1. Carlson, Elizabeth A.

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In 2009, Jones & Bartlett published two evidence-based practice (EBP) books. I was aware of one of them and was surprised to learn of a second, seemingly identical publication from the same publishers in the same year. However, upon review, it is clear that the two books address different audiences from different perspectives. In addition, the two books work nicely together precisely because of the differing approaches and audiences.


As a reminder, EBP is a process that examines, evaluates, and implements research-based findings to improve patient care. In conjunction with the research-based findings, EBP also uses evidence gained from nursing clinical judgment and patient preferences as considerations in changing nursing practice.


The first book reviewed is by Nola A. Schmidt, PhD, RN, CNE, and Janet M. Brown, PhD, RN. Both editors are nursing faculty members at Valparaiso University, Indiana. The contributors they selected come from both practice and academic settings, which contributes to the strength of the material presented.


This book, Evidence-Based Practice for Nurses: Appraisal and Application of Research, is directed, according to the preface, at "baccalaureate undergraduate nursing students and their faculty in an introductory nursing research course" (p. xxv). I also found the book useful for practicing nurses interested in learning about EBP and how to use the process to improve patient care. The framework of this book is "the model of diffusion of innovations, which gives readers a logical and useful means for creating an evidence-based practice" (p. xxv).


Two features of this book to highlight are the "Keeping It Ethical" material in each chapter and the use of a case study that "challenges students to make decisions about practice related to the elimination of medication errors" (p. xxvi). The same case study (Apply What You Have Learned) is used throughout the book to illustrate key points present in each unit. A companion Web site offers additional resources. Some of the Web links are still under construction so that a complete evaluation of all the resources available was not possible; however, the evidence pyramid was available and is a useful visual tool. Scattered throughout the chapters are short questions to test your knowledge and help you understand the key points being made. Critical thinking opportunities are also found throughout the book and serve as another manner in which the reader can apply what they just learned.


There are six overarching units, with chapters serving to further group the content. Evidence-based practice is introduced in Unit 1, which discusses what EBP is, what are sources of evidence, how to adopt an EBP practice, as well as how to overcome barriers to the implementation of EBP. Nursing research is defined and the evolution of nursing as a science is briefly presented. Five levels of collaboration to promote excellence in nursing practice are discussed as well.


Unit 2, Acquisition of Knowledge, is divided into three chapters: identifying research questions (Chapter 3); finding sources of evidence (Chapter 4); and linking theory, research, and practice (Chapter 5). The information about developing hypotheses is particularly useful, as it simply and concisely presents the different type of hypotheses and how they are stated. The chapter on finding sources of evidence clearly explains the purpose of finding evidence, types of evidence, how sources of evidence are organized, and how to search for the evidence. This section is very useful if you have limited knowledge of how to search subject-specific databases and/or which ones to search. In the chapter linking theory, research, and practice, several case studies are given that illustrate the role theory plays in research and subsequent practice.


Unit 3, Persuasion, has five chapters focused on the type of research design to use (Chapters 6 and 7), collecting the data (Chapter 8), and sampling methods (Chapter 9). Chapter 10, The Pyramid of Evidence, clearly explains the importance and contribution of various levels of information to evidence-based nursing. The five Ss are studies, syntheses, synopses, summaries, and systems. Each of these Ss is discussed and the usefulness of each source of evidence is explained.


Unit 4 is titled "Decision." Chapter 11 discusses qualitative data use and meaning. Frequently used statistical tests are clearly described and easy-to-understand examples and figures are used to illustrate key points. Similarly, Chapter 12 discusses qualitative data analysis and interpretation. In Chapter 13, the appraisal of the evidence is discussed and very specific questions are offered for your guidance. The information in Table 13.2 on page 318 offers a succinct set of questions to consider when appraising nursing research studies. Evidence hierarchy is discussed.


The fifth unit is about implementation. The quote on the title page of Unit 5 sums it up nicely, "Innovations are not helpful if they are not adopted" (p. 333). Chapter 14 presents the various EBP models and how they assist in increasing the use of research to guide nursing care. Barriers to moving research into practice are discussed. Kotter's eight phases of change are the framework used to engage others in change.


