1. The presentation defined evidence-based practice and walked through the process of assessing questions, acquiring evidence, appraising validity and significance, and applying evidence to improve patient care. 2. An example case study examined the use of magnets to relieve osteoarthritis pain and applied the evidence-based practice process to search for and evaluate relevant literature. 3. While some studies found magnets reduced osteoarthritis pain compared to placebos, nurses should provide education on magnets rather than recommendations due to a lack of clear evidence on effectiveness.

1. Especially for Nurses
Thinking in an Evidence Based Way
Helen-Ann Brown Epstein MLS, MS, AHIP
Kim Barrett Medical Library
epsteinhab@hss.edu
http://hss.edu/academic-kimbarrett-library.asp
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2. I DO NOT have a financial interest in
commercial products or services.
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3. Goal: To improve health through enhanced patient
care and research practice.
Objectives: At the close of this 1.5 hour hands-on workshop,
participants will have:
1. Defined evidence based practice and worked through the
EBP process of assess, ask, acquire, appraise and apply.
2. Framed background and foreground searching questions.
3. Translated search questions into searching concepts.
4. Climbed an evidence pyramid.
5. Searched PubMed Clinical Queries.
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4. Evidence based practice: Based on the current evidence available to me today,
I will practice my health care..
Available
My experience
evidence
EBP
Is the combination
of what the
My patient’s values literature shows,
EBP
your experience
and your
patient’s values.
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5. Evidence Based Practice Process
ASSESS Everything starts with a story. Interpretation of the situation.
Background questions to fill in your knowledge gaps.
ASK Foreground questions pertaining to the situation.
Find the best available evidence.
ACQUIRE
Consider evidence for validity, statistical significance and
APPRAISE application for your patient.
Put evidence to work for improved health.
APPLY
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6. Evidence Based Practice Process
ASSESS Everything starts with a story. Interpretation of the situation.
H is a new patient on the unit. He is a 52 year old gentleman with
osteoarthritis in a variety of joints, including his wrists and knees.
He is wearing a magnetic bracelet and sleeps on a magnet pad at
home. H claims the magnets help ease pain. Incidentally, there was a
piece on a TV health news show about medical magnets the
other day. You decide to try and find evidence based literature on
the value of magnets for pain relief of osteoarthritis.
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7. Evidence Based Practice Process
ASK Background questions to fill in your knowledge gaps.
What are medical magnets? What is osteoarthritis?
How does a medical magnet work? What is osteoarthritis ?
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8. Evidence Based Practice Process
Foreground, searchable question is particular to this story.
ASK Fill in the PICO formula to help frame the searchable question.
.
P Patient, problem, population
I intervention therapy/prevention, diagnosis/screening
etiology/harm prognosis
C Comparison to nothing to placebo
to benchmark to gold standard
O Outcome eliminate symptoms, relieve pain
better quality of life
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9. Evidence Based Practice Process
Foreground, searchable question is particular to this story.
ASK Fill in the PICO formula to help frame the searchable question.
.
H is a new patient on the unit. He is a 52 year old gentleman with osteoarthritis in a
variety of joints, including his wrists and knees. He is wearing a magnetic bracelet and
sleeps on a magnet pad at home. H claims the magnets help ease pain. Incidentally,
there was a piece on a TV health news show about medical magnets the other day. You
decide to try and find evidence based literature on the value of magnets for pain relief of
osteoarthritis.
P 52 year old gentleman with osteoarthritis in a variety of joints, including wrists and knees
wearing a medical magnet on his wrist and sleeps on a magnetic pad
I medical magnet
C
O Relieve of his pain
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10. Evidence Based Practice Process
Foreground, searchable question is particular to this story.
ASK Fill in the PICO formula to help frame the searchable question.
.
P 52 year old gentleman with osteoarthritis in a variety of joints, including wrists and knees
wearing a medical magnet on his wrist and sleeps on a magnetic pad
I medical magnet
C
O Relieve of his pain
(patient)
In a 52 year old gentleman with osteoarthritis in a variety of joints,
(intervention)
including wrists and knees will wearing a medical magnet on his
(outcome)
wrist and sleeping on a magnetic pad relieve his pain ?
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11. Evidence Based Practice Process
Foreground, searchable question is particular to this story.
ASK Fill in the PICO formula to help frame the searchable question.
.
In a 52 year old gentleman with osteoarthritis in a variety of joints,
including wrists and knees will wearing a medical magnet on his
wrist and sleeping on a magnetic pad relieve his pain ?
Translate question into significant words, significant phrases and MeSH.
Magnets (word, MeSH)
Magnetics (word, MeSH) Osteoarthritis (word, MeSH)
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12. Evidence Based Practice Process
ACQUIRE 6S Evidence Pyramid
Climb up
as far as you
can to be
freer of bias
and have
more
summary,
analysis and
commentary
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13. Evidence Based Practice Process
ACQUIRE Plan #1: Use information found in a background resource.
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14. Evidence-Based Nursing is
an abstraction journal.
It contains an abstract of a
quality paper with an
additional commentary.
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15. Move citation information
into the PubMed Single
Citation Matcher
BMJ
2004
32
1450
9
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16. Click on a Related Citation
Click on a PubMed Central paper
Use MeSH to find more
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17. PubMed Clinical Queries
When you search here PubMed adds evidence based filters to your search strategy
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18. Randomized Controlled Trials Systematic Reviews Medical Genetics
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19. Evidence Based Practice Process
Consider evidence for validity, statistical significance and
APPRAISE application for your patient
Are the results of the study valid?
Are there statistics? Are they the right statistics for the question asked?
Are the results statistically significant?
How does the study result apply to your patient?
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20. Evidence Based Practice Process
Consider evidence for validity, statistical significance and
APPRAISE application for your patient
Randomised Controlled Trials
Systematic Reviews
Cohort Studies
Case-Control Studies
Qualitative Studies
Economic Evaluations http://www.casp-uk.net/
Diagnostic Studies
Clinical Prediction Rule
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21. HSS

22. HSS

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24. Evidence Based Practice Process
APPLY Put evidence to work for improved health
CONCLUSION:
Pain from osteoarthritis of the hip and knee decreases when wearing magnetic bracelets.
It is uncertain whether this response is due to specific or non-specific (placebo) effects.
CONCLUSION
Patients who wore standard magnetic bracelets reported reduced pain associated with
osteoarthritis of the hip and knee at 12 weeks compared with patients who wore
placebo bracelets.
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25. Evidence Based Practice Process
APPLY Put evidence to work for improved health
The lack of evidence on magnet effectiveness dictates that nurses
should neither recommend nor discourage their use but rather should
provide education to clients…
Although magnets are usually promoted as being safe and inexpensive,
several contradictions …patients with cardiac pacemakers, defibrillators, or
insulin pumps (because these devices are magnetically controlled).2
Nurses have an important role in promoting health literacy about the
use of magnets for chronic pain.
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26. Evidence Based Practice Process
ASSESS Everything starts with a story. Interpretation of the situation.
Background questions to fill in your knowledge gaps.
ASK Foreground questions pertaining to the situation.
Find the best available evidence.
ACQUIRE
Consider evidence for validity, statistical significance and
APPRAISE application for your patient
Put evidence to work for improved health
APPLY
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27. Helen-Ann Brown Epstein MLS, MS, AHIP
Kim Barrett Medical Library
epsteinhab@hss.edu
http://hss.edu/academic-kimbarrett-library.asp
HSS