Evidence Based NursingResources* South University Libraries October 2009
Scholarly Library Research Using the library resources effectively during your academic coursework in nursing will ensure that you have information literacy skills to equip you for evidence-based practice and continued success in your nursing career. This PowerPoint will serve as a guide to information literacy for evidence-based practice.
What is Evidence Based NursingPractice? Evidence-based practice (EBP) in nursing is a process of locating, appraising, and applying the best evidence from the nursing and medical literature to improve the quality of clinical practice. It involves the following steps: Constructing a relevant, answerable question from a clinical case. Planning and carrying out a search of the literature for the best external evidence. Critically appraising the literature for validity and applicability. Applying the evidence to your clinical practice. Evaluating your performance.
Why? Melnyk and Fineout-Overhold, in their book Evidence-Based Practice in Nursing & Healthcare (2005) p. 3-4, argue for the utility of EBP through real-life examples: If you are caring for a child who was in a motor vehicle accident and sustained a severe head injury, would you want to know and use the most effective, empirically supported treatment established from randomized controlled trials to decrease his or her intracranial pressure? If your mother was diagnosed with Alzheimers disease, would you want her health care providers to give you information about how other family caregivers of patients with this disease have coped with the illness, based on evidence from well-designed qualitative and/or descriptive studies? If you were diagnosed with cancer today and were faced with the decision about which type of chemotherapy to choose, would you want to know the evidence regarding the risks and benefits of each therapeutic agent as generated from prior clinical trials with other similar cancer patients?
Information Literacy is arequirement to practice effective evidence-based nursing. Information literacy involves the ability to: ◦ determine the nature and extent of the information needed ; ◦ locate and access information; ◦ manage information effectively; ◦ critically evaluate information; and ◦ use information for problem solving, research, decision making, current awareness, and professional development.
Getting started: Why do I need library journals and databases? Cant I just search the web? Many people believe that everything is now available on the web, for free to everyone. This just isnt so. In addition to the uncertainty of credible health and medical information on the web, the web is not indexed and searching it can be overwhelming. Only 8% of scholarly research is available on the web*. Additionally, medical and health information on the web can often be misleading, biased, incorrect, or outdated. While some web-based resources may be free, many of the quality resources, such as the indexes, databases and journals you need to do your job have a cost (subscription) that the library provides as part of your education experience at South. As professionals you will want to use bibliographic databases such as The Cochrane Library, CINAHL , PubMed/Medline, and Ovid to keep current with the research literature. In addition, library resources such as STAT!Ref, Science Direct , PQ Central and EMEDICINE can provide needed background information, quickly and easily. *Herring. M.Y. (2001, April). 10 reasons why the Internet is no substitute for a library. American
Step 1: Formulating the question: PICO PICO is a framework that nurses can use to formulate effective clinical questions in a step-by-step manner. Nurse clinicians encounter many situations for which they do not have the information needed to provide the best care for their patients. From this uncertainty springs forth clinical inquiry. Clinical inquiry is a process in which clinicians gather data using narrowly defined clinical parameters. This process allows for an appraisal of the available choices of treatment, for the purpose of finding the most appropriate choice of action. Clinical inquiry is encapsulated in the form of a clinical question. PICO is a useful format and structure for developing a clinical research question. PICO helps the clinician in finding the right evidence to answer questions and decrease uncertainty.
PICO What patient population/problem are you trying to address? What will you do for the patient or problem? Alternatives to your chosen intervention? (optional) What will be improved for the patient or problem? Time frame (optional)
Step 1 continued:Formulating search strategies: Determine your Search Vocabulary Your search vocabulary consists of the subject headings, keywords and key phrases you will use in your search. These are also referred to as controlled and uncontrolled vocabulary. It is useful to identify main concepts for questions. It is highly recommended to use the PICO method to identify main concepts.
Step 2: Database/ResourceSearching After successfully formulating the clinical question, you need to find relevant evidence. You may need to consult several types of credible information resources— available from the South University library. These resources generally fall into three categories and are used in sequential order depending on need and applicability. The three categories are: ◦ General information (background) resources ◦ Filtered (secondary) resources ◦ Unfiltered (primary) resources
General Information Background Resources: You may often encounter conditions outside your specialty area or that you don’t see often, and need to get a comprehensive overview. Background resources provide excellent detailed information. This category contains resources that provide background information about various diseases, conditions, and clinical questions. South University electronic resources include CINAHL, StatRef, EMedicine, Ovid books and journals, PQ Central (Joanna
Filtered (secondaryresources): Reviews, syntheses, or summaries of literature and research findings (found in articles, monographs, and textbooks) Entries in nursing or medical encyclopedias Drug information in handbooks, databases, pamphlets Nursing or medical bibliographies Abstracting/Indexing services/databases Newsletters and professional news sources Practice guidelines & standards Clinical care notes Nursing education videos/DVDs Patient education Information Government & legal Information Example of a filtered resource is The Cochrane Library database, which provides a variety of information backed up with links to the literature and references to the resources used to pulled together the conclusions and/or information provided.
Cochrane Library A collection of databases that contain high- quality, independent evidence to inform healthcare decision-making. Cochrane reviews represent the highest level of evidence on which to base clinical treatment decisions. In addition to Cochrane reviews, The Cochrane Library provides other sources of reliable information, from other systematic review abstracts, technology assessments, economic evaluations and individual clinical trials and all the current evidence in one single environment.
