MLA-Phil

Librarians Dolores Judkins and Patrice O’Donovan presented a 4 hour session, “Finding the Evidence: Evidence-based Practice in Nursing” at the New Jersey Hospital Association Conference Center, Princeton, New Jersey on Wednesday, November 28, 2007. Dolores Judkins is the Head of the Research and Reference Department at the Oregon Health & Science University, Portland, Oregon. Patrice 0’Donovan is the Portland Campus Library Director, Linfield College School of Nursing and Health Sciences, Portland, Oregon.

102 medical librarians and nurses attended this very informative session. While most of the attendees came from New Jersey, there were attendees from New York, Massachusetts, Pennsylvania and Delaware.

The presenters covered a wealth of material in this workshop. They began by giving a history of evidence-based medicine and defining terms. They continued with examples of how to ask the question, rank the evidence, and search the literature.

The term “Evidence Based Medicine” was coined in the 1980’s at McMaster Medical School, Hamilton, Ontario. Definitions of “Evidence Based Practice” and “Evidence Based Medicine” are available at http://www.shef.ac.uk/scharr/ir/def.html. Evidence based medicine originated in Canada, Australia, and Great Britain. The Joanna Briggs Institute in Australia, the Registered Nurses’ Association of Ontario in Canada, and The Royal College of Nursing in Great Britain provide valuable resources relating to evidence based medicine (e.g., guidelines, practice sheets, publications).

In evidence based medicine the PICO model is used to phrase a foreground question. A foreground question is a comparison question, comparing two or more treatments, procedures, tests, etc.

In a foreground question:

P is the Patient, Population or Problem studied
I is the Intervention, Exposure, or Prognostic factor
C is the Comparison (Not every question has a comparison component)
O is the Outcome

After defining the PICO model attendees were given a set of questions and asked to identify the PICO components. A sample question given to the attendees was “What is the best approach to the evaluating of resting tachycardia in an adult?”

The next step after asking the question is looking at the research. The presenters gave an overview of research published in the nursing literature. Research falls into quantitative and qualitative and can be from a primary (original) or secondary source. Examples of quantitative primary sources are: randomized controlled trials, controlled trials, cohort studies, case studies and case reports. Examples of qualitative primary sources are ethnography research, phenomenological research, grounded theory, participatory action research, and heuristics. A glossary of the types of nursing research was included in each attendee’s handout. The different types of research have been ranked according to best levels of evidence by various organizations and institutions (e.g., The American Academy of Family Physicians, Oxford Centre for Evidence Based Medicine)

Evidence-based literature is found through searching of databases. Medline/PubMed, CINAHL, and PsycINFO are three databases with controlled vocabularies and limiters. Once subject headings are selected and searched, additional descriptors or subject headings can be applied to restrict results to evidence-based literature. The descriptors and subject headings vary across databases. “Evidence-Based Medicine” is a descriptor used in Medline/PubMed. “Professional Practice, Evidence Based” is a subject heading in CINAHL. “Evidence-Based Practice” and “Treatment Guidelines” are subject headings in PsychINFO. Other sources for searching evidence-based literature are EBSCOHOST, EMBASE, Scopus, Google Scholar.

Two evidence-based practice databases that search multiple sources and organize results according to evidence based practice categories are TRIP (Turning Research into Practice) and SUMsearch. TRIP is produced in the U.K. and searches 75 websites. SUMsearch is a product of the University of Texas Health Science Center at San Antonia. The Texas Health Center also established the Academic Center for Evidence-Based Nursing (ACE), a meta-site for evidence based nursing practice.

The presenters highlighted 2 journals on evidence based nursing and one blog. The two journals on Evidence Based Nursing are: Worldviews on Evidence-Based Nursing, a quarterly journal from Sigma Theta Tau International, and Evidence Based Nursing, published by the BMJ Publishing Group and the Royal College of Nursing Publishing Company. The following 2 articles from Evidence –Based Nursing were included in the attendees’ handouts:

“Searching for the best evidence. Part 1: where to look’, Evidence-Based Nursing July 1998, vol. 1. no. 3, p.68-70. (EBN Notebook).

“Searching for the best evidence. Part 2:searching CINAHL and Medline, Evidence-Based Nursing October 1998, vol. 1. no. 4, p.105-107. (EBN Notebook)

The blog is Evidence Informed Nursing Practice Blog. Some links on the right side of the blog are: Glossary - Cochrane Collaboration, What’s PICO?, Excellent articles from EBN.

During the lunch break attendees were asked to read the article “Evidence-based resources and the role of librarians in developing evidence-based practice curricula” by Mary L. Klem and Patricia M. Weiss, Journal of Professional Nursing, vol. 21 no. 6 (November – December) 2005: pp. 380-387. After a lovely hot luncheon provided to attendees at the conference center, the group reassembled and briefly discussed the article.

In the afternoon session the presenters spoke about “Filters and Hedges”, and “Criteria for Evaluating Literature.” The presenters ended the workshop with a series of questions posed to the group as a whole using the game format “ Who wants to be a Millionaire?” As a group we answered all questions correctly to win the million dollars and demonstrated that we had learned a lot through attending the workshop.