E VIDENCED -B ASED N URSING M ONOGRAPHS
A UTHORING P ROCESS
Intended Audience Topic Identification
Subject Matter Expert (SME) Commissioning Research and Development of Recommendations Peer Review
Clinical Edit
NOC/NIC Creation
Posting to Mosby’s Nursing Consult Monograph Updates/Revisions
Evidence-based nursing monographs provide the latest, most relevant evidence about a common clinical problem. They are written by nurse experts for nurses. Each monograph undergoes a rigorous editorial process.
Intended Audience
Although the intended audience for these evidence-based monographs is nurses in clinical practice, others will also benefit from the content of the monographs. The monographs can be used by nurse researchers as an impetus to conduct new research. For those monographs with limited nursing research available, nurses are encouraged to develop evidence-based nursing research studies to fill the void. In addition, nurses can replicate studies presented in the monographs to build the body of nursing research. Monographs can also be used for instruction in schools of
nursing to emphasize the role and application of evidence-based research in nursing practice, and to illustrate the development, conduction, and evaluation of
translational research.
Topic Identification
Topics are determined by examining current clinical problems in practice that nurses manage on a daily basis and developing monographs to address those conditions.
Topics are also determined by reviewing the most frequently searched topics on Mosby’s Nursing Consult. Suggestions for topics are also provided by nurse experts in the clinical arena, as well as by members of the Nursing Advisory Board of Mosby’s Nursing Consult and the Clinical Editor of the monographs.
Subject Matter Expert (SME) Commissioning
Individuals with both broad and specific clinical expertise and an advanced degree in nursing (Master’s degree or higher) are selected to participate as Subject Matter Experts (SMEs). Our SMEs and peer reviewers have extensive knowledge about current practice and specific knowledge of particular clinical topics. Additionally, SMEs have knowledge about research and its application to practice.
Research and Development of Recommendations
To create a monograph, SMEs use a variety of research tools and a methodical process to select, evaluate, and summarize current guideline-based practices and new research-based evidence. From the evidence and current practice, the SMEs then develop recommendations for clinical nursing practice.
The selection of evidence focuses on providing practicing nurses with the most relevant and timely research to improve patient care and aid in development of clinical protocols. Selected evidence includes nursing research and other healthcare research because nurses practice as integral members of multidisciplinary healthcare teams. Critical review and evaluation of research from all areas of health care
enables practicing nurses to use the most comprehensive evidence in providing quality patient care. The following systematic approach is used for the development of each monograph:
1. Development of a Clinical Question
The clinical question focuses on a particular patient condition that nurses frequently manage. The question is both answerable and relevant to nursing practice.
2. Selection of Appropriate Databases for Search
The selection of databases is determined by the SME and clinical editor. This two-person approach ensures that the most relevant and appropriate databases are searched. Appropriate databases may be selected from such evidence-based research sites as Cochrane, DARE, OVID, Medline, EMBASE, Mosby’s Index, and the Joanna Briggs
Institute. In addition, searches may include nursing journals, academic nursing centers, the National Guideline Clearinghouse, and other evidence-based sites.
3. Systematic Search of Literature/Research
Once the appropriate databases are selected, nursing and healthcare literature is searched to cull relevant studies that provide the best and most suitable available evidence.
4. Organization and Critical Appraisal of Evidence
Nursing and other healthcare evidence-based research studies are organized and critically appraised for validity, reliability, and
applicability to practice. The available evidence is ranked according to the following criteria:
Levels of Evidence
Level I All relevant randomized controlled trials (RCTs) Level II At least one well-designed RCT
Level III Well-designed controlled trials without randomization
Level IV Well-designed case-controlled or cohort studies Level V Descriptive or qualitative studies
Level VI Single descriptive or qualitative study
Level VII Authority opinion or expert committee reports
Rankings are based primarily on:
Agency for Healthcare Research and Quality (AHRQ). Systems to Rate the Strength of Scientific Evidence. Evidence Report/Technology Assessment: Number 47.
http://www.ahrq.gov/clinic/epcsums/strengthsum.htm. Accessed May 18, 2009.
