Informatics and Evidence-Based Practice

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Chapter 3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORInformatics SALE OR DISTRIBUTION and NOT FOR SALE OR DISTRIBUTION

Janie T. Best, DNP, RN, ACNS-BC, CNL Karen H. Frith, PhD, RN, NEA-BC © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Ron Schwertfeger, MLIS, BA NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

LEARNING OBJECTIVES

1. Distinguish between the hardware and software components of computer systems. © Jones & Bartlett2. Search Learning, electronic resources LLC for evidence-based practice (EBP),© Jones including & databases, Bartlett journals, Learning, and LLC NOT FOR SALEprofessional OR DISTRIBUTION organizations, efficiently to find current nursingNOT research, FOR systematic SALE reviews, OR DISTRIBUTION and clinical practice guidelines. 3. Discuss methods of integrating EBP into electronic health records or other health information technology. 4. Apply knowledge of EBP to patient care. © Jones & Bartlett Learning,5. Discuss LLC the role of health information© technology Jones standards& Bartlett in EBP. Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION KEY TERMS

Agency for Healthcare Research Cochrane Databases Google Scholar and© QualityJones (AHRQ) & Bartlett Learning,Cumulative Index LLC to Nursing Interlibrary loan© Jones & Bartlett Learning, LLC BooleanNOT operators FOR SALE OR DISTRIBUTIONand Allied Health Literature Literature searchNOT FOR SALE OR DISTRIBUTION Centers for Disease Control and (CINAHL) Medical Subject Headings (MeSH) Prevention (CDC) Directory of Open Access National Center for Clinical decision-support Journals Biotechnology Information systems (CDSS) Evidence-based practice (EBP) (NCBI) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC

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National Guideline© Jones & BartlettPlan-Do-Study-Act Learning, (PDSA) LLC PubMed LinkOut © Jones & Bartlett Learning, LLC Clearinghouse PubMed PubMed sidebar filters National LibraryNOT of FORMedicine SALE PubMed OR DISTRIBUTION Advanced Search Rich site summary (RSSNOT feeds) FOR SALE OR DISTRIBUTION (NLM) Builder Zotero Open access PubMed Clinical Queries

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR▸ SALE OR DISTRIBUTION of EBP, describesNOT the FORmajor stepsSALE associated OR DISTRIBUTION ▸ Chapter Overview with EBP, and supplies readers with resources Since the passage of the Affordable Care Act in to conduct literature searches for evidence. 2009, and with the opportunity to capture incen- Finally, this chapter gives an overview of health tive monies from the Centers for Medicare and information management technology standards © Jones & BartlettMedicaid Learning, Services LLC (CMS), the use of technology © asJones they apply & Bartlettto clinical practice.Learning, LLC NOT FOR SALE ORhas explodedDISTRIBUTION as healthcare organizations have NOT FOR SALE OR DISTRIBUTION accepted the challenge to convert their paper records to an electronic health record (EHR) ▸▸ Introduction to (Duffy, 2015). Gugerty and Delaney (2009) describe how the Technology Informatics Guiding Information and Education Reform© Jones (TIGER) & initiativeBartlett addressed Learning, LLC © Jones & Bartlett Learning, LLC this explosionNOT of technology FOR SALE in health OR care DISTRIBUTION and Computer Science NOT FOR SALE OR DISTRIBUTION the need for nurses to be prepared to effectively use technology to provide evidence-based care. Computer Architecture TIGER competencies include: (a) basic computer Computers are used to find, manipulate, and proficiency; (b) the ability to identify a clinical store data in an electronic format. In recent © Jonesquestion, & find,Bartlett evaluate, Learning, and apply information LLC on years, computers© haveJones become & Bartlett more complex Learning, LLC NOTthe FOR question SALE (information OR DISTRIBUTION literacy); and (c) the and mobile, andNOT they areFOR increasingly SALE essentialOR DISTRIBUTION ability to appropriately collect, process, and com- to individuals in their personal and professional municate data (information management). The lives (Kaminski, 2015). Desktop devices, laptops, TIGER report encourages inclusion of all three tablets, cell or smartphones, and a wide vari- areas in nursing programs as these are key skills ety of medical and household equipment use © Jones & Bartlettof evidence-basedLearning, LLC practice (Cheeseman, 2012; © computerJones &software Bartlett to performLearning, their functions LLC NOT FOR SALE ORGugerty DISTRIBUTION & Delaney, 2009). NOT(Dainow, FOR 2016). SALE A basic OR understanding DISTRIBUTION of how Successful use of technology by nurses to computers operate provides the nurse with the implement evidence-based practice and thus first step to exploring the evidence as it relates to improve patient care requires a basic under- to clinical practice (Cheeseman, 2012). standing of computer architecture, computer A computer system has four main functions: terminology,© and Jones data and& Bartlett file management Learning, collection, LLC processing, storage, and© retrieval Jones of & Bartlett Learning, LLC (Cheeseman, NOT2012). DevelopingFOR SALE the skill OR of finding DISTRIBUTION data (Cheeseman, 2011), and consistsNOT of FORinput SALE OR DISTRIBUTION and appraising current evidence from research, devices, the central processing unit (CPU), mem- systematic reviews of literature, and clinical ory, and output devices. Two main components practice guidelines may be difficult as the nurse of a computer are its hardware (physical com- moves from the academic to practice settings. ponents) and software (applications). Physical © JonesHowever, & Bartlett evidence-based Learning, practice LLC (EBP) is components include© Jones the casing & (desktop,Bartlett laptop, Learning, LLC NOTa FOR core skill SALE necessary OR toDISTRIBUTION improve nursing care or mobile) and NOTthe internal FOR mechanisms SALE OR (CPU, DISTRIBUTION and enhance the safety of patients. This chapter motherboard, power supply, hard disc, and mem- provides basic computer information, a synopsis ory). External hardware includes touch screens,

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keyboards, a mouse to control screen position, eight bits of data. From these small units, stor- and a© monitor Jones that & displaysBartlett information Learning, on a LLCage can be expanded in increments© Jones of & 1,000 Bartlett Learning, LLC screen.NOT Additional FOR hardware SALE isOR available DISTRIBUTION to help to kilobytes (KB), megabytesNOT (MB), FOR gigabytes SALE OR DISTRIBUTION the user print information or enhance listening (GB), and terabytes (TB). Decisions about the (Kaminski, 2015). amount of storage needed in a computer system Computers are further categorized on the is based on the amount of data to be processed basis of size and use. Supercomputers are large and stored, and on estimated storage time. Data © Jones &and Bartlett only run a fewLearning, programs at LLC a high processing can be collected,© Jones organized, & Bartlett and stored Learning, in a da- LLC NOT FORspeed. SALE Their OR specific DISTRIBUTION uses range from anima- tabase whereNOT it canFOR be retrievedSALE OReasily DISTRIBUTION and in a tions and simulations, or training to weather way that is meaningful to the user. Commonly forecasting. Mainframe computers have large used databases in health care include electronic memory capacity, work at a high speed, and medical records, databases that support mobile have the ability for many users to operate the applications, and many more, which are de- © Jones & Bartlett Learning,computer systemLLC at the same time. Healthcare© Jones scribed & Bartlett in chapters Learning, that follow. In LLC academic set- NOT FOR SALE OR DISTRIBUTIONand university computer systems are examplesNOT of FORtings, SALE bibliographic OR DISTRIBUTION and citation databases are mainframe computers. The smallest computers, commonly used. Synthesized databases allow microcomputers or personal computers, are the user to search for information from practice designed for single users, can be connected as guidelines, systematic reviews, and meta-analysis a network, and are small and affordable to most documents (Che eseman, 2011). Directions for individuals© Jones (Cheeseman, & Bartlett 2011). Learning, LLChow to conduct a literature© search Jones using & largeBartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONdatabases are discussed laterNOT in this FOR chapter. SALE OR DISTRIBUTION Data Organization, Representation Software applications are internal programs that can be modified without changes to the ex- and Structure ternal hardware of the computer (Dainow, 2016). A computer’s work begins with input of infor- These applications are categorized as produc- © Jones &mation Bartlett via an externalLearning, or touch-screen LLC keyboard tivity, creative,© Jones or communication & Bartlett Learning,programs. LLC NOT FORto SALE a CPU whereOR DISTRIBUTION a processor chip collects data ProductivityNOT software FOR includesSALE ORa variety DISTRIBUTION of pro- and makes decisions based on the software’s grams including databases, email, presentations, program code (instructions). The memory of a spreadsheets, and word processing applications computer is divided into random-access (RAM) to support a wide variety of information pro- and read-only (ROM). RAM provides temporary cessing needs. Creative software can be used © Jones & Bartlett Learning,storage of data LLC during the creation of work before© Jones to create& Bartlett drawings, Learning, music, or digital LLC photogra- NOT FOR SALE OR DISTRIBUTIONit is stored in a more permanent location, eitherNOT FORphy/videos. SALE Communication OR DISTRIBUTION software includes in the computer’s hard drive or other storage email programs, Internet browsers, instant mes- location. Unless saved to a more permanent saging, and a variety of conferencing programs location, RAM storage is lost when the program (Dainow, 2016; Kaminski, 2015). is closed or the computer is turned off. ROM is located© Jones in the motherboard & Bartlett (circuit Learning, boards) LLC © Jones & Bartlett Learning, LLC and savesNOT data FOR in a moreSALE permanent OR DISTRIBUTION way after Networking and Data CommunicationNOT FOR SALE OR DISTRIBUTION the computer is turned off. During work, data Computer networks are formed when two or more are uploaded in the RAM and, when directed by computers are linked in a way that allows them to the user, stored in ROM on the hard drive, on a share information. A local area network (LAN) USB flash drive, or in other external locations. is confined to a single site, a metropolitan area © Jones &(Cheeseman, Bartlett 2011;Learning, Kaminiski, LLC 2015). network© (MAN) Jones connects & Bartlett regional areas,Learning, and a LLC NOT FOR SALEThe ORability DISTRIBUTION to store information is based wide areaNOT network FOR (WAN) SALE reaches OR far beyond DISTRIBUTION the on the capacity of the device. The basic (small- single location to connect many LANs together. est) unit of memory is a bit; a byte consists of Connections to the Internet are available through

