Andrea Spector

Hello everyone and welcome to EBSCO's webinar "Driving Evidence-Based Practice: The Role of CINAHL Ultimate". I'm Andrea Spector, Director of Medical Sales here at EBSCO. I'm so glad you could all join us today. 

Before we get started, I want to go over a few housekeeping points. We are recording this webinar, and everyone is muted due to the high number of registrants. So if you have any questions, please use the chat box. We will monitor it throughout the presentation, but we will answer questions at the end.

Okay. So let's get started. Our two speakers today are Jill Seys and June Levy. Jill is a nurse executive and health leader who serves as a digital health strategist at Health Care Information and Management Systems Society, also known as HIMSS. There, she is advancing advancing digital transformation strategies that strengthen evidence-based practice and improve patient outcomes. Her career includes leadership roles at Mercy, BJC Healthcare, and Mayo Clinic. And she continues to advise Mercy on enterprise clinical practice. 

And then we also have June Levy. June has been with CINAHL Information Systems for over twenty years. She and her team are responsible for the content in the CINAHL product line. She received her Master's degree in Library and Information Science from the University of Peter Maritzburg, South Africa. 

We are very excited to have you both speaking today about the importance of evidence-based practice and the role CINAHL Ultimate plays.

And with that, Jill, I will turn it over to you.

Jill Seys

Thank you so much, Andrea. When Andrea and Meg asked me to speak about EBP and my use of the tools of EBSCO, I'm honored. I have had a varied career in my past with ability and privilege to serve organizations of Mayo Clinic, BJC Healthcare, and most recently Mercy, where I served as the director of clinical practice at the enterprise level. In that journey, we worked to accelerate the adoption of EBP across the system. Several of our hospitals were using EBP but it was integrated at varying levels.

And as we evaluated the process, we encountered and began a journey with EBSCO which I'll talk to today. But you may wonder why someone from a health system from HIMSS, the Health Care Information Management System Society, is here speaking about EBP, it's because EBP is foundation to my core and I believe if we are going to transform outcomes, we need a closer relationship between the evidence and the workflows that we execute our practice through. We make it easy for our nurses to do the right thing, and when we make it easy for our teams to access the evidence we accelerate the transformation of our clinical outcomes. 

But before we go on, it's important to note that the current organization I serve is also vendor agnostic, but these experiences are my own and and I'm excited to share them with you today.

Next slide.

So our journey in in at Mercy really began with a culture of inquiry. Our assistant CNE and chief nurse executive at the time sought to, as I mentioned earlier, to expand the application of an incorporation of evidence-based practice throughout the enterprise.

One key aspect of that is ensuring we have access to the literature. It is far more difficult - it is not impossible, but far more difficult - if we can't access some of the peer reviewed literature or evidence, it takes far longer on this journey. So we began a process to evaluate some of the vendors and think about what we needed to support that acceleration of EBP and integrating it into the tools that we have today. As we began, only three of our hospitals out of nearly fifty had librarians and digital libraries. So, really, we had a need to support and expand access to tools and support equity of access to digital tools throughout the organization if we wanted to provide equity in the distribution of care that we delivered throughout our our organization.

So really, when we needed to get started - we needed tools like CINAHL Ultimate.

Next slide, Meg.

So why would an organization choose CINAHL Ultimate? We, like anyone else on this journey, may evaluate multiple vendors. We also collaborated with an academic partner who shared similar interests in evaluation and use of evidence-based tools. They shared with us at that time that it was the most evidence-based tool available and that weighed heavily in in our decisions.

We also encourage our teams to evaluate in the evidence, the tools during our test process. And we've identified several advantages to CINAHL Ultimate. One component is continuing education. We previously did not offer that throughout the enterprise or reimburse ongoing CEUs previously for our team our nurses even though some of our states did require CEUs to re-update their license. We also saw, for us, a key aspect was continuity with our physician tools. Our physicians were concurrently shifting over to an EBSCO product, so we had synergies in the platform.

Not only did we evaluate CINAHL Ultimate, but also the corollary product with EBSCO is their Dynamic Health, and we found the combination of CINAHL Ultimate and the synthesized evidence available with Dynamic Health fit our needs through that decision making process.

