EIDM and the 6S PyramidNURS 1G03

Laura BanfieldSchool of Nursing Librarian

January 2012

Learning Objectives

• Review the definition and model of Evidence Informed Decision Making

• Become familiar with the components of the 6S Pyramid

• Practice searching resources from the 6S Pyramid

EBP is:“The integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making”

(Sackett et al., 2000)

EIDM was originally called Evidence-Based Practice (EBP)

Clinical state, setting, and circumstances

Patient preferences and actions

Research evidence

Health care resources 

Clinical ExpertiseClinical Expertise

Best decision…all things considered

Steps of EIDM1. Construct a relevant, answerable question from

a clinical case. *clinical uncertainty*

2. Search the literature to retrieve the best evidence.

3. Critically appraise the literature (evidence) for validity and applicability.

4. Apply the evidence to your clinical practice.

5. Evaluate the outcome or performance. *From: Flemming, K. (1998). Asking answerable questions. Evidence-Based Nursing, 1(2), 36-7.

Sample foreground question

Are silver dressings more effective than standard gauze dressings for promoting healing of leg ulcers in an elderly woman?

Clinical questions ?????

• Background questions • Need to be answered first • Can be answered by books or general

Websites

• Foreground questions (use 6S pyramid)• Need to be very focused• Can be answered by research published in

journal articles

Learn to love PICO

6S Pyramid Find answers to foreground questions

(DiCenso, Bayley & Haynes, 2009)

Systems

“Support clinical decision making through linking all relevant best research evidence about a clinical situation directly to a patient’s record.”

(Haynes 2008)

Sources of Systems• Integrative Electronic Patient Records*Note: We will not be using Systems.

Summaries

“Summaries integrate best available evidence from lower layers … to provide a full range of evidence concerning management options for a given health problem.”

(Haynes, 2007)

Sources of Summaries• Clinical Practice Guidelines• Evidence Based Texts

SynopsesSynopses condense and highlight the key points of a study or systematic review and comment on their application to patient care. They are often written in the form of an abstract.

Sources of Synopses • Database of Abstracts of Reviews of Effects (DARE) – intervention focus• health-evidence.ca – public health focus• evidence-based abstract journals

Syntheses: Systematic Reviews

Consolidate the literature on a specific topic:• comprehensive identification of best studies• review of study relevance• evaluation of quality of research methodology• extraction and analysis of data• draw conclusions

Sources of Syntheses:• The Cochrane Library (the “gold” standard)• Health care journals

Summary of 6S

(DiCenso, Bayley & Haynes, 2009)

Meta Search Tools

• MacPLUS FS• TRIP