This document provides an overview of evidence-based nursing practice and how to effectively search for and evaluate evidence. It defines evidence-based practice as using the best available evidence from research to improve clinical practice. A 5-step process is outlined: formulating a question, searching literature, critically appraising evidence, applying evidence to practice, and re-evaluating. Guidance is given on formulating search strategies using PICO and searching various library databases and resources like Cochrane and CINAHL to find relevant evidence to answer clinical questions.

1. Evidence Based Nursing
Resources*
South University Libraries
October 2009

2. Scholarly Library Research
 Using the library resources effectively
during your academic coursework in
nursing will ensure that you have
information literacy skills to equip you for
evidence-based practice and continued
success in your nursing career.
 This PowerPoint will serve as a guide to
information literacy for evidence-based
practice.

3. What is Evidence Based Nursing
Practice?
 Evidence-based practice (EBP) in nursing is a
process of locating, appraising, and applying the
best evidence from the nursing and medical
literature to improve the quality of clinical
practice.
 It involves the following steps:
 Constructing a relevant, answerable question
from a clinical case.
 Planning and carrying out a search of the
literature for the best external evidence.
 Critically appraising the literature for validity and
applicability.
 Applying the evidence to your clinical practice.
 Evaluating your performance.

4. Why?
 Melnyk and Fineout-Overhold, in their book Evidence-Based
Practice in Nursing & Healthcare (2005) p. 3-4, argue for the
utility of EBP through real-life examples:
 If you are caring for a child who was in a motor vehicle
accident and sustained a severe head injury, would you want
to know and use the most effective, empirically supported
treatment established from randomized controlled trials to
decrease his or her intracranial pressure?
 If your mother was diagnosed with Alzheimer's
disease, would you want her health care providers to give you
information about how other family caregivers of patients with
this disease have coped with the illness, based on evidence
from well-designed qualitative and/or descriptive studies?
 If you were diagnosed with cancer today and were faced with
the decision about which type of chemotherapy to
choose, would you want to know the evidence regarding the
risks and benefits of each therapeutic agent as generated
from prior clinical trials with other similar cancer patients?

5. Information Literacy is a
requirement to practice effective
evidence-based nursing.
 Information literacy involves the ability
to:
◦ determine the nature and extent of the
information needed ;
◦ locate and access information;
◦ manage information effectively;
◦ critically evaluate information; and
◦ use information for problem
solving, research, decision
making, current awareness, and
professional development.

6. Getting started:
 Why do I need library journals and databases? Can't I just search the
web?
 Many people believe that everything is now available on the web, for free
to everyone. This just isn't so. In addition to the uncertainty of credible
health and medical information on the web, the web is not indexed and
searching it can be overwhelming. Only 8% of scholarly research is
available on the web*.
 Additionally, medical and health information on the web can often be
misleading, biased, incorrect, or outdated.
 While some web-based resources may be free, many of the quality
resources, such as the indexes, databases and journals you need to do
your job have a cost (subscription) that the library provides as part of your
education experience at South.
 As professionals you will want to use bibliographic databases such as The
Cochrane Library, CINAHL , PubMed/Medline, and Ovid to keep current
with the research literature.
 In addition, library resources such as STAT!Ref, Science Direct , PQ
Central and EMEDICINE can provide needed background
information, quickly and easily.
*Herring. M.Y. (2001, April). 10 reasons why the Internet is no substitute for a library. American

7. Step 1: Formulating the question:
PICO
 PICO is a framework that nurses can use to formulate
effective clinical questions in a step-by-step manner. Nurse
clinicians encounter many situations for which they do not
have the information needed to provide the best care for their
patients. From this uncertainty springs forth clinical inquiry.
 Clinical inquiry is a process in which clinicians gather data
using narrowly defined clinical parameters. This process
allows for an appraisal of the available choices of
treatment, for the purpose of finding the most appropriate
choice of action. Clinical inquiry is encapsulated in the form of
a clinical question.
 PICO is a useful format and structure for developing a
clinical research question. PICO helps the clinician in
finding the right evidence to answer questions and decrease
uncertainty.