Fundamentally, and that's really where that last bullet point is that synthesize evidence that's available through both CINAHL Ultimate and the dynamic tools more key in our decision making.

Next slide.

So if you've embarked on an EBP initiative, which is fundamentally that problem-solving approach that we were seeking to accelerate transforming use to accelerate the transformation of those patient outcomes. It's really, really difficult to do so without the right tools. And both EBP and research find access to tools equally important on this journey.

Our key members that were performing searches needed a mechanism to learn effective search strategies, and the EBSCO team supported us in that journey. And throughout after our implementation, they also released some of the PICOT widgets, which was a piece that we incorporated as that made sense in our tools to increase ease of access and accelerate our search strategies. The curated subject headings in CINAHL that are really curated by the nursing experts, not just automated simply with AI, but are validated, are also helpful and important tools in this process.

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So, fundamentally, regardless of what your organization goals are, we all seek excellence to improve patient care. And health systems use EBP as a problem-solving approach as a foundation for that transformation.

It allowed us to ground ourselves in the evidence rather than incorporating opinions to guide standardizations in our practice. And we could not do that without the access to the literature and tools like CINAHL Ultimate.

EBP mentors are also important aspect in this process. Our EBP mentors were provided additional training, and there are key folks that synthesize evidence and learn advanced search strategies and integrate and apply the practice into our workflows.

Importance of ensuring your leadership supports the journey is absolutely key, and that was a big part of our story to identify and actually achieve some of the transformation and clinical outcomes that we sought throughout our path.

Susan mentioned before, I've worked in a number of different organizations, including those that were Magna status, others that have considered pathways to excellence, or others that are simply using evidence-based practice to support the foundation of transformation.

Regardless of your journey and where you are at, and you can see on the right the keys elements in magnet and pathways excellence, EBP and access to key tools like CINAHL Ultimate are essential to support your journey, and we'll map to some of these key elements. Or I absolutely advise cult cultivating a culture of EBP is essential to hand for results for our patients and our nurses and all the teams that we serve.

Next slide.

So in summary, our shared goal on this journey is always to improve patient care, whether you are in library services and the fantastic searching experts that I love to access and learn from as I use the tools, or you're a clinician who seeks to solve a problem - tools like CINAHL Ultimate and easy access to peer reviewed literature is absolutely critical in this journey. 

CINAHL Ultimate and using the tools and the synthesized evidence in dynamic health it's the first place we reference when I have a problem or a question about what is current practice. Practice has changed since I first was licensed as a nurse, and I always like to reference the current evidence. 

And this creates an easy way for our teams, they can they can integrate into their workflows, whether it's in the middle of a day in patient care or after the end of a shift or if a unit-based council needs to solve a problem, they can use the tools if we make it easily accessible to them and give them some key strategies on how to use them.

Evidence-based tools continue to be used in my workflow today at HIMSS as we create evidence-based frameworks that evaluate the use of an adoption of electronic health records and all the interoperable tools used in the health care environment.

So I'm grateful for the access to CINAHL and CINAHL Ultimate and ease of access to peer reviewed literature on this journey.

Thank you, Andrea, for the the chance to chat about this.

Andrea Spector

Yeah. Thank you. 

Jill Seys

Over to Andrea.

Andrea Spector

I really appreciate it and for all your insights. I think that's really great information.

And I think now we can start to transition.

And, June, I will turn it over to you.

June Levy

Thanks, Jill. Thanks, Andrea. Hi, everybody. Thanks, Meg.

Alright. The first thing is I'd like to cover the history of CINAHL. It it started with three hospital librarians in the nineteen forties who got together and decided that they wanted to put together an organized index for the nurses in their hospitals. At that time there was just something for the doctors, and they felt that the nurses had been neglected.

So they felt that consolidating and indexing the journals that were available at the time, and there were only seven available, by organizing them into a collection that the students and the researchers, the clinicians could more effectively search for and access reliable evidence-based information relevant to their fields. And instead of going to multiple sources, they had one source to go to. 

Next slide, please.

