Nursing Reference Center Plus Editorial Policies
"Evidence-based" is a descriptor that is often used to describe health care-related reference resources.
For a clinical reference resource to truly be evidence-based, conclusions must be based on the best available evidence. Conclusions can be based on the best available evidence only if the evidence is consistently and systematically identified, evaluated and selected.
The CINAHL Nursing Guide editorial process adheres to the following strict 7-Step Evidence-based Methodology and protocol:
- Systematically identify the evidence
- Systematically select the best available evidence from that identified
- Systematically evaluate the selected evidence (critical appraisal)
- Objectively reflect the relevant findings and quality of the evidence
- Synthesize multiple evidence reports
- Derive conclusions and recommendations from the evidence synthesis; obtain peer review
- Change the conclusions when new evidence alters the best available evidence
Every article considered for inclusion in the CINAHL Nursing Guide is processed using this system, and the system ensures the integrity of the conclusions.
Step 1: Identify the Evidence
Perform systematic searching
- When adding a new CINAHL Nursing Guide topic or critically revising an existing topic, appropriate databases (MEDLINE, CINAHL and others) are searched to identify the best available evidence. In addition, numerous sources are searched for evidence-based reviews (such as Cochrane Database of Systematic Reviews), for guidelines (such as National Guideline Clearinghouse), and more.
Perform systematic literature surveillance and update schedule
The content is updated as follows:
- Top Priority Content – These articles may be updated frequently as a result of new studies that impact the information contained in the Quick Lesson or Evidence-Based Care Sheets.
- All Other Content – These articles are scheduled for full review within a 12-month period. Articles are rewritten as necessary.
Step 2: Select the Best Available Evidence
Each article is assessed for clinical relevance and each relevant article is further assessed for validity relative to existing CINAHL Nursing Guide content. The most valid articles are used to create the Quick Lessons and Evidence-Based Care Sheets.
Determining clinical relevance is the first consideration in systematically selecting the best available evidence from the literature retrieved. The relevance of information is different for every user. CINAHL Nursing Guide is used in clinical care by nurses with a wide range of experience and interests, and is also used in continuing education. When adding information the following is considered:
- This information has a direct bearing on patient-oriented outcomes.
- This information is useful in clinical decision-making.
- In situations where the evidence does not clearly support or refute a clinical fact, opposing views are presented.
- Some medical information is not clinically relevant, but is widely publicized. Summarization of this type of information (often with commentary) is relevant to the CINAHL Nursing Guide users if it is likely that nurses will be asked about it during clinical encounters. It is important to point out where this type of information is not clinically applicable.
Clinically relevant articles must be assessed to determine the scientific validity of conclusions and facts presented before consideration for use.
Step 3: Evaluate the Evidence (Critical Appraisal)
Examine the article to evaluate the article’s methodologic quality and results and determine its level of evidence.
Reports used for updating CINAHL Nursing Guide represent the best available evidence for the specific content under consideration. Evidence may be labeled in several ways as outlined under Levels of Evidence.
Step 4: Objectively Reflect the Relevant Findings and Quality of the Evidence
When reporting the evidence, the following is considered:
- What are the most relevant outcomes to report in the topic?
- Were all relevant outcomes reported in the original article?
- For relevant outcomes, what is the magnitude of effect?
- Were the findings clinically significant?
- In the case of no statistically significant differences, were the findings robust enough to rule out clinically significant difference?
- Are there any methodologic limitations sufficient to alter reliability of clinical conclusions?
Step 5: Synthesize Multiple Evidence Reports
Evaluate the findings, both positive and negative, from the relevant articles and organize in a systematic fashion.
Step 6: Derive Conclusions and Recommendations from the Evidence Synthesis; Obtain Peer Review
Based on the synthesis of relevant evidence, conclusions about current knowledge are drawn and recommendations for clinical practice are made.
Step 7: Change Conclusions When New Evidence Alters the Best Available Evidence
The final step in our evidence-based methodology is changing conclusions when new evidence alters the best available evidence. This step is crucial because new evidence is published every day. Having new evidence summaries handled separately from reviewed content in a manner requiring the nurse or clinician to search in two locations to synthesize the entire story would make finding the best available evidence more difficult.
As soon as new evidence is evaluated, it is added to the appropriate topic(s) in context. Latest Revision date is provided on papers when a paper has been updated based on best available evidence or when a paper has been revised. Original Document date is the date the paper was first written.
The update surveillance process occurs daily and high use content is reviewed quarterly and all content is reviewed annually.