Topic: Evidenced Based Practice in Nursing

Audience: Nursing students

Date: September

Time: 11: 30 pm

Duration: 45 Minutes

Venue: Lecture Room (The Annex)

Methodology: Lecture Discussion

Number of participants: 102-110

Learning Theories: Ausubel: Emphasized the use of advance organizers which he said was

different from overviews and summaries. His use of an advance organizer acted to bridge the

chasm between learning material and existing related ideas. The advanced organizer used; sought

to bridge new knowledge with what was known (sometimes what is known is uncertain and not

concrete). Though he specified that his theory applied only to reception learning in schools, it

was utilized because it introduced the topic and aided the sequence of the information to be

imparted. (Ormrod & Rice, 2003).

Rogers: Dealt with the adult learner, he posited that learning is student centered and

personalized and the educator’s role is that of a facilitator. Affective and cognitive needs are

central and the goal is to develop self-actualized persons in a cooperative, supportive

environment. This theory was used because all the participants were adult learners, thus they

were responsible for their learning experience and the teacher sought to guide them through this

experience. (Quinn, 2006).

Bruner: Believed that learners were not blank slates but brought past experiences to a new

situation, he also stated that new information was linked to prior knowledge, thus mental

representations are subjective. Bruner’s Discovery learning is an inquiry-based, constructivist

learning theory that takes place in problem solving situations where the learner draws on his or

her own past experience and existing knowledge to discover facts and relationships and new

truths to be learned. (Quinn, 2006). Students interact with the world by exploring and

manipulating objects, wrestling with questions and controversies, or performing experiments. As

a result, students may be more likely to remember concepts and knowledge discovered on their

own (in contrast to a transmissionist model). (Quinn, 2006). Models that are based upon

discovery learning model include: guided discovery, problem-based learning, simulation-based

learning, case-based learning, incidental learning, among others. The advantages of this theory

are: it encourages active engagement, promotes motivation, a tailored learning experience, and

promotes autonomy, responsibility, independence, the development of creativity and problem

solving skills. (Quinn, 2006) Bruner’s theory was used because it encouraged active engagement,

promotes motivation, a tailored learning experience, and promotes autonomy, responsibility,

independence and the development of creativity and problem solving skills for this presentation.

Vygotsky: Posited that individuals learn from each other through social interaction and the

teacher and the learner collaborate in a reciprocal relationship where each learns from each other

through the same process of social interaction (Quinn, 2006). This theory was chosen since it

lays the overall foundation for human behaviours that of interaction, where students learn from

the more knowledgeable other (MKO) it coincides with the topic and the overall mode of

delivery of the topic.

Aim of the activity: To educate nursing students about the importance of evidenced based

Practice (EBP)

Scientific Principle: All the above theories cited, each gives a different perspective on the

concept of teaching making the lesson a ‘whole.”

Resources: Nurse Instructor, lap top computer, multimedia, white board, markers

handouts.

Objectives: At the end of 45 minutes interactive session students should be able to:

1. Define evidenced based practice (EBP) as cited by McGinty & Anderson (2008); Melnyck & Fineout Overholt (2011)

2. State the components of evidenced based practice Melnyck & Fineout-Overholt, (2011).

3. Discuss the steps utilized in EBP according to Melnyck & Fineout Overholt, (2011); Fineout-Overholt, Melnyk, & Schultz, (2005) Rycroft-Malone, (2008); (Fineout-Overholt & Johnston, (2005); Melnyk & Fineout-Overholt, (2002); Guyott & Rennie (2002); Sweet & Moynihan (2007); (Fineout-Overholt, O’Mathúna, & Kent, B. (2008); Ciliska, Cullum & Marks (2008); Newhouse (2010)

4. Identify the major databases utilized in EBP as proferred by Melnyck and Fineout Overholt (2011)

Evaluation: Formative and Summative. Questions will be asked before and after each

objective as well as demonstration followed by a test at the end

References:

Ciliska, D., Callum, N & Marks, S. (2001).Evaluation of systematic reviews of treatment or

prevention interventions. Evid Based Nurs. 4:100-104 

Fineout-Overholt, E & Johnston, L. (2005). Teaching EBP: Asking searchable, answerable

clinical questions. Worldviews on Evidence-Based Nursing. 2(3), 157–160

Fineout-Overholt, E., Melnyk, B. M & Schultz, A. (2005). Transforming healthcare from the

inside out: Advancing evidence-based practice in the 21st century. Journal of

Professional Nursing, 21(6), 335-344.