Thanks, so using a consistent set of terms, we call them a controlled vocabulary or the semaphorescence, enables a more efficient and accurate search for relevant research. To find evidence on a specific topic, a clinician can search for using a subject's heading terms that have been used for indexing the articles, and they'll find articles that won't be really found if you just do a keyword search alone.

Subject headings help locate relevant articles regardless of the specific keywords that authors use. They account for spelling variations, acronyms, and synonyms. This ensures getting a more complete picture of the available evidence to inform practice. By using a controlled vocabulary alongside keywords - so using both of them - there is more accurate and thorough information retrieval, reducing the risk of missing key studies.

Searches in CINAHL and, of course, CINAHL Ultimate can be limited using either controlled vocabulary or limiters that show evidence through quantitative or qualitative research. For example, we have publication types like clinical trials, systematic reviews, meta analysis, meta synthesis, and these are both publication types and limiters.

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The full text that we have in our full text versions, especially CINAHL Ultimate, which is the most comprehensive. We added full text to CINAHL to allow users to access it more easily. We found that there was a time barrier of people nurses going to the shelf to get down that journal or looking for a full article in various sources or various libraries in the network. So we added full text to CINAHL. Having the full text of an article for evidence-based practice is essential because it provides the detailed methodology.

It's got the complete results, so you have all the results and the necessary context that is omitted in an abstract, allowing for a more accurate and thorough critical appraisal of the evidence. We do use the abstracts in CINAHL. We provide abstracts within the available from the author, but mostly, they're used to select the best records or articles to look at or the best studies, and then we link to the full text.

The level of detail is essential. This level of the detail that we provide is essential in implementing evidence-based practice to ensure the highest quality of care by enabling professionals to understand the study's limitations, to replicate the findings, and make informed confident decisions.

Next slide, please, Meg.

Here is the content that we have on CINAHL Ultimate, Jill was referring to it. These are topics that synthesize the available evidence, and they are updated on a regular basis. We do systematic literature surveillance on a couple of databases and we review the content and update them regularly on an annual basis.

These were created in two thousand and five because we found that there was a need, since we were in the basement of a hospital, we found that our nurses needed to have a quick way of looking at the synthesis of the evidence. So we put these together and they were first added here, and then we got such a demand for them that we created the the suite of point of care products, nursing reference center, nursing reference center plus, and today, Dynamic Health, which Jill mentioned.

The evidence-based care sheets and the quick lessons were to provide concise evidence-based overviews of treatment. They cover assessment and patient care, and they often include - they, of course, include references - but they're often linked to the continuing education units, and they have exam questions. So we have a a continuing education system where the user can go in, look at the content, take a quiz, and it's graded, and we keep the transcripts. We also added research instruments. We got a lot of demand. A lot of this work that we did was based on the need that we saw from nurses.

We got the request to add research instruments to the database because it was difficult to look for them, to find them. And so they wanted one place to have them, but they needed to be related to the work that nurses and allied health professionals were doing. So we did add them and they provide the right tools. So if they, you know, these professionals can access them, they can see if that fits the study that they're doing for original research, or maybe it's some research they're looking at. And they are available in CINAHL Ultimate and the rest of the CINAHL versions as well. 

Next slide, please.

PICOT.

We added PICOT because searching for clinical research evidence is an integral part of the evidence-based practice process, and it's very -sometimes it's difficult for - all of us to break out a question into elements. And so this is a guided search. There are two required fields. We all look at the population, the problem, or the patient, and especially the intervention.

The other three, the comparison, the outcomes, and time or type are optional. The last one was only added recently in the last year or so, because, of course, the PICOT guided search had been updated. So they're all there now and they identify the terms to search for the best evidence to answer a clinical question.

We can, you can enable it. So I know there are some facilities that don't wish to have it available. So there is a way to disable it if you don't want it.

Next slide, please.

So, improved patient outcomes. It really requires - since I've been working in the hospital with CINAHL for so long, our focus there is patient-centered care. Where, obviously, the focus is patient preferences. It's the effective communication between the health care provider and a patient.

