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 Library DNP Bound Frontier School of Midwifery and Family Nursing

2. Alice Whitman Memorial Library

3. Alice Whitman Memorial Library Library Home Page Library 101 in ANGEL

4. Evidence Based Practice Searching for the evidence

5. Evidence Based Practice What 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 Practice The EBP Cycle Identify/define the problem Formulate a focused clinical question Identify the appropriate resources Search for valid and relevant information Critically appraise/review this information Implement in practice Clinical audit

7. Formulate a Question Ask a focused, answerable question: NOT Are febrile seizures in babies dangerous? INSTEAD Does a febrile seizure in a 6-month old infant increase the likelihood that s/he will develop epilepsy?

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

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

10. P Population Disease or condition Stage of disease Gender Age group Socioeconomic group Healthcare setting

11. I Intervention What is being done? Drug therapy, surgery, radiotherapy Level of intervention: frequency, dosage Stage of intervention: prevention, secondary prevention; advanced Delivery of intervention: self-medication, etc.

12. C Comparison What could be done instead?

13. O Outcome What happened to P as a result of I? Patient oriented: quality of life; reduction in severity of symptoms; adverse effects Provider oriented: cost-effectiveness

14. Medical vs. Nursing Concerns Medical Abnormalities of joint ( Xrays, tests) Medication Surgical intervention Nursing Prevention ADLs Pain Sleep problems

15. Is acupuncture effective in inducing labor?

16. Exercise or antidepressants for depression?

17. What is Evidence? Hierarchy of research evidence: Systematic reviews Randomized controlled trials Non-randomized controlled trials e.g. cohort studies, case-control studies Consensus statements from respected authorities Individual/expert knowledge Anecdotal evidence

18. Where is the Evidence? Traditional bibliographic databases MEDLINE, CINAHL Point of care/clinical resources DynaMed, Essential Evidence Plus

19. Finding the Evidence Use functions of the database to narrow searches: Subject Headings Limiters Filters

20. Subject Headings Specific words or phrases selected from a controlled vocabulary that describe a work MEDLINE = MeSH CINAHL = CINAHL Headings

21. Limiters Parameters for your search MEDLINE limiters include: Age group Publication type Language Dates

22. Research Filters Research filters are pre-designed search strategies Clinical Queries PubMed page: http://www.ncbi.nlm.nih.gov/pubmed/clinical Limiter 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 Evidence Search Example: What should the NP do to prevent pressure ulcers in the elderly?

24. Searching for the Evidence Forming a Question What is the effect of Nursing Care/Intervention –Intervention is the predictor variable On – Preventing pressure ulcers – this is the given characteristic or outcome For – the elderly – the specific group of patients or population characteristic

25. Searching for the Evidence EBP Search Strategy

26. Searching for the Evidence Qualitative Research MEDLINE – Qualitative filter under Clinical Queries CINAHL – Heading for “Qualitative Studies”

27. Searching for the Evidence Search Example 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?

28. Searching for the Evidence Search Example 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?

29. What’s Your Question?

30. Library Staff Billie Anne Gebb, Director of Library Services billieanne.gebb@frontierschool.edu (859) 253-3637 x5019 Zach Young, Information Service Librarian zach.young@frontierschool.edu (859) 253-3637 x5011 Jeretta Hall, Library Technician librarian@frontierschool.edu (859)253-3637 x5026

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