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cable or digital subscriber lines (DSL) or through communication with others. Individuals can set dial-up telephone© Jones services & (Cheeseman,Bartlett Learning, 2011; up LLC blogs or join social networks like© JonesFacebook & Bartlett Learning, LLC Dainow, 2016).NOT To connectFOR SALE to the Internet, OR DISTRIBUTION the or Twitter to share information withNOT friends, FOR SALE OR DISTRIBUTION computer has to be connected to an Internet family, or others with similar health conditions service provider (ISP) through a modem and a (Dainow, 2016). Social media has become a unique Internet protocol (IP) address (Dainow, way that patients, families, and caregivers gain 2016). Each website is identified by a unique information and support from one another, © Jonesuniform & resource Bartlett locator Learning, (URL) protocol. LLC Two particularly with© chronic Jones illnesses & Bartlett or life-limiting Learning, LLC NOTtypes FOR of URLSALE addresses OR DISTRIBUTION are commonly used to illnesses (RupertNOT et al., FOR2016). SALE OR DISTRIBUTION reach web resources: hypertext transfer protocol (HTTP) or hypertext transfer protocol—secure (HTTPS). There are also URL addresses for Basic Terminology of Computing email and file transfers (FTP) (Cheeseman, 2011; Understanding basic computer terminology is © Jones & BartlettDainow, Learning, 2016; TechTarget, LLC 2016). © theJones first step& Bartlett to effective Learning, computer use.LLC Many NOT FOR SALE OR ComputerDISTRIBUTION networks allow knowledge to be NOTInternet FOR sites SALE have compiled OR DISTRIBUTION comprehensive lists shared in multiple ways. The World Wide Web of computer terms and definitions that can be (www) is a network program that is familiar to easily accessed and used for teaching and learn- most Internet users. A collection of documents, ing basic computer language. One list, created images, and web pages, the World Wide Web specifically for the older population, has been makes it possible© Jones to gather & Bartlettinformation Learning, from developed LLC by the National Institute© Joneson Aging & Bartlett Learning, LLC many resources,NOT as wellFOR as toSALE share information OR DISTRIBUTION and can be found at https://nihseniorhealth.govNOT FOR SALE OR DISTRIBUTION around the globe. Smartphones add another /toolkit/toolkitfiles/pdf/Glossary.pdf. layer of information gathering and storage via Having a common terminology is essential telephone and global positioning system (GPS) to the effective use of retrieved computer data technology, preserving the ability to access and to improve patient care and outcomes. Nurses © Jonesdisseminate & Bartlett information, Learning, no matter LLC where we must be able to ©capture Jones their & work Bartlett in a way Learning,that LLC NOTare, FOR 24 hours SALE a day OR (Cheeseman, DISTRIBUTION 2011; Dainow, is meaningful andNOT allows FOR for evaluationSALE OR of theDISTRIBUTION 2016; Kaminiski, 2015). effectiveness of nursing interventions (Ruther- Another use of the Internet is to store large ford, 2008). The American Nurses Association amounts of information in a cloud. This method (2012) published 12 approved standardized of storage allows an organization to achieve cost terminologies that support nursing work. The © Jones & Bartlettsavings Learning, in many areas LLC (maintenance, infrastructure, © InternationalJones & Bartlett Council of Learning, Nurses (2015) LLC devel- NOT FOR SALE ORuse of DISTRIBUTION less expensive computers). For an organiza- NOToped FOR a framework SALE forOR nursing DISTRIBUTION practice that tion that requires fast and consistent access to the allows for inclusion of different terminologies cloud storage, loss of, or a slow, Internet service that support the work of nurses. The goals of connection will be a disadvantage of this method these two documents are similar and support of data storage (Cheeseman, 2011). the use of common nursing language to raise Health care© hasJones benefited & fromBartlett recent computerLearning, awareness LLC of nursing work, communication© Jones & Bartlett Learning, LLC advances in NOTsoftware FOR programming, SALE OR including DISTRIBUTION within the healthcare team, ease of NOTdata retrieval FOR SALE OR DISTRIBUTION educational packages for online instruction through and analysis for evaluation of nursing work, and courses, simulation experiences (avatars, high- increased ability to incorporate and adhere to fidelity mannequins, and online student resources), evidence-based standards of care (Rutherford, artificial intelligence/robotics to improve life for 2008). Use of standard terminologies ensures © Jonesindividuals & Bartlett with disabilities, Learning, and research LLC (e.g., that communications© Jones are & understood Bartlett Learning,and LLC NOTthe FOR Human SALE Genome OR Project DISTRIBUTION to map DNA). Social interpreted in NOTthe same FOR way SALE by all members OR DISTRIBUTION networking applications (also known as social of the healthcare team (Halley, Sensmeier, & media) are software programs that encourage Brokel, 2009).

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▸ Fineout-Overholt, 2011). The term PICOT ▸ Integrating© Jones & Bartlett Evidence- Learning, LLCidentifies the patient or population© Jones (P), & issueBartlett Learning, LLC BasedNOT FOR Practice SALE OR DISTRIBUTIONor intervention (I), whatNOT will be FOR compared SALE OR DISTRIBUTION (C), the expected outcome (O), and the time Introduction (T) that it will take to achieve and evaluate the outcome (Melnyk & Fineout-Overholt, 2011). EBP is a process that has developed from a need The PICOT format is a systematic method of © Jones &to improveBartlett the qualityLearning, and manage LLC the economics question© writing Jones and & helps Bartlett decrease Learning, the time LLC NOT FORof SALE healthcare OR delivery DISTRIBUTION (Salmond, 2007). The com- and effortNOT it takes FOR to findSALE evidence OR DISTRIBUTIONspecific to ponents of EBP include a systematic and critical the topic being investigated. Consistently using evaluation of the current literature, the nurse’s a set format to write the question ensures that clinical expertise and available resources, and all components of the question are addressed patients’ values and preferences. This informa- before the literature search begins (Stillwell, © Jones & Bartlett Learning,tion is used LLC to make deliberate clinical decisions© Jones Fineout-Overholt, & Bartlett Learning,Melnyk, & Williamson, LLC 2010). NOT FOR SALE OR DISTRIBUTIONbased on theory and relevant research that guideNOT FOR ItSALE takes time OR and DISTRIBUTION practice to learn how to patient care (Ahrens & Johnson, 2013; Ingersoll, write questions in the PICOT format. Melnyk 2000; Melnyk & Fineout-Overholt, 2011). The and Fineout-Overholt (2011) suggest that it expected results of these carefully considered takes “practice, practice, practice” to become decisions are improved outcomes for patients, proficient in writing PICOT questions (p. 31). efficiency,© Jones and cost-effective& Bartlett Learning,care delivery forLLC Questions may be written following© Jones a template & Bartlett Learning, LLC organizationsNOT FOR (Melnyk SALE & Fineout-Overholt, OR DISTRIBUTION and may focus on interventions,NOT FOR predictions SALE OR DISTRIBUTION 2011; Salmond, 2007). or prognosis of outcomes for a specific patient population, comparison of diagnosis or diag- Cultivating a Spirit of Inquiry nostic tests, etiology and associated risk factors for a specific condition, or meaning within a © Jones &The Bartlett process of Learning,EBP is best learned LLC in sequence with © Jones & Bartlett Learning, LLC distinct steps. The preliminary step, cultivating situation (Melnyk & Fineout-Overholt, 2011; NOT FORa SALEspirit of inquiryOR DISTRIBUTION (Melnyk, Fineout-Overholt, Stillwell NOTet al., 2010). FOR SALE OR DISTRIBUTION Stillwell, & Williamson, 2010, p. 51), means to Nurses who embrace EBP may find support be curious about the effectiveness of nursing in forming groups interested in certain topics. interventions, to take interest in changing Lawson (2005) suggests that getting other nurses nursing practice or questioning practice, and involved helps to clarify clinical issues and to write © Jones & Bartlett Learning,to try new LLCapproaches. Nurses with a spirit© ofJones clear & and Bartlett specific clinicalLearning, questions. LLC Once a group NOT FOR SALE OR DISTRIBUTIONinquiry understand EBP as a way of thinking,NOT not FORis assembled SALE and OR the DISTRIBUTION individuals are comfortable an additional burden to their practice. Nurses in identifying issues and writing questions, the who are passionate about EBP will likely become second step, searching for evidence, can begin. informal leaders, or be promoted to leadership Finding the Evidence Using positions,© Jones and can influence& Bartlett others Learning, to grow sup- LLC © Jones & Bartlett Learning, LLC port for EBP. Those who have a spirit of inquiry Library Sources will haveNOT questions FOR andSALE a desire OR to findDISTRIBUTION the best NOT FOR SALE OR DISTRIBUTION evidence to support their practice (Melnyk, In order to use evidence in EBP, a nurse must locate Fineout-Overholt, Stillwell, & Williamson, 2009). and review the evidence found in research articles as published in reliable sources. This process begins with using appropriate electronic databases © Jones &Writing Bartlett the Learning, Question LLC and performing© Jones effective & Bartlett online searches. Learning, Using LLC NOT FORNurses SALE who OR use DISTRIBUTION the steps of EBP to formal- appropriateNOT databases FOR canSALE be easier OR for DISTRIBUTION nursing ize their questions about practice should use students during their coursework and for nurses the PICOT format (Lawson, 2005; Melnyk & at university-affiliated hospitals and clinics, with

