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ICN
Nursing and Health Policy Perspectives
Back to the future of nursing through the Cochrane Collaboration As I prepared content for this editorial, the movie Back to the Future was playing on television (Zemeckis et al. 1985). I reflected on my present nursing practice and what it would be like to go back in time prior to the Cochrane Collaboration, formed in 1993. In the early 1990s, evidence-based practice was an emerging concept. The Internet browser had just been introduced (GCN 2007). Internet searching of literature and access to high quality systematic reviews were limited. As a nursing student, I answered clinical questions by using card catalogues to find research articles or books. For those of you who are not familiar with card catalogues, they are large cabinets containing cards for articles and books stored in libraries. Libraries housed rows upon rows of card catalogues. To find relevant articles, I would need to search through hundreds of cards using subject terms or just plain luck. This arduous process limited literature searches and made it next to impossible to locate high quality systematic reviews. Next I would have to search through volumes of printed journals to find the selected articles. If I was fortunate, the library had a copier machine to make copies of relevant articles. If not, I would have to transcribe relevant information from the articles onto index cards. It took hours upon hours to research my original clinical question, and the answer was limited to information contained in the articles available in the library to which I happened to have access. This exhaustive process made evidence-informed clinical decisions at the point of care next to impossible. Fast forward to the nurse of today. With a few keystrokes and a search of the Cochrane Database of Systematic Reviews, now nurses can quickly access high quality research evidence and find answers to clinical questions at the point of care. The plain language summary provided with each systematic review in the Cochrane database may be leveraged to expedite answering clinical questions for nurses who do not have extensive research or statistical knowledge. For example, a clinical question may be posed regarding the efficacy of proactive telephone counselling for smoking cessation as compared to self-help materials, pharmacotherapy or brief advice alone. A Cochrane systematic review completed by Stead et al. noted that relative success with smoking cessation increased between 20% and 36% with the use of telephone
© 2013 International Council of Nurses
counselling and improved with increased dose response (three or more calls) as compared to the other stand-alone interventions (Stead et al. 2013). Now that we are back to the future, the question before us is how Cochrane may support moving nursing forward for the next 20 years. One instrumental effort Cochrane has undertaken already is the creation of the Cochrane Nursing Care Field (CNCF) (http://cncf.cochrane.org). Key functions of the CNCF are to foster systematic reviews relevant to nursing; to share inter-professional perspectives; and to disseminate and augment utilisation of findings from Cochrane reviews through evidence-transfer strategies (review summaries and pod casts) (Cochrane Collaboration, 2012). Additional strategies employed include the CNCF journal section in the International Journal of Nursing Practice; monthly CNCF newsletters; and online or face-to-face workshops, seminars and symposia focused on evidence-based nursing care. To continue this momentum, future efforts of the CNCF should consider the following. First, the increase in electronic health records (EHR) allows for more efficient clinical decisionmaking support at the point of care. Partnering with nurse and health informatics specialists to develop interfaces between EHR elements (e.g. nursing care plan interventions, patient education and safety alerts) and the Cochrane evidence-transfer strategies and review summaries will further augment evidencebased practice. Second, Hughes recommended closer collaboration between direct care nurses, researchers and healthcare consumers to identify gaps in knowledge and needed systematic reviews through the Cochrane Collaboration (Hughes 2007). Another need for nursing, identified by Gartlehner and Flamm, is increased access to patient-centred outcome measures that focus on the continuum of care and are relevant to patients (Gartlehner & Flamm 2013). They suggested that Cochrane expand the scope of reviews to include non-randomised studies and examine strategies to engage patients and consumers in the process of outcome identification and prioritisation for patientcentred reviews. Such patient-centred outcomes are of specific relevance to nursing. Thus, Gartlehner and Flamm recommended creating a Cochrane repository of unmeasured patientcentred outcomes to inform future research. According to the Cochrane Library Oversight Committee (2012), a Cochrane systematic review takes approximately two years from protocol to publication. With increased efforts to
413
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Nursing and Health Policy Perspectives
reduce costs, both Brassey and Grimshaw cited infrastructure funding and the costs of conducting systematic reviews as significant opportunities for the Cochrane Collaboration in the future (Brassey 2013a,b; Grimshaw 2004). Brassey suggested that the use of an ultra-rapid review process in addition to the more traditional and extensive systematic review process would reduce costs by 90%, increasing the number of systematic reviews ten-fold (Brassey 2013a). Expediting the systematic review process would enhance the evidence base for nursing practice. Finally, improving access to systematic review findings through innovative methods is paramount. A Cochrane mobile application would allow nurses to access findings via cell phones, tablets and eventually watches. Barbour reported that an app is under review for the iPad (Barbour 2013). Such mediums would be ideal for nurses practicing in rural areas where Internet and computer access may be limited. Furthermore, social media (e.g. Facebook, Twitter, LinkedIn) could be used as an engaging, evidence-transfer strategy. Pod casts, webinars, evidence summaries, the CNCF journal section and CNCF newsletters could be shared with the world of nursing in a fun and easily accessible manner. In summary, our trip back to the future of nursing highlights the significant contribution the Cochrane Collaboration has made to nursing practice over the past two decades. The next 20 years holds promise for innovative strategies to improve access to high quality evidence reviews, and to continue the development of a strong foundation for evidence-based nursing interventions. Finally, expanding our focus from nursing-centred outcomes to patient-centred outcomes ensures that our patients’ preferences and values are part of the evidence base and propels our nursing practice forward. Roberta Christopher, MSN, APRN, CHTS-CP is Director of Nursing Research & Magnet with University of Florida Health Jacksonville, located in Jacksonville, Florida in the USA. She is a member of the Cochrane Nursing Care Field.