Melnyk BM, Fineout-Overholt E. Evidence-based Practice in Nursing and Healthcare: A Guide to Best Practice. Philadelphia: Lippincott, Williams & Wilkins; 2005.
Based on the criteria, evidence is selected for applicability to nursing practice and that of other healthcare professions. It is important to note that although RCTs are the most relevant and robust design for studies of effectiveness, other study endpoints are not amenable to RCTs. Additionally, because the body of nursing research is still developing and growing, many of the relevant nursing studies are singular quantitative and/or qualitative studies.
Once studies are selected for presentation within the monograph, the research findings from each study are synthesized by the SME. A description is provided of each study, including the type of
study/systematic review, methodology, findings, conclusions, and recommendations. This summation provides nurses with quick access to the most important information about the study design, purpose, and results. The clinical editor provides research expertise and assistance in this process.
5. Development of Evidence-Based Nursing Recommendations Evidence-based nursing recommendations are developed based on two sources: current practice and relevant nursing and other healthcare evidence. Many of the nursing recommendations are drawn from the Current Practice section of the monograph, which is based on current clinical guidelines. The remaining nursing recommendations are derived from the presented evidence within the Synopsis of Current Literature section of the monograph. Recommendations drawn from the presented evidence within the monograph are hyperlinked so that readers can quickly link back to read/review the
summation of the evidence for that recommendation. This two-source approach to developing evidence-based nursing recommendations provides the practicing nurse with the most comprehensive list of recommendations based on timely and relevant evidence.
Recommendations are presented in nursing process format and include dependent, interdependent, and independent nursing interventions, as well as interventions for discharge planning. Recommendations that are dependent (require a doctor’s order) are indicated.
Peer Review
Peer reviewers have specific clinical expertise in the topics they review and an advanced degree in nursing. They carefully scrutinize the monographs to verify that the content is accurate, complete, current, and clearly organized; and they ensure that each monograph includes the most relevant evidence.
Clinical Edit
The Clinical Editor and Project Director, Lois Marshall, PhD, RN, is a nurse expert with more than 30 years of clinical and nursing education experience. Dr. Marshall is currently a nurse education consultant and holds an appointment as the Leadership Program Consultant for Sigma Theta Tau and was immediate past Nurse Researcher Scholar in Residence for Sigma Theta Tau. She has expertise in the development of evidence-based nursing materials, translational research, and a myriad of other nursing education consulting projects. Dr. Marshall completes a thorough review of each monograph’s evidence-based research and evidence-based nursing
recommendations for relevance, timeliness, and accuracy. She works collaboratively with the SMEs to ensure the development and presentation of quality monographs that present the best evidence available to answer the posed clinical question, with evidence-based nursing recommendations appropriate for the practicing nurse to provide comprehensive patient care.
NOC/NIC Creation
Each monograph includes NOC and NIC classifications. When a draft is finalized by the clinical editor, our expert in NOC and NIC reviews the monograph and provides appropriate nursing outcome and nursing intervention classifications, indicated at the end of each monograph. These classifications are linked directly to the text of that classification in the text of NOC or NIC.
Posting to Mosby’s Nursing Consult
The article is then posted to the Evidence-Based Nursing collection.
Monograph Updates/Revisions
Monographs are updated when there is an appropriate trigger, and at least every 2 years. Triggers for monograph updates and revisions include the availability of new evidence and research relevant to the clinical question; changes in the existing evidence of the benefit or harm related to specific recommended interventions; the importance of outcomes presented; and the availability of interventions, and healthcare resources. Any time a monograph is updated, the date of the update is clearly indicated.
According to Shekelle and colleagues,i a reassessment of clinical-based guidelines should take place every 3 years since 90% of the guidelines of the Agency for
Healthcare Research and Quality (AHRQ) are estimated to have a survival time of 3.6 years (95% confidence interval, 2.6–4.6 years).
If you have additional questions, please send an email to [email protected].
i Shekelle PG, Ortiz E, Rhodes S, Morton SC, Eccles MP, Grimshaw JM, Woolf SH.
Validity of Agency for Healthcare Research and Quality clinical practice guidelines:
how quickly do guidelines become outdated? JAMA. 2001;286(12):1461-1467.
Updated: July 2009 Version 4.0
