1. Alexander, Mary BS, CRNI(R), CAE

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Last year at a nursing editor's conference, some of my colleagues led a discussion on the subject of peer review and its effect on the credibility of nursing journals. I had always assumed that nursing journals claiming to be peer-reviewed were subjected to the same rigorous method of double-blind review used in this journal. The process by which articles are selected for publication has become critically important as evidence-based practice grows. Readers of nursing journals need to know which "evidence" should be used to develop nursing policy. But with the exponential growth of nursing publications in the last 20 years and the flood of information available on the internet, it has become harder for nurses to know which publications they can trust.

Figure. Mary Alexand... - Click to enlarge in new windowFigure. Mary Alexander, BS, CRNI(R), CAE, INS Chief Executive Officer, Editor, Journal of Infusion Nursing.

Readers should understand that different journals are intended for different audiences and therefore contain different types of articles. Some journals publish articles that have been "peer reviewed" only by the editorial staff, not by an outside review panel. This does not mean that the articles aren't worth reading, but if they are not reviewed objectively, they should not be used to support evidence-based practice.


Blind peer review is considered the most objective process for evaluating research articles because the author's identity (and any other identifying information such as the name of the healthcare organization where the study took place) is withheld from the reviewers. The reviewers are also blind to each other and to the author. In this process, authors are protected from bias, especially in small fields where researchers may recognize each other's work. This review method requires reviewers to evaluate the article solely on the merit of its content, the quality of the research, and its potential to advance current practices.


If you have read an article that you believe could support evidence-based nursing practices in your organization, there are a few things to consider before making it part of your policy handbook. First, was the article published in a reputable scientific journal that uses blind peer review? Next, read the author's information. Authors who are employees or consultants of a commercial entity (and are writing about that company's product) should disclose any relationship to that company. This does not necessarily mean that the article has no merit, but readers should bear in mind the potential for commercial interests to influence the work.


When evaluating an article for evidence-based practice, pay particular attention to the level and scope of the research. Is it a review of existing literature or secondary sources? Scan the reference list. Are the sources current? The reference list should be comprised mainly of sources from journals or textbooks, not personal communication or obscure Web sites (government Web sites may be the only exception). Evidence-based practices should rely on solid clinical studies. Those studies should be based on sample sizes large enough to yield statistically significant results, and readers should pay attention to how authors interpret their findings.


Where does the Web fit into all of this? The internet has been a blessing to overworked nurses who need to get published information quickly and easily. The flip side of this new technology is its potential to spread outdated, oversimplified, or non-research based information. Many nursing Web sites offer advice from "experts." Although these experts may indeed have experience in a particular field, many do not provide references to support their claims, and some rely heavily on their personal experience.


Whether you are heading up the evidence-based practice committee for your organization or just reading to increase your own knowledge base, be aware of each journal's editorial policy (some journals will publish an editorial policy statement at the front of each issue). If you are unsure of the review process for a journal and would like to know, call the editorial offices and ask. As evidence-based nursing practice becomes the standard, nursing journals will be judged not only by the articles they publish, but the process by which they are selected.


Mary Alexander, BS, CRNI(R), CAE