Evidence-based Practice in Nursing
This page is designed to help you find evidence-based literature in the library.
There are several steps involved in evidence-based practice (EPB) including asking a formulated clinical question, searching the literature for appropriate evidence, evaluating the evidence and integrating the evidence with clinical expertise and patient preference. This site
focuses on one of those steps – conducting a successful literature search for the best and relevant evidence.
Steps for finding evidence-based literature
1. Formulate a clinical question
2. Decide what type of study will best answer your question
3. Choose a database
4. Search and refine
1. Formulate a clinical question
The first step in finding evidence-based literature is to formulate a clinical question. Clinical questions usually have four components, termed PICO.
Patient or population of interest. (e.g. age, gender, ethnicity of person or population)
Intervention or interest (e.g. exposure, diagnostic test, prognostic factor, therapy or patient perception, etc.)
Comparison intervention or group
Outcome.
Example of a clinical question using PICO: For patients 65 years and older (P), does the use of an influenza vaccine (I) reduce the future risk of pneumonia (O) compared with patients who have not received the vaccine? (C)
In addition to formulating the question you should decide what type of clinical question you are asking. Some common type of clinical questions include:
- Therapy
- Diagnosis
- Prognosis
- Harm/Etiology
- Prevention
- Quality Improvement
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Question from: Melnyk, Bernadette Mazurek and Ellen Fineout-Overholt. Evidence-based practice in nursing and healthcare. Philadelphia :; Lippincott Williams & Wilkins, 2005.
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2. Decide what type of study will best answer your question
After you have designed a search strategy you need to decide what type of study (methodology) will best provide the evidence needed to answer your question.
Examples of study designs include:
Meta-analysis
"A process of using
quantitative
methods to summarize the results from the multiple studies, obtained and critically reviewed using a rigorous process (to minimize bias) for identifying, appraising, and synthesizing studies to answer a specific question and draw conclusions about the data gathered. The purpose of this process is to gain a summary statistic (i.e. a measure of a single effect) that represents the effect of the intervention across multiple studies."(1)
Systematic reviews
"A summary of evidence typically conducted by an expert or expert panel on a particular topic, that uses a rigorous process (to minimize bias) for identifying, appraising, and synthesizing studies to answer a specific clinical question and draw conclusions about the data gathered." (1)
Randomized Control Trials (RCTS)
"A true experiment (i.e. one that delivers an intervention of treatment), the strongest design to support cause and effect relationships in which subjects are randomly assigned to control and experimental groups." (1)
Guidelines
Information in guidelines is usually based on exhaustive systematic reviews of the relevant empirical literature coupled with expert opinion. They are created by specialty associations, professional societies, or governmental agencies that develop recommendations about a specific topic to guide clinical practice decisions (2).
Qualitative studies
"Research that involves the collection of data in numeric form and emphasizes precise measurement of variables; often conducted in the form of rigorously controlled studies."(1)
Rating System for the Hierarchy of Evidence* |
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| Level I | Evidence for a systematic review or meta-analysis of all relevant RCTs or evidence-based clinical practice guidelines based on systematic reviews of RCTs. |
| Level II | Evidence obtained from at least one well-designed RCT |
| Level III | Evidence obtained from one well-designed controlled trials without randomization |
| Level IV | Evidence from well-designed case-control and cohort studies |
| Level V | Evidence from systematic reviews of descriptive or qualitative study |
| Level VI | Evidence from a single descriptive or qualities study |
| Level VII | Evidence from the opinion of authorities and/or reports of expert committees. |
(1) Definitions from: Melnyk, Bernadette Mazurek and Ellen Fineout-Overholt. Evidence-based practice in nursing and healthcare. Philadelphia :; Lippincott Williams & Wilkins, 2005.
(2) Fonteyn ME. "Teaching advanced practice nursing students how to use the Internet to support an evidence-based clinical practice." ACN CLIN ISSUES ADV PRACT ACUTE CRIT CARE, 2001 Nov; 12(4): 509-19
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3. Choose a database
Sources of evidence-based literature can be found in databases such as those listed below. Click on the database links for additional information and search hints. Click here to access the databases directly. You may also want to review some of the evidence-based literature websites listed here listed here.
