NUR 339 Research in Healthcare  

Research in nursing encompasses using many resources as well as understanding the types of research/publications available, where to find them, and how to evaluate them. It also involves a working understanding of theoretical and conceptual frameworks as the concept of evidence-based practice.

Evidence-based medicine is the "conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients" (Sackett, DL, Rosenberg WM, Gray JA, et al. BMJ. 1996 312(7023):71-2).

EBM Pyramid and EBM Page Generator, copyright 2006 Trustees of Dartmouth College and Yale University. All Rights Reserved. Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang.

Five Steps in Evidence-Based Practice
 1. Develop clinical question
 2. Search and retrieve relevant literature.
 3. Read and evaluate literature.
 4. Apply the information gained to your healthcare setting.
 5. Re-evaluate results of application of evidence.

This guide will mostly concentrate on helping with the first three steps of evidence-based practice, but will also highlight finding theory-related articles.

Electronic Resources

Evidence-Based Practice in Nursing -

Brief Description: Provides information about evidence-based practice in nursing and finding appropriate resources for nursing questions.

PICO Flow Chart

Richardson, WS. et al. "The well-built clinical question: a key to evidence-based decisions." ACP-Journal Club 123 (Nov-Dec 1995): A12.

*This editorial provides an easily readable explanation to developing clinical questions. Available in full text.

Print Resources

Melnyk, Bernadette Mazurek, and Ellen Fineout-Overholt. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. Lippincott, Williams & Wilkins, c2005. (Science Reference RT42 .M44 2005)

Straus, Sharon E., et al. Evidence-Based Medicine: How to Practice and Teach EBM, 3rd ed. Elsevier Churchill Livingstone, 2005. (Science Reference R723.7 .E954 2005)

Referring to the evidence pyramid above, it is usually advisable to start from the top and work down to the wide base of the pyramid. Filtered resources appraise the quality of studies and often make recommendations for practice.

Systematic Reviews/Meta Analyses

Authors of a systematic review ask a specific clinical question, perform a comprehensive literature search, eliminate the poorly done studies and attempt to make practice recommendations based on the well-done studies. A meta analysis is a systematic review that combines all the results of all the studies into a single statistical analysis of results.

Cochrane Database of Systematic Reviews -

Brief Description: The Cochrane Database of Systematic Reviews includes the full text of the regularly updated systematic reviews of the effects of healthcare prepared by The Cochrane Collaboration.

CINAHL (EBSCO) -

Call Number: Reference Z6675.N7 C8 Coverage: 1981 to present Brief Description: Provides monthly updated indexing of more than 2,900 journals in the fields of nursing and allied health and publications from the American Nurses' Association and the National League of Nursing, covering 1981 to present. Other IPFW Formats: IPFW library owns the printed index 1956-1997.

Search for systematic reviews specifically in CINAHL by using the "Publication Type" limiter. To search for meta analyses, combine your search with the subject heading "Meta Analysis."

Medline (Ovid) -

Coverage: 1950 to present Brief Description: Produced by the National Library of Medicine, Medline indexes over 4,600 national and international journals covering all areas of medicine, 1950 to present.

Search for systematic reviews in MEDLINE by using the limiter of "Subject Subsets." Choose "Systematic Reviews" to limit a relevant search. To find meta analyses, use the "Publication Type" limiter and choose Meta Analysis to limit a relevant search.

Critically Appraised Topics

Authors of critically-appraised topics evaluate and synthesize multiple research studies.

National Guideline Clearinghouse

A comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Health Care Research and Quality, in partnership with the American Medical Association and the American Association of Health Plans. Guideline evidence ranges from expert opinion to high levels of evidence.

Critically-Appraised Individual Articles

Authors of critically-appraised individual articles evaluate and synopsize individual research studies.

ACP-Journal Club -

Coverage: 1991 to the present Brief Description: This database includes bibliographic records from two journals that publish enhanced abstracts of relevant and sound clinical studies.

