For – the elderly – the specific group of patients or population characteristic<br />
  25. 25. Searching for the Evidence<br />EBP Search Strategy<br />
  26. 26. Searching for the Evidence<br />Qualitative Research<br />MEDLINE – Qualitative filter under Clinical Queries<br />CINAHL – Heading for “Qualitative Studies”<br />
  27. 27. Searching for the Evidence<br />Search Example<br />Mary is a nurse midwife practicing in an large city in the Midwest. She has noticed an increase in the number of pregnant teens who are addicted to heroin. The drug treatment facilities near by will not take pregnant teens. Mary wants to know what she should include in her prenatal plan for these teens?<br />
  28. 28. Searching for the Evidence<br />Search Example<br />Mark is a nurse practitioner in a pain management clinic. He is looking for alternative ways to treat chronic pain in adjunct with medication and injection. He wants to know what alternative therapies are available for patients with chronic back pain?<br />
  29. 29. What’s Your Question?<br />
  30. 30. Library Staff<br />Billie Anne Gebb, Director of Library Services<br />billieanne.gebb@frontierschool.edu<br />(859) 253-3637 x5019<br />Zach Young, Information Service Librarian<br />zach.young@frontierschool.edu<br />(859) 253-3637 x5011<br />Jeretta Hall, Library Technician<br />librarian@frontierschool.edu<br />(859)253-3637 x5026<br />
  31. 31. Stay in Touch!<br />Library Information Forum on the Banyan Tree<br />Find us on Facebook<br />Follow us on Twitter @FSMFNLibrary<br />Read the FSMFN Library blog: http://frontierlibrary.blogspot.com/<br />Email<br />Phone<br />

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