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their many research database subscriptions, but One of the greatest skills that nurses learn other options© are Jones available. & Bartlett Learning,in theirLLC academic program is the ability© Jones to find & Bartlett Learning, LLC Nurses NOTshould FORuse databases SALE and OR websites DISTRIBUTION relevant research on clinical topics.NOT To FORbegin SALE OR DISTRIBUTION that have valid and reliable information. PubMed the search in one of these research databases, and Cumulative Index to Nursing and Allied nurses should select key terms from the PICOT Health Literature (CINAHL) are two databases question. These terms are entered using Boolean that index a comprehensive body of healthcare operators (and, or, not) to combine multiple © Jonesliterature. & Bartlett The Cochrane Learning, Databases LLC and the search terms. In© addition, Jones many & Bartlettdatabases allow Learning, LLC NOTNational FOR SALE Guideline OR Clearinghouse DISTRIBUTION support the use of quotationNOT marks FOR to search SALE for ORphrases DISTRIBUTION EBP by including systematic reviews and current of multiple words. A good search technique is practice guidelines. Government sources for to set limits on the search, to narrow down the reliable information include the Centers for results to articles that are more suitable. For Disease Control and Prevention (CDC) and example, limiting a search to English-language, © Jones & Bartlettthe Learning, Agency for LLCHealthcare Research and © peer-reviewedJones & Bartlett journals andLearning, articles published LLC NOT FOR SALE ORQuality DISTRIBUTION (AHRQ). Many professional organi- NOTwithin FOR the lastSALE 5 years OR can DISTRIBUTION help in the selec- zations have their journals and evidence-based tion of valid findings that may be applicable guidelines available electronically for members to the topic (Hoss & Hanson, 2008; Melnyk & or individuals who have subscribed online Fineout-Overholt, 2011). (Fineout-Overholt, Berryman, Hofstetter, & Sollenberger,© 2011;Jones Hoss & &Bartlett Hanson, Learning,2008). LLC © Jones & Bartlett Learning, LLC InformationNOT about FORadditional SALE resources OR isDISTRIBUTION ad- Systematic Reviews and ClinicalNOT FOR SALE OR DISTRIBUTION dressed later in this chapter. Practice Guidelines Systematic reviews are literature reviews that Searching for Evidence in Research follow a certain methodology to standardize © JonesLiterature & Bartlett Learning, LLC the critique of research© Jones findings. & Bartlett Two excellent Learning, LLC NOT FOR SALE OR DISTRIBUTION sources of systematicNOT FORreviews SALE are McMaster OR DISTRIBUTION Searching the literature may seem like a daunting Plus Nursing+ and the Cochrane Collabora- task, and overwhelming to those who have not tion. McMaster Plus has three functions: (1) it had experience with electronic databases. While serves as a database of peer-reviewed articles lack of access to an onsite library or computer that have been rated by nursing professionals, © Jones & Bartlettdatabase Learning, applications LLC can be a major barrier to © (2)Jones it contains & Bartlett an email alert Learning, system for selectedLLC conducting a search for evidence, the inability topics of interest, and (3) it provides links to NOT FOR SALE ORof a DISTRIBUTIONnurse to effectively use the computer to NOTabstracts FOR of SALE systematic OR reviewsDISTRIBUTION of research search the literature adds an additional barrier literature. The Cochrane Collaboration is a to embracing EBP (Hoss & Hanson, 2008; library built by healthcare professionals who Wells, Free, & Adams, 2007). Nurses without author Cochrane Reviews, which are the gold computer skills© Jones or experience & Bartlett in data searches Learning, standard LLC for preappraised research© evidence.Jones & Bartlett Learning, LLC can seek assistance from a university or hospital Only a few Cochrane reviews are free; most librarian, orNOT other FORexperienced SALE professionals OR DISTRIBUTION are contained in the CochraneNOT Database FOR SALE OR DISTRIBUTION (Fain, 2009). Time spent with a librarian who of Systematic Reviews and available with a loves to teach others how to find these treasure subscription. Nurses can join the Cochrane troves of information is priceless, and will Journal Club and other electronic notifications © Jonesreturn & a lifetimeBartlett of informationLearning, power. LLC Links of systematic ©reviews Jones and & clinical Bartlett practice Learning, LLC to tutorials and videos for using commonly guidelines at no cost. Table 3-1 provides a NOTaccessed FOR SALE databases OR can DISTRIBUTION be found in the com- list of resourcesNOT and FORInternet SALE addresses OR forDISTRIBUTION panion website for this book. these sites.

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Table© Jones 3-1 Resourc & Bartlettes to Learn Learning, About EBP LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Tutorials Internet Address

Appraising the Evidence http://nursingworld.org/MainMenuCategories/The PracticeofProfessionalNursing/Improving-Your-Practice © Jones & Bartlett Learning, LLC /Research-Toolkit/Appraising-the-Evidence© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION American Nurses Association (ANA) list of http://ana.nursingworld.org/research-toolkit/Education online tutorials about EBP

University of North Carolina EBP tutorials http://www.hsl.unc.edu/Services/Tutorials/EBM © Jones & Bartlett Learning, LLC © /welcome.htmJones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Academic Center for Evidence-Based Practice at the University of Texas Health Science Center at San Antonio Basic Modules http://acestar.uthscsa.edu/modules/Basic.htm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Intermediate Modules http://acestar.uthscsa.edu/modules/Intermediate.htm NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Clinical guidelines are valuable because There are ways to access libraries free or at © Jones &they Bartlett contain preappraisedLearning, research.LLC Authors low costs© for Jones individual & Bartlettnurses. The Learning, best place LLC of clinical practice guidelines rate the research to start is PubMed, which is freely available NOT FORfor SALE the quality OR ofDISTRIBUTION evidence and the strength of online. SomeNOT of FORthe research SALE journals OR publishedDISTRIBUTION making a recommendation for change based on online are available as open access journals— the findings. The federal government provides if those journals are indexed in PubMed, then at least three sources of free clinical practice those results will link to the article. Google guidelines at the Agency for Healthcare Quality Scholar can also be a useful tool. © Jones & Bartlett Learning,and Research, LLC the National Guidelines Clearing© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION House, and the PubMed Clinical Queries. PubMed Table 3-2 provides the Internet addresses for the free resources for clinical practice guidelines. As a service of the National Center for Bio- technology Information (NCBI) at the U.S. National Library of Medicine (NLM), PubMed is Using© Free Jones Resources & Bartlett Learning, LLCan extensive index of published© medicalJones literature & Bartlett Learning, LLC AfterNOT students FOR leave SALE their colleges OR DISTRIBUTION and univer- with over 22 million citations.NOT Nursing FOR literature SALE OR DISTRIBUTION sities, access to subscription databases, such as is indexed in this service too. However, unlike CINAHL, depends on resources available in CINAHL and other subscription databases, it their places of employment. For those in ac- does not provide full-text access to those articles. ademic medical centers, access to databases While articles can be accessed with the LinkOut © Jones &may Bartlett be assured; Learning, those in community LLC hospitals functionality,© Jones they may & Bartlettnot be housed Learning, within LLC NOT FORor SALE ambulatory OR DISTRIBUTIONsettings will likely find them- the PubMedNOT database. FOR SALE OR DISTRIBUTION selves disconnected from the very lifeline of ev- PubMed offers several noteworthy features. idence-based practice—a library. Rather than using keywords, the most effective

