In this guide you will find Evidence-Based Practice tools, as well as recommended databases, books, practice sites, and information about Evidence-Based Research. Evidence-Based Medicine (EBM) is the integration of clinical expertise, patient values and the best research evidence into the decision making process for patient care.
Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002)
The levels of evidence pyramid provides a way to visualize both the quality of evidence and the amount of evidence available.
For example, systematic reviews are at the top of the pyramid, meaning they are both the highest level of evidence and the least common.
As you go down the pyramid, the amount of evidence will increase as the quality of the evidence decreases.
Filtered Information (secondary literature)
Systematic Review - Uses explicit rigorous methods to identify, critically apprise, and synthesize relevant studies
Meta Analysis - A quantitative method of combining the results of independent studies and synthesizing summaries and conclusions that may be used to evaluate therapeutic evidence
Critically Apprised Topic (CAT's) - A summary of the best evidence on a topic. CAT's usually include evidence from more than one study, are brief and their methods are less rigorous than SR
Critically Appraised Individual Article - A summary of a single paper, authors evaluate and synopsize individual research study
Unfiltered Information (primary literature)
Randomized Controlled Trial - A clinical trial that subjects are assigned randomly to one of two groups with one group is receiving intervention and is tested and the other is receiving alternative treatment and the follow up
Cohort Study - An observational study that compares two groups with exposure of interest and control one (no exposure)
Case Control Trial - A study that identifying subjects with disease of interest and control group without the disease and comparison
Clinical Trial - Pre-planned studies to answer questions on safety or efficacy of specific interventions according to protocol or research plan created by investigators
Studies are assigned levels of evidence based on their methodology. The evidence pyramid is an easy way to visualize this hierarchy of evidence.
At the top of the pyramid is filtered evidence including systematic reviews, meta-analyses, and critical appraisals. These studies evaluate and synthesize the literature. The top of the pyramid represents the strongest evidence.
At the base of the pyramid is unfiltered evidence including randomized controlled trials, cohort studies and case reports. These are individual reports and studies, also known as the primary literature.
You should seek the highest level of evidence available, but remember that evidence at the top of the pyramid might not exist for your particular clinical question. If that is the case, you'll need to move down the pyramid to find the strongest evidence that addresses your clinical question.
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Evidence Rating |
Evaluation Criteria |
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Level I
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Evidence from a Systematic Review or Meta-Analysis of all relevant Randomized Controlled Trials (RCTs) or evidence based Clinical Practice Guidelines based on systematic reviews of RCTs |
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Level II |
Evidence obtained from at least one well-designed RCT |
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Level III |
Evidence obtained from well-designed Controlled Trials without Randomization |
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Level IV |
Evidence from well-designed Case-Control and Cohort Studies |
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Level V |
Evidence from Systematic Reviews of descriptive and qualitative studies |
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Level VI |
Evidence from a single descriptive or qualitative study |
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Level VII |
Evidence from the opinion of authorities and /or reports of expert committees |
From: Melnyk, Bernadette Mazurek, and Ellen Fineout-Overholt. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice
Image source: Georgetown University Medical Centre
Evidence-Based Practice for Nursing and Healthcare Quality Improvement by Equip yourself to expertly conduct EBP or quality improvement projects. Written by renowned EBP experts LoBiondo-Wood, Haber, & Titler, Evidence-Based Practice for Nursing and Healthcare Quality Improvement provides a straightforward yet comprehensive guide to planning and conducting EBP and quality improvement projects This brand-new, full-color, richly illustrated textbook begins with foundational content and then works through the processes of developing and exploring clinical questions, implementing results, and disseminating information. The book's content and approach have been developed specifically with the adult learner in mind, with multiple full-text appendix articles referenced throughout as examples, along with unique pedagogical aids including EBP Tips and EBP Key Points to ground concepts in a "real-life" context. NEW! Written by renowned EBP experts LoBiondo-Wood, Haber, & Titler to provide a straightforward yet comprehensive guide to planning and conducting EBP and QI projects. NEW! A straightforward, practical approach begins with foundational content and then works through the processes of developing and exploring clinical questions, implementing results, and disseminating information. NEW! Developed specifically with the adult learner in mind, with multiple full-text appendix articles referenced throughout as examples, along with unique pedagogical aids including EBP Tips and EBP Key Points to ground concepts in a "real-life" context.