Fineout-Overholt, E., O’Mathúna, D. P & Kent, B. (2008); How systematic reviews can foster

evidenced based clinical decisions. Worldviews on Evidence-Based Nursing (51), 45-48

Guyatt, G. H., & Rennie, D. (2002). Users’ guides to the medical literature: A manual for

evidence-based practice. Chicago: American Medical Association.

Newhouse, R. P. (2010). Interdisciplinary Evidence-based Practice: Moving from Silos to

Synergy. Nurs Outlook. 58(6): 309–317.

McGinty J, Anderson G. (2008) Predictors of physician compliance with American Heart

Association guidelines for acute myocardial infarction. Crit Care Nurs Q 31(2):161-72

Melnyk B. M & Fineout-Overholt E. (2002). Putting research into practice. Reflections on

Nursing Leadership/Sigma Theta Tau International, Honor Society of Nursing. 28(2):22–5. 45.

Melnyk, B. M & Fineout-Overholt, E. (2011). Evidence-based practice in nurisng & healthcare.

(2nd ed). Philadelphia: Wolters Kluwer/Lippencott Williams & Wilkins

Rycroft-Malone, J (2008). Leadership and the Use of Evidence in Practice. Worldviews on

Evidence-Based Nursing. 5 (1): 1–2

Sweet, M & R. Moynihan. (2007). Improving population health: The uses of systematic reviews.

New York: Milbank Memorial Fund in collaboration with the Centers for Disease

Control and Prevention. Retrieved from

http://www.milbank.org/reports/0712populationhealth/0712populationhealth.html

Time Objectives Contents Teacher Activity

Learner’s Activity

Evaluation

1 min Ice-breakerDavid Ausubel:

Teacher will ask students to identify the issue/s in picture and consequently ascertain the topic of the presentation

Students will attempt to identify the issues in the picture and ascertain the topic for presentation

Students will correctly identify the topic of presentation subsequent to looking at the picture

5min Define evidenced based practice (EBP) as cited by McGinty & Anderson (2008); Melnyck & Fineout Overholt (2011)

It is now widely recognized throughout the globe that evidence-based practice (EBP) is key to delivering the highest quality of healthcare and ensuring the best patient outcomes. Findings from numerous studies have indicated that an evidence-based approach to practice versus the implementation of clinical care that is steeped in tradition or based upon outdated policies results in a multitude of improved health, safety, and cost outcomes, including a decrease in patient morbidity and mortality (McGinty & Anderson, 200).

When clinicians especially nurses know how to find, critically appraise, and use the best evidence in clinical practice, and when patients are confident that their healthcare providers are using evidence-based care, optimal outcomes are achieved for all (Melnyck & Fineout-Overholt, 2011) .

Teacher will randomly ask three students to define the term evidenced based practice in their own words

Teacher will define the term evidenced based practice using PowerPoint/Flashcards according to the

Three students will attempt to define the term evidenced based practice in their own words.

Students will listen attentively and follow on PowerPoint as definition of evidenced based learning

Students will be able to correctly define the term evidenced based practice according to the content using terms such as “best research evidenced, clinical expertise,

content.

Teacher will ask three student seated at the back of class to define the term evidenced based practice according to the content

is shown and stated.

Three students seated at the back of class will define evidenced based practice according to the content

patient values & preferences”

3 min State the components of evidenced based practice Melnyck & Fineout-Overholt, (2011).

