Over the past decade, it has been laudatory to watch how the concepts of evidence-based research (EBR) and evidence-based practice (EBP) have become accepted parts of health care. These concepts have required an enormous change in what educators teach in medical and nursing schools and influence the way clinicians think about how they practice and whether specific research should cause them to change their practice. While much of the published literature has become infused with “evidence-based” jargon, I also observe that many clinicians remain a little confused about how reviews of the literature and basic research studies differ from true EBR. I'm not always sure that everyone really understands and correctly uses the term EBR, the latest buzzword in health care.
Theoretically, EBR is designed to upgrade clinical practice and represents a paradigm shift in both practice and teaching. The focus with EBR is on critically appraising available evidence; this requires the increased use of randomized clinical trials and the promulgation of rigorous clinical guidelines based on the findings. Research has confirmed that traditionally, clinicians continued to practice in ways they were taught in school and had difficulty making changes based on new research findings. Now, traditional and well-established treatment patterns are changing as a result of undergoing this rigorous EB evaluation process. Today, even clinicians who recently learned standards of treatment may find it necessary to relearn diagnostic priorities and management protocols based on new information. This change may be unsettling and has the potential to create clinical confusion.
The Evidence-based Medicine Working Group (1992) suggests that EB health care should focus primarily on the development of research skills and critical appraisal of the content. At the general research and database level, this critical appraisal may reduce complex information from thousands of different studies into user-friendly information through the following four main steps:
1.Define an answerable and structured question about the target population, outcomes, and intervention or exposure
2.Search the published literature for sources of data that might answer the question
3.Appraise or evaluate the data for methodologic rigor and relevance to the question; critically evaluate studies to determine their validity and applicability. Well-designed and executed, randomized, controlled trials are considered the gold standard, with the least susceptibility to bias. Concerns about bias increase in the following order with other types of study designs: nonrandomized controlled trials, prospective or retrospective cohort studies, cross-sectional studies, case-control studies, case series and registries, and case reports.
4.Describe and analyze study data to answer the question posed
As an editor, I see manuscripts with conceptual or implementation problems in each of these categories. Resolving these problems will strengthen the quality of the materials submitted for publication. Just doing a literature search on a general topic isn't EBR. EBR requires the practitioner to have a strong foundation in the pathological or physiologic process being studied and in research methodology and using this information in critical analysis. The most common problem authors demonstrate is citing the research but not critically evaluating it to know if the findings are valid and if they can be generalized beyond the study sample. Therefore, the strength or quality of the research recommendations must always be addressed if clinicians are to know if they should change their way of practice or not.
It is clear that many of the things nurse practitioners need to know have not had a high level of intellectual scrutiny. It is better to say that no valid research exists than to try to mask it by quoting myriad studies with no analysis.
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