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Evidence-based practice

After reading this article, you will be able to:

  • Discuss best practices for performing a literature search
  • Determine whether Web sites are reputable sources of information
  • Evaluate how to put research into action

Editor’s note: Nurses can be intimidated by evidence-based practice (EBP) and unsure how to search literature or evaluate evidence. The following excerpt from the book Quick-E! Pro Evidence-Based Practice, published by HCPro, Inc., provides tips and tools that can help nurses overcome their fear.

Getting started

Perhaps one of the biggest challenges in conducting EBP projects is learning how to search the literature. There are a variety of ways to approach this challenge.

Asking a librarian or an educator to explain how to conduct literature searches gives an overview and understanding of the process. Doing a computer-based real-time search together builds confidence in the process of searching electronic resources and provides a real-life learning opportunity.

If your organization has partnered with a local college, you can take advantage of the facilities made available to it. Schedule an appointment with the college reference librarian and ask for an overview of how to access the library’s resources. If there is no dedicated medical or nursing library readily available in your area, the local community library may have resources, such as PubMed, that can help you begin to build EBP resources.

Nurses who have experience or the inclination might want to learn to navigate electronic databases and investigate journals that are available in print or electronic copy in your organization. Contact other healthcare facilities in your area and consider visiting one that is doing an EBP project to see what journals and electronic databases they are using for the project.

Once you are comfortable reading and discussing articles you find in your literature searches, then you are ready to start doing formal critiques of the nursing literature. Organize your findings so that you can easily compare and contrast the conclusions or recommendations from the articles. Using a table format to summarize the research articles helps others review the conclusions you reach. (See “Evaluating the strength of the evidence” on p. 6 for a sample table.)

Evaluating Web sites

Not all Web sites are created equal. Nurses need a discerning eye to make sure that the Web sites used for finding literature are reputable. Look for evidence that the Web site is monitored and evaluated by experts and run by a respected person, organization, or institution in which you already have confidence. When you’re on a Web site, click on its About Us page to find out more about who runs the site.

Most reputable Web sites are run by:

  • Federal government agencies
  • Universities
  • Medical associations
  • Reputable healthcare-related organizations

Less reputable Web sites (in terms of literature findings) are run by companies trying to sell products and services, bulletin board sites (where anyone can post opinions), and personal Web sites. Look for these symbols that show that the Web site has been approved by an independent accreditation group:

  • The Health on the Net (HON) code is given by the Health On the Net Foundation to Web sites that provide useful and reliable online medical and health information
  • A URAC code is given by the Utilization Review Accreditation Commission, which is an independent, nonprofit organization known as a leader in promoting healthcare quality through its accreditation and certification programs

Other resources exist that are helpful when you are trying to evaluate healthcare information on the Internet. Here are some sites that might be helpful in guiding you in the evaluation process:

When examining Web pages and the content within these resources, one way to avoid taking them at face value is to look for the primary source of the evidence and evaluate how conclusions were reached. Conduct a systematic evaluation of the information’s worth.

Putting research into action

Once you have developed your EBP question, thoroughly searched the literature, and determined the strength of the evidence, you have to evaluate whether the EBP changes worked. When deciding to make EBP changes, always evaluate the outcomes of any changes. Never assume that changes in clinical practice will have the anticipated outcomes. Therefore, test pilot the changes on one or two clinical units to help detect unexpected outcomes and to understand any implementation-related problems. Based on findings from the pilot units, you can decide to move forward with the practice change in all the applicable units or modify or reject the change.

After you have instituted a practice change based on the best evidence, remember that ongoing monitoring is important. Set up a process to continue monitoring the change at specific intervals of time, evaluate the findings, and determine whether the change has sustained value over the long term. Even if the implementation is successful at the outset, the project is not completed because it is not known if the success will continue over time. Any evidence-based project requires clinicians to monitor the findings in an ongoing fashion. New knowledge or information may be developed that will need to be integrated into the practice change.

Evidence-based projects are never complete; they require the ongoing efforts of dedicated professionals who are willing to question their practice and continually find ways to improve patient outcomes.

Introducing staff members to EBP

Here are eight questions to start with:

  • What is EBP?
  • Why is EBP important to me?
  • Why is EBP important to my patients and our organization?
  • How do we find time for developing EBP projects?
  • How do I get started?
  • How do I undertake a literature search?
  • What resources do I need?
  • What resources are available?