8. PICO
What patient population/problem are you
trying to address?
What will you do for the patient or problem?
Alternatives to your chosen intervention?
(optional)
What will be improved for the patient or
problem?
Time frame (optional)

9. Step 1 continued:
Formulating search strategies:
 Determine your Search Vocabulary
 Your search vocabulary consists of the
subject headings, keywords and key phrases
you will use in your search. These are also
referred to as controlled and uncontrolled
vocabulary.
 It is useful to identify main concepts for
questions.
 It is highly recommended to use the PICO
method to identify main concepts.

10. Step 2: Database/Resource
Searching
 After successfully formulating the clinical
question, you need to find relevant
evidence. You may need to consult several
types of credible information resources—
available from the South University library.
 These resources generally fall into three
categories and are used in sequential order
depending on need and applicability. The
three categories are:
◦ General information (background) resources
◦ Filtered (secondary) resources
◦ Unfiltered (primary) resources

11. General Information
 Background Resources:
You may often encounter conditions
outside your specialty area or that you
don’t see often, and need to get a
comprehensive overview. Background
resources provide excellent detailed
information.
 This category contains resources that
provide background information about
various diseases, conditions, and clinical
questions.
 South University electronic resources
include
CINAHL, StatRef, EMedicine, Ovid
books and journals, PQ Central (Joanna

12. Filtered (secondary
resources):
 Reviews, syntheses, or summaries of literature and research
findings (found in articles, monographs, and textbooks)
 Entries in nursing or medical encyclopedias
 Drug information in handbooks, databases, pamphlets
 Nursing or medical bibliographies
 Abstracting/Indexing services/databases
 Newsletters and professional news sources
 Practice guidelines & standards
 Clinical care notes
 Nursing education videos/DVD's
 Patient education Information
 Government & legal Information
 Example of a filtered resource is The Cochrane Library
database, which provides a variety of information backed up with
links to the literature and references to the resources used to pulled
together the conclusions and/or information provided.

13. Cochrane Library
 A collection of databases that contain high-
quality, independent evidence to inform
healthcare decision-making.
 Cochrane reviews represent the highest level
of evidence on which to base clinical
treatment decisions.
 In addition to Cochrane reviews, The
Cochrane Library provides other sources of
reliable information, from other systematic
review abstracts, technology
assessments, economic evaluations and
individual clinical trials and all the current
evidence in one single environment.

14. Cochrane Library
 The Cochrane Library - an introduction
 http://www3.interscience.wiley.com/homepages
/106568753/CochraneLibraryBrochure_new.pd
f
 Tips on Advanced and MESH
searching
 http://www.brainshark.com/wiley/cochrane2
 Saving Searches and Setting Alerts
 http://www.brainshark.com/wiley/cochrane3

15. Unfiltered (primary)
resources:appropriate answer in the filtered
 If you don’t find an
resources, you’ll need to search unfiltered resources (the
primary literature) to locate studies that answer your question.
Additionally, you may choose to search the unfiltered
resources to see if any new research has been done since
the conclusions reached in the filtered resources were
released.
 Unfiltered resources provide the most recent information, but
it’s up to the clinician to evaluate each study found to
determine its validity and applicability to the patient.
 Effectively searching and evaluating the studies found in
unfiltered resources takes more time and skill, which is why
filtered resources are the first choice for answering clinical
questions.

16. CINAHL
 journal content summarizing, analyzing, or commenting
on primary sources
 nursing and allied health books & book chapters
 conference proceedings
 standards of practice
 educational software
 audiovisual materials
 legal cases
 clinical innovations
 critical paths
 drug records
 research instruments
 clinical trials

17. MEDLINE® /Pub Med
 medical and health reference book content
 bibliographies
 biographies
 conference reports
 dictionaries and directories
 practice and administrative guidelines
 patient education handouts
 technical reports
 medical news
 government publications and legal information
 To learn more about searching MEDLINE® in
PubMed, go to
http://www.nlm.nih.gov/bsd/pubmed_tutorial/m1001.htm
l

18. EMedicine
 The largest and most current Clinical
Knowledge Base available to
physicians and other healthcare
professionals. Nearly 10,000 physician
authors and editors contribute to the
EMedicine Clinical Knowledge
Base, which contains articles on 7,000
diseases and disorders. The
evidence-based content, updated
regularly, provides the latest practice
guidelines in 59 medical specialties.

19. OVID
 Allied Health and Nursing Journals
 Full text coverage of over 60
current, highly respected nursing and
allied health titles, including
general, medical, and pharmacy titles.

