Monday E-mail 11.04.02

Evidence-Based Nursing Practice

How does evidence-based practice apply to nursing? As Carol A. Ledbetter,
RN, PhD suggests in “Evidence-Based Best Practice: The Common Knowledge of
Ethical Clinical Scholarship,” an editorial in the Online Journal of
Knowledge-Synthesis for Nursing available at
http://www.stti.iupui.edu/library/ojksn/e.html , health care practices not based on the best evidence available are not ethical. All health providers owe it to their patients to use the best available evidence in their
practice. This means using validated knowledge-based information resources
that can be found via the Internet and in libraries. Evidence is not
limited to randomized clinical trials. Although they are the “Gold
standard” for evidence-based practice, other types of research may be
equally appropriate for nursing interventions.

In her ACE Star Model of the Cycle of Knowledge Transformation
http://www.acestar.uthscsa.edu/Goals/model1325.html, Kathleen Stevens, RN,
PhD depicts how knowledge development is a circular process, from Discover
(research) to Summary (Systematic Reviews), Translation (practice
guideline, standards, protocols and other “best practices”), Implementation
and Evaluation – which can lead to new discoveries. Finding and using
recent evidence-based translation literature, such as practice guidelines,
is the best place to start when trying to implement evidenced-based
practices in a busy health care organization.

The Oncology Nursing Society Evidence-Based Practice Resource Center
http://onsecom.ons.org/ebp/ provides an excellent overview of evidence
based practice (EBP), including working definitions – a great place to
start your review EBP for application in clinical settings.

For reviews of research studies and systematic reviews relevant to nursing,
consider subscribing to the Evidence Based Nursing journal
http://ebn.bmjjournals.com/. These abstracts with commentary are similar
to those published for physicians in the ACP Journal Club and Clinical
Medicine. Two nursing journals publish systematic reviews similar to those
published in the Cochrane Library:
*Online Journal of Clinical Innovations
http://www.cinahl.com/cexpress/ojcionline3/
Published by Cinahl Information Systems, 1998-
Reviews include practice recommendations
*Online Journal of Knowledge Synthesis for Nursing
http://www.stti.iupui.edu/library/ojksn/
Published by Sigma Theta Tau International, The Honor Society for
Nursing, 1993-Integrative reviews that include all types of research

Searching for the best evidence

Effective searching for evidence-based nursing resources includes MEDLINE,
CINAHL http://www.cinahl.com, and the Internet. Search for all three types
of literature relevant to evidence-based practice: research; summaries
(systematic reviews including meta-analysis, and translation (guidelines).
Two search sites search multiple sites, including the National Guidelines
Clearinghouse, DARE (Databases of Abstracts of Reviews of Effectiveness),
and PubMed MEDLINE, dividing the results into guidelines, systematic
reviews, and research:

SUMSearch
*Uses MeSH headings for searches – use MeSH browser link to find
appropriate subject
*Uses filters to search for research in PubMed: Treatment; Diagnosis;
Adverse Effects; Etiology; Prognosis; Physical diagnosis and
Screening/prevention. Four of these are also available as PubMed clinical
queries – the others are unique.
*Developed by a physician and a librarian at the University of Texas San
Antonio.

TRIP (Turning Research into Practices) database
http://www.tripdatabase.com/
*Searches more than 75 sites, including DARE and PubMed MEDLINE, for
relevant information sources
*Also searches include high-quality medical journals
*No controlled vocabulary such as MeSH, so search with synonyms including
British spelling
*From the UK National Electronic Library for Health

Examples of nursing organizations publishing guideline on their websites
include:
* Hartford Institute for Geriatric Nursing http://www.hartfordign.org/ *Registered Nurses Association of Ontario (RNAO) http://www.rnao.org/ (see
Best Practice Guidelines)
*RN+ Systems http://www.rnplus.com
*Royal College of Nursing (RCN) http://www.rcn.org.uk/
* Wound, Ostomy and Continence Nurses Society (WOCN) http://www.wocn.org/

CINAHL search hints
*Access CINAHL via your library website, AACN membership, or subscription
to CINAHLdirect, http://www.cinahl.com
*For guidelines and other Translation literature, add the following
publication types to your search: Care Plan; Clinical Innovations;
Critical Path; Practice Guidelines; Protocol; or Standards. *For Systematic Reviews, limit to the Systematic Review publication type. *For Research, limit to the Research publication type *For websites that might have guidelines or other best practices, limit
subject search to Website publication type – considering broadening search
to include nursing specialties dealing with the topic.

For Evidence-Based Nursing Practice links from April 2002 symposium
sponsored by U.W. Madison School of Nursing, see
http://www.pegallen.net/presentations.htm. Want to learn more? Catch the
Wave in San Diego, including invitation to Evidence-Based Nursing Practice
Symposium and Medical Library Association Annual Meeting, May 2-7 2003 at
http://nahrs.library.kent.edu/annmtg/index.html. The symposium is co- sponsored by the Interagency Council on Information Resources for Nursing
(ICIRN), http://icirn.org/

Additional evidence-based practice resources can be found on NAHEC’s “For
Health Providers” EBM (Evidence-Based Medicine) page at http://www.nahec- wi.org/ebm_resources.html.



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