WHAT IS EVIDENCE BASED NURSING?

Evidence-Based Nursing is a quarterly journal designed to alert practicing nurses to important and clinically
relevant advances in treatment, diagnosis, etiology, and prognosis. Published by the BMJ Publishing Group and the
Royal College of Nursing Publishing Company, and compiled by EBN's research staff, Evidence-Based Nursing
selects and examines every aspect of the very best international nursing research to your practice. It keeps you up
to date with the most important new evidence within nursing. What's more, Evidence-Based Nursing helps you to
put this evidence into practice, as expert commentators put every article into a clinical context and draw out the
key research findings. Every edition of Evidence-Based Nursing contains 24 different summaries covering a wide
variety of nursing related issues which are relevant to you. . We scan over 50 journals and around 25,000 articles a
year so that we can identify the most important and valid 96 research articles and publish them in the journal. This
means that if you read Evidence-Based Nursing, you’ll get all the important research material you need in just 4
volumes that are published throughout the year, saving you all important time to concentrate on other things.
What's more, Evidence-Based Nursing includes 'Other articles noted' which includes mentions of high quality
articles that were not abstracted but are still recommended reading. This means that you have a ready made list of
extra reading for you to use. And all the articles are rated for clinical relevance and newsworthiness so you’ll be
able to quickly and clearly see how relevant the article will be to you, again, saving you time.

WHAT IS THE PURPOSE OF E.B.N.?

The general purpose of Evidence-Based Nursing is to select from the health-related literature *those articles
reporting studies and reviews that warrant immediate attention by nurses attempting to keep pace with important
advances in their profession. These articles are described, critiqued and commented on by nurses and other health
professionals.
The specific purposes of Evidence-Based Nursing are:
■. to identify, using predefined criteria, the best quantitative and qualitative original and review articles on the
meaning, cause, course, assessment, prevention, treatment, or economics of health problems managed by nurses
and on quality improvement
■. to provide a description and expert commentary on the context of each article, its methods, and the clinical
applications that its findings warrant
■. to disseminate the summaries in a timely fashion to nurses

HOW ARE THE ARTICLES / JOURNALS BEING SELECTED?

The basic inclusion criteria are based on study design and methodology principles for evidence-based healthcare.
Their use identifies studies that have data related to patients or those at risk of disease, diseases and conditions,
and real-life clinical settings. Therefore, a study or review article that meets the criteria can be considered to be
appropriate for possible use in patient care decision-making. The article readers are trained and retested annually
so that they can reliably apply these selection rules for inclusion in our evidence-based journals (kappa measuring
chance-adjusted agreement > 80% for all categories).

All articles in a journal issue are considered for inclusion if, based on their abstracts, they meet the following basic
and category-specific criteria:
Basic criteria
■. original or review articles
■. in English
■. quantitative and qualitative studies
■. about topics that are important to the clinical practice of nurses in any setting
■. analysis of data consistent with the study question
Category-specific criteria (quantitative studies)
Studies of prevention or treatment must also include:
■. random allocation of participants to comparison groups
■. outcome measures of known or probable clinical importance

Studies of assessment (screening or diagnosis) must also include:

■. a spectrum of participants, some (but not all) of whom have the condition of interest
■. an objective diagnostic (gold) standard (eg, central venous pressure) or current clinical standard for diagnosis
(eg, sphygmomanometer reading for hypertension), preferably with documentation of reproducible criteria for
subjectively interpreted diagnostic standard (ie, report of statistically significant measure of agreement beyond
chance among observers)

Studies of prognosis must also include:

■. an inception cohort (first onset or assembled at a uniform point in the development of a condition or disease) of
individuals, all initially free of the outcome of interest

Studies of causation must also include:

■. observations of the relation between modifiable exposures and putative clinical outcomes
■. clearly identified comparison group(s) for those at risk of, or having, the outcome of interest (ie, randomised
controlled trials, quasi-randomised controlled trials, non-randomised controlled trials, cohort studies with case by
case matching or statistical adjustment to create comparable groups, or nested case–control studies) and
preferably prospective data collection