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Table 3-2© JonesPubMed T&utorials Bartlett and V ideos:Learning, Learn H owLLC to Search Efficiently for Articles© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Tutorials Internet Address

PubMed Tutorial http://www.nlm.nih.gov/bsd/disted /pubmedtutorial/ © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORMedical SALE Subject HeadingsOR DISTRIBUTION (MeSH) in http://www.nlm.nih.gov/bsd/distedNOT FOR SALE OR DISTRIBUTION MEDLINE/PubMed: A Tutorial /meshtutorial/introduction/index.html

Branching Out: The MeSH Vocabulary http://www.nlm.nih.gov/bsd/disted/video/

© Jones & BartlettVideos Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION My NCBI—National Center for Biotechnology http://www.youtube.com/watch?v=ks46w3mNAQE Information

PubMed Simple Subject Search http://www.nlm.nih.gov/bsd/viewlet/search © Jones & Bartlett Learning,/subject/subject.html LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION PubMed Author Search http://www.nlm.nih.gov/bsd/viewlet/search /author/author.html

Getting Full-text Articles from PubMed http://www.youtube.com/watch?v=V0NYKFSphKY © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORUsing SidebarSALE Filters OR to DISTRIBUTION Limit Results http://www.youtube.com/watch?vNOT FOR =SALE696R9GbOyvA OR DISTRIBUTION &feature=youtu.be

Advanced PubMed Search Builder http://www.youtube.com/watch?v=dncRQ1cobdc &feature=relmfu © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORSave DISTRIBUTION Search Results in Collections, Including NOThttp://www.youtube.com/watch?v FOR SALE OR DISTRIBUTION=iXSttEKntCE Favorites

Searching by Using the MeSH Database http://www.youtube.com/watch?v=uyF8uQY9wys

Search for Journal© Jones in PubMed & Bartlett Learning,http://www.nlm.nih.gov/bsd/viewlet/search LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION/journal/journal.html NOT FOR SALE OR DISTRIBUTION

Retrieving Citations from a Journal Issue http://www.nlm.nih.gov/bsd/viewlet/search /scm/scmissue.html

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way to search in PubMed is by using Medical are then set to MeSH terms, and Boolean oper- Subject© JonesHeadings & (MeSH) Bartlett. MeSH Learning, is a thesaurus LLCators (and, or, not) should be© usedJones as needed. & Bartlett If Learning, LLC of controlled-vocabularyNOT FOR SALE terms. OR OnceDISTRIBUTION MeSH the yield is too high for a reasonableNOT FOR review SALE of OR DISTRIBUTION terms are found for the topic, a more fruitful articles, then the sidebar filters can be added yield will result from searches of PubMed. including article types (clinical trials, systematic Figure 3-1 shows a MeSH tree for obstructive reviews, practice guidelines, to name a few), sleep apnea. Other features of PubMed are the text availability (abstract available, free full text © Jones &PubMed Bartlett Advanced Learning, Search LLCBuilder, sidebar available,© or Jones full text available), & Bartlett and publicationLearning, LLC NOT FORfilters, SALE LinkOut, OR DISTRIBUTION and My NCBI. dates. TheNOT filters FOR will limit SALE the searchOR DISTRIBUTION to a num- The MeSH terms selected are entered into ber that is more manageable. When the desired the PubMed Advanced Search Builder, the articles are selected, some full-text articles may open boxes in PubMed. The drop-down menus be freely available using the LinkOut service. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Figure 3-1 MeSH tree of obstructive sleep apnea produced from a search of PubMed. Courtesy of National Center for Biotechnology Information. Available at http://www.ncbi.nlm.nih.gov/pubmed

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LinkOut is found in the upper right-hand cor- disciplines. Its index includes literature from both ner of the screen.© Jones To find & the Bartlett desired reference Learning, free LLC and paid repositories, professional© Jones societies, & Bartlett Learning, LLC material, theNOT LinkOut FOR icon SALE should ORbe clicked. DISTRIBUTION academic publishers, and other sourcesNOT across FOR the SALE OR DISTRIBUTION Icons change depending on the source of the web. The primary focus is to index all academic reference material. If full text is not available, papers on the web (Google). While there is no nurses can order the articles from their hospitals doubt of the value of the service for researchers or from public libraries using interlibrary loan of all kinds, it also has its shortcomings. Google © Jonesservices. & Typically,Bartlett a Learning,public library willLLC have a takes articles from© Joneseverywhere & itBartlett can access Learning, on LLC NOTnominal FOR SALEcharge for OR an interlibraryDISTRIBUTION loan. the web, and usersNOT must FOR be careful SALE to ORvet the DISTRIBUTION Searches of PubMed should be managed articles they find using Google Scholar, because such that the MeSH terms and the yields from the articles may or may not be peer reviewed. searches can be retrieved if needed. PubMed One particularly celebrated and useful feature of provides a cloud-based folder called My NCBI Google Scholar is the “cited by” feature. The “cited © Jones & Bartlett(My Learning, National Center LLC for Biotechnology Infor- © by”Jones feature & allows Bartlett users to Learning,view a list of later LLC works NOT FOR SALE ORmation) DISTRIBUTION for searching and storing the history NOTthat haveFOR cited SALE the original OR DISTRIBUTION paper. This ability to of searches. Up to 6 months of search histories connect literature through citations has histori- can be stored in My NCBI. Registration and cally only been available through paid services. A use is free. Written tutorials and short videos particularly pervasive shortcoming of the service provide excellent help for nurses who are new is that it strengthens the Matthew Effect, a term to PubMed. ©Some Jones of the &most Bartlett helpful tutorials Learning, coined LLC by sociologist Robert Merton© Jonesto refer to & Bartlett Learning, LLC and videos areNOT listed FOR in Table SALE 3-3. OR DISTRIBUTIONthe way in which starting advantagesNOT tend FOR to SALE OR DISTRIBUTION build on themselves (Rigney, 2010). With Google Scholar this is seen in the way that articles with Google Scholar more citations are more likely to be at the top of Google Scholar is a web-based search engine the search results, and newer articles with fewer © Jonesfor scholarly & Bartlett literature Learning, across a broad LLC range of citations are more© likelyJones to be & lower Bartlett on the pageLearning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Table 3-3 Electronic Alerts for Systematic Reviews and Clinical Practice Guidelines © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Resource Internet Address NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION McMaster Plus, British Medical Journal Updates https://plus.mcmaster.ca/EvidenceAlerts/

PubMed https://www.ncbi.nlm.nih.gov/pubmed/ © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Knowledge Finder from the National Library of http://www.kfinder.com/kfinder/Default.htm Medicine NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Cochrane Library Journal Club http://www.cochranejournalclub.com/self Scroll to bottom to find sign-up form -monitoring-and-self-management-oral -anticoagulation-clinical/default.asp?moreinfo © Jones & Bartlett Learning, LLC -1#moreinformation© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION National Guideline Clearinghouse Email Alerts http://www.guideline.gov/subscribe.aspx

