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Evidence - Based Practice

This guide is a collection of resources for learning Evidence-based Nursing.

Welcome

Welcome to the Evidence-Based Practice (EBP) Research Starter! Here you will find different resources and tools for helping you incorporate EBP into your practice. This guide provides a definition of EBP, resources for finding the best available evidence, analyzing the evidence, and applying it to practice.

If you have questions about retrieving these resources or need help formulating a search for evidence based nursing journal articles, Hoffman Family Library's reference librarians can assist you. You are welcome to contact us about your research needs. If you need help with any of these resources, please contact your Embedded Librarian (to the left)!

By the end of this self-guided research starter you will be able to:

  • Identify the purpose, format and characteristics of the following types of evidence: research article, review, case study, and pre-appraised sources
     
  • Distinguish between quantitative and qualitative research
     
  • Distinguish between primary and secondary literature
     
  • Describe other types of content that may be found in a scholarly health sciences journal

What is Evidence-Based Practice?

Evidence-Based Medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn’t. BMJ : British Medical Journal, 312(7023), 71–72.


What is the need?

The need for EBM

  • Medical research is continually discovering improved treatment methods and therapies
  • Research findings are often delayed in being implemented into clinical practice
  • Clinicians must stay current with changing therapies
  • Evidence-based practice has been shown to keep clinicians up to date

How do I find the evidence?

It begins with a patient dilemma, or problem - then a question is asked - The literature is searched to acquire information- the results are appraised - then applied to the specific question and patient.

The Steps in the EBP Process:

ASSESS
the patient

1. Start with the patient -- a clinical problem or question arises from the care of the patient

ASK
the question

2. Construct a well built clinical question derived from the case 

ACQUIRE
the evidence

3. Select the appropriate resource(s) and conduct a search

APPRAISE
the evidence

4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)

APPLY:
talk with the patient

5. Return to the patient -- integrate that evidence with clinical expertise, patient preferences and apply it to practice

Self-evaluation

6. Evaluate your performance with this patient

Evidence-Based Nursing - A way of providing nursing care that is guided by the integration of the best available scientific knowledge with nursing expertise. This approach requires nurses to critically assess relevant scientific data or research evidence, and to implement high-quality interventions for their nursing practice. (NLM PubMed MeSH)

Evidence-Based Practice (EBP) is patient care backed up by research. It is an approach of practicing medicine with the goal to improve and evaluate patient care, and it requires the judicious integration of best research evidence with the patient's values to make decisions about medical care (NLM, MESH, 2009).

Begin by clicking on the PubMed Link: https://www.ncbi.nlm.nih.gov/pubmed/

MeSH Database
 1. In this example, we are searching for evidence-based practice research articles on the prevention of falls and our patient population is elderly, 65 years and older.

 2. On PubMed's home page you will see a MeSH Database link using the drop down menu. MeSH is the controlled vocabulary of PubMed.

 3. Type the subject of our search "falls" into the MeSH search box. When you are searching for MeSH Headings, you get better results when you type in a single word or a single concept at a time. The first MeSH heading "Accidental Falls" is what we need for our search. The definition of "Accidental Falls" is "Falls due to slipping or tripping which result in injury."

 4. Click directly on the blue, highlighted MeSH Heading "Accidental Falls." When you click directly on the blue, highlighted MeSH Heading, you bring up the full MeSH record for the term you have selected.

 5. Notice the full MeSH record for Accidental Falls. We can search all of the literature on "Accidental Falls" or we can search portions, or subsets, of the literature about falls by selecting one or more subheadings. The subheadings are listed in columns beneath our MeSH Heading.

 6. Our search is for the "prevention of falls in the elderly." Select the check box with the subheading "prevention and control."

 7. On the right side of the screen, select "Add to search builder." Our MeSH Heading and subheading "Accidental Falls/prevention and control" are now in the PubMed search builder on the right side of the screen. We are now ready to search PubMed. Select "Search PubMed."

PubMed Limits
A new screen appears with our PubMed search results. In the  left of the screen, you will see the PubMed icon. You will see a list of thousands of results. Select the following limits:

  • Published in the last 5 years
  • English language
  • Type of article: select Clinical Trial, Meta-Analysis, Randomized Controlled Trial and Review. (Scroll down the list slightly to get to Randomized Controlled Trial and Review)
  • Species: Human
  • Ages: scroll down and select Aged 65+ years
  • Subsets: scroll down and select Nursing Journals (This will limit our search to articles published in nursing journals)

Selecting Articles You Want From Your PubMed Search

Place a check in the box next to the article you want. When you have finished selecting your articles, select "Send to"which is located at both the top and bottom of the PubMed results screen. You can send the selected articles to an email address, save them to a file or print them.

Ordering Articles the Library Does Not Own

  • If you locate articles in your search that are not available in the library's full text collection, (no link to the full text) you can order them using the Interlibrary Loan service,  the library's free document delivery system.

There are three sources of research that are best for EBP:

  • guidelines or protocols (secondary research)

  • clinical studies (original research)

  • systematic reviews (secondary research)

A guideline or protocol is a precise and detailed plan for the study of a medical or biomedical problem and/or plans for a regimen of therapy (NLM, MESH, 1988).

A clinical study/clinical query is original research which indicates a specific therapy, diagnosis, etiology, prognosis.

A systematic review is a high-level overview of primary research on a focused question that identifies, selects, synthesizes, and appraises all high quality research evidence relevant to that question. It is very different from a literature review, which provides an overview of a topic.