NURS350

Ferris State University Library for Information, Technology and Education (FLITE).

NURS 350 - Hoisington
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	Evidence-Based Nursing Guide

What is Evidence-Based Practice (EBP)?

Let's dissect the phrase:

Evidence-Based = Substantiated data as foundation
Practice = Utilizing the knowledge in the clinical setting

Figuring out the meaning of Evidence-Based Practice is fairly simple, but in order to find substantiated data to put into clinical practice, it is essential to use the proper resources. Proper resources would include:

Systematic Reviews: are reviews "of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies (U S Department of Veterans Affairs Glossary of Technology Assessment Terms)"
Meta-analyses: are "the use of statistical techniques in a systematic review to integrate the results of included studies. Sometimes used as a synonym for systematic reviews, where the review includes meta-analysis (U S Department of Veterans Affairs Glossary of Technology Assessment Terms)"
Consensus Statements/Guidelines: Consider using the National Guidelines Clearing House made available through U. S. Government agencies
Articles from journals specializing in evidence-based medicine: When looking at these articles, there is a hierarchy related to the publication type

*Randomized Controlled Trial - Depending on the sample size and overall study design, this may provide as weighty evidence as a systematic review
Clinical Trial
Review
Case Study: Least preferred because provides evidence from only single case (but with rare conditions may be only info. available)

Starting your Research

Delving directly into evidence-based literature may seem daunting if you have not gathered significant background information on your topic. To gather background information, reference books - including encyclopedias, manuals and handbooks are great starting points. Subject-specific encyclopedias may be found in the Online Catalog by doing a keyword search for medical and encyclopedia. If you specifically want online encyclopedias, you may wish to search your topic in the Electronic Medical Library Stat!Ref that searches the contents of many medical reference books. There are also online encyclopedias available at FLITE's Electronic Reference Resources webpage. Also, Ebrary is a collection of many online books that may prove to be helpful.

After gathering background information on your topic, you will want to focus your search in databases to find relevant information on your topic. If you are doing research from off-campus, you will need to log-on to use databases and other online resources licensed by FSU. You can use your MyFSU username and password to log-on to the databases. Click here for more information on off-campus database access.

FLITE Databases

Stat!Ref
As stated above, Stat!Ref is an excellent starting point for researching medical topics. Enter your search term into the search box and you will obtain a rank-ordered list of results taken from various medical encyclopedias, dictionaries, handbooks, and other medical reference books. A very helpful feature of this database is the Related Concepts box to the left of the results that will provide you with synonyms for your topic. These related concepts or synonyms can be used to enhance your searches in this database, as well as the other databases. This database also can be used for finding evidence-based information by clicking on the Advanced Search and selecting ACP PIER: The Physicians' Information and Education Resource as the only source you are searching. According to the Stat!Ref search page on 9/11/2007, ACP PIER "was named as the leading evidence-based medicine point-of-care tool in a study presented at the South Central Chapter MLA meeting."

Click here for a Stat!Ref Database Guide.

PubMed
This is the largest biomedical database, with over 17 million citations. You can use the Clinical Queries feature from the PubMed sidebar to find systematic reviews. You can also use the limits tab, and specifically limit your type of article to Meta-Analysis, Practice Guideline, or Randomized Control Trial. The Subsets limit will allow you to limit your search to systematic reviews. For general information retrieval in PubMed, you can search using keywords. Keywords will often yield too many results, so you may need to limit your search by using the limits tab, related articles link, or selecting the Review tab to see only review articles. Other highly useful resources linked from PubMed include Single Citation Matcher and Consumer Health.

Click here for a PubMed Database Guide OR click here for a brief tutorial on the Clinical Queries feature.

Cochrane Library
The Cochrane Library is a valuable resource for evidence-based medicine. The reviews in this library are meta-analyses, meaning that each review contains pooled data from numerous independent studies on a particular topic. The pooled data has been synthesized and scrutinized to arrive at a statistically valid conclusion regarding the effectiveness of a treatment/procedure. This library is growing, so be sure to check back at a later time if you are not currently finding information on your topic. You can search using keywords, such as disease names and treatments, or browse Cochrane Reviews by topic. *Please note that Cochrane Reviews can also be found in PubMed. If you find a Cochrane Review in PubMed, open the Cochrane Database and search for the review within Cochrane to get the full text.

CINAHL
The Cumulative Index of Nursing and Allied Health (CINAHL) currently gathers information from more than 1800 journals. Use the CINAHL Headings subtab to get more subject-specific information on various topics. When you have found your subject heading, you may click on it to break your topic down by subdivision. Click on the refine search tab to add Publication Type limits so you are viewing evidence-based publications. Publication type limits to assist with obtaining EBP materials include: practice guidelines, systematic review, and clinical trial. You may also want to select the Nursing Journals Journal Subset.

Click here for a CINAHL Database Guide.

Nursing Journals Relevant to Evidence-Based Practice:

Evidence-Based Practice Websites/Article:

EBM Guidebook from the University of California, Irvine
National Guidelines Clearing House
Florida State University EBM Tutorial
University of Minnesota Guide on Evidence Based Nursing
University of North Carolina Evidence Based Medicine Tutorial
Systematic Review Made Simple for Nurses

Need Help Picking a Topic... Check out these Ideas

Cochrane Database: Click on Updated Reviews to see recent changes in clinical evidence
PubMed: Try searching using the following phrases [including the quotes, parentheses]..."updates and guidelines" OR ("practice guideline" or "practice guidelines"). You can also click on the Limits tab, make sure there is nothing in the search box, and under Type of Article select Meta-analysis or Practice Guideline.
National Institutes of Health Clinical Alerts and Advisories
Physicians' First Watch Article Archive
FDA MedWatch

Obtaining the Full-Text of Articles

In some databases you will see an option for a Text version of the document or a PDF version. In general, the PDF version is preferable as it is most often a scanned version of the original and will therefore contain the graphics. When e-mailing, printing, or saving a group of articles, be sure to select the full-text or PDF option if available.

Some databases contain little full-text, but allow you to link out to Ferris' holdings or the interlibrary loan request form. You will notice the Find it! links following individual citations that will indicate the availability of the article online, in the library, or the need to interlibrary loan the article. Click on the Go button and you will be taken to the online version, library holdings record, or interlibrary loan form to obtain the article you desire.

Evaluating your Articles

Before requesting articles from interlibrary loan, please review the abstract and make sure that the article is on-topic. Also, please insure that the article is in a language that you speak, as some databases, such as PubMed index many non-English articles that have abstracts written in English. After you have evaluated the topical coverage and language of the article, please do not hesitate to request it through interlibrary loan if it is not available on campus.