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and thus less likely to be read and used (Beel & evaluate the quality of research studies. These Gipp, ©2009). Jones Google & Scholar Bartlett is a valuable Learning, resource LLCtools address the validity of the© study,Jones reliability & Bartlett of Learning, LLC for researchersNOT FOR of all SALEkinds, but, OR as is DISTRIBUTION true with all the results, and the applicabilityNOT to theFOR particular SALE OR DISTRIBUTION research tools, it is the responsibility of researchers patient care setting (see Table 3-1). to verify the veracity of any sources they use. Putting the EBP Process into Practice © Jones &Open Bartlett Access Learning, Journals LLC Once the© literature Jones is analyzed & Bartlett using aLearning, systematic LLC NOT FORFreely SALE available OR DISTRIBUTIONarticles are provided by pub- approach,NOT nurses FOR working SALE on an EBP OR project DISTRIBUTION will lishers who offer open access. The rationale for need to decide if a change in practice is needed. providing free, online access to scholarly articles If so, then creating enthusiasm for the project and research is to advance scientific thought, and soliciting input from all stakeholders early particularly for individuals in developing in the planning stages will be critical. Early © Jones & Bartlett Learning,countries whoLLC cannot afford the high prices© Jonesof and & frequent Bartlett communication Learning, by LLCemail or other NOT FOR SALE OR DISTRIBUTIONjournal subscriptions (Carroll, 2011). The costNOT of FORinnovative SALE strategies OR DISTRIBUTION such as Twitter, Facebook, publication is shifted to the authors, rather than or blogging can keep stakeholders involved. the readers. While this makes research avail- As with any change, a plan needs to be able, nurses must ensure that they are selecting prepared. A theoretical model or process, such articles from peer-reviewed journals. Journals as Plan-Do-Study-Act (PDSA), can be used that are© Jonesopen access & Bartlettcan be found Learning, by search- LLCas a framework to plan and© Jones implement & Bartlettthe Learning, LLC ing onlineNOT for FOR the Directory SALE OR of Open DISTRIBUTION Access project. A timeline for theNOT project FOR is essential SALE OR DISTRIBUTION Journals (DOAJ). A particular advantage of the to keep it on track. Even strategies to over- DOAJ is that it gives smaller publications a way come barriers to the planned change need to to expand their reach. Nurses should always be be included. Selecting an evaluation strategy as vigilant about the quality of their sources, but part of the initial project plan is also necessary © Jones &they Bartlett should not Learning, neglect open LLC access journals, (Melnyk© & JonesFineout-Overholt, & Bartlett 2011). Learning, The plan LLC NOT FORas SALE they often OR haveDISTRIBUTION research from more varied must addressNOT any FOR ethical SALE issues ORand protectedDISTRIBUTION sources and in smaller research niches. health information issues by seeking Institu- tional Review Board approval for the project (Levin, 2013). The project plan can be made Analyzing the Literature using an Excel spreadsheet or using specific © Jones & Bartlett Learning,Not all evidence LLC is equal; nor will all evidence© beJones software & Bartlett for project Learning, planning such LLC as Microsoft NOT FOR SALE OR DISTRIBUTIONapplicable to a particular clinical setting. WhenNOT FORProject. SALE Following OR theDISTRIBUTION timeline and sharing the searching for evidence, it is prudent to look for project results during implementation will help clinical practice guidelines, systematic reviews, other nurses and stakeholders remain engaged meta-analyses of evidence, or randomized con- in the practice change (Lawson, 2005). trolled trials relevant to the particular clinical question.© Jones Single studies & Bartlett or case studiesLearning, can be LLC © Jones & Bartlett Learning, LLC used toNOT demonstrate FOR SALE how evidence OR DISTRIBUTION is put into Communicating the FindingsNOT FOR SALE OR DISTRIBUTION practice, and textbooks can be used as resources Once the practice change is stable, the final for information on a particular condition. Most step of EBP is to share the results with others. nursing research and evidence-based practice Failure to share the outcomes of EBP projects textbooks will have guides to help evaluate may lead to unwarranted duplication and delay © Jones &the Bartlett quality of Learning,quantitative and LLC qualitative re- in getting© evidenceJones into& Bartlett practice throughoutLearning, LLC NOT FORsearch SALE studies OR (Levin,DISTRIBUTION 2013; Fineout-Overholt the practiceNOT setting FOR and SALE beyond. OR Results DISTRIBUTION can et al., 2011). The American Nurses Association be disseminated in the organization at staff has developed a list of resources to help nurses meetings, in a nursing newsletter, as a blog

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posting, or as a poster presentation. Findings solutions: Zotero and Mendeley, among others. should be presented© Jones at local& Bartlett specialty Learning, group Each LLC of these citation management© Jonesprograms & Bartlett Learning, LLC meetings or NOTat regional FOR or nationalSALE conferencesOR DISTRIBUTION (sometimes called citation managersNOT or reference FOR SALE OR DISTRIBUTION (Melnyk et al., 2010). Nurses can also partner managers) has different computer requirements with local schools or colleges of nursing to cre- and installation instructions. ate an Evidence-Based Practice Day, in which As one example, Zotero can be installed nurses from various clinical settings can share either as a plug-in for the Mozilla Firefox Internet © Jonesthe results & Bartlett of their projects. Learning, LLC browser or as a standalone© Jones desktop & Bartlett program. Learning, (If LLC NOT FOR SALE OR DISTRIBUTION the standalone desktopNOT FOR program SALE is installed, OR DISTRIBUTION a browser plug-in for Google Chrome, Apple Safari, Evaluating EBP and/or Firefox should also be installed.) Once Standardized computer terminology and data- Zotero is installed, databases such as PubMed, bases provide the opportunity to evaluate EBP. CINAHL, or Google Scholar can be searched as © Jones & BartlettOutcome Learning, data are LLC available from the EHR, © normal.Jones Any & relevantBartlett search Learning, results can easilyLLC be NOT FOR SALE ORdisease-specific DISTRIBUTION registries, and other quality care NOTsaved FOR into the SALE Zotero OR library DISTRIBUTION on the computer. databases. In order for these data to be useful, Researchers can also create a free online account they must be entered correctly, processed in a with Zotero, in order to save their desktop/ meaningful way, and retrieved and analyzed using laptop citation library online (in order to have appropriate statistical tools (Tymkow, 2016). access to their library when working at another © Jones & Bartlett Learning,computer). LLC In addition to storing© references, Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONmany citation managers (includingNOT Zotero) FOR can SALE OR DISTRIBUTION Finding More About EBP Online be integrated into Microsoft Word (or other Because this chapter provides a brief overview word-processing programs). This add-in feature of EBP, Internet-based resources can be used to is the real magic of reference software. When a supplement knowledge of EBP. The American reference is selected in the Zotero library, with © JonesNurses &Association Bartlett (ANA) Learning, provides a listLLC of online the click of one ©icon Jones the reference & Bartlett is cited in Learning, the LLC NOTtutorials FOR SALE that can assistOR DISTRIBUTIONnurses in learning more narrative and addedNOT toFOR a reference SALE list OR in theDISTRIBUTION about EBP, and the University of North Carolina word-processing document. Any changes are also has free EBP tutorials available for nurses automatically reflected in the in-text citations and who seek information about the EBP process. reference list. Finally, references in Zotero can These resources can be found in the companion be shared with other Zotero users; this feature © Jones & Bartlettwebsite Learning, for this book. LLC © isJones helpful for& Bartlettteams of nurses Learning, focused on LLC EBP. NOT FOR SALE OR DISTRIBUTION NOT FORThere SALEare multiple OR choicesDISTRIBUTION for reference managers, in addition to Zotero. (Mendeley Using Reference Manager Software works in a similar manner, is fully compatible with Windows and Mac operating systems, and to Store and Use Sources can work with any Internet browser.) In most Nurses who plan© Jones to carry out & formalBartlett EBP projectsLearning, cases, LLC a researcher will only need to select© Jones and use & Bartlett Learning, LLC need to learnNOT how to FOR manage SALE the results OR of DISTRIBUTION their one reference manager (e.g., Zotero NOTor Mendeley, FOR SALE OR DISTRIBUTION searches using software. This is particularly critical but not necessarily both). In selecting which if the nurse plans to communicate findings in reference manager to use, it may help to check poster sessions or in published articles. Without with colleagues. (If sharing a citation library with software, the research articles, systematic reviews colleagues, it is helpful for all the team members © Jonesof literature, & Bartlett and clinical Learning, practice LLCguidelines to use the same© reference Jones manager.) & Bartlett Note Learning,that LLC NOTcan FOR become SALE stacks OR of DISTRIBUTIONpaper with little or no free programs likeNOT Zotero FOR and MendeleySALE OR provide DISTRIBUTION organization. Fortunately, there are free software users with the option to pay for upgraded levels

© Jones & Bartlett Learning, LLC© Jones & Bartlett Learning, LLC.© NOTJones FOR SALE& Bartlett OR DISTRIBUTION Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284138443_CH03.indd 36 12/09/17 1:33 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Staying Current in Nursing Practice and Specialty Areas 37

Table© Jones 3-4 Repositories & Bartlett of Clinical Learning, Practice LLCGuidelines © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Resource Internet Address

Agency for Healthcare Research and Quality (AHRQ) http://www.ahrq.gov/clinic/cpgsix.htm

© Jones & AHRQBartlett Innovations Learning, Exchange LLC https://innovations.ahrq.gov/© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION National Guideline Clearinghouse http://www.guideline.gov/

PubMed Clinical Queries https://www.ncbi.nlm.nih.gov/pubmed/clinical

© Jones & Bartlett Learning,National InstituteLLC for Health and Care Excellence© Jones http://www.nice.org.uk/ & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION(NICE) Organization NOT FOR SALE OR DISTRIBUTION