Although evidence from systematic reviews of RCTs has been regarded as the strongest level of evidence (i.e., Level 1 evidence) on which to base practice decisions about treatments to achieve a desired outcome, evidence from descriptive and qualitative studies as well as from opinion leaders should be factored into clinical decisions when RCTs are not available.

Evidence-based theories (i.e., theories that are empirically supported through well-designed studies) also should be included as evidence.In addition, patient preferences, values, and concerns should be incorporated into the evidence-based approach to decision making along with a clinician’s expertise.

These includes (a) clinical judgment (i.e., the ability to think about, understand, and use research evidence; the ability to assess a patient’s condition through subjective history taking, thorough physical examination findings, and laboratory reports), (b) internal evidence generated from quality improvement or outcomes management projects, (c) clinical reasoning (i.e., the ability to apply the above information to a clinical issue), and (d) evaluation and use of available

Teacher will ask students to state the components of evidenced based practice

Teacher will state the components of evidenced based practice using PowerPoint presentation, white board and markers

Teach will ask three students

Students will attempt to state the components of evidenced based practice

Students will follow on white board and on PowerPoint presentation and ask questions where necessary

Three students seated in the

Students will correctly state the components of evidenced based practice by utilizing key terms such as, “clinical judgement, internal evidence, clinical reasoning and evaluation and use of

healthcare resources needed to implement the chosen treatment(s) and achieve the expected outcome (Melnyck & Fineout-Overholt, 2011).

Clinicians often ask how much and what type of evidence is needed to change practice. A good rule of thumb to answer this question is that there needs to be strong enough evidence to make a practice change. Specifically, the level of evidence plus the quality of evidence equals the strength of the evidence, which provides clinicians the confidence that is needed to change clinical practice (Melnyck & Fineout-Overholt, 2011).

in the middle and one at the front to state one component of evidenced based practice each according to the content

middle and one at the front of the class will state one component of evidenced based practice each according to the content

available health care resources….”

15min

Discuss the steps utilized in EBP according to Melnyck & Fineout Overholt, (2011); Fineout-Overholt, Melnyk, & Schultz, (2005) Rycroft-Malone, (2008); (Fineout-Overholt & Johnston, 2005; Melnyk & Fineout-

THE STEPS OF EVIDENCE-BASED PRACTICE

The seven critical steps of EBP include: 0. Cultivate a spirit of inquiry. 1. Ask the burning clinical question in the format that will yield the most relevant and best evidence (PICOT). 3. Search for and collect the most relevant and best evidence to answer the clinical question (e.g., searching for systematic reviews, including meta-analyses) 4. Critically appraise the evidence that has been collected for its validity, reliability, and applicability, then synthesize that evidence 5. Integrate the evidence with one’s clinical expertise and the patient’s preferences and values to implement a clinical decision 6. Evaluate outcomes of the practice decision or change based on Evidence 7. Disseminate the outcomes of the EBP decision or change (Melnyck & Fineout-Overholt, 2011).

CULTIVATING THE SPIRIT OF INQUIRY

Before embarking on the well-known steps of EBP, it is critical to cultivate a spirit of inquiry (i.e., a consistently questioning attitude toward practice) so that clinicians are comfortable with and excited about asking questions regarding their patients’ care as well as challenging current institutional or unit-based practices. Without a

Teacher will ask each student to locate pieces of papers placed under their desks and will discuss the concept/step that is written on them

Teacher will discuss the steps of evidenced based practice utilizing PowerPoint presentation and handouts on the types of

Students will locate pieces of papers placed under their desks and will attempt to discuss the concepts/step that are written on them

Students will follow on PowerPoint and in handouts and ask questions as necessary as teacher discuss the steps of evidenced

Students will correctly discuss the steps in evidenced based practice by utilizing terms such as, “cultivating the spirit of inquiry, ask the burning clinical question, search for and collect most relevant and best

Overholt, 2002a; Guyott & Rennie (2002); Sweet & Moynihan (2007); (Fineout-Overholt, O’Mathúna, & Kent, B. (2008); Ciliska, Cullum & Marks (2008); Newhouse (2008)

culture that is supportive of a spirit of inquiry and EBP, individual and organizational EBP change efforts are not likely to succeed and sustain (Fineout-Overholt, Melnyk, & Schultz, 2005; Rycroft-Malone, 2008).