Cochrane Library The Cochrane Library - an introduction http://www3.interscience.wiley.com/homepages /106568753/CochraneLibraryBrochure_new.pd f Tips on Advanced and MESH searching http://www.brainshark.com/wiley/cochrane2 Saving Searches and Setting Alerts http://www.brainshark.com/wiley/cochrane3
Unfiltered (primary)resources:appropriate answer in the filtered If you don’t find an resources, you’ll need to search unfiltered resources (the primary literature) to locate studies that answer your question. Additionally, you may choose to search the unfiltered resources to see if any new research has been done since the conclusions reached in the filtered resources were released. Unfiltered resources provide the most recent information, but it’s up to the clinician to evaluate each study found to determine its validity and applicability to the patient. Effectively searching and evaluating the studies found in unfiltered resources takes more time and skill, which is why filtered resources are the first choice for answering clinical questions.
CINAHL journal content summarizing, analyzing, or commenting on primary sources nursing and allied health books & book chapters conference proceedings standards of practice educational software audiovisual materials legal cases clinical innovations critical paths drug records research instruments clinical trials
MEDLINE® /Pub Med medical and health reference book content bibliographies biographies conference reports dictionaries and directories practice and administrative guidelines patient education handouts technical reports medical news government publications and legal information To learn more about searching MEDLINE® in PubMed, go to http://www.nlm.nih.gov/bsd/pubmed_tutorial/m1001.htm l
EMedicine The largest and most current Clinical Knowledge Base available to physicians and other healthcare professionals. Nearly 10,000 physician authors and editors contribute to the EMedicine Clinical Knowledge Base, which contains articles on 7,000 diseases and disorders. The evidence-based content, updated regularly, provides the latest practice guidelines in 59 medical specialties.
OVID Allied Health and Nursing Journals Full text coverage of over 60 current, highly respected nursing and allied health titles, including general, medical, and pharmacy titles.
ProQuest Central (PQ) Search full-text journals and dissertations in ProQuest Nursing & Allied Health Source alongside Systematic Reviews, Evidence Summaries, and Best Practice Information Sheets from the renowned Joanna Briggs Institute. ProQuest Nursing & Allied Health Source provides abstracting and indexing for more than 850 titles, with over 715 titles in full-text, plus more than 12,000 full text dissertations representing the most rigorous scholarship in nursing and related fields. ProQuest Health and Medical Complete™ combines the clinical research titles available in ProQuest Medical Library™ with hundreds of additional consumer and health administration titles. ProQuest Health and Medical Complete provides in-depth coverage from over 1,530 publications with over 1,270 available in full text and of
Step 2: Plan and carry outStep 1: Construct a a search of the literature forQuestion the best external evidence Select searchable terms Identify available from your question. resources and choose search tools Think of keywords, synonyms, re Search appropriate lated library databases terms, phrases, and (Cochrane, CINAHL, EM subject headings etc. edicine) , to convert your need into a question
Step 3: Critically appraise theliterature for validity and Step 4: Apply the evidence to yourapplicability. clinical practice. Evaluate your information for Once you have determined quality considering the that a study is internally following questions: valid (step 3), you must ◦ Who wrote it? decide how the study ◦ Who sponsored the research? and/or other information ◦ What institutional or applies to your question. To organizational affiliation exists? reach your conclusion you ◦ When was it published? may consult questions ◦ Has it been reviewed? By whom? related to ◦ Why was it published? diagnosis, therapy, harm, a ◦ Has it been cited? Whom does it nd prognosis. Keep in mind cite? that you must interpret the ◦ Is the information valid? (critique information based on a the study design) number of criteria and ◦ How useful is the information for depending on your skill and your particular clinical or research problem? experience, you may need to confer with a peer.
Step 5: Re-Evaluate Was the diagnosis and treatment successful? Is there new information/data in the literature? How can I improve and/or update my clinical decisions?
Additional resources: EBM/EBN Websites EBM/EBN Organizations Evidence-Based Nursing Agency for Health Care syllabi and resources Research and Policy Centre for Evidence Based (AHRQ) Medicine - University of http://www.ahrq.gov Toronto http://www.cebm.utoronto.c a/syllabi/nur/ Centre for Evidence Based Medicine - Evidence Based Medicine University of Toronto tutorial http://www.cebm.utoronto.c Health Sciences Library - a/ UNC-Chapel Hill http://www.hsl.unc.edu/serv ices/tutorials/ebm/index.ht m Health Information EBM Education Center of Research Unit-- Excellence - North McMaster University Carolina http://hiru.mcmaster.ca/ http://library.ncahec.net/eb m/pages/index.htm
For more information: Evaluating Internet Health Information: A Tutorial from the National Library of Medicine: This tutorial teaches you how to evaluate the health information that you find on the Web. It is about 16 minutes long. You need a Flash plug-in, version 6 or above, to view it. If you do not have Flash, you will be prompted to obtain a free download of the software before you start. ◦ http://www.nlm.nih.gov/medlineplus/webeval/webeval_start.html University of North Carolina nursing tutorial and resources: ◦ http://www.hsl.unc.edu/Services/Tutorials/EBN/intro.htm Academic Center for Evidence Based Practice, University of Texas Health Science Center: ◦ http://www.acestar.uthscsa.edu/Resources_www.htm Penn State Nursing tutorial, this site has practice examples: ◦ http://www.libraries.psu.edu/instruction/ebpt-07/index.htm
Questions? Please contact your South University librarian for more information. Valerie Yaughn 912 201 8046 firstname.lastname@example.org Kate Sawyer 912 201 8088 email@example.com
* This work is licensed under aCreative Commons Attribution-Noncommercial-Share Alike 3.0United States LicenseFourth Edition, November 2004.edited and amended with permission fromhttp://www.lib.umn.edu/ andhttp://www.biomed.lib.umn.edu/learn/ebp/, andhttp://library.wcsu.edu/web/assistance/research/nursing/tutorial/