McMaster Plus Nursing+ http://plus.mcmaster.ca/np/Default.aspx

of online© Jones cloud storage. & Bartlett On the Learning, other hand, LLClists journal publishers who© provide Jones free & email Bartlett Learning, LLC EndNoteNOT is an FOR example SALE of a referenceOR DISTRIBUTION manager notifications. NOT FOR SALE OR DISTRIBUTION with an up-front cost, but which includes greater levels of online storage and free online training (along with other resources). Rich Site Summary Rich Site Summaries (RSS), often called RSS © Jones & Bartlett Learning, LLC feeds, are© simplified Jones &summaries Bartlett of theLearning, informa- LLC NOT FOR SALE OR DISTRIBUTION tion providedNOT on FOR whole websites.SALE ForOR example, DISTRIBUTION an ▸▸ Staying Current in RSS feed of the CNN website would show a list of all the stories on the page. RSS feeds provide a Nursing Practice and clear and easy way of tracking information from a large number of sources, and nurses should be © Jones & Bartlett Learning,Specialty LLC Areas © Jonesaware & Bartlettof the wealth Learning, of information LLC available to NOT FOR SALE OR DISTRIBUTION NOT FORthem SALE through OR RSS feeds.DISTRIBUTION Some notable sources Email Notifications of feeds include the National Institutes of Health, It is impossible to read enough journals to the Food and Drug Administration, the CDC, stay current with the short shelf-life of most and the AHRQ. The U.S. government web portal research. Using technology to stay current is provides a large index of these feeds on their a smart© decision.Jones &With Bartlett registration Learning, at journal LLCwebsite (https://www.usa.gov).© Jones & Bartlett Learning, LLC publisherNOT websites, FOR emailSALE notifications OR DISTRIBUTION will be NOT FOR SALE OR DISTRIBUTION sent when new content is available. Publishers send a table of contents with every issue of the Social Media journal. Links from the table of contents often Social media includes Facebook, Twitter, Linke- provide an abstract. If an interesting journal dIn, and all the other similar services. In health © Jones &article Bartlett is in the Learning, table of contents, LLC then the nurse care, social© Jonesmedia has & not Bartlett been a widely Learning, used LLC NOT FORcan SALE order ORthe article DISTRIBUTION using interlibrary loan if tool, butNOT that may FOR be changing.SALE OR Social DISTRIBUTION media it is not available from other sources. Table 3-5 services help people to connect, share their

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Table 3-5© JonesElectronic & S ubscriptionsBartlett Learning, to Journal Email LLC Notifications © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Resource Internet Address

RSS Feeds for Nursing http://journals.lww.com/ajnonline/_layouts/15/oaks.journals/feeds Journals .aspx © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORMobile SALECINAHL OR DISTRIBUTIONhttps://health.ebsco.com/products/the-cinahl-databaseNOT FOR SALE OR DISTRIBUTION

Lippincott Williams & http://journals.lww.com/pages/login.aspx?ContextUrl Wilkins Email Alerts =%2fsecure%2fpages%2myaccount.aspx

© Jones & BartlettSage Learning, Publishers EmailLLC Alerts http://www.sagepub.com/emailAlerts.sp?_DARGS© Jones & Bartlett Learning,=/common LLC NOT FOR SALE OR DISTRIBUTION /components/extras_big.jsp.1_A&_DAVNOT FOR SALE=Dummy&_dynSess OR DISTRIBUTION -Conf=1994759084613409176

Springer Publishing Email http://www.springerpub.com/products/Journals/Nursing Alerts #.UdjEufnVCQo © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION experiences, develop groups, and communicate new ways for nurses to engage with one another more effectively. For a healthcare provider (HCP) to learn about the best practices in patient care. that might mean instant-messaging services Technologies such as Skype, Google Hangouts, between patients and nurses or doctors, or and join.me offer low-cost or free services to © Jonesvideo-conference-based & Bartlett Learning, appointments. LLC It could connect multiple© people Jones with & audio, Bartlett video, Learning,and LLC NOTalso FOR mean SALE social OR networks DISTRIBUTION specific to nurses desktop sharing.NOT When FOR used as SALE continuing OR edu DISTRIBUTION- and doctors where opportunities, research, and cation or webinars, nurses can participate with wisdom could be shared. A free EHR system experts on clinical topics anywhere Internet called Hello Health is used by a Brooklyn-based service is available. Sortedahl (2012) developed practice that provides a model for this type of an online journal club for school nurses and © Jones & Bartlettintegration Learning, (Hawn, LLC 2009). The practice has de- © assessedJones nurses’& Bartlett satisfaction Learning, with the methodLLC NOT FOR SALE ORveloped DISTRIBUTION a patient management platform where NOTafter FOR 3 months. SALE Sortedahl OR DISTRIBUTIONfound that the nurses patients can communicate with their HCP via valued three key elements: having well-informed private instant messaging, schedule video-chat knowledgeable moderators, getting research ar- appointments, renew prescriptions, and access ticles in advance, and discussing the application their own personal health record (Hawn). As of findings to nursing practice. The researcher the landscape© continuesJones &to Bartlettdevelop and Learning, these also LLC found that using Internet-based© technology Jones & Bartlett Learning, LLC tools evolve, NOTnurses FORmust adapt. SALE By focusing OR DISTRIBUTION on allowed the journal club to invite theNOT author FOR of SALE OR DISTRIBUTION the improved communication enabled by social a research article to the club meeting, which media, nurses will be able to build communities benefited the researcher and nurses. There were and share their experiences and wisdom. issues with slow Internet connections, firewalls and other security measures, and operating © Jones & Bartlett Learning, LLC system incompatibilities.© Jones Despite & Bartlett the technical Learning, LLC NOTWebinars FOR SALE and ORTeleconferences DISTRIBUTION issues, the nursesNOT liked FOR the method SALE and OR wanted DISTRIBUTION Communication technology, particularly even more interaction with each other between Internet-based communications, have opened up journal club meetings (Sortedahl).

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▸ customized for use in the particular healthcare ▸ Evidence-Based© Jones & Bartlett Practice Learning, LLCsetting. Nurses and other© HCPs Jones need & to Bartlett be Learning, LLC IntegratedNOT FOR SALE in Clinical OR DISTRIBUTION involved in the developmentNOT of the FOR CDSS SALE be- OR DISTRIBUTION cause the system should reflect the best clinical Decision-Support Systems decisions, and HCPs are equipped to translate clinical research into clinical processes through The most efficient means for integrating EBP in a reasoning engine in the EHR (Brokel, 2009). © Jones &clinical Bartlett processes Learning, is to have clinical LLC decision- In a very ©basic Jones way, order & Bartlett sets and nursing Learning, plans LLC NOT FORsupport SALE system OR DISTRIBUTION (CDSS) embedded in health of care inNOT EHRs FOR represent SALE clinical OR DISTRIBUTIONdecision information technology (health IT). Clinical support because the predetermined orders decision-support systems are computer systems are used to simplify the cognitive processes designed to impact clinical decision making necessary for planning care. When order sets and about individual patients at the moment nursing plans of care are developed, nurses © Jones & Bartlett Learning,those decisions LLC are made (Berner & La Jande,© Jones can & influence Bartlett the Learning, process by serving LLC on a task NOT FOR SALE OR DISTRIBUTION2007) by presenting contextually appropriateNOT FORforce SALE to develop OR the DISTRIBUTION CDSS by bringing research information. CDSSs bring the available, ap- evidence and clinical practice guidelines to this plicable knowledge and research together into decision-making group. In this way, nurses con- systems that clinicians can use throughout the tribute to the implementation of evidence-based decision-making process. The key aspect is that practice (Brokel, 2009). the usefulness© Jones comes & Bartlett from the interactionLearning, of LLC © Jones & Bartlett Learning, LLC the humanNOT and FOR the SALEcomputer. OR Modern DISTRIBUTION CDSSs NOT FOR SALE OR DISTRIBUTION are not designed as black boxes that interpret Health Information Technology information and deliver concrete answers, but as tools that provide the clinician with the and EBP best possible evidence relevant to the patient’s Health information includes all the information © Jones &assessment Bartlett data Learning, and laboratory LLC results to en- related to© the Jones interactions & Bartlett of patients, Learning, HCPs, and LLC NOT FORsure SALE the patient OR DISTRIBUTIONreceives the best possible care the healthNOT information FOR management SALE OR (HIM) DISTRIBUTION team. (Berner & La Jande, 2007). Beginning with the registration process, health Most CDSSs are made up of three essential information is captured, categorized, stored, and components: the knowledge base, the reasoning retrieved to use in making decisions related to engine, and a mechanism to communicate with the delivery of health care. Managing health © Jones & Bartlett Learning,the user (Berner LLC & La Jande, 2007). The knowl© Jones- information & Bartlett through Learning, the life span LLC of EHRs is NOT FOR SALE OR DISTRIBUTIONedge base contains all the relevant knowledgeNOT FORthe responsibility SALE OR ofDISTRIBUTION HIM professionals (ITI expressed as if-then rules. The reasoning engine Planning Committee, 2015). contains a set of instructions that tell the computer As outlined in the ITI Planning Committee how to apply the rules to real patient data. The white paper (2015), responsibilities and require- communication mechanism provides the means ments for HIM professionals include ensuring for patient© Jones data to & be Bartlett entered into Learning, the system LLCthe integrity, protection, ©and Jones availability & Bartlett of Learning, LLC and forNOT any pertinentFOR SALE findings OR to DISTRIBUTIONbe relayed to health information. HIM professionalsNOT FOR work SALE in OR DISTRIBUTION the user. Many CDSSs rely on the user to input a variety of roles to capture, validate, maintain, data manually, but the continued acceptance of and analyze data as well as providing decision EHRs and improved interoperability among support for health professionals. HIM practice systems will enable more systems to input data by these professionals support the life cycle of © Jones &automatically Bartlett Learning, from multidisciplinary LLC team health information© Jones from& Bartlett capture orLearning, input of LLC NOT FORmembers SALE (BernerOR DISTRIBUTION & La Jande, 2007). data intoNOT the computer FOR SALE system ORto the DISTRIBUTION disposal Commercially available EHRs typically of health information data. Principles governing have CDSSs, but the system may need to be health information have been developed by the

