Guide to Writing Evidence-Based Papers in Nursing and Medicine

In the ever-evolving fields of nursing and medicine, staying current with the latest research and best practices is crucial. Writing evidence-based papers is a fundamental skill that allows healthcare professionals to contribute to the body of knowledge, improve patient care, and advance their careers.

This comprehensive guide will walk you through the process of writing an evidence-based paper, from selecting a topic to polishing your final draft.

We’ll use simple language and provide plenty of examples to make this complex process more accessible.

What is an Evidence-Based Paper?

Before we delve into the writing process, it’s essential to understand what an evidence-based paper is and why it’s so important in healthcare.

An evidence-based paper is a scholarly document that uses the best available research evidence to answer a specific clinical question or address a particular healthcare problem. It’s a way of applying scientific research to real-world healthcare situations. Think of it as being a detective in the world of medicine – you’re gathering clues (research studies) to solve a mystery (your clinical question).

For instance, let’s say you’re a nurse working in a neonatal intensive care unit (NICU), and you’ve noticed that some premature babies seem to respond better to certain feeding methods than others. An evidence-based paper on this topic might examine all the available research on feeding methods for premature infants to determine which approaches are most effective for different situations.

Why Are Evidence-Based Papers Important?

Evidence-based papers play a crucial role in nursing and medicine for several reasons:

1. Improved Patient Care: By basing our practices on the best available evidence, we can provide higher quality care to our patients. This can lead to better outcomes, faster recoveries, and improved quality of life.
2. Continuous Learning: Writing evidence-based papers keeps healthcare professionals up-to-date with the latest research in their field. This ongoing learning is crucial in a field that’s constantly evolving.
3. Decision-Making Based on Facts: Evidence-based papers help shift healthcare decision-making away from tradition, intuition, or outdated practices towards approaches that have been scientifically proven to be effective.
4. Advancement of Medical Knowledge: When healthcare professionals write and publish evidence-based papers, they contribute to the collective knowledge of their field. This can lead to new discoveries and improvements in healthcare practices.
5. Cost-Effectiveness: By identifying the most effective treatments and interventions, evidence-based practice can help reduce unnecessary procedures and make healthcare more cost-effective.
6. Ethical Practice: Using evidence-based approaches ensures that we’re providing care that has been shown to be beneficial, which aligns with the ethical principle of beneficence (doing good for the patient).
7. Professional Development: The skills involved in writing evidence-based papers – critical thinking, research, analysis, and clear communication – are valuable for career advancement in healthcare.

Imagine you’re a patient about to undergo surgery. Wouldn’t you want your surgical team to use techniques and procedures that have been proven effective through rigorous research? That’s the power of evidence-based practice, and evidence-based papers are how this knowledge is shared and implemented across the healthcare community.

Steps to Writing an Evidence-Based Paper

Now that we understand the importance of evidence-based papers, let’s break down the process of writing one into manageable steps.

Step 1: Choose Your Topic

Selecting the right topic is crucial for a successful evidence-based paper. Your topic should be:

• Relevant to your field of practice
• Interesting to you (you’ll be spending a lot of time with it!)
• Specific enough to research thoroughly
• Broad enough that sufficient evidence exists
• Important or controversial enough to warrant investigation

Here are some examples of good topics for evidence-based papers in nursing and medicine:

1. The effectiveness of mindfulness-based stress reduction techniques in managing chronic pain
2. Comparison of different wound dressing techniques for preventing surgical site infections
3. The impact of nurse-led discharge planning on hospital readmission rates for heart failure patients
4. Evaluating the effectiveness of various insulin administration methods for managing type 1 diabetes in children
5. The role of probiotics in preventing antibiotic-associated diarrhea
6. Comparing the efficacy of different smoking cessation interventions in pregnant women
7. The impact of music therapy on anxiety levels in preoperative patients
8. Evaluating the effectiveness of different fall prevention strategies in elderly care facilities

When choosing your topic, consider your own clinical experiences. Have you noticed any recurring issues or questions in your practice? These can often be great starting points for an evidence-based paper.

For example, let’s say you’re a nurse working in an emergency department, and you’ve noticed that patients with severe allergic reactions (anaphylaxis) are treated with different medications depending on which doctor is on duty. This observation could lead to a great topic: “Comparing the efficacy of different first-line medications for the treatment of anaphylaxis in emergency settings.”

