Evidence-Based Nursing: 4 years down the road
Evidence-based practice in the nursing profession is gaining wider popularity as shown by the increasing number of nursing conferences with an evidence-based theme, journals that feature “evidence-based, best practices in healthcare”, professional nursing organisations that are developing or promoting clinical practice guidelines, and subscription to this journal by over 8000 nurses from around the world. As we begin our fifth year of production of Evidence-Based Nursing (EBN), it is useful to look back at developments that have occurred over the past 4 years. In this editorial, we will describe the involvement of our many colleagues in the production of this journal, identify the journals from which we abstract the most studies, highlight the purposes of our editorials, and update our readers about our website.
Involvement of nursing colleagues and others in EBN
The production of this journal relies on many nursing colleagues from around the world. Once studies have been screened for methodological quality, the studies of most relevance to nursing practice are identified. Although the 3 editors are able to identify many of these, we rely heavily on colleagues to review qualitative studies and studies in areas of nursing in which we do not have expertise. We enjoy the commitment and assistance of a panel of judges who review all the qualitative studies both for methodological quality and for nursing relevance. Additionally, colleagues in clinical areas such as critical care, neonatology, surgery, and advanced practice nursing review select studies for quality and relevance.
Once an abstract is written, an associate editor reviews the abstract for accuracy and identifies a nurse with expertise in the topic area to write a brief commentary about the study, highlighting its strengths, limitations and clinical applicability. When the commentary is completed, the associate editor, through exchanges with the commentator, fine tunes the abstract and commentary. Our team of associate editors has grown to 10, with several others currently trying out the role; most of the communication between the associate editors, journal staff, and commentators is now done through email, allowing us to invite associate editors from around the world to join our team. Currently, our associate editors include nurses from Canada, New Zealand, UK, and USA.
Many nurses have volunteered to write commentaries for topics in which they have clinical expertise. Commentaries have been written by nurses from Australia, Canada, Germany, Hong Kong, Japan, Korea, New Zealand, Sweden, UK, and USA. We look forward to recruiting additional international associate editors and commentators in the future.
Facilitating the work of the editors, associate editors, and commentators is a team of extremely competent staff who work diligently to ensure high quality journal production. Their names are listed on the inside cover of each issue. The staff, who have extensive research training and experience in clinical epidemiology and biostatistics, meticulously review every issue of approximately 135 clinical journals (a complete list appears in each issue of EBN) and apply the appropriate methodological criteria as outlined in the Purpose and Procedure section of each issue. For each selected study, they write a structured abstract that summarises the question, design, setting, patients, results, and evidence-based conclusions, and work closely with the associate editor to edit the abstract, identify the most appropriate commentator, and ensure timely receipt of the completed commentary. Once the commentary is received, the staff, in conjunction with the associate editor, make final revisions to the abstract and commentary. The staff then send the completed abstract and commentary to the author of the original study to ensure their accuracy. As a final step, the abstract and commentary are reviewed once more by a member of the journal staff who has not read the original paper, to ensure their clarity. Once submitted to our publishers, the technical editors work closely with the journal staff through a number of cycles of typesetting and proofreading before the issue is published. The dedication and hard work of the journal staff and their close collaboration with the editors, associate editors, and commentators throughout this multistep process maximise the accuracy and usefulness of the abstracts and commentaries. Susan Marks has been the chief research associate for EBN since it was introduced, and the editors are particularly grateful to her for her commitment, humour, creativity, and her unfailing attention to detail.
Journals that contribute the most studies to EBN
In the first 4 volumes of the journal, we included 384 abstracts each summarising a published research study. The published articles that were abstracted were selected from 92 of about 150 journals that were reviewed regularly. The top 10 journals (table) yielded 192 (50%) of the abstracted articles. Only 2 of the top 10 journals are specifically published for nurses, Journal of Advanced Nursing and Western Journal of Nursing Research. The remainder are general healthcare journals, specialty healthcare journals, a journal focusing on qualitative research, and the Cochrane Database of Systematic Reviews. Clearly many high quality research studies of relevance to nursing are published in general healthcare journals as well as in nursing journals. This increases considerably the number of journals nurses need to read regularly to stay up to date and confirms the need for resources such as the abstraction journals and Clinical Evidence1 that screen the healthcare literature for quality studies and summarise the findings. Most original articles (29) were identified through the Cochrane Database of Systematic Reviews.2 (table) Systematic reviews are preferable to single studies because they provide a summary of all methodologically sound studies related to a specific topic, which in most cases, is much more powerful than the results of any one single study.