© Jones & Bartlett Learning, LLC© Jones & Bartlett Learning, LLC.© NOTJones FOR SALE& Bartlett OR DISTRIBUTION Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284138443_CH03.indd 39 12/09/17 1:33 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 40 Chapter 3 Informatics and Evidence-Based Practice

Box 3-1 ©Case Jones Study: &Searching Bartlett for, Learning,Evaluating, and LLC Managing Research Articles © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Beth works at the OB/GYN clinic in a medium-sized hospital. She has noticed that many of her patients develop diabetes during their pregnancy, even though they do not have a previous history of diabetes. Beth wants to use EBP to help improve the care these patients receive. As her first step, Beth wants to look in a reputable online resource for evidence-based research in © Jonesmedicine & Bartlett and nursing. Learning, She decides to LLC use PubMed. © Jones & Bartlett Learning, LLC When Beth begins her research in PubMed, she searches for “diabetes,” but she finds a lot of the NOT FORresults SALEdo not seem OR relevant; DISTRIBUTION many of the research articles describe olderNOT patients, FOR or teenagers, SALE or OR DISTRIBUTION males. In order to perform a more effective search for evidence-based research on her topic, Beth uses the MeSH database option within PubMed. When she searches in the MeSH database for diabetes and pregnancy, she finds the term “Diabetes, Gestational.” When Beth adds the MeSH term “Diabetes, Gestational” to her search in PubMed, she finds © Jones & Bartlett thousandsLearning, of articles LLC that are specific to diabetes during© Jones pregnancy. & AfterBartlett beginning Learning, to scan through LLC NOT FOR SALE ORthe DISTRIBUTION articles in this list, she uses filters to narrow downNOT her search FOR to articlesSALE from OR the DISTRIBUTION last 5 years that are about clinical trials. She still finds hundreds of articles, so she starts reading the following article: Karamali, M., Heidarzadeh, Z., Seifati, S. M., Samimi, M., Tabassi, Z., Hajijafari, M., . . . Esmaillzadeh, A. (2015). Zinc supplementation and the effects on metabolic status in gestational diabetes: A randomized, double-blind, placebo-controlled trial. J Diabetes Complications, 29(8), 1314–1319. Beth decided© Jones to start &with Bartlett this article, Learning,because the citation LLC indicates that this research article© Jones is & Bartlett Learning, LLC relevant to NOTher area FOR of research, SALE it is recent, OR DISTRIBUTIONand it reports on clinical trials with human patients.NOT After FOR SALE OR DISTRIBUTION she reviews this article and saves it, she continues looking for other similar articles. As Beth continues her research for recent articles about clinical trials with human patients, she begins to save the article citations into a personal “library.” In order to easily review these articles, she begins to use Zotero, saving her articles on her laptop and online. This has several added benefits: © Jonesshe can& Bartlettsave citations Learning, from PubMed asLLC well as articles that she finds in other© Jones research databases,& Bartlett she can Learning, LLC access those citations from other computers, she can share her library of references with her colleagues, NOT FORand she SALE can build OR a bibliography DISTRIBUTION from these articles, if she wants to documentNOT the FOR EBP at SALE her clinic. OR DISTRIBUTION Check Your Understanding 1. When Beth starts her research, she decided to start in PubMed. For what possible reasons might she have started in PubMed (over another medical database, such as CINAHL)? What advantages © Jones & Bartlett Learning,would PubMed LLC have over another resource, such© Jones as Google & Scholar? Bartlett Learning, LLC NOT FOR SALE OR2. DISTRIBUTION In Beth’s first PubMed search, she found a lot ofNOT results FOR for older SALE patients OR or males. DISTRIBUTION What benefits does she gain from using a MeSH term? 3. In the results that Beth found, she started with the 2015 article “Zinc supplementation and the effects on metabolic status in gestational diabetes.” Why would she choose this article? What information in this citation indicates that it might meet her needs? 4. When© Beth Jones starts to & sa veBartlett a personal Learning, library of her references, LLC she has several reasons to© use Jones & Bartlett Learning, LLC Zotero. How can a citation manager like Zotero (or Mendeley, or EndNote, etc.) help you with your research?NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

American Health Information Management As- of health information are focused on the interop- sociation (AHIMA) and are focused on integrity, erability of information technology systems to © Jonesprotection, & Bartlett transparency, Learning, accountability, LLC compli- support distribution© Jones of patient & Bartlettinformation Learning, by LLC NOTance, FOR and SALE the timely OR availability, DISTRIBUTION retention, and authorized usersNOT (Halley FOR et al., SALE 2009). Incorpo OR DISTRIBUTION- disposition of health information (ITI Planning ration of clinical practice guidelines and nursing Committee, 2015). Standards governing the use terminology into the EHR provides a common

© Jones & Bartlett Learning, LLC© Jones & Bartlett Learning, LLC.© NOTJones FOR SALE& Bartlett OR DISTRIBUTION Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284138443_CH03.indd 40 12/09/17 1:33 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION References 41

language and interventions that support data American Nurses Association. (2012). ANA recognized ter- collection© Jones and evaluation & Bartlett of clinical Learning, outcomes LLC minologies that support nursing© practice. Jones Retrieved & from:Bartlett Learning, LLC http://www.nursingworld.org/npii/terminologies.htm (Barey,NOT Mastrian, FOR & SALEMcGonigle, OR 2016). DISTRIBUTIONBarey, E. B., Mastrian, K., & McGonigle,NOT FORD. (2016). SALE The OR DISTRIBUTION The use of sophisticated CDSS, developed electronic health record and clinical informatics. In by multidisciplinary teams, is an efficient way to S. M. DeNisco & A. M. Barker (Eds.), Advanced translate research evidence into everyday practice. practice nursing: Essential knowledge for the profession However, the steps involved in the appraisal of (3rd ed., pp. 349–367). Burlington, MA: Jones & Bartlett © Jones & Bartlett Learning, LLC Learning.© Jones & Bartlett Learning, LLC evidence cannot be missed. It would be irrespon- Beel, J., & Gipp, B. (2009). Google Scholar’s ranking algo- NOT FORsible SALE to take OR current DISTRIBUTION practice and automate the rithm: NOTAn introductory FOR overview.SALE In OR B. Larse DISTRIBUTION & J. Leta clinical decisions based on status quo. Likewise, (Eds.), Proceedings of the 12th International Conference it would be imprudent to base care on a single on Scientometrics and Informetrics (ISSI ’09), 1, 230–241, research article. Nurses and other HCPs need to Rio De Janeiro (Brazil). International Society for Scientometrics and Informetrics. Retrieved from http:// take the time to examine their current practices www.sciplore.org/publications/2009-Google_Scholar © Jones & Bartlett Learning,with respect LLC to best practices when EHRs© orJones &%27s_Ranking_Algorithm_--_An_Introductory_Overview Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONother health IT are implemented. NOT FOR_--_preprint.pdf SALE OR DISTRIBUTION Berner, E., & La Jande, T. (2007). Overview of clinical decision support systems. In E. Berner (Ed.), Clinical decision support systems: Theory and practice (2nd ed., pp. 4–18) ▸▸ Summary New York: Springer. Best, J., Frith, K., Anderson, F., Rapp, C. G., Rioux, L., & While© moving Jones from & academia Bartlett to nursing Learning, practice LLC Ciccarello, C. (2011). Implementation© Jones of an evidence-based & Bartlett Learning, LLC basedNOT on evidence FOR maySALE seem OR daunting, DISTRIBUTION nurses order set to impact initial antibioticNOT time FOR intervals SALE in OR DISTRIBUTION should transform traditional practices into ones adult febrile neutropenia. Oncology Nursing Forum, 38(6), 661–668. doi:10.1188/11.ONF.661-668 supported by the best scientific evidence. Nurses Brokel, J. M. (2009). Infusing clinical decision support can get access to primary research, systematic interventions into electronic health records. Urologic reviews, and clinical practice guidelines by Nursing, 29(5), 345–353. © Jones &using Bartlett information Learning, technology LLC effectively. In- Carroll, M.© W. Jones(2011). Why & full Bartlett open access matters.Learning, PLoS LLC NOT FORformation SALE ORmanagement DISTRIBUTION strategies are essential Biol, 9(11),NOT e1001210. FOR doi:10.1371/journal.pbio.1001210 SALE OR DISTRIBUTION Centers for Disease Control and Prevention. (2016). including subscribing to RSS feeds, registering Meaningful use. Retrieved from http://www.cdc.gov for email alerts from journal publishers and /ehrmeaningfuluse/introduction.html from government resources, and purchasing Cheeseman, S. E. (2011). Mastering basic computer com petencies subscriptions to services that provide EBP one byte at a time. Neonatal Network, 30(6), 413–419. © Jones & Bartlett Learning,support. Finally, LLC nurses should advocate© for Jones Cheeseman, & Bartlett S. E. (2012). Learning, Information LLC literacy: Using computers to connect practice to evidence. Neonatal NOT FOR SALE OR DISTRIBUTIONthe selection of health information technologyNOT FORNetwork, SALE 31(4), OR 253–258. DISTRIBUTION that has best practices as an integrated feature. Dainow, E. (2016). Understanding computers, smartphones Technology can make the practice of EBP and the Internet. Retrieved from https://www.smash more seamless for nurses and fulfill the need words.com/books/view/630245 to improve patient care. Duffy, M. (2015). Nurses and the migration to electronic health © Jones & Bartlett Learning, LLC records. American Journal of Nursing,© Jones 115(12), & 61–66. Bartlett Learning, LLC Fain, J. A. (2009). Reading, understanding, and applying nursing NOT FOR SALE OR DISTRIBUTIONresearch (4th ed.). Philadelphia:NOT FA Davis. FOR SALE OR DISTRIBUTION References Fineout-Overholt, E., Berryman, D. R., Hofstetter, S., & Ahrens, S., & Johnson, C. S. (2013). Finding the way to Sollenberger, J. (2011). Finding relevant evidence to evidence-based practice. Nursing Management, 44(5), answer clinical questions. In: B. M. Melnyk & E. Finout- 23–27. doi: 10.1097/01.NUMA.0000429009.93011.ea Overholt, (Eds.), Evidence-based Alexander, S., Hoy, H., Maskey, M., Conover, H., Gamble, J., practice in nursing & healthcare: © Jones & Bartlett& Fraley, A.M. Learning, (2013). Initiating LLC collaboration among A guide© Jonesto best practice. & Bartlett Learning, LLC NOT FOR SALEorgan transplant OR DISTRIBUTION professionals through web portals and (2nd ed.).NOT Philadelphia: FOR SALE OR DISTRIBUTION mobile applications. Online Journal of Issues in Nursing, Lippincott Williams & 18(3). doi: 10.3912/OJIN.Vol18No02PPT03 Wilkins.