STEP 1: FORMULATE THE BURNING CLINICAL PICOT QUESTION

In step 1 of EBP, clinical questions are asked in PICOT format (i.e., Patient population, Intervention or Issue of interest, Comparison intervention or group, Outcome, and Time frame) to yield the most relevant and best evidence. For example, a well-designed PICOT question would be: In teenagers (the patient population), how does cognitive-behavioral skills building (the experimental intervention) compared to yoga (the comparison intervention) affect anxiety (the outcome) after 6 weeks of treatment (the time frame)?

When questions are asked in a PICOT format, it results in an effective search that yields the best, relevant information and saves an inordinate amount of time (Fineout-Overholt & Johnston, 2005; Melnyk & Fineout-Overholt, 2002a, Melnyk & Fineout-Overholt, 2011). In contrast, an inappropriately formed question (e.g., What is the best type of intervention to use with teenagers who are anxious?) would lead to a search outcome that would likely include hundreds of non-usable abstracts and irrelevant information (Melnyck & Fineholt-Overholt, 2011)

For other clinical questions that are not intervention focused, the meaning of the letter I can be “issue of interest” instead of “intervention.”

An example of a non-intervention PICOT question would be: How do new mothers who have breast-related complications perceive their

learners according to the contents

based practice according to the contents

evidence, critically appraise the evidence, integrate the evidence with one’s clinical expertise and patient’s preference….”

ability to breast-feed past the first 3 months after their infants’ birth? In this question, the population is new breast-feeding mothers, the issue of interest is breast-feeding complications, there is no appropriate comparison group, the outcome is their perception of their ability to continue breast-feeding, and the time is the 3 months after their infants’ birth. When a clinical problem generates multiple clinical questions, priority should be given to those questions with the most important consequences or those that occur most frequently (Melnyck & Fineholt-Overholt, 2011).

STEP 2: SEARCH FOR THE BEST EVIDENCE

The search for best evidence should first begin by considering the elements of the PICOT question. Each of the key words from the PICOT question should be used to begin the search. The type of study that would provide the best answer to an intervention or treatment question would be systematic reviews or meta-analyses, which are regarded as the strongest level of evidence on which to base treatment decisions (Guyatt & Rennie, 2002).

There are different levels of evidence for each kind of PICOT question. Although there are many hierarchies of evidence available in the literature to answer intervention PICOT questions we have chosen to present a hierarchy of evidence to address these questions that encompasses a broad range of evidence, including systematic reviews of qualitative evidence, also referred to as meta-syntheses(Melnyck & Fineout-Overholt, 2011)

HIERARCHY OF EVIDENCE FOR INTERVENTION/TREATMENT QUESTIONS

Level I: Evidence from a systematic review or meta-analysis of all relevant RCTs

Level II: Evidence obtained from well-designed RCTsLevel III: Evidence obtained from well-designed controlled trials without randomizationLevel IV: Evidence from well-designed case-control and cohort studiesLevel V: Evidence from systematic reviews of descriptive and qualitative studiesLevel VI: Evidence from single descriptive or qualitative studiesLevel VII: Evidence from the opinion of authorities and/or reports of expert committees (Melnyck & Fineout Overholt, 2011)

Systematic Review - is a summary of evidence on a particular topic, typically conducted by an expert or expert panel that uses a rigorous process for identifying, appraising, and synthesizing studies to answer a specific clinical question. Conclusions are then drawn about the data gathered through this process (e.g., In adult women with arthritis, how does massage compared to pharmacologic agents reduce pain after 2 weeks of treatment? In women, what factors predict heart disease in older adulthood?) (Melnyck & Fineout Overholt, 2011).

