1. MSN 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 By Appointment: Thursday 1 pm to 5 pm - Muskogee 3

4. http://library.nsuok.edu/collegesh/healthpr/nursing/index.html 4

5. From the NSU Libraries Home Page 5

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7. 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 7

8. 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 MSN student” and provide your contact information If you have questions or need assistance, contact:  Donna Graham – x3243 – grahamdg@nsuok.edugrahamdg@nsuok.edu

9. 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 9

10. Overview of Online Resources Research and Clinical Databases e-Journals e-Books Consumer Health Instruction 10

11. 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 11

12. 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 Follow links on Nursing Library Web Page for Basic and Advanced Tutorials to get started 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 – 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 14

15. 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 fields Link to Tutorial from Nursing Library Page 15

16. 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 16

17. 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 17

18. Consumer Health Resources MEDLINE Plus Joanna Briggs Database Mosby’s Nursing Consult Current, authoritative, peer-reviewed, evidence-based 18

19. 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 19

20. 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

21. Integration of Clinical Research into Patient Care Process

22. 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

23. 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?

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

25. 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

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

27. 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

28. 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.

29. Evidence Based Health Care “Integrating the best scientific evidence into the context of clinical care”. Steps  Defining a clinical question  Identifying the best available scientific evidence to answer the question Search Terms + Study Type + Level of Evidence  Deciding on the most appropriate course of action for a given patient

30. 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

31. Therapy/Prevention Question 1. Are drug regimens effective in managing or preventing chemotherapy-induced nausea or vomiting in cancer patients? 2. Find the answer that is supported by valid studies, appropriate to the type of question, and that is available in a timely manner.

32. 1. Possible Search Terms Chemotherapy, nausea, vomiting

33. 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

34. 3. Begin Search at Top Level of Evidence

35. Hierarchy of Evidence-Based Resources 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

36. Critically Appraised Content

37. Appraisal Required by User

38. 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 38

39. 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 39

40. 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 40

41. 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 41

42. 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 42

43. 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 43

44. Life-Long Learning Selecting and searching online databases is challenging Information is ever changing Contact Sandra (email preferred) 44

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46. MSN 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 46