Step 2: Formulate Your Question

Once you have your topic, the next step is to formulate a specific, answerable question. In evidence-based practice, we often use the PICO format to structure our questions:

• P: Patient, Population, or Problem
• I: Intervention or Exposure
• C: Comparison
• O: Outcome

Let’s break this down with an example:

Topic: The effectiveness of mindfulness-based stress reduction techniques in managing chronic pain

PICO Question: In adults with chronic lower back pain (P), does practicing mindfulness-based stress reduction techniques (I) compared to conventional pain management approaches (C) lead to greater pain reduction and improved quality of life (O)?

Here’s another example:

Topic: Comparison of different wound dressing techniques for preventing surgical site infections

PICO Question: In patients undergoing abdominal surgery (P), does the use of negative pressure wound therapy dressings (I) compared to standard adhesive dressings (C) reduce the incidence of surgical site infections (O)?

Creating a well-structured PICO question helps in several ways:

1. It focuses your research by clearly defining what you’re looking for.
2. It helps you develop effective search strategies for finding relevant studies.
3. It makes it easier to determine which studies are relevant to your question.
4. It provides a clear structure for presenting your findings.

Remember, a good PICO question should be:

• Focused on a single issue
• Answerable through existing research
• Relevant to your practice
• Neither too broad nor too narrow

Step 3: Search for Evidence

Now that you have your PICO question, it’s time to start your search for evidence. This step is crucial – the quality of your paper depends on the quality and relevance of the evidence you find.

Here are some key places to look for evidence:

1. PubMed: A free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics.
2. CINAHL (Cumulative Index to Nursing and Allied Health Literature): An excellent resource for nursing and allied health professional literature.
3. Cochrane Library: A collection of databases containing different types of high-quality, independent evidence to inform healthcare decision-making.
4. EMBASE: A biomedical and pharmacological database of published literature.
5. Google Scholar: A broad search engine for scholarly literature across many disciplines and sources.
6. Joanna Briggs Institute EBP Database: A database of systematic reviews, evidence summaries, and best practice information sheets for healthcare professionals.
7. TRIP Database: A clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care.

When searching these databases, use keywords from your PICO question. For our mindfulness and chronic pain example, you might use terms like:

• “mindfulness-based stress reduction”
• “MBSR”
• “chronic pain”
• “lower back pain”
• “pain management”
• “quality of life”

Here are some tips for effective searching:

1. Use Boolean operators (AND, OR, NOT) to combine search terms. For example: (mindfulness OR MBSR) AND “chronic pain”
2. Use quotation marks for exact phrases: “mindfulness-based stress reduction”
3. Use truncation to find variations of a word. For example, nurs* will find nurse, nurses, nursing.
4. Use MeSH (Medical Subject Headings) terms in PubMed for more precise searches.
5. Look at the reference lists of relevant articles you find – this can lead you to other useful studies.
6. Consider setting up alerts on databases for your topic to stay updated on new research.

As you search, keep track of your search strategies. Note which databases you searched, what terms you used, and how many results you got. This information should be included in the methods section of your paper.

Remember to look for high-quality evidence. In general, the hierarchy of evidence (from highest to lowest) is:

1. Systematic reviews and meta-analyses of randomized controlled trials
2. Randomized controlled trials
3. Cohort studies
4. Case-control studies
5. Cross-sectional studies
6. Case reports
7. Expert opinion

While you should focus on the highest levels of evidence available, don’t completely disregard lower levels. Sometimes, especially for newer or more specific topics, the best available evidence might come from case studies or expert opinions.

Step 4: Evaluate the Evidence

Once you’ve gathered a collection of potentially relevant studies, it’s time to evaluate them. Not all studies are created equal, and it’s crucial to critically appraise the evidence you’ve found.

Here are some key factors to consider when evaluating a study:

1. Study Design: What type of study is it? Is the design appropriate for answering the research question?
2. Sample Size: How many participants were in the study? Generally, larger sample sizes provide more reliable results.
3. Participant Selection: How were participants chosen? Was there any selection bias?
4. Randomization: For experimental studies, were participants randomly assigned to groups?
5. Blinding: Were the participants and/or researchers blinded to the treatment allocation?
6. Control Group: Was there an appropriate control or comparison group?
7. Methods: Were the study methods clearly described and appropriate?
8. Statistical Analysis: Were appropriate statistical tests used? Were the results statistically significant?
9. Results: What were the main findings? Are they clinically significant as well as statistically significant?
10. Limitations: What limitations did the authors acknowledge? Are there any other limitations you can identify?
11. Applicability: Can the results be applied to your specific PICO question and patient population?
12. Conflicts of Interest: Were any conflicts of interest declared? How might these have influenced the study?

