1. Finding, Evaluating, and Presenting Evidence Sharon E. Lock, PhD, ARNP NUR 603 Spring, 2001

2. Sources of Knowledge Intuition Trial and error Tradition Authority Experience Scientific

3. 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”

4. 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.

5. Types of Research Studies Single research studies Randomized Controlled Trials (RCT’s) Descriptive studies Evidence summaries Systematic reviews Meta-analysis Integrative reviews

6. 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

7. Verschuere, 1999 Formulate question to guide search Break question down into searchable components PICO formula Patient population/problem Intervention or exposure Comparison Outcome

8. 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

9. 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

10. Nicoll & Beyea, 2000 Evaluating info on the internet Are you PLEASED with the site? Purpose Links Editorial Author Site Ethical Dates

11. Evaluating evidence Who is qualified to judge? Clinical experts Methodology experts Other stakeholders

12. 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

13. Strength of evidence: Bradford-Hill Criteria for Causation Temporality Strength Dose-response Reversibility Consistency Biologic plausibility Specificity Analogy

14. Presenting Evidence to the Patient

15. The patient has a choice

16. Gray, 1997 ProviderPatient The last patient Experience Litigation Education Resources Audit Evidence Other professionals The media Resources Friends & relatives Evidence

17. Gray, 1997 Elements of face-to-face decision- making Information given by nurse Interpretation by patient Discussion between nurse and patient

18. 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

19. 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

20. Gray, 1997 Discussion between patient & nurse Nurse/patient relationship How evidence is presented Confidence demonstrated by nurse Time