Using a rigorous process of well-defined, preset criteria to select studies for inclusion in the review as well as stringent criteria to assess quality, bias is overcome and results are more credible.

Population health stands a better chance for improvement when there is effective integration of scientific evidence through systematic reviews that are made available to influence policy makers’ decisions(Sweet & Moynihan, 2007).Many systematic reviews incorporate quantitative methods to summarize the results from multiple studies - these reviews are called meta-analyses (Melnyck & Fineout Overholt, 2011).

A meta-analysis - generates an overall summary statistic that represents the effect of the intervention across multiple studies. Because a meta-analysis can combine the samples of each study included in the review to create one larger study, the summary statistic is more precise than the individual findings from any one of the contributing studies alone (Ciliska, Cullum, & Marks, 2001).

Thus, systematic reviews and meta-analyses yield the strongest level of evidence on which to base practice decisions. Caution must be used when searching for systematic reviews as some evidence reviews or narrative reviews may be labeled systematic reviews; however, they lack the rigorous process that is required of true systematic reviews(Fineout-Overholt, O’Mathúna, & Kent, 2008; Newhouse, 2010).

If syntheses (e.g., systematic reviews, meta-analyses) are not available to answer a clinical practice treatment question, the next step should be a search for original RCTs that are found in databases such as MEDLINE or CINAHL (Cumulative Index of Nursing and Allied Health Literature). If RCTs are not available, the search process should then include other types of studies that generate evidence to guide clinical decision making (e.g., nonrandomized, descriptive, or qualitative studies) (Melnyck & Fineout Overholt, 2011).

STEP 3: CRITICAL APPRAISAL OF EVIDENCE

This step is vital, in that it involves critical appraisal of the evidence obtained from the search process.

Although healthcare professionals may view critical appraisal as an exhaustive, time-consuming process, the first steps of critical appraisal can be efficiently accomplished by answering three key questions as part of a rapid critical appraisal process in which studies are evaluated for their validity, reliability, and applicability to answer

the posed clinical question Are the results of the study valid? (Validity) That is, are the results as close to the truth as possible? Did the researchers conduct the study using the best research methods possible? (Melnyck & Fineout Overholt, 2011)

For example, in intervention trials, it would be important to determine whether the subjects were randomly assigned to treatment or control groups and whether they were equal on key characteristics prior to the treatment. What are the results? (Reliability) For example, in an intervention trial, this includes (a) whether the intervention worked, (b) how large a treatment effect was obtained, and (c) whether clinicians could expect similar results if they implemented the intervention in their own clinical practice setting (i.e., the preciseness of the intervention effect) (Melnyck & Fineout Overholt, 2011).

In qualitative studies, this includes evaluating whether the research approach fits the purpose of the study, along with evaluating other aspects of the study. Will the results help me in caring for my patients? (Applicability) - This third critical appraisal question includes asking whether (a) the subjects in the study are similar to the patients for whom care is being delivered, (b) the benefits are greater than the risks of treatment (i.e., potential for harm), (c) the treatment is feasible to implement in the practice setting, and (d) the patient desires the treatment.

The answers to these questions ensure relevance and transferability of the evidence to the specific population for whom the clinician provides care (Melnyck & Fineout Overholt, 2011).

STEP 4: INTEGRATE THE EVIDENCE WITH CLINICAL EXPERTISE AND PATIENT PREFERENCES TO MAKE THE BEST CLINICAL DECISION

The next key step in EBP is integrating the best evidence found from the literature with the healthcare provider’s expertise and patient preferences and values to implement a decision. Consumers of healthcare services want to participate in the clinical decision-making process, and it is the ethical responsibility of the healthcare provider to involve patients in treatment decisions (Melnyk & Fineout-Overholt, 2006).