CINAHL
Cochrane Library
National Guidelines Clearinghouse
Medline
Pubmed
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4. Search and Refine
Start with a basic keyword search to see what type of information has been published on your topic. After the keyword search, you will likely need to refine your search strategy.
You can refine your search by limiting the publication type and date range. You can also refine your search by using subject headings.
Two types of subject headings often found in nursing and health related databases are MeSH Headings (the National Library of Medicine's controlled vocabulary thesaurus) and CINAHL Headings .
Additional Resources
Journals
Websites
Books
Journals
Evidence Based Nursing
Coverage from 01/01/1998 to 1 year ago
Designed to alert practicing nurses to important and clinically relevant advances in treatment, diagnosis, etiology, and prognosis.
ACP Journal Club
Coverage from 01/01/2002 to present
Reports of original research reviews, debate, & commentary on a broad range of topics related to the care of adults & adolescents.
Websites
Agency for Healthcare Research and Quality (AHRQ)- Evidence-based Practice Program -
"The AHRQ promotes evidence-based practice in everyday care through establishment of 12 Evidence-based Practice Centers (EPCs). The EPCs develop evidence reports and technology assessments on topics relevant to clinical, social science/behavioral, economic, and other health care organization and delivery issues—specifically those that are common, expensive, and/or significant for the Medicare and Medicaid populations"
American College of Physicians Guidelines
Bandolier -
An independent journal about evidence-based healthcare, written by Oxford scientists.
Centre for Evidence-Based Medicine -
Established in Oxford (U.K.). The centre promotes evidence-based health care and provides support and resources.
Guide to Community Preventive Services -Evidence-based recommendations for programs and policies to promote population health.
Evidence Based Nursing - UNC-CH School of Information Science's Evidence-Based Medicine class
Evidence-based Health Care: A Guide to the Resources - Health Sciences Library of the University at Buffalo
The Health Services Technology/Assessment Texts (HSTAT) - a free, Web-based resource of full-text documents that provide health information and support health care decision making. HSTAT is part of the expanded Health Services Research Information Program coordinated by NLM's National Information Center on Health Services Research and Health Care Technology (NICHSR).
Introduction to evidence-based nursing -Centre for Evidence Based Medicine, University of Toronto
Introduction to Evidence Based Medicine Tutorial - Duke University Medical Center Library and Health Sciences Library, University of North Carolina at Chapel Hill.
Joanna Briggs Institute - international collaboration involving nursing, medical and allied health researchers, clinicians, academics and quality managers across 40 countries in every continent.
Oncology Nursing Society - Evidence-Based Practice Resource Centre
Research & Clinical Resources for Evidence Based Nursing - McGill University Health Centre Nursing Research
Search Strategies to Identify Reviews and Meta-analyses in MEDLINE and CINAHL - Centre for Reviews and Dissemination, University of York, York, UK
Trip Database
Allows rapid access to evidence-based healthcare information.
Virginia Henderson International Nursing Library - Honor Society of Nursing, Sigma Theta Tau International
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Evidence-based practice in nursing & healthcare : a guide to best practice Bernadette Mazurek Melnyk and Ellen Fineout-Overholt Science Library Stacks -- RT42 .M44 2005 -- REGULAR LOAN |
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The practice of nursing research : conduct, critique, and utilization Nancy Burns, Susan K. Grove. Science Library Stacks -- RT81.5 .B86 2005 -- REGULAR LOAN |
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Essential evidence-based medicine Dan Mayer Science Library Stacks -- R723.7 .M396 2004 -- REGULAR LOAN |
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Shaping the facts : evidence-based nursing and health care Edited by Pam Smith ... [et al.] ; foreword by Michael Traynor Science Library Stacks -- RT42 .S537 2004 -- REGULAR LOAN |
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Fundamentals of nursing research Dorothy Young Brockopp, Marie T. Hastings-Tolsma Science Library Stacks -- RT81.5 .B76 2003 -- REGULAR LOAN |
References
McKibbon KA, Marks S. Searching for the best evidence. Part 2: searching CINAHL and Medline [editorial]. Evidence-Based Nursing 1998 Oct; 1 :105-7
Melnyk, Bernadette Mazurek and Ellen Fineout-Overholt. Evidence-based practice in nursing and healthcare. Philadelphia :; Lippincott Williams & Wilkins, 2005.