finding, evaluating, and presenting evidence sharon e. lock, phd, arnp nur 603 spring, 2001
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Finding, Evaluating, and Presenting Evidence
Sharon E. Lock, PhD, ARNP
NUR 603
Spring, 2001
Sources of Knowledge
Intuition Trial and error Tradition Authority Experience Scientific
Stevens & Ledbetter, 2000, p. 91
Sources of knowledge
“…not all sources of knowledge are highly reliable, nor when applied do they consistently produce desired outcomes.”
“Experience, although a good teacher, results in conclusions about care that contain bias”
Stevens & Ledbetter, 1999, p. 92
Scientific Approach
Research evidence provides a scientific basis for nursing practice.
A scientific approach to clinical decision-making results in a “practice with known cause and effect and predictable outcomes.
Types of Research Studies
Single research studies• Randomized Controlled Trials (RCT’s)• Descriptive studies
Evidence summaries• Systematic reviews• Meta-analysis• Integrative reviews
Finding Evidence
What counts as evidence?• RCT’s• Systematic reviews• Meta-analysis• Quasi-experimental• Prospective cohort studies• Case-control studies• Cross-sectional surveys• Correlational studies• Qualitative studies
Retrospective vs. Prospective
Verschuere, 1999
Formulate question to guide search
Break question down into searchable components
PICO formula• Patient population/problem• Intervention or exposure• Comparison• Outcome
Retrieve relevant evidence effectively
Textbook Journal Bibliographic database (MEDLIBE, CINAHL) Evidence-based journal series Systematic reviews (Cochrane Library, STTI Online Journal) Evidence-based clinical practice guidelines
• AHRQ• National Guideline Clearinghouse• U. S. Preventive Services task Force
Internet
Harris, 2000
Designs that produce the best evidence
Treatment (interventions)– RCT’s– Systematic reviews– Meta-analyses
Diagnosis (screening & assessment)– Positive & negative ratios of diagnostic tests
Prognosis (nature of the disease)– Prospective cohort studies
Causation (risk or harm)– Cohort studies– Case-control studies
Nicoll & Beyea, 2000
Evaluating info on the internet
Are you PLEASED with the site?• Purpose• Links• Editorial• Author• Site• Ethical• Dates
Evaluating evidence
Who is qualified to judge?• Clinical experts• Methodology experts• Other stakeholders
Lohr & Carey, 1999
Variables thought to affect quality of evidence
Sample selection Randomization Blinding Sample size Description of
intervention
Outcomes Length of follow-up Attrition Confounding variables Statistical analysis
Strength of evidence:Bradford-Hill Criteria for Causation
Temporality Strength Dose-response Reversibility Consistency Biologic plausibility Specificity Analogy
Presenting Evidence to the Patient
The patient has a choice
Gray, 1997
ProviderProvider PatienPatientt
The last patientThe last patient
ExperienceExperience
LitigationLitigation
EducationEducation
ResourcesResources
AuditAudit EvidenceEvidence
Other professionalsOther professionals
The mediaThe media
ResourcesResources
Friends & relativesFriends & relatives
EvidenceEvidence
Gray, 1997
Elements of face-to-face decision-making
Information given by nurse Interpretation by patient Discussion between nurse and patient
Gray, 1997
Providing information
Finding research evidence Systematic appraisal
• Probability that pt will benefit• magnitude of benefit• probability that pt will have adverse effects of
intervention• magnitude of adverse effects
Gray, 1997
Patient Interpretation
Pt may need time to think Educational pamphlets Pt will interpret in two ways
• How evidence appears to him/her• How outcome of intervention correlates with his/her
values
Gray, 1997
Discussion between patient & nurse
Nurse/patient relationship How evidence is presented Confidence demonstrated by nurse Time
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