And then, of course, coming to best practice. We wanna have the best practice. We want to have the best practice available for our patients so we have good patient outcomes. And it's supported by digital tools. As Jill mentioned, we have the full text literature.

But in addition to that, our goal has always been right from the start, and since I started with CINAHL, is the authoritative sort of - sorry. I've lost my screen. Authoritative resource, authoritative resource for nursing and allied health professionals by providing access to a vast collection of scholarly information, research articles, and evidence-based materials. And with the journals that we get, they are peer reviewed, which they do add credibility and reliability.

In addition to this goal that we've had for all these years, we are supporting accuracy, performance, and transparency because we find that these are the three components that are required for an effective search. And they impact the validity, the efficiency, of a search because there's such a time barrier in health care for people to do research and reproducibility. So, with employing the subject headings, which I've mentioned before, alongside of the keywords, because in systematic reviews, we use both subject headings and we search the title and abstract. Some folks even search the subject field. That is a much better search to do because it increases the precision and accuracy in locating the specific relevant topics.

The performance element that we, or component element that we look at, which is efficiency and effectiveness of the actual search, how well the search strategy balances, the balance is the sensitivity. So you want to the professional really wants to retrieve all the all the relevant searches, relevant studies, or they want to make it more specific, so it's specificity, and they only want to retrieve the relevant study. So one's broad and one's narrow. And for this, we have advanced search options. So, of course, the terminology, the controlled vocabulary because the content is indexed by an indexing team: they read the article, and they are able to get at the specific focus of the article. And, also, we have limiters, the clinical queries in the database, which we put together with the help of the McMaster group in Canada, enables users to conduct efficient, powerful, and precise searches, thus enhancing the performance of the research.

And lastly, and this is one that I've heard from a lot of researchers and librarians over the past several years, is transparency. It's so important to have a transparent search strategy detailing the databases you've searched - a lot of us do multidatabase searching. The search terms you've used, subject heading, so you know what you've been sort of asking for, along with the keywords, and the filters used allows the researchers to and, of course, in this process, we want to be able to export the searches. So exporting is an important part of it in order to not only be able to rerun it later yourself, but to share it with other colleagues and some of the centers have clients. So they want to scrutinize, replicate, and update the search. And this is essential for, obviously, scientific rigor and validation.

Ultimately, the goal of CINAHL Ultimate, it continues to evolve along with the needs of the nursing and allied health profession. It it never seems to stay still, there are always changes. But we want to support evidence-based practice and we want to export clinical decision making and professional development of our key audiences, key users, which are nurses and allied health professionals.

Thanks, Meg. Thanks, Andrea.

Andrea Spector

Thank you, June.

Yeah. Thank you for your expertise about and how it can support evidence-based practice. So now let's take some time for questions. One of the things that I wanted to note about making CINAHL and research easier for nurses: There are two functionalities that are free on EBSCOhost now today, one of which is natural language search. 

Which I always say we live in a Google world where I can ask Siri and Alexa questions all day every day. Natural language search is so easy for novice researchers, for nurses that are starting out for nurse residency or conducting their first ever evidence-based practice, it just makes it a lot easier to put your search or your question, even if it is a PICOT question, into the CINAHL or the EBSCOhost search bar, and then it will take that question and put it into a Boolean phrase to search. That is freely available and available now on EBSCOhost. If you have it, please reach out to the connect, through EBSCO Connect to EBSCO support and get that enabled today. 

The other one is AI Insights. AI Insights is a great, easy tool for your busy clinicians. What it does is it summarizes the article in three to five bullet points about what that article the research is is saying. So very easy to use, very easy to turn on. I always call it a time saver. So those are two nice, easy components that are also readily available today for CINAHL Ultimate and on the EBSCOhost platform.

Any other questions in the search? Nope. Okay. Well, thank you so much for joining us today. We hope you gained a lot of knowledge and insight. 

Just a reminder that we will be sending a recording of today's webinar in a follow-up email. Thank you again, and I hope you have a wonderful rest of your day. 

Thanks, Jill. Thanks, June. 

June Levy

Thank you.

Jill Seys

Thank you. 

Andrea Spector

Take care. Bye.