Laura Banfield, Nursing Librarian Health Sciences Library

1. Introduction to Evidence-Informed Decision Making (EIDM) Laura Banfield, Nursing Librarian Health Sciences Library September 2010

2. Learning Objectives Review the definition of Evidence (Informed) Based Practice and the steps in the process Formulate questions using PICO and PS models Introduce the concept of preprocessed evidence and the hierarchy of evidence Identify databases and sources for locating pre-processed evidence

3. Evidence-Informed Decision Making (EIDM) “The integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making” (Sackett et al., 2000)

4. Clinical Decisions Clinical state, setting, and circumstances Patient preferences and actions Clinical Expertise Clinical Expertise Health care resources  Research evidence

5. Steps of EIDM • Construct a relevant, answerable question from a clinical case. • Search the literature to retrieve the best evidence. • 3. Critically appraise the literature (evidence) for validity and applicability. • 4. Apply the evidence to your clinical practice. • 5. Evaluate the outcome or performance. *From:Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2), 36-7.

6. Steps of EIDM • Construct a relevant, answerable question from a clinical case. • Search the literature to retrieve the best evidence. • 3. Critically appraise the literature (evidence) for validity and applicability. • 4. Apply the evidence to your clinical practice. • 5. Evaluate the outcome or performance. *From:Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2), 36-7.

7. Asking Clinical Questions Two Types of Clinical Questions: 1. Background 2. Foreground

8. Background & Foreground Questions Background questions are: general in nature address gaps in background knowledge examples include: pathophysiology, or risk factors of a disease; an overview of a nursing theory Foregroundquestions are: focused on the particular patient scenario, and ask for specific knowledge to manage the patient

9. Background & Foreground Questions Background questions Need to be answered first Can be answered by books or general Websites Foreground questions Need to be very focused Can be answered by searching journal databases

10. Background & Foreground Questions Examples of Background questions: What is the mechanism of action of insulin? How do you conduct a neurological assessment? Examples of Foreground questions: Is exercise more effective than a low-fat diet in reducing blood pressure in hypertensive patients? Is there a relationship between cell phone use in adults and the incidence of brain tumors?

11. Two Major Research ‘Categories:’Quantitative Research & Qualitative Research

12. Two Major Research ‘Categories’ Quantitative Researchis an “objective, systematic process to describe and test relationships and, examine cause and effect interactions among variables” (Burns & Grove, 1993, p. 777) Qualitative Researchis a systematic, subjective approach used to describe life experiences and give them meaning” (Burns & Grove, 1993, p. 777)

13. Quantitative Research Goal is the discovery of relationships, or causation (cause & effect). Based on scientific method (hypothesis formation and testing) Many quantitative designs compare two or more groups Often involves an element of control Objectivity (related to measurement) Collection of data (numerical) and analysis via statistics Burns & Groove, 1993; Roberts & Burke, 1989

14. Quantitative Research Studies Studies focus primarily on one of the following: Therapy/Treatment/Intervention; Prevention and Control – Effectiveness Etiology/Causation/Harm Prognosis – Outcome Diagnosis and Screening/Assessment Economics

15. Quantitative Research Designs Quantitative research designs (studies) include: Randomized Controlled Trials (RCTs) Cohort Study (Cohort Analytic) Case-Control Study Cross-Sectional Study (survey) Case Report or Study Greenhalgh, 1997

16. Formulating the Question (Quantitative) P -- Population/Situation I -- Intervention/Exposure C -- Comparison/Counter Exposure O -- Outcome

17. Question Intervention Is exercise more effective than rest for relieving chronic back pain?

18. People with back pain Exercise Bed rest Reduced pain Question Population Intervention Comparison Outcome

19. Question Causation Does the presence of hand sanitizer stations in nursing homes reduce the number of infections transferred to residents?

20. Nursing home residents Hand sanitizer stations No hand sanitizer Reduced infection Question Population Exposure Comparison Outcome

21. Qualitative Research Aim is to discover meaningor gain understanding of a phenomena Investigates a phenomena in-depth Roberts & Burke (1989)

22. Qualitative Research How people feel or experience a certain situation or circumstance Sampling of a small group of people Data collected via in-depth unstructured interviews, observation, focus groups, diaries Analysis of findings in narrative format

23. Qualitative Research Examples of qualitative research designs include: Phenomenology Examine the ‘lived experience” of individuals experiencing a phenomena Grounded Theory Goal is to understand a social-psychological process and develop a theory Ethnography Study of a group or culture within their own setting

24. Formulating the Question (Qualitative) P -- Population S -- Situation

25. Question How do people with HIV/AIDS living in a rural community feel about disclosing their status to their health care provider?

26. People with HIV/AIDS Disclosing their status to their health care providers Question Population Situation

27. Hierarchy of Pre-processed Evidence (Haynes, 2007)

28. Systems Support clinical decision making through linking all relevant best research evidence about a clinical situation directly to a patient’s record. (Haynes 2008) Sources of Systems Integrative Electronic Patient Records

29. Summaries “Summaries integrate best available evidence from lower layers … to provide a full range of evidence concerning management options for a given health problem.” (Haynes, 2007) Sources of Summaries Clinical Practice Guidelines Evidence Based Texts

32. Syntheses: Systematic Reviews Consolidate the literature on a specific topic: comprehensive identification of studies review of study relevance evaluate methodologic quality extraction and analysis of data draw of conclusions Sources of Synthesis The Cochrane Library Health Care Journals

34. Synopses “Synopses of individual studies or systematic reviews encapsulate the key methodologic details and results required to apply the evidence to individual patient care.” (Haynes, 2001) • Sources of Synopses • Database of Abstracts of Reviews of Effects (DARE) • health-evidence.ca • Evidence-based abstraction journals

37. Single Studies Single Studies are used: To keep up with the literature To update summaries and systematic reviews To contribute to clinical decisions if no higher preprocessed level is available Sources of Single Studies CINAHL Medline

40. EBN Resources Page http://hsl.mcmaster.ca/resources/topic/eb/nurse.html

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