1. Nursing Orientation 2014 Sandra A. Martin, M.L.I.S. Instructor of Library Services Health Sciences Resource Coordinator John Vaughan Library Room 305B marti004@nsuok.edumarti004@nsuok.edu – 918-444-3263 1

2. Knowledge is the Enemy of Disease Sir Muir Gray Existing Knowledge Can Prevent – Waste & Errors – Poor Patient Experience – Adoption of low value interventions – Failure to adopt high value interventions 2

3. Sandra Martin Provides…. Instruction Research Assistance Small Group Consulting Database Searches Collection Development (Selection of print and online books, audiovisuals, journals and databases) Assistance with any health-related information need Office Hours: Tuesday 10 am to 4 pm – Tahlequah 3

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5. From the NSU Libraries Home Page 5

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7. http://library.nsuok.edu/collegesh/healthpr/nursing/index.html 7

8. Remote Access Enter NT-NSU user id and password to access the library’s electronic resources Contact your instructor if you have problems with your user id or password Contact Sandra to report other technical problems or for search assistance 8

9. Interlibrary Loan/Document Delivery Services  Delivery of journal articles, books, and other items not owned by the library  Delivery of books, audiovisuals, and journal articles in the library’s print collection  Journal articles delivered electronically if possible ILL Requests  Click on Interlibrary Loan link from Nursing Web Page  Complete and submit the online registration form  Complete the online request form  Provide complete information about the journal article or book that you need. Indicate your status as a “distance ed Nursing student” and provide your contact information If you have questions or need assistance, contact:  Donna Graham – x3243 – grahamdg@nsuok.edugrahamdg@nsuok.edu

10. Learning Objectives To provide a mechanism for nursing students to access the most current nursing and health care information To familiarize nursing students with specific information resources and services to support the nursing curriculum To familiarize nursing students with evidence- based nursing and lifelong learning skills 10

11. Overview of Online Resources Research and Clinical Databases e-Journals e-Books Consumer Health Evidence-Based Information Retrieval 11

12. Journal Article Databases CINAHL Plus w/Full Text, Nursing@Ovid, and Mosby’s Nursing Consult are most frequently used resources to find journal articles on nursing topics. Search this section when you need articles on subjects, e.g., electronic medical record, nursing education, pressure ulcer, etc. Databases in this section provide links to full text journal articles and other resources You must start at the library’s Nursing web page to access our subscribed full text http://library.nsuok.edu/collegesh/healthpr/nursing/index.html http://library.nsuok.edu/collegesh/healthpr/nursing/index.html 12

13. Databases – Nursing@Ovid Comprehensive, integrated Nursing and Allied Health portal with full text from 1950 to the current week Content includes nursing practice, education, research, and administration Based on the nursing and allied health subset of Ovid MEDLINE Ovid Nursing Subject Thesaurus provides search terms included in MeSH (medical subject headings) as well as those unique to nursing Link to Tutorial from Nursing Library Page 13

14. Databases - CINAHL Plus w/Full Text CINAHL stands for Cumulative Index to Nursing and Allied Health Literature Core research tool that contains full text of hundreds of nursing and allied health journals Use “CINAHL Headings” to search topics for best results, e.g., search “mentorship” to find articles on “mentoring” Follow links on Nursing Library Web Page for Basic and Advanced Tutorials to get started 14

15. Databases – Mosby’s Nursing Consult All in one resource provides full text of e-Journals, e- Books, drug monographs, and patient education handouts Unique features include full text evidence-based nursing care sheets and pre-searches of popular health topics for nursing and allied health Widely used in major hospitals and medical centers Link to Tutorial from Nursing Library Page 15

16. Databases - MEDLINE Premier biomedical database from the National Library of Medicine Provides journal articles from 1946 to present in medicine, nursing, health care system, and allied health care practice, education, and research Link to Tutorial from Nursing Library Page 16

17. Databases – Science Direct Scientific database produced by Elsevier Provides journal articles from over 2,500 journals and chapters from almost 20,000 books in all life sciences disciplines Contains full text of nursing journals not found in Ovid or CINAHL Plus w/Full Text 17

