RNSG 1413: Foundations for Nursing Practice: Evidence Based Medicine

You would have to read 628 hours a month to keep up with all of the new research.

Research is constantly being done to help improve all aspects of health care, whether it be patient care, care of the family, or improving the workplace environment, but it doesn’t always get used. This is where Evidence Based Practice can help.

Evidence Based Practice helps  to ensure that we are using the best information possible to care for our patients or improve the workplace.

Evidence Based Research always starts with a question.

To formulate a good question, use the letters PICO as a guide.

P = Patient/Problem/Population - Usually describe relevant demographics of the patient, problem or population (Sex, age, specific problem, location)

I = Intervention - What is the intervention - test/medication/therapy

C = Comparison - Is there an alternative  (Optional, you may not have something to compare it to) 

O = Outcome - What is the desired outcome/accomplishment/effect

Example:  In a patient in the second stage of labor who has received an epidural analgesia, does left or right lateral patient positioning versus lithotomy position decrease assisted vaginal deliveries?

Evidence Pyramid

http://rubydeubry.com/health-glossary/clinical-evidence/

What kind of sources can be used as Evidence Based  Practice?

Evidence can be found in all types of sources: journals, books, websites, etc…But there are different levels of evidence.  There is very strong evidence and then there is very weak evidence, with different levels in between.  When making a decision, you want to try and find the best evidence that you can.  Best is a strong study that was not biased and looked at a large amount of data. Weaker evidence may be taken from research that looked at only one person (case study) or research that was conducted with a small limited amount of data, more probability of bias etc..

Evidence Based Research begins with a question.  It could be an intervention, work place issue, etc...

• Then you look for what evidence exists to answer this question.
• Evidence Based articles shows that an intervention, pratice, program, etc... has been prove to be effective or ineffective or needs more information based on strong rigorous research. 
• There are different levels of evidence.  You want the best evidence that you can find.

Strong Evidence (If done well):

• Systematic Review:  Not original research. Researchers try to answer a question by searching through the databases to find studies that have already been done on this topic.  Summarize all of the research and comes up with a conclusion.  (Searches the databases systematically, hence the name Systematic Review)
• Meta-Analysis: Same as a systematic review, except they put all of the studies together like one big study and then use statistics to analyze it.
• Randomized Controlled Trial:  Study with a control group and an experimental group.  If blinded, that means that the participant and researcher do not know which group is which. Randomized means participants were placed randomly into control or experimental group.

Weaker Evidence (Weak due to possible bias or other issues)

• Cohort Study:  Follow 2 groups.  One has been diagnosed, treated, or exposed to something and the other group of similar people has not.  They follow them through time to see what happens.
• Case Control Study:  Interested in knowing why a group has a certain outcome and another group does not.  Begins looking back to see what the group had in common.
• Critically Appraised Topic:  Evaluate and analyze multiple research studies on a topic.