Evidence Based Practice for Nurses: Part 1

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Evidence Based Practice for Nurses Part 1

• Angelique Jenks-Brown
• Interview Presentation at Le Moyne College
• December 2, 2004

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Objectives

• Brief introduction to evidence based medicine
• To construct a well-built question
• Search techniques using MEDLINE
• Obtaining articles at the library

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What is Evidence Based Medicine (EBM)?

• Conscientious, explicit, and judicious use of
  current best evidence in making decisions about
  the care of individual patients. It means
  integrating individual clinical expertise with
  the best available external clinical evidence
  from systematic research - Sackett et. al.
• Clinical expertise Patient values Best
  evidence Patient care decision making process
  of EBM

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How is EBN Different from EBM?

• EBN stems from Evidence Based Practice, which is
  evidence-based methods of clinical decision
  making in healthcare practice.
• Nurses approach to Evidence Based Practice
• Providing holistic care
• Acceptability to the patient
• Cost-effectiveness

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Why learn Evidence Based Nursing (EBN)?

• Nursing students preparation for critical
  thinking skills
• As an approach to managing the explosion of
  literature
• To enrich nurses clinical training and experience
  with up to date research.

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Process of EBN the Five As

• Ask
• Acquire
• Appraise
• Apply
• Assess

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Ask

• Creation of a focused and structured question
• Four parts to building a question
• Situation
• Intervention
• Outcome
• Comparison

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Scenario

• You are a school nurse who regularly visits a
  number of elementary and middle schools in your
  region. It is cold and flu season once again.
  One of the teachers stops you in the hall to ask
  you a question about his 10-year old daughter who
  also has a cold. He has heard that zinc lozenges
  can help to relieve cold symptoms and wonders if
  they really do work and if it is OK to give them
  to children.

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Scenario Question

• In children with colds, are zinc lozenges safe
  and effective for relief of cold symptoms?
• Can you pick out the different parts of the
  question?
• Situation
• Intervention
• Outcome

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Scenario Question Difficulty?

• Having trouble building a question? Use this
  question outline
• In this situation does intervention or a
  comparison affect the outcome?

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Types of Questions

• Diagnosis
• Therapy
• Prognosis
• Etiology / Harm
• Overview / Meta analysis / Systematic reviews
• Qualitative research

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Acquire

• Selecting resources and conducting the search
• Tools
• Journals and databases vs. the web
• Databases
• Journals

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Scenario Search

• In children with colds, are zinc lozenges safe
  and effective for relief of cold symptoms?
• Type of Question?
• Start search in MEDLINE

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Scenario 2

• You are a nursing administrator responsible for
  cutting the personnel budget with the least
  amount of impact on patient care. You consider
  decreasing the number of RNs, and as an
  alternative you consider cutting unlicensec
  assistive personnel.

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Scenario 2 Question Search

• Question Will decreasing the number of RNs
  versus UAPs have a low impact on patient care?
• Question Type Qualitative
• Search Strategy
• Nurses aides AND patient outcomes (textword)
• Explode Nursing (MeSH) OR qualitative research
  (textword) OR grounded theory (textword) OR
  ethnograph (textword)
• Combine searches

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Scenario 3

• You are a nurse caring for a 28-year old woman
  who has just had a D C (dilation and curettage)
  following a spontaneous miscarriage. She was ten
  weeks pregnant and this was her first pregnancy.
  In a team meeting, one of your colleagues vaguely
  recalls seeing an article about grief after
  miscarriage and you decide to track it down to
  determine whether your patient is at risk of
  severe or prolonged grief.

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Scenario 3 Question Search

• Question In healthy women who have recently had
  a miscarriage, does the grieving process last
  longer than usual?
• Question Type Prognosis
• Search Strategy
• Grief (textword) AND grief (subject heading)
• Pregnancy loss (textword) OR abortion (subject
  heading)
• Explode cohort studies (MeSH)
• Combine searches

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Scenario 4

• You are a nurse practitioner in a primary care
  setting. You are familiar with a number of
  validated instruments to detect depression.
  However, a colleague describes a two-question
  instrument that she feels is as effective in
  detecting probable cases of major depression and
  would be much quicker to use. You decide to
  investigate the instrument and its properties
  further.

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Scenario 4 Question Search

• Question In patients with suspected depression,
  is a two-question instrument or previously
  validated instrument more accurate?
• Question Type Diagnosis
• Search Strategy
• Deppression OR depressive disorder (textwords)
• Questionnaire AND sesitivity (textwords)
• Primary care OR primary health care (textwords)
• Explode sensitivity and specificity (MeSH) OR
  predictive value (textword)
• combine

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Resources

• Evidence-Based Nursing (2004). Center for
  Evidence-Based Medicine at the University of
  Toronto Libraries. Last accessed 30 Nov. 2004 lt
  http//www.cebm.utoronto.ca/syllabi/nur/ gt.
• Evidence Based Nursing Tutorial (Sept. 2003).
  University of North Carolina at Chapel Hill
  Health Sciences Library. Last accessed 15 Nov.
  2004 lt http//www.hsl.unc.edu/Services/Tutorials/E
  BN/index.htm gt.
• Flemming, K. (1998). Asking answerable
  questions. Evidence-Based Nursing, 1(2), 36-37.

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Resources cont.

• Kessenich, C.R., Guyatt, G.H. DiCenso, A.
  (1997). Teaching nursing students
  evidence-based nursing. Nurse Educator, 22(6),
  25-29.
• McKibbon, K.A. Marks, S. (1998) Searching
  for the best evidence. Part2 searching CINAHL
  and Medline. Evidence-Based Nursing 1(4),
  105-107.
• Richardson, W.S., et.al. (Nov-Dec 1995). The
  well-built clinical question a key to
  evidence-based decisions. ACP Journal Club,
  123(3), A12-13.

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Resources cont.

• Sackett, D.L. et.al. (1996). Evidence based
  medicine What it is and what it isnt. BMJ,
  312, 71-72.
• University of North Carolina at Chapel Hill,
  School of Information and Library Science. (Fall
  2002 semester). Online course titled Evidence
  Based Medicine.

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Questions?