An Introduction to Evidence-Based Practice for Nursing & Midwifery Students

Evidence-Based Practice is a five-step process:

1. Construct a relevant, answerable question from a clinical case.
2. Plan and carry out a search of the literature for the best external evidence:
   • Hierarchy of Pre-Processed Evidence
     • Systems
     • Summaries
       • Clinical Practice Guidelines
       • Evidence-Based Texts
     • Synopses
       • Of Syntheses
       • Of Studies
     • Syntheses (Systematic Reviews)
     • Studies
       • Meta Searches
       • Consumer Resources
3. Critically appraise the literature for validity and applicability.
4. Apply the evidence to your clinical practice.
5. Evaluate your performance

• Other resources
  • Tutorials
  • Directories

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

• Flemming K. EBN notebook. Asking answerable questions. Evidence-Based Nursing 1998;1:36-37.
• Formulating Answerable Clinical Questions (Centre for Evidence-Based Medicine, Mount Sinai Hospital)
• The Well-Built Clinical Question (Duke University Medical Center Library and Health Sciences Library, UNC-Chapel Hill)
• Formulating Patient Centered Questions (University Library, University of Illinois at Chicago)
• Asking Focused Questions (Centre for Evidence-Based Medicine, Oxford)

Step 2: Plan and carry out a search of the literature for the best external evidence.

NOTE: To use the resources identified by , you will need to login to LibAccess

Hierarchy of pre-processed evidence

[Adapted from Dicenso A, Bayley L, Haynes RB (2009). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence-Based Nursing, 12,99-101]

Tips for Searching for the Evidence

Systems

“An evidence-based clinical information system integrates and concisely summarizes all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links (through an electronic medical record) a specific patient’s circumstances to the relevant information."

Summaries

"These include clinical pathways or textbook summaries that
integrate evidence-based information about specific clinical
problems and provide regular updating."

Syntheses: Systematic Reviews

"A synthesis or systematic review is a comprehensive summary of all the research evidence related to a focused clinical question."

Synopses of Studies

“...the synopsis of a single study provides a brief, but often sufficiently detailed, summary of a high-quality study that can inform clinical practice."

Studies:

Step 3: Critically appraise the literature for validity and applicability.

• Users' guide to the Medical Literature (1st ed.) Click on Access UGI
• EBM Tools

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Other Resources:

• ClinicalTrials.gov
• Bandolier "Evidence based thinking about health care"
• Health and Psychosocial Instruments (HaPI)
• Tutorials:
  • Introduction to Evidence-Based Medicine (Duke University Medical Center Library and Health Sciences Library, University of North Carolina at Chapel Hill)
• Directories:
  • Netting the Evidence: : A ScHARR Introduction to Evidence Based Practice on the Internet
  • Evidence Based Medicine (EBM) Toolkit (New York University School of Medicine. The Frederick L. Ehrman Medical Library)
  • Nesbit guide to evidence based resources (University of Rochester, Edward G. Miner library)
  • Resource Guide for Evidence-Based Practice (University of Alberta Libraries
• Web of Science (to link articles by citation)

Need some help? Contact: Laura Banfield
Health Sciences Library, HSC-2B33
Tel: (905)525-9140, ext. 20239
Email: banfie@mcmaster.ca