Unit 6 is confirmation, or the process of evaluating the outcomes of the innovations and the substantiation of adoption or rejection of the innovation. Chapter 16 looks at what outcomes were expected, what factors should be considered when selecting an outcome, and how to evaluate the outcome. The last chapter presents why it is important to disseminate what you have learned while participating in EBP. The three Ps of dissemination (posters, papers, and presentations) are discussed.


I recommend this book because it offers a clearly written basis for EBP. Both conceptual and practical materials are found in its pages. I think it is a good resource not only for its target audience, nursing students, but also for practicing nurses who desire to understand the EBP process.


The second EBP book from Jones & Bartlett published in 2009 is Evidence-Based Nursing: The Research-Practice Connection, by Sarah Jo Brown, PhD, RN. The approach taken by this author is different than the approach taken in the previous book. Brown based her book layout on the following statement: "Achieving evidence-based nursing practice is not a grab-and-go enterprise. It takes knowledge of research methods and time to locate, read, and summarize the research regarding a clinical problem or issue" (p. ix). Brown first leads the reader through research methods and the different kinds of research evidence and, in Part 2, discusses how "to find research evidence, appraise it, and consider how to use it in practice" (p. 242).


In Part 1, Brown presents the key features of five different types of research. Each of these types of research has a different purpose and method. Brown states that her emphasis for Part 1 is to (1) determine the purpose of the study, (2) understand how the study was conducted, and (3) understand what was found. Thus, in Chapter 3, Brown details how to read a research article in general. A brief orientation to the format of research reports is given, what you expect to find in the various sections, and how the approach to reading research articles differs somewhat from other types of reading.


In Chapters 4-9, research designs that are widely used in nursing and healthcare research are presented. Each chapter has a similar three-part format that can best be understood using Chapter 5, Descriptive Research, as an example. The chapter begins with an explanation of what descriptive research is. Study variables specific to descriptive research are discussed as well as how the variables are measured. How do you determine the target population? What types of measures are used? A research report is included as an exemplar of a descriptive research report. Brown states that the studies selected are chosen because of the representative nature of the type of research being addressed. She notes that the studies are selected not just because they are perfect models, because "all studies have warts," (p. 34) but because of the design used. The third section of each chapter is the "Profile and Commentary." In this section, the research report is "dissected" so that you can understand what particular points and features of the study need your attention. This allows you to apply the content you learned in the first part of the chapter to the article you read in the second part and see if what you gleaned from the research report is what a seasoned researcher would glean. Brown comments on the strengths of the report as well as areas that are weaker or missing entirely. I found this approach to be very useful and enabled me to see what I had missed as well as be proud of the details I had noted.


In Part 2, Brown details how to find research evidence, appraise it, and consider how to use it in practice. The skills learned in Part 1 would be applied to the appraisal of the research report's quality and applicability. Similar to the content in Schmidt and Brown's Unit 2, Chapter 11 in Brown's book discusses the various research evidence databases available and offers a step-by-step example of how to do a basic search. If you do the same search as the example given, you learn how to narrow the search and get a starting point for your own search. Advanced search tools and an example searching PubMed are presented. Chapter 12 offers a template for appraising research evidence; Chapters 13-15 walk you through the appraisal process for the recommendations of clinical practice guidelines, conclusions of integrative research reviews, and findings of individual studies. In each chapter, a worksheet is offered to help guide you as you learn the appraisal process.


Chapter 16 delves into the research-practice connection in more detail and discusses how research evidence is translated into action. Sections include evidence-based care design, the function of evidence-based protocols, and evidence-based quality management. The book concludes with a discussion about research-informed practice and the nurse's role in using research in the care of his or her patients. Strategies to introduce research-informed practice into the clinical setting are presented.


The seven appendices are an excellent resource. Appendix A defines the terms used in clinical practice guidelines, so you know what is really meant by supportive versus suggestive or insufficient versus inconclusive. A 22-step process for producing an evidence-based clinical practice guideline is found in Appendix B. Appendixes D, E, and F offer completed worksheets as a companion to what was learned in Chapters 13-15.


Two different EBP books were published by Jones & Bartlett in 2009. Both books stand alone as excellent resources for someone interested in not only becoming conversant with EBP but also wanting to learn the how-to's involved. In addition, the two books work well together by each offering a different approach and slightly different levels of detail for the various components of EBP and its implementation. I highly recommend both books singly and in conjunction with each other.