References Barbour, K. (2013, April) Cochrane Library, a Meta-Analyses App at the Tip of Your Metacarpals. Available at: http://www.imedicalapps.com/2013/04/ cochrane-library-app/ (accessed 26 August 2013). Brassey, J. (2013a) A Critique of the Cochrane Collaboration. Available at: http://blog.tripdatabase.com/2013/04/a-critique-of-cochranecollaboration.html (accessed 26 August 2013). Brassey, J. (2013b) Ultra-Rapid Reviews, First Results. Available at: http:// blog.tripdatabase.com/2013/08/ultra-rapid-reviews-first-test-results.html (accessed 26 August 2013). Gartlehner, G. & Flamm, M. (2013) Is the Cochrane Collaboration Prepared for the Era of Patient-Centered Outcomes Research? Available at: http:// www.thecochranelibrary.com/details/editorial/4502681/Is-TheCochrane-Collaboration-prepared-for-the-era-of-patient-centredoutcomes-research.html (accessed 26 August 2013). GCN (2007) 25 Years: A Technology Timeline. Available at: http://gcn.com/ Articles/2007/12/06/25-years–A-technology-timeline.aspx?Page=2 (accessed 26 August 2013). Grimshaw, J. (2004) So what has the Cochrane Collaboration ever done for us? A report card on the first 10 years. Canadian Medical Association Journal, 171, 747–749. Hughes, E. (2007) Meta-Analysis – The Role of Cochrane Collaboration. Will It Change Future Medical Studies? Available at: http:// www.comtecmed.com/cogi/COGI2_FullPapers/59.rtf (accessed 26 August 2013). Stead, L.F., Hartmann-Boyce, J., Perera, R. & Lancaster, T. (2013) Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews, (8), CD002850. doi: 10.1002/14651858.CD002850.pub3. The Cochrane Collaboration (2012) Cochrane Nursing Care Field. Available at http://cncf.cochrane.org/ (accessed on August 26 2013). The Cochrane Library Oversight Committee (2012) Measuring the performance of the Cochrane Library [Editorial]. Cochrane Database of Systematic Reviews, (11), ED000048. Available at: http://www .thecochranelibrary.com/details/editorial/3620281/Measuring-theperformance-of-The-Cochrane-Library.html (accessed 26 August 2013). Zemeckis, R. (Author & Director), Gale, B. (Author) & Spielberg, S. (Producer) (1985) Back to the Future [Motion picture]. USA: Universal Pictures.
The Cochrane Collaboration, which marks its 20th anniversary in 2013, is an international network of more than 31 000 dedicated people from over 120 countries. They work together to help healthcare practitioners, policy-makers, patients, their advocates and carers, make well-informed decisions about healthcare.
They prepare, update and promote the accessibility of the over 5000 Cochrane Reviews published online in the Cochrane Database of Systematic Reviews, part of The Cochrane Library. The Collaboration also prepares the largest collection of records of randomised controlled trials in the world, called CENTRAL, published as part of The Cochrane Library. Their work is internationally recognised as the benchmark for high quality information about the effectiveness of healthcare. The Collaboration believes that effective healthcare is created through equal partnerships between researcher, provider, practitioner and patient. Their vision is that healthcare decision-making throughout the world will be informed by high-quality, timely research evidence.
