This document provides information and guidance on conducting evidence-based practice (EBP) searches. It defines EBP as using the best current evidence to make decisions about patient care. The EBP process involves identifying a problem or question, formulating a focused clinical question using the PICO framework, searching appropriate resources, critically appraising the evidence found, implementing in practice, and conducting a clinical audit. It provides tips for developing search strategies, including using subject headings, limiters, filters, and qualitative research filters. Examples of developing clinical questions and search strategies are also included. Contact information is provided for the library staff who can assist with EBP searches.

1. Using the LibraryDNP BoundFrontier School of Midwifery and Family Nursing

2. Alice Whitman Memorial Library

3. Alice Whitman Memorial LibraryLibrary Home PageLibrary 101 in ANGEL

4. Evidence Based PracticeSearching for the evidence

5. Evidence Based PracticeWhat is EBP?Most commonly cited definition is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”Sackett, et al.

6. Evidence Based PracticeThe EBP CycleIdentify/define the problemFormulate a focused clinical questionIdentify the appropriate resourcesSearch for valid and relevant informationCritically appraise/review this informationImplement in practiceClinical audit

7. Formulate a QuestionAsk a focused, answerable question: NOTAre febrile seizures in babies dangerous?INSTEADDoes a febrile seizure in a 6-month old infant increase the likelihood that s/he will develop epilepsy?

8. Formulate a QuestionWhat is the effect of [the Intervention or predictor variable]On [the Outcome or given characteristic]For [the group or patient characteristics]

9. Formulate a QuestionUse the PICO framework:P – patient/problem I – intervention C – comparison O – outcome

10. PPopulationDisease or conditionStage of diseaseGenderAge groupSocioeconomic groupHealthcare setting

11. IInterventionWhat is being done?Drug therapy, surgery, radiotherapyLevel of intervention: frequency, dosageStage of intervention: prevention, secondary prevention; advancedDelivery of intervention: self-medication, etc.

12. CComparisonWhat could be done instead?

13. OOutcomeWhat happened to P as a result of I?Patient oriented: quality of life; reduction in severity of symptoms; adverse effectsProvider oriented: cost-effectiveness

14. Medical vs. Nursing ConcernsMedical Abnormalities of joint ( Xrays, tests)Medication Surgical interventionNursingPreventionADLsPain Sleep problems

15. Is acupuncture effective in inducing labor?

16. Exercise or antidepressants for depression?

17. What is Evidence?Hierarchy of research evidence:Systematic reviewsRandomized controlled trialsNon-randomized controlled trials e.g. cohort studies, case-control studiesConsensus statements from respected authoritiesIndividual/expert knowledgeAnecdotal evidence

18. Where is the Evidence?Traditional bibliographic databasesMEDLINE, CINAHLPoint of care/clinical resourcesDynaMed, Essential Evidence Plus

19. Finding the EvidenceUse functions of the database to narrow searches:Subject HeadingsLimitersFilters

20. Subject HeadingsSpecific words or phrases selected from a controlled vocabulary that describe a workMEDLINE = MeSHCINAHL = CINAHL Headings

21. LimitersParameters for your search MEDLINE limiters include:Age groupPublication typeLanguageDates

22. Research FiltersResearch filters are pre-designed search strategiesClinical QueriesPubMed page: http://www.ncbi.nlm.nih.gov/pubmed/clinicalLimiter in MEDLINE (EBSCOhost)((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])

23. Searching for the EvidenceSearch Example:What should the NP do to prevent pressure ulcers in the elderly?

24. Searching for the EvidenceForming a QuestionWhat is the effect of Nursing Care/Intervention –Intervention is the predictor variableOn – Preventing pressure ulcers – this is the given characteristic or outcomeFor – the elderly – the specific group of patients or population characteristic

25. Searching for the EvidenceEBP Search Strategy

26. Searching for the EvidenceQualitative ResearchMEDLINE – Qualitative filter under Clinical QueriesCINAHL – Heading for “Qualitative Studies”

27. Searching for the EvidenceSearch ExampleMary 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?

28. Searching for the EvidenceSearch ExampleMark 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?

29. What’s Your Question?

30. Library StaffBillie Anne Gebb, Director of Library Servicesbillieanne.gebb@frontierschool.edu(859) 253-3637 x5019Zach Young, Information Service Librarianzach.young@frontierschool.edu(859) 253-3637 x5011Jeretta Hall, Library Technicianlibrarian@frontierschool.edu(859)253-3637 x5026

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