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Google Scholar. About. Retrieved from http://scholar.google Levin, R. F. (2013). Searching the sea of evidence: It takes a .com/intl/en/scholar/about.html© Jones & Bartlett Learning, LLClibrary. In: R. F. Levin & H. R. Feldman© (Eds.), Jones Teaching & Bartlett Learning, LLC Gugerty, B., & Delaney, C. (2009). Technology Informatics evidence-based practice in nursing (2nd ed., pp. 103–118). Guiding EducationalNOT FOR Reform SALE (TIGER). ORTIGER DISTRIBUTION Infor- New York: Springer. NOT FOR SALE OR DISTRIBUTION matics Competencies Collaborative (TICC) final report. Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence- Retrieved from http://tigercompetencies.pbworks based practice in nursing & healthcare: A guide to best .com/f/TICC_Final.pdf practice (2nd ed.). Philadelphia: Lippincott Williams & Halley, E. C., Sensmeier, J., & Brokel, J. M. (2009). Nurses Wilkins. © Jonesexchanging & Bartlett information: Learning, Understanding LLC electronic Melnyk, B. M., Fineout-Overholt,© Jones & E., Bartlett Stillwell, S. B.,Learning, & LLC health record standards and interoperability. Urologic Williamson, K. M. (2010). The seven steps of evidence- NOT FORNursing, SALE 29(5), 305314. OR DISTRIBUTION based practice.NOT American FOR Journal SALE of Nursing, OR 10 (1),DISTRIBUTION Hawn, C. (2009). Take two aspirin and tweet me in the 51–53. morning: How Twitter, Facebook, and other social media Rigney, D. (2010). What is the Matthew Effect? The Mat- are reshaping healthcare. Health Affairs, 28(2), 361–368. thew Effect: How advantage begets further advantage. Retrieved from http://content.healthaffairs.org/content New York: Columbia University Press. Retrieved /28/2/361.full#sec-6 from http://cup.columbia.edu/book/978-0-231-14948 © Jones & BartlettHealth Learning, RSS Feeds. USA LLC Government Web Portal. Retrieved © Jones-8/the-matthew-effect/excerpt & Bartlett Learning, LLC NOT FOR SALE ORfrom DISTRIBUTION http://www.usa.gov/Topics/Reference-Shelf NOTRupert, FOR D. J., GardSALE Read, OR J., Amoozegar, DISTRIBUTION J. B., Moultrie, /Libraries/RSS-Library/Health.shtml R. R., Taylor, O. M., O’Donoghue, A. C., . . . O’Donoghue, Hello Health Patient Information. Hello Health. Retrieved A. C. (2016). Peer-generated health information: The from https://hellohealth.com/telemedicine/overview/ role of online communities in patient and caregiver Hoss, B., & Hanson, D. (2008). Evaluating the evidence: health decisions. Journal of Health Communication, Web sites. AORN Journal, 87(1), 124–141. 21(11), 1187–1197. doi:10.1080/10810730.2016.1237592 Ingersoll, G. L.© (2000). Jones Evidence-based & Bartlett nursing: Learning, What it Rutherford, LLC M. (2008). Standardized nursing© Jones language: & Bartlett Learning, LLC is and whatNOT it isn’t. FORNursing Outlook,SALE 48 OR(4), 151–152. DISTRIBUTION What does it mean for nursing practice?NOT OJIN: FOR The SALE OR DISTRIBUTION doi:10.1067/mno.2000.107690 Online Journal of Issues in Nursing, 13(1). doi: 10.3912 ITI Planning Committee. (2015). Integrating the health care /OJIN.Vol13No01PPT05 infrastructure white paper: Health IT standards for 10 Salmond, S. W. (2007). Advancing evidence-based practice: health information management practices. Retrieved A primer. Orthopaedic Nursing, 26(2), 114–123. from http://ihe.net/uploadedFiles/Documents/ITI Sortedahl, C. (2012). Effect of online journal club on © Jones/IHE_ITI_WP_HITStdsforHIMPratices_Rev1.1_2015 & Bartlett Learning, LLC evidence-based© practice Jones knowledge, & Bartlett intent, and Learning,utili- LLC NOT FOR-09-18.pdf SALE OR DISTRIBUTION zation in schoolNOT nurses. WorldviewsFOR SALE on Evidence-Based OR DISTRIBUTION International Council of Nurses. (2015). International Nursing, 9(2), 117–125. doi: 10.1111/j.1741-6787.2012 classification for nursing practice (ICNP) information .00249.x sheet. Retrieved from http://www.icn.ch/images/stories Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & /documents/pillars/Practice/icnp/ICNP_FAQs.pdf Williamson, K. M. (2010). Asking the clinical question: Kaminski, J. (2015). Computer science and the foundation A key step in evidence-based practice. American Journal © Jones & Bartlett Learning,of knowledge model. LLC In D. McGonigle & K. G. Mastrian © Jonesof Nursing, & 110Bartlett(3), 58–61. Learning, LLC (Eds.), Nursing informatics and the foundation of knowl- TechTarget. (2016). URL. Retrieved from http://search NOT FOR SALE ORedge DISTRIBUTION (2nd ed., pp. 33–56). Burlington, MA: Jones & NOTnetworking.techtarget.com/definition/URL FOR SALE OR DISTRIBUTION Bartlett Learning. Tymkow, C. (2016). Clinical scholarship and evidence-based Karamali, M., Heidarzadeh, Z., Seifati, S. M., Samimi, M., practice. In S. M. DeNisco & A. M. Barker (Eds.), Tabassi, Z., Hajijafari, M., . . . Esmaillzadeh, A. (2015). Advanced practice nursing: Essential knowledge for Zinc supplementation and the effects of metabolic status the profession (3rd ed., pp. 495–552). Burlington, MA: in gestational© diabetes:Jones A randomized,& Bartlett double-blind Learning, LLCJones & Bartlett Learning. © Jones & Bartlett Learning, LLC placebo-controlled trial. Journal of Diabetes Compli- Wells, N., Free, M., & Adams, R. (2007). Nursing research cations, 29(3),NOT 1314–1319. FOR SALE OR DISTRIBUTIONinternship: Enhancing evidence-basedNOT practice FORamong SALE OR DISTRIBUTION Lawson, P. (2005). How to bring evidence-based practice to staff nurses. Journal of Nursing Administration, 37(3), the bedside. Nursing 2005, 35(1), 18–19. 135–143.