Hit the Web to help guide your practice


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Today's emphasis on evidence-based practice (EBP) has evolved from our desire to provide the best possible care to patients based on sound research. With EBP, clinical decisions are made using the available research evidence, clinical expertise and experience, and patient preferences. For this process to be effective, nurses need to know how to find credible evidence and decide on its relevance for their patients and setting.Despite this, nurses don't seem inclined to go to the literature or seek evidence from reputable sources when they have questions about patient care. Instead, they base their clinical decisions on their own experiences or ask other nurses for advice.1-3 Colleagues consulted may be experts in clinical practice who are aware of the current evidence.4 However, it may be instead that nurses consult with their friends in the unit or other nurses available at the time when a question arises. These individuals may not know what's best practice based on the evidence.What to doThe first step in finding evidence is to identify the clinical question or problem for which more information is needed. This step is important as it guides you in searching for evidence to answer that question. Next, find evidence that answers it. In some cases there may be sufficient research done on a topic for experts to synthesize the findings.The best evidence you can find is from a meta-analysis or other type of systematic review. A systematic review takes research studies that answer the same question and combines them. A meta-analysis is a type of systematic review that uses statistical methods to combine and summarize the results of randomized controlled trials.5 It strengthens the evidence so you can be more confident about its implications for your clinical practice.When searching for evidence, look for systematic reviews such as those produced by the Cochrane Collaboration. The Cochrane Collaboration produces systematic reviews and other types of evidence reports. Cochrane reviews examine various studies and use a rigorous method for identifying, critiqu-ing, and synthesizing them.6 To get a full Cochrane review, you need a subscription to the Cochrane Library. However, abstracts of the systematic reviews are free; these can be searched by topic and by keywords. Based on the results, you'll find a number of systematic reviews that might be useful.Systematic reviews are also available through other sources. You can find them by using PubMed's Clinical Queries, which provides access to Medline, and the National Library of Medicine's bibliographic database with articles and other resources in medicine, nursing, and other life sciences. PubMed also provides evidence summaries and reviews of the literature—these don't provide as strong a level of evidence as a systematic review, but are useful because they summarize the current state of knowledge, including what's known and unknown.7 They also provide a starting point for answering your questions without having to find individual articles and critiquing them.Additional resourcesIn addition to these resources, there are many Web sites for finding systematic reviews, evidence summaries, clinical practice guidelines, critiques of clinical research studies, literature reviews, and tools for implementing EBP. Evidence reports are available through the Agency for Healthcare Research and Quality and their associated Web sites. If you're looking for evidence-based clinical practice guidelines, you can search for them at the National Guideline Clearinghouse Web site (http://www.guideline.gov). When using the Web to find EBP resources, search beyond the United States because there are many valuable Web sites from other countries.

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