© 2013 International Council of Nurses
ICN
Nursing and Health Policy Perspectives
Back to the future of nursing through the Cochrane Collaboration As I prepared content for this editorial, the movie Back to the Future was playing on television (Zemeckis et al. 1985). I reflected on my present nursing practice and what it would be like to go back in time prior to the Cochrane Collaboration, formed in 1993. In the early 1990s, evidence-based practice was an emerging concept. The Internet browser had just been introduced (GCN 2007). Internet searching of literature and access to high quality systematic reviews were limited. As a nursing student, I answered clinical questions by using card catalogues to find research articles or books. For those of you who are not familiar with card catalogues, they are large cabinets containing cards for articles and books stored in libraries. Libraries housed rows upon rows of card catalogues. To find relevant articles, I would need to search through hundreds of cards using subject terms or just plain luck. This arduous process limited literature searches and made it next to impossible to locate high quality systematic reviews. Next I would have to search through volumes of printed journals to find the selected articles. If I was fortunate, the library had a copier machine to make copies of relevant articles. If not, I would have to transcribe relevant information from the articles onto index cards. It took hours upon hours to research my original clinical question, and the answer was limited to information contained in the articles available in the library to which I happened to have access. This exhaustive process made evidence-informed clinical decisions at the point of care next to impossible. Fast forward to the nurse of today. With a few keystrokes and a search of the Cochrane Database of Systematic Reviews, now nurses can quickly access high quality research evidence and find answers to clinical questions at the point of care. The plain language summary provided with each systematic review in the Cochrane database may be leveraged to expedite answering clinical questions for nurses who do not have extensive research or statistical knowledge. For example, a clinical question may be posed regarding the efficacy of proactive telephone counselling for smoking cessation as compared to self-help materials, pharmacotherapy or brief advice alone. A Cochrane systematic review completed by Stead et al. noted that relative success with smoking cessation increased between 20% and 36% with the use of telephone
© 2013 International Council of Nurses
counselling and improved with increased dose response (three or more calls) as compared to the other stand-alone interventions (Stead et al. 2013). Now that we are back to the future, the question before us is how Cochrane may support moving nursing forward for the next 20 years. One instrumental effort Cochrane has undertaken already is the creation of the Cochrane Nursing Care Field (CNCF) (http://cncf.cochrane.org). Key functions of the CNCF are to foster systematic reviews relevant to nursing; to share inter-professional perspectives; and to disseminate and augment utilisation of findings from Cochrane reviews through evidence-transfer strategies (review summaries and pod casts) (Cochrane Collaboration, 2012). Additional strategies employed include the CNCF journal section in the International Journal of Nursing Practice; monthly CNCF newsletters; and online or face-to-face workshops, seminars and symposia focused on evidence-based nursing care. To continue this momentum, future efforts of the CNCF should consider the following. First, the increase in electronic health records (EHR) allows for more efficient clinical decisionmaking support at the point of care. Partnering with nurse and health informatics specialists to develop interfaces between EHR elements (e.g. nursing care plan interventions, patient education and safety alerts) and the Cochrane evidence-transfer strategies and review summaries will further augment evidencebased practice. Second, Hughes recommended closer collaboration between direct care nurses, researchers and healthcare consumers to identify gaps in knowledge and needed systematic reviews through the Cochrane Collaboration (Hughes 2007). Another need for nursing, identified by Gartlehner and Flamm, is increased access to patient-centred outcome measures that focus on the continuum of care and are relevant to patients (Gartlehner & Flamm 2013). They suggested that Cochrane expand the scope of reviews to include non-randomised studies and examine strategies to engage patients and consumers in the process of outcome identification and prioritisation for patientcentred reviews. Such patient-centred outcomes are of specific relevance to nursing. Thus, Gartlehner and Flamm recommended creating a Cochrane repository of unmeasured patientcentred outcomes to inform future research. According to the Cochrane Library Oversight Committee (2012), a Cochrane systematic review takes approximately two years from protocol to publication. With increased efforts to
413
414
Nursing and Health Policy Perspectives
reduce costs, both Brassey and Grimshaw cited infrastructure funding and the costs of conducting systematic reviews as significant opportunities for the Cochrane Collaboration in the future (Brassey 2013a,b; Grimshaw 2004). Brassey suggested that the use of an ultra-rapid review process in addition to the more traditional and extensive systematic review process would reduce costs by 90%, increasing the number of systematic reviews ten-fold (Brassey 2013a). Expediting the systematic review process would enhance the evidence base for nursing practice. Finally, improving access to systematic review findings through innovative methods is paramount. A Cochrane mobile application would allow nurses to access findings via cell phones, tablets and eventually watches. Barbour reported that an app is under review for the iPad (Barbour 2013). Such mediums would be ideal for nurses practicing in rural areas where Internet and computer access may be limited. Furthermore, social media (e.g. Facebook, Twitter, LinkedIn) could be used as an engaging, evidence-transfer strategy. Pod casts, webinars, evidence summaries, the CNCF journal section and CNCF newsletters could be shared with the world of nursing in a fun and easily accessible manner. In summary, our trip back to the future of nursing highlights the significant contribution the Cochrane Collaboration has made to nursing practice over the past two decades. The next 20 years holds promise for innovative strategies to improve access to high quality evidence reviews, and to continue the development of a strong foundation for evidence-based nursing interventions. Finally, expanding our focus from nursing-centred outcomes to patient-centred outcomes ensures that our patients’ preferences and values are part of the evidence base and propels our nursing practice forward. Roberta Christopher, MSN, APRN, CHTS-CP is Director of Nursing Research & Magnet with University of Florida Health Jacksonville, located in Jacksonville, Florida in the USA. She is a member of the Cochrane Nursing Care Field.