Evidence-Based Practice in Nursing and Healthcare by Develop the skills and knowledge you need to make evidence-based practice an integral part of your clinical decision making and everyday nursing practice with Evidence-Based Practice in Nursing & Healthcare . Written in a friendly, conversational style, this Third Edition of the authors' gold standard textbook covers all the information you need to use evidence-based practice to improve patient outcomes. Real world examples and meaningful strategies in every chapter show you how to take a clinical issue from inquiry toa sustainable solution that drives a preferred standard of care. Enhance your understanding of the EBP process through Making EBP Real features at the end of each unit that present real world case stories and EBP Fast Facts that highlight important points from each chapter. Master the content of the course with critical appraisal checklists, evaluation tables, and synthesis tables. Further develop evidence-based practice knowledge and skills using handy web alerts that direct you to helpful Internet resources. Take your learning beyond the book with a wide range of online resources, including the American Journal of Nursing EBP Step-by-Step Series, which provides a real-world example of the EBP process, plus learning objectives, journal articles, and checklists, templates, and evaluation tables. This title is an American Journal of Nursing 2015 Book of The Year Contest Winner.
Evidence-Based Nursing by Evidence Based Nursing is written in response to numerous requests by nurse practitioners and other graduate faculty for a nursing literature resource. This reader-friendly, accessible guide features plentiful examples from the nursing literature and the addition of specific nursing issues such as qualitative research, with direct application for clinical practice. The guide enables nurses to: frame their clinical questions in a way that will help them find the evidence to support their opinions; distinguish between strong and weak evidence; clearly understand study results; weigh the risks and benefits of management options; and apply the evidence to their individual patients to improve outcomes. Part One provides a basic approach to the problems faced by nurses when determining optimal care, predicting patient progress, and protecting patients from potentially harmful side effects, in addition to including a literature assessment summary and management recommendations. Part Two expands on Part One, providing concrete examples through case studies. This is the only book of its kind that helps nurses use the nursing literature effectively to solve patient problems. Three-step approach to dissecting a problem - to help find the best evidence and improve patient care, most questions can be divided into three parts: (1) Are the results valid? (2) What are the results? and (3) How can I apply the results to patient care? Part One - The Basics: Using the Nursing Literature provides a basic approach to the problems faced by nurses when determining optimal care, predicting patient progress, and protecting patients from potentially harmful side effects and includes a literature assessment summary and management recommendations. Part Two - Beyond the Basics: Using and Teaching the Principles of Evidence-Based Nursing expands on Part One, providing concrete examples through the presentation of cases. Two-part organization helps both beginners and those more accomplished at using the nursing literature. Clinical Scenario provides a brief but detailed description of a clinical situation that requires the application of research through a critical thinking process. Using the Guide examines a clinical scenario, and then evaluates the way in which research findings are collected, analyzed, and applied to the resolution of the problem presented in the scenario. Free CD-ROM contains everything found in the book, allowing for electronic outlining, content filtering, full-text searching, and alternative content organizations.
Evidence-Based Practice for Nurses by Doody's Review Service - 5 Stars!The Second Edition of Evidence-Based Practice for Nurses: Appraisal and Application of Research continues to serve as the definitive reference for transitioning research into nursing practice. Based on the innovation-decision process (IDP), each unit is shaped according to the five steps of the IDP: knowledge, persuasion, decision, implementation, and confirmation. This unique organizational approach combined with updated case studies and ethical principles allows the research process to be tangible and linked with strategies that promote advancement. Fully Integrated with Dynamic Technology Solutions!Perfect for nursing research or role development courses, the Second Edition is the cornerstone of a complete teaching and learning system. Authoritative content from the text has been supplemented with a host of online resources that reinforce evidence-based practice and strategies for a truly interactive and engaging learning experience. Web site icons within the text indicate when students should navigate to the companion Web site to engage in online activities that will strengthen their understanding of how to apply evidence at the point of care.
