1. MODULE 1: Evidence Based Practice and Informatics
NURS 736: Technology Solutions for Knowledge Generation in Healthcare

2. Objectives
Provide an overview of the benefits, barriers and steps associated with EBP.
Explore the informatics contributions to EBP.
Develop a PICO question related to an informatics topic or emerging technology.
You will be discussing Evidence Based Practice (EBP) in much more detail in other courses so the focus of this presentation is to provide an overview of the benefits, barriers and steps associated with EBP. This information will be useful for determining your informatics topic and developing your EBP paper. We will also explore the informatics contributions to EBP and revisit many of these items in more detail throughout of course.

3. Evidence-Based Practice (EBP)
“Evidence-Based Practice is the explicit, judicious, and conscientious use of current best evidence from health care research in decisions about the care of individuals and populations” (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2002).

4. EBP - Benefits Improve patient outcomes Standardize practice
Strengthen Nursing as a profession and science
Increase patient satisfaction
Reduces liability
Saves health care dollars
Helps providers & facilities meet regulatory requirements

5. EBP- Steps Ask clinically focused questions. (PICO)
Collect the most relevant and best evidence to answer the clinical question. Search the literature.
Critically appraise the evidence that has been collected for its validity, relevance, and applicability.
Integrate the evidence with your own clinical expertise, assessment of the patient’s condition, and available resources. Refine that to meet your patient’s preferences and values.
Evaluate the change resulting from implementing the evidence into practice.

6. EBP - Resistance Ten most common reasons nurses don’t use EBP:
Practice inertia
Satisfied with the ways things are always done
Don’t like change
Organizational politics
Don’t really understand what EBP is all about

7. Inability to understand research findings
EBP - Resistance
Ten most common reasons nurses don’t use EBP (cont.):
Lack skills to find appropriate evidence
Lack of relevant research evidence
Inability to apply findings (personal and/or organizational)
Lack of time to do searches and/or read literature
#1 REASON
Inability to understand research findings

8. EBP – Informatics Contribution
Improving information access to “evidence”
Literature search databases (Medline, PubMed, CINAHL)
Supporting access to information in the clinical setting to improve care and care planning
Referential links with EBP clinical content
Infobuttons (Cimino)
EBP InfoBot (Seckman, Fisher & Demner-Fushman)
Facilitating communication among healthcare team members
and other communication devices
Electronic Medical Record/Electronic Health Record
Personal Health Records

9. EBP – Informatics Contribution
Automating surveillance for real-time error detection and prevention (Alerts)
Allergy notifications, drug-drug or drug-food interactions
Other decision support tools
Supporting and maintaining standardization of practice patterns
Protocols, SOP, Clinical Guidelines
Enhancing educational programs
Internet based learning, simulation, gaming etc.
Supporting research and the generation of knowledge
Tools for data coding and analysis, model building, meta- analysis, qualitative analysis
Dissemination of results ( , internet, posters etc.)

10. Getting Started on your EBP Informatics Paper

11. Asking a Clinical Question
PICO Method:
P = What is your population or setting? Be specific.
I = Identify an intervention of interest related to this group or setting.
C = Compare this with standard treatments (could be no treatment) or a comparison group.
O = What is the intended outcome?
Polit & Beck (2009) p. 46
One way to craft a clinical question is the PICO method. Start by identifying your population or setting. Then identify an intervention (which is your practice, procedure, or instrument/technology) of interest related to this group or setting. Depending on the intervention you may or may not want to do a comparison to a standard treatment. This may also depend on what you find in the literature on the topic. Finally what is the intended outcome for this intervention.
See the next slide for some examples.

12. PICO Examples Example 1: Example 2: P = Pediatric patients (inpatient)
I = Medication barcoding
C = Standard (no barcoding)
O = Decrease medication administration errors
Clinical question: What is the effectiveness of barcoding for decreasing medication errors among hosptialized pediatric patients?
Example 2:
P = Intubated and sedated patients
I = Capnography
C = Standard treatment
O = Therapeutic effect
Clinical question: What is the therapeutic effect of capnography on intubated and sedated patients?