20. ProQuest Central (PQ)
 Search full-text journals and dissertations in ProQuest
Nursing & Allied Health Source alongside Systematic
Reviews, Evidence Summaries, and Best Practice
Information Sheets from the renowned Joanna Briggs
Institute.
 ProQuest Nursing & Allied Health Source provides
abstracting and indexing for more than 850 titles, with
over 715 titles in full-text, plus more than 12,000 full text
dissertations representing the most rigorous scholarship in
nursing and related fields.
 ProQuest Health and Medical Complete™ combines the
clinical research titles available in ProQuest Medical
Library™ with hundreds of additional consumer and health
administration titles. ProQuest Health and Medical
Complete provides in-depth coverage from over 1,530
publications with over 1,270 available in full text and of

21. Let’s review..

22. Step 2: Plan and carry out
Step 1: Construct a
a search of the literature for
Question
the best external evidence
 Select searchable terms  Identify available
from your question. resources and choose
search tools
 Think of
keywords, synonyms, re  Search appropriate
lated library databases
terms, phrases, and (Cochrane, CINAHL, EM
subject headings etc. edicine)
, to convert your need
into a question

23. Step 3: Critically appraise the
literature for validity and Step 4: Apply the evidence to your
applicability. clinical practice.
 Evaluate your information for  Once you have determined
quality considering the that a study is internally
following questions:
valid (step 3), you must
◦ Who wrote it? decide how the study
◦ Who sponsored the research? and/or other information
◦ What institutional or applies to your question. To
organizational affiliation exists?
reach your conclusion you
◦ When was it published? may consult questions
◦ Has it been reviewed? By whom? related to
◦ Why was it published? diagnosis, therapy, harm, a
◦ Has it been cited? Whom does it nd prognosis. Keep in mind
cite? that you must interpret the
◦ Is the information valid? (critique information based on a
the study design) number of criteria and
◦ How useful is the information for depending on your skill and
your particular clinical or
research problem? experience, you may need
to confer with a peer.

24. Step 5: Re-Evaluate
 Was the diagnosis and treatment
successful?
 Is there new information/data in the
literature?
 How can I improve and/or update my
clinical decisions?

25. Additional resources:
 EBM/EBN Websites  EBM/EBN Organizations
 Evidence-Based Nursing  Agency for Health Care
syllabi and resources Research and Policy
Centre for Evidence Based (AHRQ)
Medicine - University of http://www.ahrq.gov
Toronto
http://www.cebm.utoronto.c
a/syllabi/nur/  Centre for Evidence
Based Medicine -
 Evidence Based Medicine University of Toronto
tutorial http://www.cebm.utoronto.c
Health Sciences Library - a/
UNC-Chapel Hill
http://www.hsl.unc.edu/serv
ices/tutorials/ebm/index.ht
m  Health Information
 EBM Education Center of Research Unit--
Excellence - North McMaster University
Carolina http://hiru.mcmaster.ca/
http://library.ncahec.net/eb
m/pages/index.htm

26. For more information:
 Evaluating Internet Health Information: A Tutorial from the
National Library of Medicine: This tutorial teaches you how
to evaluate the health information that you find on the Web. It
is about 16 minutes long. You need a Flash plug-in, version
6 or above, to view it. If you do not have Flash, you will be
prompted to obtain a free download of the software before
you start.
◦ http://www.nlm.nih.gov/medlineplus/webeval/webeval_start.html
 University of North Carolina nursing tutorial and resources:
◦ http://www.hsl.unc.edu/Services/Tutorials/EBN/intro.htm
 Academic Center for Evidence Based Practice, University of
Texas Health Science Center:
◦ http://www.acestar.uthscsa.edu/Resources_www.htm
 Penn State Nursing tutorial, this site has practice examples:
◦ http://www.libraries.psu.edu/instruction/ebpt-07/index.htm

27. Questions?
 Please contact your South University
librarian for more information.
 Valerie Yaughn 912 201 8046
vyaughn@southuniversity.edu
 Kate Sawyer 912 201 8088
kasawyer@southuniversity.edu

28. * This work is licensed under a
Creative Commons Attribution-
Noncommercial-Share Alike 3.0
United States License
Fourth Edition, November 2004.
edited and amended with permission from
http://www.lib.umn.edu/ and
http://www.biomed.lib.umn.edu/learn/ebp/, and
http://library.wcsu.edu/web/assistance/research/nursing/tutorial/