1. #1 Construct your question #2 Track down the best evidence #3 Critically appraise the evidence #4 Integrate with clinical expertise and patient considerations #5 Evaluate

2. Evidence-Based practice is… The acknowledgement of uncertainty followed by the seeking, appraising, and implementation of new knowledge.

3. “Evidence based nursing involves the application of best research evidence in clinical decision making. The best research evidence can be quantitative or qualitative depending on the question asked.” DiCenso, Guyatt, and Ciliska, 2005

4. Time

5. © 2010 Lippincott Williams & Wilkins, Inc. Published by Lippincott Williams & Wilkins, Inc.2 TABLE. Evidence-Based Practice, Step by Step: Searching for the Evidence. Stillwell, Susan; DNP, RN; Fineout-Overholt, Ellen; PhD, RN; FNAP, FAAN; Melnyk, Bernadette; Mazurek PhD, RN; PMHNP, FNAP; Williamson, Kathleen; PhD, RN AJN, American Journal of Nursing. 110(5):41-47, May 2010. DOI: 10.1097/01.NAJ.0000372071.24134.7e TABLE. Hierarchy of Evidence for Intervention Studies 2

6. © 2010 Lippincott Williams & Wilkins, Inc. Published by Lippincott Williams & Wilkins, Inc.2 TABLE. Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice. Stillwell, Susan; DNP, RN; Fineout-Overholt, Ellen; PhD, RN; FNAP, FAAN; Melnyk, Bernadette; Mazurek PhD, RN; PMHNP, FNAP; Williamson, Kathleen; PhD, RN AJN, American Journal of Nursing. 110(3):58-61, March 2010. DOI: 10.1097/01.NAJ.0000368959.11129.79 TABLE. Templates and Definitions for PICOT Questions 5, 6

7. Sometimes for nursing clinical questions… P Population, Patient S Situation

8. Systems Evidence Based Summaries UpToDate, PIER, MDConsult,Joanna Briggs Institute, National Guideline Clearinghouse, Evidence Based Journal Abstracts journals such as Evidence-Based Nursing, Evidence-Based Medicine, ACP Journal Club; Database of Abstracts of Reviews of Effects Systematic Reviews Cochrane Database of Systematic Reviews, PubMed Clinical Queries, and databases below using the “limits” feature Find Original Studies in CINAHL, PubMed/Medline, PsycINFO, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov Integrated computerized decision support systems found in specialized/highly automated departments Finding the best current evidence based on Haynes “5S” levels of organization of evidence from healthcare research* *Brian Haynes. Of Studies, syntheses, synopses, summaries, and systems: the “5S” evolution of information services for evidence-based healthcare decisions. Evid Based Nurs 2007;10;6-7

9. Resources for finding the evidence... Cochrane Database of Systematic Reviews PubMed Clinical Queries UpToDate, MDConsult, PIER Evidence-Based Abstraction Journals Practice Guidelines Limiters in CINAHL and Medline Nursing Reference Center Evidence Based Care Sheets and Quick Lessons

10. Medline 1966CINAHL 1983 PubMed Clinical Queries 1996 Archie Cochrane’s criticism 1972 Cochrane Collaboration debuts 1992 UpToDate 2001 Nursing Reference Center 2007 Cochrane Library CDSR 1996 PIER 2003 Evidence Based Nursing Journal 1998 Joanna Briggs Institute 1996