Evidence-Based Practice in Pediatric Nursing

Instructor: Megan Gilbert

Megan has a master's degree in nursing and is a board certified Women's Health Nurse Practitioner. Her area of clinical focus is the impact of infectious disease on pregnancy. She has experience teaching college allied health classes. She is also a certified EMT and holds a certificate of added qualification in electronic fetal monitoring.

This lesson provides an introduction to evidenced-based practice in pediatric nursing using an easy to follow example. It covers the ask, acquire, appraise, and apply model.

What is Evidence-Based Practice?

When you read an article about a new medicine or a new treatment for children, how do you decide if it's safe? How do you decide if it's something that's right for your child or another child in your care?

The goal of evidence-based practice is to help us answer this question when caring for our patients. Evidence-based practice combines research and clinical experience, while also taking into account the particular patients values to determine the best practice for a particular situation.

Evidence-based practice can also be used to develop policies for populations or a larger system (such as a hospital) using the same critical thinking process.

Evidence-based practice is composed of research, clinical experience, and the values of the patient or organization.
evp components

The Process

Evidence-based practice follows a process with four steps:

  1. asking a question
  2. acquiring information
  3. appraising the research
  4. applying the findings

Let's follow the process using an example.

Ask

First, we need to decide what question we want to ask, or critically review, to determine the best choice. It's important to ask a specific question, otherwise we'll end up with too much information and it can be hard to come to a decision.

For example, do school-age children who are given a stuffed animal cry less in the emergency room during procedures compared with to children who are not?

To see if stuffed animals help children during procedures, we need to follow evidence-based practices.
pediatrics

Acquire

Second, we need to acquire information. This is where we will look for research articles related to our question. Good sources for pediatric articles can be found in PubMed, Cochrane Library, National Guideline Clearinghouse, and TRIP (Turning Research into Practice). Don't be afraid to check with your local librarian for help finding research articles.

When looking at articles, it's important that we consider how the research was collected. In general, we find the strongest evidence from randomized controlled trials. In randomized controlled trials, subjects, in this case children, are randomly assigned to either have an intervention or not. So, children in our stuffed animal example will either get a stuffed animal or not.

When possible, it's best for both the researchers and subjects to not know who had the intervention, this is known as a double blinded study (for example in a drug test, half the patients would get a medication and half the patients would get a placebo, a pill with no medication).

At this point, the most important thing is that you're finding the articles that provide information about your topic.

Appraise

Third, we need to appraise the research by considering what the results are saying. Certain sources are considered pre-appraised - for example, the Cochran Library, because it includes a summary of the available research up until the time it was published with a recommendation for best practice.

Every study you found while you were acquiring research should now be reviewed. When looking at the article, you want to consider three main things:

  1. Does it have any glaring problems that make you questions it's legitimacy? If the study is not reliable, it shouldn't be included in your decision-making.
  2. What did the study actually find? Was it what they expected?
  3. How does this information answer your research question?

At this point you'll be able to determine what conclusion the data supports.

Apply

Lastly, it's time to apply the findings. In this case, let's say that the research showed that giving children a stuffed animal made them more comfortable in the ER. Let's take that information and determine the best way to apply it to our hospital.

It's important to ask if adding stuffed animals supported our values. This would likely be 'yes', as helping keep children comfortable is a central goal of hospitals.

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