The Evidence-Based Practice Manual for Nurses by The Evidence-based Practice Manual successfully breaks down the skills for evidence-based nursing into manageable components. The reader will learn how to find, critically read and interpret a range of research studies, and will discover optimal approaches to helping patients reach decisions that are informed by the best-available evidence. The more-strategic concepts of developing an organisational evidence-based culture and making evidence-based changes at organisational level are the focus of the final section. This book will be invaluable both for students and for qualified nurses who are reviewing their clinical practice, developing guidelines or protocols, undertaking systematic reviews, learning about research or carrying out a literature review to inform research. Step-by-step guide to finding, appraising and applying research evidence in nursing Teaches skills for successfully reviewing published literature: formulating a focused question developing a search strategy for efficient retrieval of relevant studies appraising the retrieved studies All examples are relevant to nurses and nursing Reflects contemporary nursing issues A new chapter on 'Using research evidence in making clinical decisions with the individual patient' provides practical guidance and tools for decision-making A new chapter on 'Using evidence from qualitative studies' explains the complexities of qualitative methodologies and methods in a simple, easily understood way Online exercises and solutions provide an opportunity to critically appraise studies with the following range of designs: qualitative research a randomised controlled trial a cohort study a case control study a diagnostic test accuracy study a systematic review a clinical guideline Example solutions are provided, all written by experts in the field.
Evidence-Based Teaching in Nursing by Designed to assist aspiring, novice, and experienced faculty members in obtaining a strong foundation for Evidence-Based Teaching (EBT), Evidence-Based Teaching in Nursing: A Foundation for Educators explores past, present, and future aspects for teaching nursing in a variety of settings. This text promotes and demonstrates practical approaches for classroom, clinical, and simulation learning experiences while incorporating technology, generational considerations, and evidence. What's more, it addresses the academic environment while considering a wide array of teaching and learning aspects.
Evidence Based Medicine by Evidence Based Medicine provides a clear explanation of the central questions of EBM - how to ask answerable clinical questions, how to translate them into effective searches for the best evidence, how to critically appraise that evidence for its validity and importance, and how to integrate it with patients' values and preferences. New edition of fantastically successful book on EBM, written by the best-known authorities in the world. Will focus on the major challenge of practicing EBM in real time, providing tips and tools to help achieve this Focuses on the major challenge of practicing EBM in real time, providing tips and tools to help achieve this. All clinical examples are new. Expanded section on limitations of EBM - discusses common criticisms and the real limitations and how they can be overcome. Highlights the problems with the CAT databases available on the web. Expanded section on clinical decision rules in diagnosis. Interactive and user-friendly CD. Downloadable EBM resources for handhelds.
How to Read a Paper by How to Read a Paper describes the different types of clinical research reporting, and explains how to critically appraise the publications. The book provides the tools to find and evaluate the literature, and implement the findings in an evidence-based, patient-centered way. Written for anyone in the health care professions who has little or no knowledge of evidence-based medicine, it provides a clear understanding of the concepts and how to put them into practice at the basic, clinical level. Changes for the 4th edition The fourth edition will include two new chapters on important developments in health care research and delivery, but otherwise retains its original style, size, and scope. New chapter on quality improvement - describing papers on quality improvement projects using ebm methods; this will extend the readership to non clinical health care professionals working in hospitals and family practice, and to nurse specialists and practice nurses working in this field New chapter on complex interventions - how to set up research projects involving both qualitative and quantitative methodology (known as mixed methods) Thorough revision and updating of existing chapters and references New illustrations - diagrammatic representations of ebm concepts
PDQ Evidence-Based Principles and Practice by PDQ Evidence-Based Principles & Practice provides a foundation to understanding health care research and how best to evaluate and apply new research findings in health. In addition, the book outlines how best to identify important studies in health care published in large bibliographic databases such as MEDLINE. The text helps the reader develop optimal, effective MEDLINE search strategies with step-by-step suggestions for retrieving sound clinical studies on the etiology, prognosis, diagnosis, prevention, and management of disorders encountered in adult general medicine.
Users' Guides to the Medical Literature by Praised for its clear explanations of detailed statistical and mathematical principles, this text concisely covers both basic and advanced concepts in using evidence-based medicine, everything you need to deliver optimal patient care.
