Insp

ire.

Lead.

Enga

ge.

Laura Banfield, Nursing LibrarianHealth Sciences Library

September 2010

Introduction to Evidence-Informed Decision Making (EIDM)

Insp

ire.

Lead.

Enga

ge.

•Review the definition of Evidence (Informed) Based Practice and the steps in the process•Formulate questions using PICO and PS models•Introduce the concept of preprocessed evidence and the hierarchy of evidence•Identify databases and sources for locating pre-processed evidence

Learning Objectives

Insp

ire.

Lead.

Enga

ge.

“The integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making”

(Sackett et al., 2000)

Evidence-Informed Decision Making (EIDM)

Insp

ire.

Lead.

Enga

ge.

Clinical state, setting, and circumstances

Patient preferences and actions

Research evidence

Health care resources 

Clinical ExpertiseClinical Expertise

Clinical Decisions

Insp

ire.

Lead.

Enga

ge.

1. Construct a relevant, answerable question from a clinical case.

2. Search the literature to retrieve the best evidence.

3. Critically appraise the literature (evidence) for validity and applicability.

4. Apply the evidence to your clinical practice.

5. Evaluate the outcome or performance. *From: Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2), 36-7.

Steps of EIDM

Insp

ire.

Lead.

Enga

ge.

1. Construct a relevant, answerable question from a clinical case.

2. Search the literature to retrieve the best evidence.

3. Critically appraise the literature (evidence) for validity and applicability.

4. Apply the evidence to your clinical practice.

5. Evaluate the outcome or performance. *From: Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2), 36-7.

Steps of EIDM

Insp

ire.

Lead.

Enga

ge.

Two Types of Clinical Questions:

1. Background

2. Foreground

Asking Clinical Questions

Insp

ire.

Lead.

Enga

ge.

Background questions are:• general in nature

• address gaps in background knowledge• examples include: pathophysiology, or risk factors of a

disease; an overview of a nursing theory

Foreground questions are:• focused on the particular patient scenario, and

• ask for specific knowledge to manage the patient

Background & Foreground Questions

Insp

ire.

Lead.

Enga

ge.

Background questions

• Need to be answered first

• Can be answered by books or general Websites

Foreground questions

•Need to be very focused

•Can be answered by searching journal databases

Background & Foreground Questions

Insp

ire.

Lead.

Enga

ge.

Examples of Background questions: • What is the mechanism of action of insulin?• How do you conduct a neurological assessment?

Examples of Foreground questions:• Is exercise more effective than a low-fat diet in reducing blood pressure in hypertensive patients? • Is there a relationship between cell phone use in adults and the incidence of brain tumors?

Background & Foreground Questions

Inspir

e.

Lead.

Enga

ge.

Two Major Research ‘Categories:’Quantitative Research

& Qualitative Research

Inspir

e.

Lead.

Enga

ge.

Two Major Research ‘Categories’

Quantitative Research is an “objective, systematic process to describe and test relationships and, examine cause and effect interactions among variables” (Burns & Grove, 1993, p. 777)

Qualitative Research is a systematic, subjective approach used to describe life experiences and give them meaning” (Burns & Grove, 1993, p. 777)

Insp

ire.

Lead.

Enga

ge.

•Goal is the discovery of relationships, or causation (cause & effect).•Based on scientific method (hypothesis formation and testing)•Many quantitative designs compare two or more groups•Often involves an element of control •Objectivity (related to measurement)•Collection of data (numerical) and analysis via statistics Burns & Groove, 1993; Roberts & Burke, 1989

Quantitative Research

Insp

ire.

Lead.

Enga

ge.

Studies focus primarily on one of the following:•Therapy/Treatment/Intervention; Prevention and Control – Effectiveness•Etiology/Causation/Harm•Prognosis – Outcome•Diagnosis and Screening/Assessment•Economics

Quantitative Research Studies

Insp

ire.

Lead.

Enga

ge.