Even if the evidence from a rigorous search and critical appraisal strongly supports that a certain treatment is beneficial (e.g., Hormone Replacement Therapy (HRT) to prevent osteoporosis in a very high-risk woman), a discussion with the patient may reveal her intense fear of developing breast cancer while taking HRT or other reasons that the treatment is not acceptable. Moreover, as part of the history-taking process or physical examination, a comorbidity or contraindication may be found that increases the risks of HRT (e.g., prior history of stroke).

Therefore, despite compelling evidence to support the benefits of HRT in preventing osteoporosis in high-risk women, a decision against its use may be made after a thorough assessment of the individual patient and a discussion of the risks and benefits of treatment (Melnyck & Fineout Overholt, 2011)

STEP 5: EVALUATE THE OUTCOMES OF THE PRACTICE CHANGE BASED ON EVIDENCE

Step 5 in EBP is evaluating the evidence-based initiative in terms of how the change affected patient outcomes or how effective the

clinical decision was with a particular patient or practice setting.

This type of evaluation is essential in determining whether the change based on evidence resulted in the expected outcomes when implemented in the real-world clinical practice setting. Measurement of outcomes is important to determine and document the impact of the EBP change on healthcare quality and/or patient outcomes.

If a change in practice based on evidence did not produce the same findings as demonstrated in rigorous research, clinicians should ask themselves a variety of questions (e.g., Was the treatment administered in exactly the same way that it was delivered in the study? Were the patients in the clinical setting similar to those in the studies?) (Melnyck & Fineout Overholt, 2011).

STEP 6: DISSEMINATE THE OUTCOMES OF THE EVIDENCE-BASED PRACTICE CHANGE

The last step in EBP is disseminating the outcomes of the EBP change.All too often, clinicians achieve many positive outcomes through making changes in their care based upon evidence, but those outcomes are not shared with others, even colleagues within their same institution.

As a result, others do not learn about the outcomes and clinicians as well as patients in other settings do not benefit from them. It is so important for clinicians to disseminate outcomes of their practice changes based on evidence through such venues as oral and poster presentations at local, regional, and national conferences; EBP rounds within their own institutions; journal and newsletter publications; and lay publications (Melnyck & Fineout Overholt, 2011).

20mi Identify the Teacher will One student Students

n significant databases utilized in EBP as proferred by Melnyck and Fineout Overholt (2011)

CHOOSING THE RIGHT DATABASE

Of the many databases that index healthcare literature, some are available through several vendors at a cost, some are free of charge, and some are available both free of charge and through a vendor for a fee. For example, as noted previously, depending on the search options desired, MEDLINE can be accessed free of charge through the NLM’s PubMed or obtained for a cost through other providers (e.g., Ovid).

This lecture focuses primarily on the following databases: Cochrane Databases NGC MEDLINE CINAHL Excerpta Medica Online (EMBASE) PsycINFO PUBMED

MEDLINE and CINAHL are among the best-known comprehensive databases and can arguably be described as representing the scientific knowledge base of healthcare. However, the amount of information in healthcare exceeds the capacity of either of these databases (Melnyck & Fineout Overholt, 2011).

In addition to MEDLINE and CINAHL, there are other databases available, some of which are highly specialized, and their numbers are growing in response to the desire for more readily available information (e.g., Up-to-Date, Clinical Evidence).

COCHRANE DATABASESClassified as an international not-for-profit organization, The

ask one student from each of the last six row to write the name of one database on the board and briefly say what it is about; he/she can call on row members for assistance

Teacher the major databases utilized in EBP with the aid of PowerPoint presentation, white board and markers according to the content

Teacher will randomly ask six persons to name one database and briefly say what it is according

from each of the last six row will write on white board one database and will attempt to briefly say what it is, he/she can call on row members for assistance

Students will sit, listen, ask questions where necessary as teacher the major database utilized in EBP according to the contents

Six students randomly chosen will state one database and briefly say what it is

will be able to correctly the major databases utilized in EBP by using utilizing names such as “ NGC, MEDLINE, CINAHL, EMBASE, PUBMED and PsychINFO”

