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NURS 714: Synthesis and Application of Evidence for Advanced Practice Nursing

Instructor: Dr. Candace Mori, Fall 2020

Evidence Based Practice

  

Diagram (adapted from Haynes 2006) shows a model for the organization of some quantitative studies. Different types of studies are located at different levels of the hierarchy of evidence. All types of studies may be found published in journals, with the exception of the top two levels.

RECAP: The five steps of evidence-based medicine/nursing (or evidence-based practice) are:

  1. Asking answerable questions, i.e. formulating questions into a format whereby you can interrogate the medical literature and hopefully find an answer – to do this, you may use the PICOT format, which helps to break down the query into Population, Intervention, Comparison, Outcome, Time;
  2. You then need to search for the evidence using PubMed/MEDLINE and CINAHL. Search other databases such as Cochrane Library and others – if you can find a pre-appraised resources (e.g. systematic reviews), you can miss out the next step;
  3. The next step is critical appraisal of your results;
  4. You then decide what action to take from your findings;
  5. Finally, you evaluate your new or amended practice.

 

Common Asked Questions when conducting a Literature Review of the Literature:

1) When do I know that I should stop searching?

Look for key works on your topic or seminal works should appears in multiple references. More importantly, plan accordingly to meet deadline for submitting your work to your professor/committees.

2) If there is not a lot of information, where should I search?

Try searching for dissertations on your topic.  Usually, these documents, when available in full-text, will include an extensive literature review section. Research instruments or surveys are also included on the appendices of these documents.

3) Tips for improving the searching experience?

When in doubt, please contact me or another librarian. This will save you some time and effort.  We search everyday and are familiar with specialized resources, such as grey literature (i.e. non-commercial literature freely available online) and other sources.

 

Example of a clinical question:
“9 month old feverish girl with noted sores in her mouth for 2 days. She is restless and crying.  The mother reports that her daughter is resisting her bottle. The nurse practitioner suspects herpes gingivostamatitis and is wondering about the effectiveness of acyclovir”

 P

 Patient, Problem, Population

  Young children with possible herpes     gingivostomatitits

 I

 Intervention, Prognostic Factors, Exposure

 How good is acyclovir

 C

 Comparative Intervention, Comparison

 Compared to placebo

 O

 Outcome

 In the rate of curing herpes gingivostamatitis

 T

 Time

 NA

Essential research databases for most topics pertaining to nursing:

* When searching CINAHL, limit your search to "Evidence Based" for EBP resources.

Other health sciences databases, including multidisciplinary and specialized sources may be worthwhile to use. TIP: When possible, consider searching databases with the same interface at one time (duplicate records will be removed).

Multidisciplinary Databases

Health Sciences Databases

Other Specialized Databases

Evidence-Based Resources are filtered, which appraise the quality of studies and often make recommendations for practice. Most are review databases (i.e. index systematic reviews). IMPORTANT: Check for updates and date information.

Searching by Keywords in CINAHL

Instructions:

  1. Go to CINAHL Plus with Full Text database.
  2. Type herpes gingivostomatitis AND acyclovir into the search boxes.
  3. Answer the Critical Thinking Questions below.

    Critical Thinking Questions
  4. On the results page, click on the Advanced Search link at the top of the page. Go to the Special limiters for CINAHL Plus with Full Text option, and check the box for Evidence-Based Practice.  Then click on the Search button. What types of publications did you retrieve?

  5. On the left side of the results page, click on the Age limiter.  Limit your search further to the population as described in PICOT.  Tip: Click on "Show more" link to ensure all options are shown. Did you find relevant publications?

Remember: Dissertations and theses are not peer-reviewed publications.

Whether in print or online, books are excellent sources to help us explore, decide on a topic, find definitions, overviews or background information.

Research Tools - How-To

Conducting a Literature Review

PubMed - Searching for Systematic Reviews

PubMed -- Clinical Queries
This search filter provides citations to the evidence-based literature in the following five areas:

  • Therapy - information addressing the treatment of disease 
  • Etiology - information addressing causation/harm of disease
  • Diagnosis - information addressing disease diagnosis
  • Prognosis - information addressing disease prognosis
  • Clinical prediction guidelines - data addressing the likelihood of disease presence or absence

PubMed -- Systematic Reviews
This search filter provides citations to the highest levels of evidence including: 

  • Systematic reviews
  • Meta-analyses
  • Reviews of clinical trials.

PubMed -- Focused Topic Searches
This is a directory of pre-built concentrated searches on a variety of different topics.