Quantitative research designs (studies) include:

• Randomized Controlled Trials (RCTs)

• Cohort Study (Cohort Analytic)

• Case-Control Study

• Cross-Sectional Study (survey)

• Case Report or Study

Greenhalgh, 1997

Quantitative Research Designs

Insp

ire.

Lead.

Enga

ge.

(Quantitative)

P -- Population/SituationI -- Intervention/ExposureC -- Comparison/Counter ExposureO -- Outcome

Formulating the Question

Insp

ire.

Lead.

Enga

ge.

Intervention

Is exercise more effective than rest for relieving chronic back pain?

Question

Insp

ire.

Lead.

Enga

ge.

PopulationInterventionComparisonOutcome

Question

People with back painExerciseBed restReduced pain

Insp

ire.

Lead.

Enga

ge.

Causation

Does the presence of hand sanitizer stations in nursing homes reduce the number of infections transferred to

residents?

Question

Insp

ire.

Lead.

Enga

ge.

PopulationExposureComparisonOutcome

Question

Nursing home residentsHand sanitizer stationsNo hand sanitizer Reduced infection

Insp

ire.

Lead.

Enga

ge.

• Aim is to discover meaning or gain understanding of a phenomena• Investigates a phenomena in-depth

Roberts & Burke (1989)

Qualitative Research

Insp

ire.

Lead.

Enga

ge.

•How people feel or experience a certain situation or circumstance

•Sampling of a small group of people

•Data collected via in-depth unstructured interviews, observation, focus groups, diaries

•Analysis of findings in narrative format

Qualitative Research

Insp

ire.

Lead.

Enga

ge.

Examples of qualitative research designs include:• Phenomenology

• Examine the ‘lived experience” of individuals experiencing a phenomena

• Grounded Theory• Goal is to understand a social-psychological process and

develop a theory

• Ethnography• Study of a group or culture within their own setting

Qualitative Research

Insp

ire.

Lead.

Enga

ge.

Formulating the Question

(Qualitative)

P -- PopulationS -- Situation

Insp

ire.

Lead.

Enga

ge.

How do people with HIV/AIDS living in a rural community feel about disclosing their status to

their health care provider?

Question

Insp

ire.

Lead.

Enga

ge.

PopulationSituation

Question

People with HIV/AIDSDisclosing their status

to their health care providers

Insp

ire.

Lead.

Enga

ge.

Hierarchy of Pre-processed Evidence

(Haynes, 2007)

Insp

ire.

Lead.

Enga

ge.

Support clinical decision making through linking all relevant best research evidence about a clinical situation

directly to a patient’s record.(Haynes 2008)

Sources of Systems•Integrative Electronic Patient Records

Systems

Insp

ire.

Lead.

Enga

ge.

“Summaries integrate best available evidence from lower layers … to provide a full range of evidence concerning

management options for a given health problem.”(Haynes, 2007)

Sources of Summaries•Clinical Practice Guidelines•Evidence Based Texts

Summaries

Insp

ire.

Lead.

Enga

ge.

Consolidate the literature on a specific topic:• comprehensive identification of studies• review of study relevance• evaluate methodologic quality• extraction and analysis of data• draw of conclusions

Sources of Synthesis•The Cochrane Library •Health Care Journals

Syntheses: Systematic Reviews

Insp

ire.

Lead.

Enga

ge.

Synopses

“Synopses of individual studies or systematic reviews encapsulate the key methodologic details and results required to apply the evidence to individual patient care.”

(Haynes, 2001)

Sources of Synopses • Database of Abstracts of Reviews of Effects (DARE)• health-evidence.ca• Evidence-based abstraction journals

Insp

ire.

Lead.

Enga

ge.

Single Studies are used:• To keep up with the literature• To update summaries and systematic

reviews• To contribute to clinical decisions if no

higher preprocessed level is available

Sources of Single Studies

•CINAHL•Medline

Single Studies

Insp

ire.

Lead.

Enga

ge.

Insp

ire.

Lead.

Enga

ge.

EBN Resources Page

http://hsl.mcmaster.ca/resources/topic/eb/nurse.html

Insp

ire.

Lead.

Enga

ge.

Dates to be announced…

Library Sessions