Understanding Nursing Research by Learn how to evaluate and apply research with the #1 nursing research book! Understanding Nursing Research: Building an Evidence-Based Practice is known for its authoritative content, a time-tested step-by-step approach, and abundant use of research examples. With improved clarity and readability, the new edition strengthens its focus on evidence-based practice to better demonstrate how the steps of the research process relate to evidence-based nursing. Written by two of the leaders in the field of nursing research, Nancy Burns and Susan K. Grove, this full-color text offers unique insights into understanding, appraising, and applying published research to evidence-based practice. Authoritative content is written by two of the true pioneers in nursing research, who offer unique, first-hand insights into the field. Research examples provide practice in working with published studies, with many of the examples including Critical Appraisal and Implications for Practice sections. A clear, step-by-step organization introduces the research process and demonstrates how this systematic framework relates to evidence-based practice. An expanded emphasis on evidence-based practice helps you develop skills in studying and appraising published research, so you are prepared for your role in working with research evidence. Enhanced coverage of qualitative research allows prepares you to approach research questions and clinical questions with an unbiased view of the researcher's methodology. Two different appraisal processes are included: A traditional in-depth critical appraisal process prepares you for graduate-level work in research. A concise, practice-focused research appraisal process equips you for quick and accurate evaluation of the applicability of research findings to clinical practice. Updated research examples prepare you for evidence-based practice by using the physiologic conditions and hospitalized patients seen in clinicals.
Evidence-Based Nursing the Research Practice Connection by Evidence-Based Nursing: The Research-Practice Connection, Fourth Edition introduces students to research methods and evidence-based practice. The text helps students understand research methods, how to appraise and use research evidence in clinical decision-making, and how to fully understand and engage in evidence-based practice. By linking evidence-based practice to recent research in safety and quality programs, it provides timely information in both healthcare and nursing settings.
Evidence-Based Practice for Nurses: Appraisal and Application of Research by Evidence-Based Practice for Nurses: Appraisal and Application of Research, Fourth Edition is an essential resource for teaching students how to translate research into practice. The text is based on the five step IDP process (knowledge, persuasion, decision, implementation, and confirmation). The authors employ a fresh and updated approach to teaching nursing research using evidence-based practice. The Fourth Edition features more real-world examples, expanded coverage of qualitative methods, discussion of various types of research questions and explores the hierarchy of evidence.New to the Fourth Edition:Updated Apply What You Have Learned evolving case study Real-life evidence-based practice examplesExploration of the Hierarchy Model featuring all types of evidence for each levelExpanded content on the qualitative method Updated references and new diagrams summarizing statistical analysis and designs Navigate 2 Premier AccessInstructor ResourcesInstructor's ManualTime-on-task analysisInteractive lecturesCompetency mapping documentPowerPoint slidesTest bankPractice activitiesEvolving case study
Introduction to Nursing Research: Incorporating Evidence-Based Practice by The Fourth Edition of Introduction to Nursing Research is a distinct integration of evidence-based practice and research for the baccalaureate student and practicing registered nurses. It focuses on how students can incorporate research into their daily practice while considering all the newest trends and issues. This is not a typical introduction to nursing research book; it is an evidence-based practice text that uses research. The Fourth Edition focus on the meaning of evidence, the use of quality improvement, and the practical application of these aspects for the practicing health care provider.
Evidence-Based Geriatric Nursing Protocols for Best Practice by Named a 2013 Doody's Core Title "The evidence-based protocols are designed as a primary reference and are useful, substantive, and timely...The broader contributions of useful format and succinct review of the evidence make it likely that this text will continue to be the leading resource in nursing education and practice."--The Gerontologist "Now more than ever, nurses are called upon to lead efforts to embed evidence-based practice in daily operations. As the IOM report states, 'nurses have key roles to play as team members and leaders for a reformed and better-integrated, patient-centered health care system.' The process of implementing sweeping change in health care will likely take years; however, nurses must start pragmatically and focus on these critically important protocols that have demonstrated improved outcomes for older adults. Simply stated, 'Pick this book up and use it.'" From the Foreword, Susan L. Carlson, MSN, APRN, ACNS-BC, GNP-BC, FNGNA President, National Gerontological Nursing Association "As a gerontological clinical educator/research nurse, I will often use this as a reference. The format and the content are good, and the explanations of how to best use the evidence simplify the process of sifting through mountains of information to figure the best practice." Score: 97, 5 Stars. --Doody's One of the premier reference books for geriatric nurses in hospital, long-term, and community settings, this 