Bandolier

Bandolier is an independent journal about evidence-based healthcare published in the UK. It includes "information about evidence of effectiveness (or lack of it), and put[s] the results forward as simple bullet points of those things that worked and those that did not: a bandolier with bullets. Information comes from systematic reviews, meta-analyses, randomised trials, and from high quality observational studies."

"Evidence-Based..." Journal series

(e.g., Evidence-Based Medicine, Evidence-Based Mental Health, Evidence-Based Nursing) Primary research articles within the discipline are selected for quality and clinical relevance. A structured abstract and expert commentary are provided for each study. Check E-Journal Finder to find these journals. Type in "evidence" as a "begins with term" to find them.

Evidence is not always available via filtered resources. Searching the primary literature may be required. It is possible to use MEDLINE and other databases to achieve the highest possible level of evidence.

CINAHL (EBSCO)

EMBASE -

Coverage: 1975 to present Brief Description: Indexes more than 3,500 international scholarly journals covering drug research, pharmacology, pharmaceutics, toxicology, clinical and experimental human medicine, health policy and management, public health, occupational health, environmental health, drug dependence and abuse, psychiatry, forensic medicine, and biomedical engineering/instrumentation.

Medline (Ovid)

PsycINFO -

Call Number: Storage BF1. P65 Coverage: 1887 to present Brief Description: An international database treating psychology and related disciplines such as social work, psychiatry, pharmacology, medicine, nursing, education, law, linguistics and business. Other IPFW Formats: IPFW library owns the printed Psychological Abstracts 1927-1992 Tools Available: An online list of journals indexed is available.

Harrison's Principles of Internal Medicine -

Call Number: Science Reference RC46 .H333 2005 Brief Description: Harrison's Principles of Internal Medicine is a classic textbook providing expert information on internal medicine for both the student and practitioner. Other IPFW Formats: IPFW library owns the 2005 (16th) edition.

There are resources available that can help you evaluate information to determine its appropriateness to the clinical question at hand.

Critical Appraisal Worksheet

Greenhalgh, Trisha. How to Read a Paper: The Basics of Evidence Based Medicine, 2nd ed. BJM Books, 2001. (Science Reference R118.6 .G77 2001)

Jordan, Theresa J. Understanding Medical Information: A User's Guide to Informatics and Decision-making. McGraw-Hill, 2002. (Science Reference R858 .J67 2002)

One important fact to remember is that many original nursing theorist articles were written many years ago. Their age does not invalidate their significance. Some original works were published in books, while others were published in journals. Keep this in mind if you need original articles. Below details finding articles that are based on a particular theory or framework.

CINAHL

"Nursing Theory" and "Theoretical Nursing Models" are both subject headings in CINAHL. Additionally, several well-known nursing theories/conceptual models are subject headings in CINAHL. This includes Leininger's Theory of Culture Care Diversity and Universality, Neuman Systems Model, Peplau Interpersonal Relations Model, and Roy Adaptation Model. Combine these subject headings with the topic of your search to find articles that talk about a topic in relation to a theory. Unfortunately, theories may be mentioned in the full text of an article without getting assigned to the article as a subject heading. Since CINAHL is not searching the full text of the article, a search does not find these articles. To search full text of articles for mentions of theories or frameworks, try searching Journals@Ovid.

Medline (Ovid)

Subject headings relevant to nursing theory in Medline include "Nursing Models," "Theoretical Models," and "Nursing Theory." Specific theories and models should be searched as keywords.

Web Sites for Nursing Theory

Cardinal Stritch University Library: Nursing Theorists Overview

Hahn School of Nursing and Health Science: The Nursing Theory Page

Mayo Clinic: Nursing Theorists

The most frequently recommended style guide for nursing is the Publication Manual of the American Psychological Association (sometimes referred to as the APA style guide). APA's Web site presents examples of Electronic Reference Formats Recommended by the American Psychological Association.