TODAY'S EMPHASIS on evidence-based practice (EBP) has evolved from our desire to give patients the best possible care based on sound research. With EBP, you make clinical decisions using the available research evidence, clinical expertise and experience, and patient preferences. For this process to be effective, you need to know how to find credible evidence and decide on its relevance for your patients and setting.
The first step is identifying the clinical question or problem you need more information about. Next, look for the evidence by searching first for systematic reviews on the topic. These reviews combine research studies that answer the same question, so you can be more confident about the implications for your clinical practice.
To find systematic reviews online, start with The Cochrane Collaboration (http://www.cochrane.org/index.htm), an international, not-for-profit site that produces systematic reviews and other types of evidence reports. Cochrane reviews examine various studies and use a rigorous method for identifying, critiquing, and synthesizing them. You can search their holdings by topic or keyword and access abstracts for free; to get a full Cochrane review, you need a subscription to the Cochrane Library, which your hospital or nursing school library might have.
Other resources you can use might not provide as strong a level of evidence as systematic reviews, but they can be useful because they summarize the current state of knowledge, including what's known and unknown. They also provide a starting point for answering your questions without your having to search for and critique individual articles. For example:
* PubMed's Clinical Queries provides access to Medline and the National Library of Medicine's bibliographic database with articles and other resources in medicine, nursing, and other life sciences. PubMed also provides evidence summaries and reviews of the literature at http://www.ncbi.nlm.nih.gov/entrez/query/static/clinical.shtml.
* Agency for Healthcare Research and Quality offers many evidence-based reports on a wide variety of topics at http://www.ahrq.gov/clinic/epcquick.htm.
* National Guideline Clearinghouse publishes evidence-based clinical practice guidelines at http://www.guidelines.gov.
Don't forget to check your specialty association's resources. Some have EBP resources online, such as the Association of periOperative Registered Nurses' Web-based slide show, "Welcome to Evidence-Based Practice in Perioperative Nursing" at http://www.aorn.org/applications/courses/ebp/index.html.
If you can't find any systematic reviews or evidence-based reports, you'll need to search for and evaluate individual research studies and decide on the quality of the evidence. Because this requires time and research skills that you might not have, ask your nurse-manager whether your hospital has EBP teams. Composed of staff nurses, managers, advanced practice nurses, and other clinical leaders, these teams can plan EBP projects, search for and evaluate the evidence, and decide if it supports a change in practice.
Source: Oermann MH, Hit the Web to help guide your practice, Nursing Management, February 2007.