18. Additional Research Databases Health and Psychosocial Instruments – assists researchers in identifying tests, questionnaires, rating scales in health and psychosocial sciences. Does not include full text of the instruments National Library of Medicine – provides access to hundreds of databases covering a wide range of biomedical information resources Native Health Databases – contains citations and abstracts of documents pertaining to the health care of North American indigenous peoples 18

19. Tracking Down the Full Text If your database search does not provide a link to full text of a relevant article:  Print a list of the citations  Click on the Library e-Journals link on the Library’s Nursing web page  Enter full title of the journal  Click on link to database that contains the full text 19

20. e-Books R2 Digital Library – Nursing and allied health books from Doody’s Core Titles in the Health Sciences Books@Ovid - full text of nursing and health sciences books published by Lippincott Williams & Wilkins, American Nurses Association, Joanna Briggs Institute, Jones-Bartlett, and Springer Publishing Mosby’s Nursing Consult – full text of nursing books and handbooks published by Elsevier Access Medicine - text of leading medical and health sciences books from McGraw-Hill Mosby’s and Access Medicine contain full text monographs for the health care professional and the patient of all FDA approved drugs 20

21. Consumer Health Resources Current, authoritative, peer-reviewed, and evidence- based resources written specifically for the layperson MEDLINEPlus – the National Institutes of Health’s web site for patients and families Joanna Briggs Database - provides full text consumer information sheets Mosby’s Nursing Consult - includes patient education handouts produced by Elsevier Access Medicine – contains patient education materials for adults and children and includes handouts for drugs and medicines 21

22. Match Resource to Information Need What is the question? How will information be used? 22

23. Background vs. Foreground Questions Asking questions about your proposed topic helps to clarify your knowledge gap Clarifying type of question helps to determine which sources are most likely to have the answers you need 23

24. Background Questions Generally ask who, what, why, where or how about a single concept 24

25. Proposed Research Projects Evaluate the effectiveness of nursing residency programs Use of mentoring in nursing education to improve retention of nursing faculty 25

26. Background Questions What are methods of evaluating nursing residency programs? How do mentoring relationships clarify roles experienced by novice nursing faculty? 26

27. Answers to Background Questions Require general knowledge of concepts and processes Resources:  Nursing@Ovid  CINAHL Plus w/Full Text  e-Book Collections  Print Books 27

28. Information Retrieval to conduct Research Comprehensive in scope and time  All levels of resources  Current and Retrospective  Background and Foreground Information 28

29. Foreground Questions Usually compare two or more concepts – theories, drugs, treatments, tests, harms or benefits of two approaches 29

30. Answers to Foreground Questions Require precise information about complex issues Sources should provide current, original clinical research data  Evidence-based resources – begin search at the top levels of the 4S Hierarchy 30

31. Evidence Based Databases – Critically Appraised Decision Support Tools DynaMed – Expert summaries for over 3,000 topics to answer clinical questions at point of care. Based on studies evaluated for clinical relevance and validity. Updated daily Cochrane Systematic Reviews – Over 900 full text reviews of research studies based on specific quality criteria and produced by the Cochrane Collaboration, an international network of researchers Joanna Briggs Institute – International research organization provides full text of expert summaries, best practice information sheets, systematic reviews, and consumer information sheets 31

32. Information Retrieval for Evidence Based Nursing Care Using research findings versus conducting research Retrieving and evaluating information that has direct application to specific patient care problems Selecting resources that are current, valid and available at point-of-care Developing search strategies that are feasible within time constraints of clinical practice

33. Hierarchy of Evidence-Based Resources Evidence Based Summaries: Dynamed, Joanna Briggs Joanna Briggs, Mosby’s Nursing Consult Cochrane and Joanna Briggs Systematic Reviews Nursing@Ovid, CINAHL Plus with Full Text, MEDLINE SOURCE: Haynes, R. B. (2001). Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding current best evidence. Evidence-Based Medicine, 6 (2), 36-38. Retrieved 2-07-07 from http://ebm.bmj.com/cgi/reprint/6/2/36 http://ebm.bmj.com/cgi/reprint/6/2/36

34. Critically Appraised Content

35. Appraisal Required by User

36. www.cebm.net “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values” Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2. Patient Concerns Clinical Expertise Best research evidence EBM What is EBM?

