Review the resources found in the Week 2 Module and the Rating System for the Hierarchy of Evidence (Levels I-VII) found in Melnyk and Fineout-Overholt, 4th edition, Box 1.3 on page 18.

PICOT Question from week 1

P: Patients with advanced cancer

I:  Keeping a pain journal

C:  No interventions

O:  Lower reported pain scored 

T:  in a period of 2 years

Review the resources found in the Week 2 Module and the Rating System for the Hierarchy of Evidence (Levels I-VII) found in Melnyk and Fineout-Overholt, 4th edition, Box 1.3 on page 18.

• State the approved PICOT question from Week 1 using the intervention
• Select one peer-reviewed nursing research article that supports the problem and/or intervention stated in the PICOT question and discuss the Level of Evidence found in the chosen article using Levels I-VII from the text (Reminder: The initial post requires two (2) references). Post the article as a pdf with the Initial Post.

Reviewing Evidence for Practice

NSG 5111

Evidence and Practice

Nova Southeastern University

Ron and Kathy Assaf College of Nursing

Goals of Evidence-Based Practice (EBP)

Improve patient interventions and outcomes

Cost-effective care

Reduce variations in patient care

Increase efficient and effective decision-making

Increased job satisfaction

Levels of Evidence/Evidence Hierarchies

Models are used to rate strength and quality of individual studies, position statements, clinical practice guidelines, systematic reviews, and other types of evidence

Posing the Question Using PICOT

Consistent PICOT format drives a successful search

Intervention questions: Asks what intervention most effectively leads to an outcome

Purpose of the PICOT intervention format:

Guides the systematic search of healthcare data bases to find the best and current answer to the question

Patient population (P)

Intervention (I)

Comparison intervention (C)

Outcome (O)

Time (T)

Question Template for an Intervention PICOT

In_____________(P), how does___________(I),

compared with _____________(C), affect _________(O)

within ___________(T).

Hints for Successful Searches

Start with a well formulated PICOT question

Patience-searching takes time and practice

Search all relevant data bases

Do not limit the search to all full text

Use key words from the PICOT question

Use Boolean connectors

AND narrows the search

OR expands the search

Do not hesitate to contact the NSU Library for assistance. They are a wealth of information and help!!

Search Strategies

WHO-WHAT-WHERE-WHY?

What is the purpose of the search?

Practice guidelines

Developing guidelines and need evidence

Comparing past, current, and future practices

Research study

Quality improvement project

Evidence-based practice project

Search Strategies: Where do I Start?

PubMed

Large database that includes over 20 million citations from various sources such as MEDLINE and on-line books. Full text for some sources

ScienceDirect

Online collection of published scientific research

Mosby’s Nursing Consult

Separate tab for EBP. Very good resource

Evidence-Based Nursing Monographs

GATEWAY (entrance to resources from National Library of Medicine)

Search Strategies

CINAHL ® (Cumulative Index of Allied Health Literature)

Begin with search terms. May combine terms using ‘and’, ‘or’

Called Boolean searching technique

Several choices to limit your results

Publication date

Author

Journal

Language

Full text, abstract only

Evidence-based practice

Randomized control trials

Sources

Filtered

Appraise the quality of studies and often make recommendations for practice

Systematic reviews; meta-analysis

Cochrane Database of Systematic Reviews

National Guideline Clearinghouse

Unfiltered

Primary literature reviews

Utilize specific search strategies in various databases (MEDLINE; CINAHL)) to find the best available evidence

The Joanna Briggs Institute

Membership required but many resources are free to non-members

Provides Best Practice Summary Sheets

International collaboration with nursing, medical and allied health researchers, clinicians, academics and quality managers

Archieve Page

The Cochrane Collaboration

Over 4,000 reviews in the Cochrane Library

Plain language summaries are free

Membership needed for full guidelines

Interdisciplinary and multifocal

Interventions to improve question formulation in professional practice and self-directed learning

The effects of on-screen, point of care computer reminders on processes and outcomes of care

Best Practice Web Resources

Agency for Healthcare Research and Quality (AHRQ)

https://www.ahrq.gov/

https://www.ahrq.gov/prevention/guidelines/archive.html

https://www.ahrq.gov/gam/index.html

National Guideline Clearinghouse™

https://www.ahrq.gov/gam/updates/index.html

Large database of EBP guidelines and other documents

EBP

Clinical practice guidelines

Guidelines synthesis

Compare guidelines among groups

Example-Prevention of Pressure ulcers

Hartford Institute for Geriatric Nursing & Wound, Ostomy, and Continence Nurses Society

Professional Nursing Organizations with Published Guidelines

Oncology Nursing Society

https://voice.ons.org/topic/clinical-practice-guidelines

American Society of PeriAnesthesia Nurses (ASPAN)

https://www.aspan.org/

Registered Nurses’ Association of Ontario

https://rnao.ca/bpg

Guideline Central

Home

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Models of EBP

University of Iowa

Johns Hopkins Nursing EBP Model

Joanna Briggs Institute (JBI ) Model

Stetler Model

Evidence-Based Advancing Research and Clinical Practice Through Close Collaboration Model (ARCC)

References

Melnyk, B., & Fineout-Overholt, E. (2019) Evidence-based practice in nursing and health care. A guide to best practice (4rd ed.). Philadelphia: Wolters Kluwer.