13. Searching the Literature
Use a variety of databases to search your topic
Examples: Medline, PubMed, CINAHL
Do a preliminary search on your topic using specific keywords
If the results are large you need to focus your search
If results are too small then your question may be too narrow or there isn’t any recent literature on the topic
Based on the preliminary search you may need to refine your topic
REMEMBER: Your FINAL topic must be approved by the instructor

14. Locate Research Sources
Start with a Plan!
What databases will be searched
Commonly used databases in nursing:
CINAHL, Medline, PubMed,PsycINFO
CINAHL through library
Medline through library or through web via Pubmed:
What keywords will be used in your search (don’t forget to truncate & use (*))
Where to locate the relevant literature: use titles & abstracts to help you evaluate relevance.
How to store the references
A database is a compilation of citations. The idea of the databases is that you can search multiple journals simultaneously for a keyword, author, or subject.
Once you have your key words and have identified the databases that you are going to use, you use the key words to search the databases.
The next task is to evaluate the references for relevance. NOT ALL of the citations that come up during a search will be relevant and in many cases – even if they were all relevant, there may be too many.
To sort for relevance, start with the title - if it seems potentially relevant, you will want to look at the abstract if it’s available to further evaluate relevance. Many of the databases include abstracts from the research papers.
Don’t forget to save your references – don’t do it at the end!
A word about google – google and google scholar are useful for finding some of the sources that are out there. However searching google is not considered scholarly work and the searching that you do for your literature review must be done within one or more of these databases that contain scholarly sources.
NO WIKIPEDIA 14

15. Performing Complex Searches
Combine two or more keywords you have used to conduct simple searches to make your search more inclusive or more specific .
In CINAHL & Medline
or allows a more inclusive search than searching each term individually.
and provides a more specific search by combining keywords
not allows excluding concepts that are not of interest.
After locating relevant sources in a preliminary search, you are ready to make more complex searches. Select the keywords you have used to perform simple searches
And use the or, and, not terms to combine those terms. This can make your search more inclusive or else more specific. 15

16. Complex Search Examples
or example: cardiac or coronary or heart or myocardial returns articles with any one of these terms which may be used interchangeably.
and example: depression and risk reduction behaviors. Because both terms include many citations individually, combining the terms in a single search focuses the results.
not example: anxiety is often included in research about depression but may not be of interest. By entering depression not anxiety, you limit the search to those articles that relate solely to depression. 16

17. Limiting a Search Some searches will result in thousands of hits
To reduce number of hits while increasing the relevance of citations, try the following strategies:
Limit to English language
Limit the publication dates to recent years
Limit to peer-reviewed
Limit to papers that are research
Limit to full-text articles (this can be risky)
Note: Medline will not automatically limit to peer-reviewed so you will need to check those sources directly. The journal homepage will indicate whether their articles are peer-reviewed. 17 17

18. Types of Sources
Primary sources are written by the person who generated the ideas published
In research, written by the person(s) who conducted the research
In theory, written by the theorist who developed the theory
Secondary sources paraphrase the works of researchers and theorists
Someone else’s interpretation of a primary source i.e. books, book chapters, review articles etc.
Provides reference lists of primary sources and may present good ideas
Prone to bias and misinterpretation
The important distinction here is that in primary sources the only interpretations in a primary source belong to the researcher(s).
A secondary source is someone else’s interpretation of a primary source. Common secondary sources include books, book chapters, and review articles.
Secondary sources are useful in the research process because they provide reference lists composed of primary sources and may also present good ideas.
However, the reason that we place so much importance on reading the primary sources is because secondary sources that synthesize and interpret research done by others, are more prone to bias and misinterpretation than primary sources. 18

19. Recording Search Information
DOCUMENT YOUR SEARCH
List each keyword (or combinations of keywords) used in a search and include:
Name of the database
Date of the search
Search strategy (the database will record this with the search if prompted to do so)
Number of articles found in the search
Number of relevant articles found & approach for deciding relevance
Author(s) name
Limits applied
Often useful to save this in a table (See Database Search Form)
It is very important that you document your search. There is a form on Blackboard for you to record your search strategy. This information will be helpful in writing the Methods section of your EBP paper. 19