Studies of quality improvement or continuing education must also include:

■. random allocation of participants or units to comparison groups
■. outcome measures of known or probable clinical importance

Studies of the economics of healthcare interventions must include:

■. an economic question comparing alternative courses of action
■. comparison of alternative diagnostic or therapeutic services or quality improvement activities on the basis of
both the outcomes produced (effectiveness) and resources consumed (costs)
■. evidence of effectiveness from a study (or studies) of real (not hypothetical) patients, which meet(s) the criteria
for treatment, assessment, quality improvement, or a systematic review article
■. results presented in terms of the incremental or additional costs and outcomes of one intervention over another

Clinical prediction guides must also include:

■. generation of the guide in ≥1 set of patients (training or derivation set)
■. validation of the guide in an independent set of patients (test or validation set)

Systematic review articles must also include:

■. a clear statement of the clinical topic being reviewed
■. a clear description of the sources and methods for identifying articles
■. specification of the inclusion and exclusion criteria for selecting articles for detailed review
■. ≥1 article in the review that meets the above noted criteria for treatment, assessment, prognosis, causation,
quality improvement, economics, or clinical prediction guides

Qualitative studies
■. content reflects the phenomenon of interest from the perspective of people experiencing it
■. data collection methods are appropriate for qualitative data
■. analyses are appropriate for qualitative data
 THE CHALLENGE!
Professional nurses are constantly challenged to be aware of new information to provide the highest
quality of patient care (Barnsteiner and Prevost, 2002; IOM, 2001). Nurses are challenged to expand
their "comfort zone" by offering creative approaches to old and new health problems and designing new
and innovative programs. Nursing research provides a specialized scientific knowledge base that
empowers the nursing profession to anticipate and meet these shifting challenges and maintain our
societal relevance. The best available evidence—moderated by patient circumstances and preferences—
is applied to improve the quality of clinical judgements and facilitate cost-effective health care (Sackett,
Straus, Richardson, Rosenberg, and Haynes, 2000)
In order to be the best possible patient advocate, a nurse must be willing to continually evaluate and
change his or her practice methods. Health care is constantly changing. New information on how to
provide better care for patients is discovered every day; and old practices are being improved. Now,
health care practices are being implemented after research is done to prove their effectiveness.
Accurate research provides health care workers with the evidence needed to change their practice.
However, not all research is valid. Many studies are biased or have low external and internal validity.
These studies cannot be trusted because nurses cannot be sure if the intervention is really beneficial.
Therefore, these new methods should not be put into practice. That is how research, theory, and
practice all come together. Nurses must realize how important research is in patient care. He or she
must then learn to become a wise interpreter and evaluator of research, and continually evaluate
current research to provide the highest quality patient care.

TO THE FUTURE!
The continuation of nursing knowledge provides various opportunities for a nurse to study research
questions while promoting health, preventing illness, and optimizing patient outcomes. The increasing
number of doctoral level programs in and outside of the United States will contribute to a large number
of nurse researchers who are prepared to bring research-based knowledge to life. Nurse researchers are
focused on developing programs that incorporate quantitative and qualitative study outcomes to form a
foundation for evidence based practice. This practice is being incorporated in order for the nurses to
give patients the best care.
In the near future, information may be available online through electronic communications such as a
dedicated list server, a Virtual Hospital System, or another form of electronic media. Such a center could
facilitate networking among health care professionals working on similar EB topics and provide helpful
consultants and educational materials. This center also would provide data regarding the
interventions/strategies that have been tested to translate research into practice and provide a "tool
kit" of these interventions for use by all types of health care agencies.
Education of Nurses must include knowledge and skills in using research evidence in practice. Nurses are
increasingly being held accountable for practices based on scientific evidence and tradition. Therefore,
we must communicate and integrate into our profession the expectation that it is the professional
responsibility of every nurse to communicate with nurse scientists the numerous clinical problems for
which we do not yet have scientific base. Nursing has risen to the challenge of improving health care,
and will continue to research and implement new nursing
based practices in the future.