4th edition has been thoroughly updated to provide the most current, evidence-based protocols for care of common clinical conditions and issues in elderly patients. Designed to improve the quality, outcomes, and cost-effectiveness of health care, these guidelines are the result of collaboration between leading practitioners and educators in geriatric nursing and New York University College of Nursing. Protocols for each clinical condition have been developed by experts in that particular area, and most have been systematically tested by over 300 participating hospitals in "Nurses Improving Care for Health System Elders" (NICHE). Evidence is derived from all levels of care, including community, primary, and long-term care. A systematic method in compliance with the AGREE appraisal process was used to rate the levels of evidence for each protocol. Protocols are organized in a consistent format for ease of use, and each includes an overview, evidence-based assessment and intervention strategies, and an illustrative case study with discussion. Additionally, each protocol is embedded within chapter text, which provides the context and detailed evidence for the protocol. Each chapter contains resources for further study.Key Features: Updated to provide a wide range of evidence-based geriatric protocols for best practices Contains new chapters on function-focused care, catheter-associated urinary tract infections, mistreatment detection, acute care models, and transitional careIllustrates application of clinical protocols to real-life practice through case studies and discussionEdited by nationally known leaders in geriatric nursing education and practice, who are endorsed by the Hartford Institute for Geriatric Nursing and NICHE Encompasses the contributions of 58 leading practitioners of geriatric careWritten for nursing students, nurse leaders, and practitioners at all levels, including those in specialty roles
Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care by Ackley's Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care, 11th Edition helps practicing nurses and nursing students select appropriate nursing diagnoses and write care plans with ease and confidence. This convenient handbook shows you how to correlate nursing diagnoses with known information about clients on the basis of assessment findings, established medical or psychiatric diagnoses, and the current treatment plan. Extensively revised and updated with the new 2015-2017 NANDA-I approved nursing diagnoses, it integrates the NIC and NOC taxonomies, evidence-based nursing interventions, and adult, pediatric, geriatric, multicultural, home care, and client/family teaching and discharge planning considerations to guide you in creating unique, individualized care plans. Comprehensive, up-to-date information on all the 2015-2017 NANDA-I nursing diagnoses so you stay in the know. UNIQUE! Provides care plans for every NANDA-I approved nursing diagnosis plus two unique care plans for Hearing Loss and Vision Loss. Includes pediatric, geriatric, multicultural, client/family teaching and discharge planning, home care, and safety interventions as necessary for plans of care. Presents examples of and suggested NIC interventions and NOC outcomes in each care plan. UNIQUE! Care Plan Constructor on the companion Evolve website offers hands-on practice creating customized plans of care. 150 NCLEX exam-style review questions are available on Evolve. Promotes evidence-based interventions and rationales by including recent or classic research that supports the use of each intervention. Classic evidence-based references promote evidence-based interventions and rationales. Clear, concise interventions are usually only a sentence or two long and use no more than two references. Safety content emphasizes what must be considered to provide safe patient care. Step-by-step instructions show you how to use the Guide to Nursing Diagnoses and Guide to Planning Care sections to create a unique, individualized plan of care. List of Nursing Diagnosis Index in back inside cover of book for quick reference. Three-column index is easy to use. Easy-to-follow sections I and II guide you through the nursing process and selecting appropriate nursing diagnoses. Alphabetical thumb tabs allow quick access to specific symptoms and nursing diagnoses. NEW! Includes the new 2015-2017 NANDA-I approved nursing diagnoses, compete with 26 new diagnoses. NEW and UPDATED! Provides the latest NIC/NOC, interventions, and rationales for every care plan. EXPANDED! Additional information on concept based nursing and major nursing theories provides you with the knowledge you need for clinical success. EXPANDED! New content on QSEN, safety, and risk for infection keeps you up to date. NEW! In-depth coverage of wellness and primary prevention stresses the importance of health and wellness. NEW! Appendixes in the text provide you with valuable information in an easy-to-access location. NEW! Revised references in APA style.
Pediatric Nursing Care: Best Evidence Based Practices by Growth and Development Guide on the inside front and back covers makes quick referencing easy. Pedogogical tools help ensure the best-evidence-based practices, including... "Alerts" that focus attention on potentially life-threatening issues and describe the appropriate interventions. "Why is this Important," rationales for important topics. "Patient Education," tips for helping patients and their caregivers to understand their health status. "Offering Support," models of verbatim nurse-patient interactions that offer compassionate care advice and strategies for effective communication "Evidence for Best Practices" boxes highlighting research that support nursing practices, processes, and principles. "Best Practices," sage advice from experienced practitioners. Common mnemonics, tricks to help you remember what to do and when.