Cochrane Collaboration represents the efforts of a global network of dedicated volunteer researchers, healthcare professionals, and consumers who prepare, maintain, and promote access to The Cochrane Library’s six databases:

Cochrane Database of Systematic Reviews (CDSR), Database of Reviews of Effectiveness (DARE), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register, Health Technology Assessment Database, and NHS Economic Evaluation Database

The Cochrane Library’s “gold standard” database is the CDSR.It contains Cochrane full-text systematic reviews and should be searched first to answer intervention questions.The databases produced by The Cochrane Collaboration can be accessed via http://www.cochrane.org (Melnyck & Fineout Overholt, 2011).

NATIONAL GUIDELINE CLEARINGHOUSE

The NGC is a comprehensive database of evidence-based clinical practice guidelines and related documents that provide physicians, nurses, and other healthcare professionals and stakeholders with detailed information on the latest management and maintenance of particular health issues, along with how the guideline was developed, tested, and should be usedThe NGC is a government-supported database that was initiated by the Agency for Healthcare Research and Quality (AHRQ) within the U.S. Department of Health and Human Services.The agency has a mission to improve the quality, safety, efficiency, effectiveness, and cost effectiveness of healthThe NGC can be found at http://www.guideline.gov(Melnyck & Fineout Overholt, 2011)

to the content according to the content

MEDLINE

MEDLINE is one of the world’s largest searchable bibliographic databases covering medicine, health, and the biomedical sciences, and it is available 24 hours a day on any computer in the world with Internet access. The NLM also leases the MEDLINE data to vendors.These types of companies load the database into their own user interfaces with unique features and sell subscriptions to libraries and others.It is important to acknowledge that the original file of indexed citations is the same MEDLINE product in PubMed as in any of these other vendors’ versions of the file. It contains citations from more than 5,200 biomedical journals in medicine, nursing, pharmacy, dentistry, and allied health. The database is updated daily and has abstracts for over 52% of its articles, with 80% of its citations in English.The MEDLINE database is available free of charge through PubMed at http://www.ncbi.nlm.nih.gov/pubmed (Melnyck & Fineout Overholt, 2011).

CINAHLThe Cumulative Index of Nursing & Allied Health Literature (CINAHL) database is produced by Cinahl Information Systems and contains article citations with abstracts, when available, from 13 nursing and allied health disciplines. Articles are retrieved from journals, books, drug monographs, dissertations, and images that are sometimes difficult to locate in other databases.

The CINAHL database is usually accessed through libraries but can be accessed through a personal CINAHL direct subscription via the Cinahl Information Systems website (http://www.ebscohost. com/cinahl/) (Melnyck & Fineout Overholt, 2011).

EVALUATION

1. What is evidenced based practice?2. Name the components of evidenced based practice?3. Identify the steps utilized in evidenced based practice4. Name seven databases utilized in evidenced based practice

ANSWERS

1. Use of the best available evidenced which includes: Research, Clinical expertise and patients preferences and values

2. (a) clinical (b) internal evidence generated from quality improvement or outcomes management projects, (c) clinical reasoning and (d) evaluation and use of available healthcare resources needed to implement the chosen treatment

3. The seven critical steps of EBP include: 0. Cultivate a spirit of inquiry. 1. Ask the burning clinical question in the format that will yield the most relevant and best evidence (PICOT). 3. Search for and collect the most relevant and best evidence to answer the clinical question (e.g., searching for systematic reviews, including meta-analyses) 4. Critically appraise the evidence that has been collected for its validity, reliability, and applicability, then synthesize that evidence 5. Integrate the evidence with one’s clinical expertise and the patient’s preferences and values to implement a clinical decision 6. Evaluate outcomes of the practice decision or change based on Evidence 7. Disseminate the outcomes of the EBP decision or change

4. The seven databases are Cochrane Databases NGC MEDLINE CINAHL Excerpta Medica Online (EMBASE) PsycINFO PUBMED