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NUR 311: Nursing Research and Evidence-Based Practice

Course guide developed by your Librarian
An ongoing process by which evidence, nursing theory and the practitioners' clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide delivery of optimum nursing care for the individual

Scott K & McSherry, R. (2009). Evidence-based nursing: Clarifying the concepts for nurses in practiceJournal of Clinical Nursing. 18(8), 1085-1095. 10.1111/j.1365-2702.2008.02588.x.

About EBP

Evidence Based Practice (EBP) integrates the following three factors into the decision-making process for patient care:

  1. Clinical Expertise (the clinician’s cumulated experience, education and clinical skills)
  2. Patient Values (the patient's own personal preferences and unique concerns, expectations, and values)
  3. Best Research Evidence (usually found in clinically relevant research that has been conducted using sound methodology)

Evidence Hierarchy

  1. RCT & Systematic Review
  2. Experimental Studies & Integrative Reviews
  3. RT not controlled
  4. Cohort Studies & Quasi-experiments
  5. Correlation designs
  6. Qualitative Studies
  7. Expert Opinions & Surveys

Evidence-Based Practice requires new skills, including efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature.

THE STEPS:

1. ASK the question
Construct a well built clinical question derived from a clinical problem or question  that arises from the care of a patient

2. ACQUIRE the evidence
   Select the appropriate resource(s) and conduct a search

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

4. APPLY: talk with the patient
   Return to the patient -- integrate that evidence with clinical expertise, patient preferences and apply it to practice

5. ASSESS the process
   Evaluate your performance with this patient

The following databases contain systematic reviews and meta-analyses of healthcare interventions, diagnostic tools, and more.

- Florence Nightingale is credited with starting evidence-based research. Even though the terminology "evidence-based practice" was not used during her time, her theories of nursing and healthcare were based on this concept of research.

- During the Crimean War, she was a passionate statistician. Through her use of statistics, she kept track of mortality rates of soldiers in order to better improve patient outcomes. 

Review articles are not considered evidence.  One exception to this are Systematic Reviews - including their subset, Meta-AnalysisSystematic Reviews aim for documented, exhaustive and comprehensive searching for all research on a specified topic. Most other types of reviews either do not document their search and collection of the research nor do they verify that they have completed an exhaustive and comprehensive search. 

Examples of Sources

Systematic Review

A synthesis of research studies on a given topic. The studies included in a systematic review are selected through pre-established criteria such as hypothesis or a research question, patient/populations, study design, and methodology. Systematic reviews are used to provide an objective assessment of primary research evidence on a given topic, and are frequently used in evidence-based practice (EBP).

Protocols (for Systematic Reviews)

A document that describes and outlines that processes that wil lbe undertaken while conducting a systematic review before it is conducted. The purpose of protocols are:

  • to define the scope of the systematic review;
  • to outline the methodology used;
  • to report all anticipated research outcomes before the research is conducted; 
  • to assist researchers with anticipating necessary changes to their methods used; and,
  • to promote transparency and minimize bias

Meta-Analysis

A study that combines the statistical data of multiple studies based on pre-established criteria. This is done to increase the power over an individual study, improve estimates of the size of an intervention or effect, or attempt to resole uncertainty when the outcomes of multiple studies are not consistent. The information drawn from a meta-analysis is often utilized in evidence-based practice (EBP).