37. EBM Process – 5 Steps 1. ASSESS - Begin with the patient encounter 2. ASK - clinical questions that address important patient problems 3. ACQUIRE - the best evidence to answer the questions (Use 4S Approach) 4. APPRAISE - Evaluate the evidence for validity, importance, and usefulness 5. APPLY - Does the evidence “fit” your patient’s specific problems and needs? Practice the EBM process in daily patient encounters

38. Integration of Clinical Research into Patient Care Process

39. Information Retrieval to Answer Clinical Questions Requires New Skills Clinical question formulation Search and retrieval of best evidence Critical appraisal of study methods

40. Clinical Questions Four common types:  Therapy/prevention  Diagnosis  Etiology  Prognosis

41. Answerable Questions Select Questions That:  Are most important to the patient’s well being  Fill gaps in your clinical knowledge  Are feasible to answer in the time available

42. Is All Evidence Created Equal? Small portion of medical literature is immediately useful to answer clinical questions Understanding “wedge or pyramid of evidence” is helpful in finding highest level of evidence High levels of evidence may not exist for all questions due to nature of medical problems and research limitations

43. As you move up the pyramid the amount of available literature decreases, but it increases in its relevance to the clinical setting. Source: Sackett, D.L., Richardson, W.S., Rosenberg, W.M.C., & Haynes, R.B. (1996). Evidence-Based Medicine: How to practice and teach EBM. London: Churchill-Livingstone.

44. Evidence Based Retrieval Find the answer that is supported by valid studies appropriate to the type of question and that is available in a timely manner Requires search terms plus best study design for question plus highest level of evidence

45. Therapy/Prevention Question 1. Are drug regimens effective in managing or preventing chemotherapy-induced nausea or vomiting in cancer patients? 2. Are foam overlays versus standard hospital foam mattresses effective in preventing pressure ulcers? 3. Find the answer that is supported by valid studies, appropriate to the type of question, and that is available in a timely manner.

46. 1. Possible Search Terms Chemotherapy, nausea, vomiting Pressure ulcer, foam, overlay, mattress

47. 2. Best Study Design for Type of Question Type of QuestionStudy Design Therapy/preventionRandomized controlled trials DiagnosisProspective cohort, blind comparison to a gold standard PrognosisCohort, Case Control, Case Series Etiology/HarmCohort, Case Control, Case Series

48. 3. Begin Search at Top Level of Evidence

49. Dynamed Summaries for more than 3,000 topics Monitors >500 medical journals and systematic review databases Updated daily Each article evaluated for clinical relevance and scientific validity Recommendations labeled with Levels of Evidence 49

50. Joanna Briggs Institute (JBI) an international, not-for-profit research organization at the University of Adelaide collaborates internationally with over 70 entities to promote synthesis and transfer of evidence contributes to improving health care outcomes by supporting evidence-based practice 50

51. JBI Database Evidence Summaries – literature reviews that summarize existing literature on common health care problems Evidence-Based Recommended Practices – procedures that recommend practice on clinical topics Best Practice Information Sheets – guidelines produced for practicing health care professionals Systematic Reviews – comprehensive reviews of international research literature Consumer Information Sheets – summaries designed for patients, clients, and care providers Updated weekly 51

52. Mosby’s Evidence Based Monographs concise reviews of current evidence specific recommendations for nursing care include levels of evidence useful for evidence-based care plans teach staff links between evidence and practice 52

53. Cochrane Database of Systematic Reviews Part of the Cochrane Library (1996) 916 completed reviews, 1905 protocols Among the highest level of evidence upon which to base treatment decisions – the Gold Standard Includes Dx since 2008 Access through OVID 53

54. Systematic Review Analyzes data from several primary studies to answer a specific clinical question Provides search strategies and resources used to locate studies Includes specific inclusion and exclusion criteria (results in less bias) Meta-Analysis (subclass) statistically summarizes results of several individual studies Access Joanna Briggs and Cochrane Systematic Reviews through Ovid 54

55. Life-Long Learning Selecting and searching online databases is challenging Information is ever changing Contact Sandra (email preferred) 55

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57. Nursing Orientation 2014 Sandra A. Martin, M.L.I.S. Instructor of Library Services Health Sciences Resource Coordinator John Vaughan Library Room 305B marti004@nsuok.edumarti004@nsuok.edu – 918-444-3263 57