Search the Literature to Critically Appraise Evidence
Changes in technology have brought about significant opportunities in how we identify and manage information. We have access to published research and clinical articles from thousands of journals to answer clinical questions. Finding the right information can be challenging, but building your skills in searching for evidence and synthesizing evidence is critical to becoming an evidence-based practice expert. Here’s how to proceed.
The first step is to have a clearly defined clinical question (https://voice.ons.org/news-and-views/a-spirit-of-inquiry-leads-to-evidence-based-answers-to-practice-questions). With a clear and concise question, you can begin to search for evidence. A few good places to start are PubMed, CINAHL, and the Cochrane Library. These databases include journals covering a wide variety of health and professional specialties and are easily searchable. If your facility has a medical library, meeting with a librarian can be tremendously helpful. Medical librarians are experts at identifying and searching databases (https://doi.org/10.1188/16.ONF.549-552) and are invaluable to clinical staff trying to find the right information to answer their clinical question.
Once you’ve found relevant evidence, the next step is to appraise and synthesize it. The strongest evidence is from research studies, specifically randomized, controlled clinical trials. These types of studies are not always available for the questions that nurses may ask, so it’s important to review all evidence that is relevant to your question and rank it by quality (https://hsls.pitt.edu/resources/ebm). Systematic reviews and meta-analyses synthesize and analyze multiple research studies on a given clinical topic, so this is a great place to start understanding the current state of research evidence, because the authors have done this work already. Most often, your review of the literature will identify primary research studies: reports of a single research study. These may be from a variety of different types of research, such as experimental, quasiexperimental, nonexperimental, or qualitative. Each has distinctive features that should be considered when appraising the study.
Appraising and synthesizing evidence are also skills that take time to develop. Participate in journal clubs or on projects where you will have opportunities to review and discuss research articles. Johns Hopkins Nursing Evidence-Based Practice Model (https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html) and the Ohio State Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Health Care (https://fuld.nursing.osu.edu/) provide more information on what to look for in each type of study, including tools and guides.
Nurses should read a research study at least twice. First, gain a general understanding of what the study was about, how it was conducted, and what the results were. Having this background will make it easier to read in-depth a second time. On the second read, highlight the purpose of the study and make notes of any key points, questions you have, and key results. It’s important to keep in mind that there is no perfect research study—all have strengths and limitations. As you read more research, you’ll become experienced in identifying those strengths and limitations as well as gain confidence in your ability to summarize and synthesize the results.