Many articles pass all the methodological criteria but are not abstracted because, in the judgment of the editors, their findings are less applicable to nursing practice than those selected for abstraction, the topic is of interest to only a select group of nurse specialists, or the topic was recently addressed in another abstract. Over the past 4 years, we have identified almost 1000 such articles; the citations for these articles are included on the EBN website (Other articles noted). Updates of this list of articles will be done on a monthly basis.
When we first designed EBN, we decided to include 2 editorials per issue, EBN Notebook and Implementation Forum. EBN Notebook consists of brief descriptions of research concepts to help our readers develop skills in critical appraisal of research articles. We have designed a series that we are building on with each issue. We began by helping our readers learn to ask answerable questions and to search for the best evidence, followed by descriptions of quantitative and qualitative study designs, sampling, measurement, and data analysis issues. We then introduced the EBN Users' Guides series that reviews how to assess whether research findings from different study designs are valid and appropriate for clinical application. The Users' Guides series has so far included descriptions of how to critique studies that evaluate nursing interventions, and how to critique systematic reviews. Future Users' Guides will describe how to critique qualitative studies, as well as studies of diagnosis, prognosis, causation, and economics.
The Implementation Forum is designed for readers to share descriptions of successful implementation of evidence-based nursing interventions. To date, readers have reported findings about evidence-based practices such as pressure ulcer care3 and leg ulcer management.4 Overall, however, the response to our invitation to readers to submit such reports has been poor. In our April 2001 issue, we described an Evidence-Based Practice Contest sponsored by Sigma Theta Tau and Nursing Spectrum in which nurses were invited to describe projects that integrate the current best evidence with clinical expertise to guide practice. The contest had an excellent response and 5 nurses were selected as winners. We look forward to reading about some of these projects in future Implementation Forums. We also encourage our readers to share any of their own success stories with us.
Update on EBN website
The most recent development is our full text EBN web site that was launched in April 2001 (www.evidencebasednursing.com). Each new issue of EBN is put online at the same time as the print version is distributed, which means that readers outside the UK do not have to wait until the journal is delivered by post. It is available in PDF format, making it easy to download and print. Additional “web extra” material is provided that cannot usually be accommodated in the print copy because of limited space. Other features include email @lerts to notify readers when a new issue is available and provide a table of contents; searching across journals available on Highwire and Medline; searching the Cochrane Library, the BMJ, and other specialist journals published by the BMJ Publishing Group; eLetters, which allow readers to comment on any editorial, abstract, or commentary published in EBN; and links to other nursing resources such as Nursing Standard Online or Nursing Spectrum.
One of the most exciting features of the website is its searching function. All abstracts, commentaries, EBN Notebooks, Implementation Forums, citations of studies that were methodologically sound but not abstracted, letters, and glossaries are searchable. King provides the following example in the July 2001 issue:
“If you have an interest in the effects of smoking and smoking cessation, you can enter this into the search field. You would get a list of over 10 articles on this subject in EBN since 1998. You may read the abstract in the January 2001 issue of EBN (p13) on smoking cessation rates after various interventions and decide that you would like to identify other studies written on the same subject by the author of the original article, Tim Lancaster. If you then search for this author using the “expand your search”option, you can look across all the Highwire journals for articles that Dr. Lancaster has published. This search would highlight 2 other articles on smoking cessation, one in Tobacco Control and one in Quality in Health Care, which you can link to, plus an article in Epidemiology and Community Health that he wrote on hormone replacement therapy. If you click on the link to one of these articles, say in Tobacco Control, and still want to know more, the search facility comes up with a box that allows you to:
look for other articles on this subject within Tobacco Control
search Medline for all articles by T Lancaster
be alerted when any new articles from the Highwire journals cite this article
download the reference to your citation manager.”5
EBN online is available at no extra cost to personal print subscribers. Online only subscriptions will be available and institutions will have online access included in their print subscription until 2002. Non-subscribers will be able to purchase individual articles or short term access to the entire site. The website has been well received with approximately 5000 distinct hosts each month.
As we complete 4 years of publication of EBN, we take this opportunity to thank the many people who make this journal possible: the associate editors who help to identify articles to abstract and who edit abstracts and commentaries, the commentators, those who have written or peer reviewed editorials, the staff in the Health Information Research Unit at McMaster University, the staff at the BMJ Publishing Group and the RCN Publishing Company, and our coordinating editor, Brian Haynes.