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Nursing: Find Evidence Based Practice Resources

What is Evidence Based Practice?

What is evidence based practice" Dr. David Sackett explains: 

"Evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. That is, it integrates the best external evidence with individual clinical expertise and patients' choice". 

Evidence-based practice (or evidence-based medicine) involves 5 steps: 

1. Ask a focused question to satisfy the health needs of a specific patient

  • What is your clinical question? Use the PICO model to help inform your research question.
  • What type of clinical question are you considering? 
  • What is the best study design to answer this type of slinical question? 

Type 

Explanation

Types of evidence to answer 
Therapy (Treatment) Questions look at the effectiveness of interventions in improving outcomes in sick patients/patients suffering from some condition. Most frequently asked type of question.  Randomised Controlled Trial (RCT)
Prevention Questions examine the effectiveness of an intervention or exposure in preventing morbidity and mortality. When assessing preventative measures, it is important to evaluate potential harms as well as benefits.  RCT or Prospective Study 
Diagnosis Questions look at the ability of a test or procedure to differentiate between those with and without a condition or disease.  RCT or Cohort Study 
Prognosis (Forecast) Questions root out the probable cause of a patient's disease or the likelihood that she or she will develop an illness.  Cohort Study and/or Case-Control Study 
Etiology (Causation) Questions about the harmful effect of an intervention or exposure on a patient  Cohort Study 
Meaning Questions concerning patients' experiences  Qualitative Study
This table is adapted from  Fineout-Overholt, E. & Johnston, L. (2005), Teaching EBP: asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing, 2, 157–160. doi: http://dx.doi.org/10.1111/j.1741-6787.2005.00032.x

2. Find the best evidence by searching the literature 

  • What is the highest level of evidence/literature available to support your question? 
  • Where should begin to look for this material? 

EBP levels of evidence pyramid

Meta Search Engines (searches all levels of evidence at once)

TRIP Database, The Cochrane Library 

Systematic Reviews or Meta-Analyses  Medline, PubMed, Cochrane Database of Systematic Reviews (CDSR)
Critically Appraised Topics  DynaMed PLUS
Critically Appraised Articles ACP Journal Club, JAMAevidence 
RCTs, Cohort Studies, and Case-Controlled Studies Medline, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL)
Background Information or Expert Opinion  Textbooks, periodicals, editorials 

3. Critically appraise the literature. You are testing for validity, clinical relevance, and applicability 

  • What are the results of the study?

4. Apply the results in clinical practice 

5. Evaluate the outcomes in your patient 

Adapted from: the Centre for Evidence-Based Medicine and Sackett DL, Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.

How to Read a Paper

Critically Appraised Individual Articles (Article Synopses)

Point of Care Tools

Other EBP Resources for Nursing

Types of Studies

From University of New Hampshire

Systematic Review: a comprehensive summary of high-quality studies examining a given topic. Example: Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review

Meta-Analysis: a type of systematic review where results from available high-quality studies are statistically combined to compute a net overall effect. Example: Alcohol drinking and bladder cancer risk: a meta-analysis

Randomized Controlled Trial: a type of epidemiologic study where participants are randomly assigned to receive a given exposure (such as a new drug or therapy) and then followed to examine the effects of the exposure on outcomes. Example: Treating alcohol withdrawal with oral baclofen: A randomized, double-blind, placebo-controlled trial

Cohort: a type pf epidemiologic study design where one or more population groups (called cohorts) are classified according to their level of exposure to a given agent/risk factor and followed over time to determine if this exposure is related to the occurrence of a disease or outcome of interest. Example: Effect of retirement on alcohol consumption: longitudinal evidence from the French Gazel cohort study

Case Control: a type of epidemiologic study that compares individuals who have a disease or outcome of interest (cases) with those who do not (controls). Researchers look retrospectively to evaluate how frequently exposure to a risk factor/agent is present in each group to identify the relationship between the risk factor and the disease or outcome of interest. Example: Risk factors for alcohol dependence: A case-control study

Cross-Sectional: a type of epidemiologic study that observes the relationship between a characteristic/risk factor (the exposure) and the prevalence of the disease or outcome of interest in a specific population at a single point in time. Example: Alcohol involvement in aggression between intimate partners in New Zealand: a national cross-sectional study

Case Series: a summary of a small group of individuals' experience with a similar disease or outcome of interest. Example: Alcohol use in chronic fatigue syndrome

Case Reports: a summary of one individual's experience with the disease or outcome of interest. Example: Acute coronary ischemia during alcohol withdrawal: a case report

Ideas, editorials, opinions: put forth by experts in the field Example: Alcohol brewing and the African tuberculosis epidemic

Animal Research Studies: studies conducted using animal subjects. Example: Renal effects of alcohol withdrawal in five-week alcohol-treated rats

Test-tube lab research: "test tube" experiments conducted in a controlled laboratory setting

PICO Model

Breaking up your question into these 4 elements (which you can easily remember with the mnmeonic device PICO) will make your literature search process easier:

Patient, population, or problem
  • Description of the patient, population and/or the target disorder of interest
  • What are the most important characteristics of the patient?
  • How would you describe a group of patients similar to yours?
  • What is the disorder and condition of interest?
Intervention
  • Which intervention, prognostic factor, diagnostic tool, or exposure are you considering?

Comparison intervention

  • What alternative do you want to compare with the intervention?
  • Examples: standard of care, reference standard, Placebo

Outcome

  • What outcome you hope to accomplish or measure?

EBM Practice Guide from Duke University

Search Filters

SIGN Search Filters

Information Specialists' Sub-Group Search Filter Resource

University of Alberta Libguide Search Filters

EPPI Centre Methods for Conducting Systematic Reviews