References Barbour, K. (2013, April) Cochrane Library, a Meta-Analyses App at the Tip of Your Metacarpals. Available at: http://www.imedicalapps.com/2013/04/ cochrane-library-app/ (accessed 26 August 2013). Brassey, J. (2013a) A Critique of the Cochrane Collaboration. Available at: http://blog.tripdatabase.com/2013/04/a-critique-of-cochranecollaboration.html (accessed 26 August 2013). Brassey, J. (2013b) Ultra-Rapid Reviews, First Results. Available at: http:// blog.tripdatabase.com/2013/08/ultra-rapid-reviews-first-test-results.html (accessed 26 August 2013). Gartlehner, G. & Flamm, M. (2013) Is the Cochrane Collaboration Prepared for the Era of Patient-Centered Outcomes Research? Available at: http:// www.thecochranelibrary.com/details/editorial/4502681/Is-TheCochrane-Collaboration-prepared-for-the-era-of-patient-centredoutcomes-research.html (accessed 26 August 2013). GCN (2007) 25 Years: A Technology Timeline. Available at: http://gcn.com/ Articles/2007/12/06/25-years–A-technology-timeline.aspx?Page=2 (accessed 26 August 2013). Grimshaw, J. (2004) So what has the Cochrane Collaboration ever done for us? A report card on the first 10 years. Canadian Medical Association Journal, 171, 747–749. Hughes, E. (2007) Meta-Analysis – The Role of Cochrane Collaboration. Will It Change Future Medical Studies? Available at: http:// www.comtecmed.com/cogi/COGI2_FullPapers/59.rtf (accessed 26 August 2013). Stead, L.F., Hartmann-Boyce, J., Perera, R. & Lancaster, T. (2013) Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews, (8), CD002850. doi: 10.1002/14651858.CD002850.pub3. The Cochrane Collaboration (2012) Cochrane Nursing Care Field. Available at http://cncf.cochrane.org/ (accessed on August 26 2013). The Cochrane Library Oversight Committee (2012) Measuring the performance of the Cochrane Library [Editorial]. Cochrane Database of Systematic Reviews, (11), ED000048. Available at: http://www .thecochranelibrary.com/details/editorial/3620281/Measuring-theperformance-of-The-Cochrane-Library.html (accessed 26 August 2013). Zemeckis, R. (Author & Director), Gale, B. (Author) & Spielberg, S. (Producer) (1985) Back to the Future [Motion picture]. USA: Universal Pictures.
The Cochrane Collaboration, which marks its 20th anniversary in 2013, is an international network of more than 31 000 dedicated people from over 120 countries. They work together to help healthcare practitioners, policy-makers, patients, their advocates and carers, make well-informed decisions about healthcare.
They prepare, update and promote the accessibility of the over 5000 Cochrane Reviews published online in the Cochrane Database of Systematic Reviews, part of The Cochrane Library. The Collaboration also prepares the largest collection of records of randomised controlled trials in the world, called CENTRAL, published as part of The Cochrane Library. Their work is internationally recognised as the benchmark for high quality information about the effectiveness of healthcare. The Collaboration believes that effective healthcare is created through equal partnerships between researcher, provider, practitioner and patient. Their vision is that healthcare decision-making throughout the world will be informed by high-quality, timely research evidence.
© 2013 International Council of Nurses
