Nursing: Evidence-Based Practice
Evidence-based nursing is a crucial aspect of evidence-based practice, as described by Dr. David Sackett, which involves conscientiously using current best evidence in patient care decisions. It integrates clinical expertise with external clinical evidence derived from systematic research.
Steps in EBP:
The EBP process involves several key steps:
1. Ask a clinical question
2. Search the published literature
3. Appraise the articles
4. Integrate the findings into practice
5. Evaluate the results
6. Disseminate (share) your findings
Why Use EBP?
Evidence-based practice aims to bridge the gap between what practitioners know and what they apply in patient care. By reviewing current research, combining it with clinical expertise and patient preferences, practitioners can make informed and personalized treatment decisions, ensuring high-quality healthcare.
Meta Analysis:
This type of evidence-based research statistically combines results from independent studies, offering a synthesis of conclusions to assess therapeutic effectiveness, representing the highest level of quality.
Systematic Review:
Employing rigorous methods, systematic reviews identify, appraise, and synthesize all relevant studies on a specific topic.
Randomized Controlled Trial:
Clinical trials with test and control treatments, concurrent enrollment and follow-up of both groups, and random treatment assignment.
Prospective, Blind Comparison to a Gold Standard:
A controlled trial comparing a new diagnostic tool/test to the current “gold standard.”
Cohort Study:
Identifies subsets of a defined population over time to study the effects of certain factors.
Case Control Studies:
Identify individuals with and without a disease of interest to examine the relationship of an attribute to the disease.
Case Series / Reports:
Focus on a small group of individuals with the same issue, beneficial for rare diseases or drug/treatment reactions, though not the most robust source of evidence.
Which Study Types for Your Question?
Different clinical questions require specific study types for optimal research:
– Diagnosis: Blind comparison to a gold standard
– Therapy/Treatment: Randomized controlled trial > Cohort study > Case control > Case series
– Prognosis: Cohort study > Case control > Case series
– Harm/Etiology: Randomized controlled trial > Cohort study > Case series
How to Tell the Study Type of an Article:
1. Check the title.
2. Check the abstract if the type is not specified in the title.
3. If still unsure, examine the methods section of the full-text article.
Trip: An EBP Search Engine – Turning Evidence into Practice:
Trip Database provides users with high-quality research evidence to support practice and care. It allows searching using the PICO question format and offers results categorized by the level of evidence. Sources include Cochrane, National Guideline Clearinghouse, PubMed, and more.
Filtered Information: Suggested Resources:
– Systematic Reviews: Cochrane Database of Systematic Reviews (freely available on PubMed after 12 months), PubMed (with search filters for systematic reviews/meta-analysis).
– Critically Appraised Articles/Topics (Evidence Syntheses): CINAHL Complete, PubMed (includes links to search the Daemen catalog for full-text).
Unfiltered Information: Suggested Resources:
– RCTs, Cohort Studies, Case Studies/Reports: CINAHL Complete, MEDLINE with Full Text.
Background Information / Expert Opinion: Suggested Resources:
– AccessMedicine: Instant access to videos, self-assessment, and medical textbooks.
– UpToDate: An evidence-based clinical decision support resource with topic reviews covering multiple clinical questions across 25 medical specialties.
