In order to provide high quality evidence based care, it is vital that our knowledge base is current and supported by sound academic literature. So how can we validate what we read?
Sourcing literature can be a time consuming and endless process, it is therefore important to have a sound plan and objective.
1. Understand your topic.
We must first establish what it is we are looking for or wanting to ask:
The development of a clear and focused question is paramount. The Problem,Intervention,Comparison,Outcomes. ‘PICO’ system will help develop sound clinical questions.
To give an example. (P) In patients with type two respiratory failure. (I) Is CPAP. (C) as effective as Bi Level NIV (O) in reducing high levels of C02?
We can now search your usual databases for the literature surrounding this specific clinical question (my personal favourite is The Translating Research into Practice, TRIP database) This will reduce the need to wade through hundreds of articles which have no relevance to our question.
2. Decide on the level of evidence you require to change or confirm your practice.
Levels of evidence:
Literature is often published or provided from many sources, validating its academic integrity is essential.Often outdated, ritualistic and substandard practice is passed on either personally from one clinician to another or as is often the case via poor non peer review journal articles. Now that you have your journal article you must validate the academic credibility of each.
The most recognised system of evidence classification is illustrated below:
(However this still has limited application in sound evidenced based practice but for the purpose of this post we will use the above.)
It is said that in order to change clinical practice one must read at least three pieces of evidence of level III or above prior to considering any change. I would go further and say that protocols, policy and guidelines for clinical practice need to be supported by sound level I & II evidence.
3. Critically appraise what you find.
Did the article answer my question? If no read no more and move on.
If it did, what method of data collection was used? Meta analysis, Systematic review,Randomised trial (you can grade the evidence level from this).If it meets your evidence requirement then add to you reading list.
Once you have graded your literature you can formally compare and contrast each against the other. I personally draft a short annotated bibliography which I use to formulate a later opinion, but this is not necessary. Formulate an opinion of your own based on evaluation of the evidence, if it is credible then it might be worth discussing with peers and planning a practice change.
- Centre for Evidence Based Medicine. (2014). Asking Focused Questions. 2014,
- Lynn, G.-F., Ellen, F.-O., Bernadette Mazurek, M., & Susan, B. S. (2011). Implementing an Evidence-Based Practice Change. The American Journal of Nursing, 111(3), 54.
- Yu-Chih, C., Lee-Chun, T., & Shin-Shang, C. (2013). Strategy for Promoting Evidence-Based Nursing Practice in Hospital. Hu Li Za Zhi, 60(5), 25.