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References
This article cites 10 articles, 4 of which can be accessed free at: http://ebn.bmj.com/cgi/content/full/9/2/38#BIBL You can respond to this article at: http://ebn.bmj.com/cgi/eletter-submit/9/2/38 Receive free email alerts when new articles cite this article - sign up in the box at the top right corner of the article
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Articles on similar topics can be found in the following collections Notebook (41 articles) Other evidence based practice (494 articles) Nursing (265 articles)
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could represent multiple hits from a few centres, many different centres were represented in the first few pages of hits. As well, this search would miss the many centres that have different, but related, titles, such as the Centre for Advancement of Evidence-Based Practice at Arizona State University (http://nursing.asu.edu/caep/), Academic Centre for Evidence-Based Practice (http://www.acestar.uthscsa.edu/About.htm), or the Knowledge Utilization Studies Program at the University of Alberta (http://www.nursing.ualberta.ca/kusp/). As another macro-indicator, a PubMed search of titles and abstracts using the terms evidence and nursing resulted in 1075 hits for the entire database before 1998 and 2336 hits from 1998 to the present. Although this appears to be a large increase in the past 7 years, a similar search using the terms evidence and medicine yielded 1689 and 5664 hits, respectivelya far greater increase in medicine than in nursing over the same time period. Collectively, these macroindicators suggest considerable growth in interest in evidence-based nursing.
curricula include research skills, but not the evidence-based practice process. Graduates may know how to design studies, but not necessarily how to critique and use research results.9 Incorporating evidence-based practice content into a curriculum requires continuing education of faculty and overcoming their barriers to teaching the process. What is needed to practice in an evidence-based way? Many institutions have policies, procedures, best practices, or guidelines that use high quality evidence in their development. If this is true, the staff who follow the guidelines will be practising in an evidence-based way, without knowing the evidence-based practice process. This may be a short term strategy to promote evidence-based practice while staff are being educating in the process and the critical mass is being built. Every nurse should have at least an understanding of the purpose and process of evidence-based practice, be able to ask relevant clinical questions, and know who in their environment can assist them in answering questions. Currently, clinical specialists, clinical educators, or advanced practice nurses appear to be the ones who seek out whatever answers are available. These nurses are at a prime interface of recognising clinical problems, having the time, skills, and resources to access the research literature, critically appraising the relevant literature, and translating the findings in a way that front-line nurses can understand. In order to ensure use of guidelines in practice, the systematic reviews (on which guidelines are based) must be perceived as being done by credible people and accessed by someone in the workplace who can help translate the language of research.10 Furthermore, management teams must be clear about their expectations of nurses once they become familiar with the evidence-based practice process. This may mean declaring expectations of critical appraisal skills and application of high quality research in practice decisions in job postings, job descriptions, and annual performance appraisals. Does teaching evidence-based practice change anything? Coomarasamy and Kahn did a systematic review of 23 studies, all of which involved postgraduate trainees in medicine.11 Eighteen studies evaluated stand-alone classroom courses, which improved knowledge but not skills, attitudes, or behaviour; 5 studies evaluated clinically integrated teaching, which improved knowledge, skills, attitudes, and behaviour. Although it is not possible to generalise these findings to nurses, particularly undergraduates, this is an important area of research. Currently, many nursing programmes have an isolated evidence-based practice course, with little or no expectation or requirement that the knowledge and skills are to be used in clinical practice or other courses. Ideally, teaching of evidence-based practice should be incorporated into every courseboth classroom and clinical. Strauss et al have offered a framework to guide evaluation of teaching of evidence-based medicine.12 It involves an evaluation matrix around learners, interventions, and outcomes. They classify learners as doers (do all steps of the evidence-based practice process), users (ask the clinical questions and go directly to the pre-appraised literature), or replicators (trust and follow recommendations of others considered to be leaders).12 This framework could have considerable relevance for evaluating nursing education. At the management and policy level, an appreciation of the evidence-based practice process is necessary to support a culture of evidence-based care. Several pilot projects have been done, although the results have yet to be published. For example, in Canada, the Executive Training for Research Application (EXTRA) fellowships are awarded to provide
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healthcare managers with the skills to better use research and thus increase evidence-based decision making within their healthcare systems. It is supported by a group of national organisations including the Canadian Health Services Research Foundation, Canadian College of Health Service Executives, Canadian Nurses Association, and Canadian Medical Association (http://www.chsrf.ca/extra/ index_e.php). The first graduates of the 2 year programme will occur in spring 2006. Each fellow must do a project within their own institution, using evidence and evaluating the policy results and/or dissemination and uptake. This programme involves tremendous commitment from institutional management executive and governing boards of the fellows institution.
teachers have the skills to incorporate evidence-based practice concepts in clinical and classroom teaching. 4 We need more economic evaluations, involving long term data collection, to establish the effectiveness of evidencebased practice. This information will provide us with the rationale to support and promote the use of evidence-based nursing. This list may seem short, but each item is actually a large field of research. Within these practice and research priorities, there is a lifetime of work for each of us! Dont be too timid and squeamish about your actions. All life is an experiment. The more experiments you make the better! Ralph Waldo Emerson DONNA CILISKA RN, PhD
School of Nursing, McMaster University Hamilton, Ontario, Canada
Thanks to Kate Flemming and Carl Thompson for their helpful comments on an initial draft of this paper.
1 Heater BS, Becker AM, Olsen RK. Nursing interventions and patient outcomes: a meta-analysis of studies. Nurs Res 1988;37:3037. 2 DiCenso A, Ciliska D, Guyatt G. Introduction to evidence-based nursing. In: DiCenso A, Guyatt G, Ciliska D, editors. Evidence-based nursing: a guide to clinical practice. St Louis, Missouri: Elsevier Mosby, 2005:319. 3 Thomas L, Cullum N, McColl E, et al. Guidelines in professions allied to medicine. Cochrane Database Syst Rev 2000;(2):CD000349. 4 Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001;39:II245. 5 Ciliska D, DiCenso A, Cullum N. Centres of evidence-based nursing: directions and challenges. Evidence-Based Nursing 1999;2:1024. 6 Thompson C, Cullum N, McCaughan D, et al. Nurses, information use, and clinical decision makingthe real world potential for evidence-based decisions in nursing. Evid Based Nurs 2004;7:6872. 7 Estabrooks CA, Chong H, Brigidear K, et al. Profiling Canadian nurses preferred knowledge sources for clinical practice. Can J Nurs Res 2005;37:11840. 8 Banning M. Conceptions of evidence, evidence-based medicine, evidencebased practice and their use in nursing: independent nurse prescribers views. J Clin Nurs 2005;14:4117. 9 Ciliska D. Educating for evidence-based practice. J Prof Nurs 2005;21:34550. 10 Ciliska D, Hayward S, Dobbins M, et al. Transferring public-health nursing research to health-system planning: assessing the relevance and accessibility of systematic reviews. Can J Nurs Res 1999;31:2336. 11 Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ 2004;329:1017. 12 Straus S, Green ML, Bell DS, et al. Evaluating the teaching of evidence based medicine: conceptual framework. BMJ 2004;329:102932.
One week intensive course at McMaster University, Hamilton Ontario June 1116, 2006
N To advance your skills in critical appraisal of research literature N To learn strategies for teaching evidence-based nursing practice
The format will be small groups led by nursing faculty at McMaster. There will be specific tutorial groups for nurses in advanced practice, oncology, public health, and gerontology, in addition to groups for nursing faculty and other clinical nursing areas. For more information contact Dr. Maureen Dobbins at dobbinsm@mcmaster.ca