Review for Librarians of Evidence-Based Practice in Nursing and the Allied Health Professions in the United States*
Tweed, Elizabeth M., Sauers, Eric L., McLeod, Tamara C. Valovich, Guo, Ruiling, Trahan, Henry, Alpi, Kristine M., Hill, Beth, Sherwill-Navarro, Pamela, Allen, Margaret, Stephenson, Priscilla L., Hartman, Linda M., Burnham, Judy, Fell, Dennis, Kronenfeld, Michael, Journal of the Medical Library Association
Objective: This paper provides an overview of the state of evidence-based practice (EBP) in nursing and selected allied health professions and a synopsis of current trends in incorporating EBP into clinical education and practice in these fields. This overview is intended to better equip librarians with a general understanding of the fields and relevant information resources.
Included Professions: Professions are athletic training, audiology, health education and promotion, nursing, occupational therapy, physical therapy, physician assisting, respiratory care, and speech-language pathology.
Approach: Each section provides a description of a profession, highlighting changes that increase the importance of clinicians' access to and use of the profession's knowledgebase, and a review of each profession's efforts to support EBP. The paper concludes with a discussion of the librarian's role in providing EBP support to the profession.
Conclusions: EBP is in varying stages of growth among these fields. The evolution of EBP is evidenced by developments in preservice training, growth of the literature and resources, and increased research funding. Obstacles to EBP include competing job tasks, the need for additional training, and prevalent attitudes and behaviors toward research among practitioners. Librarians' skills in searching, organizing, and evaluating information can contribute to furthering the development of EBP in a given profession.
In the early 1990s, evidence-based medicine (EBM) was introduced as a framework for research and practice and as a methodological approach to enable physicians to more effectively access clinically relevant research [I]. EBM has conceptuaUy evolved into evidence-based practice (EBP) in recognition of the movement's inclusion of related domains including nursing, physical therapy, and others [I].
The rapid emergence of the Web, including freely accessible MEDLINE and other databases as well as full-text electronic journals and the current intense engagement with its resources, has had a significant impact on access to and use of the medical knowledgebase . Buried In the large volume of digital information is "actionable information," the information most pertinent to a clinical decision or course of action. Given the ongoing explosion of available health information, access to evidence-based, actionable information is a prime concern for clinicians and health information professionals [I].
Concomitant with these advances and challenges is the expectation that information should be used by clinicians to inform judgment and decisions . To accomplish this goal, clinicians have to find a path through the knowledgebase to the highest quality and most useful information. Further, information delivery at the point of care may facilitate its incorporation into clinical decision making.
While professionals move toward adopting the EBP model of clinical care, each of the health professions is at a different place in developing and implementing the model for their specific disciplines. Based on one author's (Kronenfeld) experience with teaching EBP skills, implementation of EBP may be viewed as including the following components:
* commitment of the profession to an EBP model
* integration of an EBP model into professional education curricula
* identification or development of an evidence knowledgebase capable of supporting EBP for clinicians in the profession
* development of EBP resources to effectively support clinicians to enable efficient use of relevant evidence in their practice
This paper presents a brief overview of the progress that a number of health professions have made in adopting an EBP model. The sections on each profession are arranged in alphabetical order: athletic training, audiology, health education and promotion, nursing, occupational therapy, physical therapy, physician assisting, respiratory care, and speech-language pathology. …