Let’s look at an example of how you might evaluate a study:

Title: “Effects of Mindfulness-Based Stress Reduction on Chronic Low Back Pain: A Randomized Controlled Trial”

1. Study Design: Randomized controlled trial (high-quality design for assessing interventions)
2. Sample Size: 150 participants (a decent size, but not extremely large)
3. Participant Selection: Adults with chronic low back pain for at least 6 months, recruited from primary care clinics (seems appropriate)
4. Randomization: Participants were randomly assigned to either MBSR or a control group (good)
5. Blinding: Participants couldn’t be blinded due to the nature of the intervention, but outcome assessors were blinded (acceptable given the intervention)
6. Control Group: Control group received usual care (appropriate comparison)
7. Methods: MBSR was delivered in 8 weekly 2-hour sessions plus a full-day retreat. Outcomes were measured at baseline, 8 weeks, and 6 months (well-described and appropriate)
8. Statistical Analysis: Used intention-to-treat analysis, appropriate statistical tests for the data type (good)
9. Results: MBSR group showed significantly greater improvement in pain intensity and functional limitation at 8 weeks and 6 months compared to control group (p < 0.01)
10. Limitations: High dropout rate in MBSR group (25%), single-center study (may limit generalizability)
11. Applicability: Directly applicable to our PICO question
12. Conflicts of Interest: None declared

Overall, this would be considered a high-quality study that provides strong evidence for our paper.

As you evaluate each study, take notes or create a table summarizing the key points. This will make it easier to write your paper later.

Step 5: Organize Your Findings

After evaluating your evidence, it’s time to organize your findings. This step will help you see patterns in the evidence and make it easier to write your paper.

A good way to organize your findings is to create an evidence table. This is a structured summary of the key studies you’ve found:

Creating this table serves several purposes:

1. It gives you a clear overview of the evidence you’ve found.
2. It helps you identify patterns or inconsistencies in the evidence.
3. It makes it easier to compare and contrast different studies.
4. It provides a structure for writing the results section of your paper.

As you create your evidence table, you might start to notice themes or patterns in the evidence. For example, you might see that MBSR seems to be more effective for some outcomes (like pain intensity) than others (like functional limitation). You might also notice gaps in the evidence – perhaps there’s a lack of long-term follow-up studies, or most studies have been done in a particular population.

These observations will be valuable when you start writing your paper, particularly in the discussion section where you’ll interpret the meaning of your findings.

Step 6: Write Your Paper

Now that you’ve gathered, evaluated, and organized your evidence, it’s time to start writing your paper. An evidence-based paper typically includes the following sections:

Title

Your title should clearly indicate the topic of your paper. It should be concise but informative. For example: “The Effectiveness of Mindfulness-Based Stress Reduction for Chronic Lower Back Pain: An Evidence-Based Review”

Abstract

The abstract is a brief summary of your entire paper. Although it appears at the beginning, it’s often easier to write this last. Your abstract should include:

• Background: A sentence or two about why this topic is important
• Objective: Your PICO question
• Methods: How you searched for and evaluated evidence
• Results: A summary of your key findings
• Conclusion: The main takeaway from your review

Keep your abstract concise – usually around 250-300 words.

Introduction

Your introduction should:

1. Provide background information on your topic
2. Explain why this topic is important
3. Clearly state your PICO question
4. Briefly outline the structure of your paper

For example:

“Chronic lower back pain affects millions of people worldwide, leading to decreased quality of life, lost productivity, and significant healthcare costs. While conventional treatments such as medication and physical therapy are commonly used, there is growing interest in mind-body interventions like Mindfulness-Based Stress Reduction (MBSR). This paper seeks to answer the question: In adults with chronic lower back pain, does practicing MBSR compared to conventional pain management approaches lead to greater pain reduction and improved quality of life? We will review the current evidence on this topic, evaluate its quality, and discuss the implications for clinical practice.”

Methods

In this section, describe how you conducted your evidence search and evaluation. Include:

• Databases searched
• Search terms used
• Inclusion and exclusion criteria for studies
• How you evaluated the quality of the evidence

For example:

“We searched PubMed, CINAHL, and the Cochrane Library for studies published in the last 10 years using the terms ‘mindfulness-based stress reduction,’ ‘MBSR,’ ‘chronic pain,’ and ‘lower back pain.’ We included randomized controlled trials, cohort studies, and systematic reviews. Case reports and studies with fewer than 50 participants were excluded. The quality of evidence was evaluated using the Joanna Briggs Institute Critical Appraisal tools.”

Results

In this section, present the findings from your evidence review. Organize this section logically – you might group studies by their design, their outcomes, or their findings. Use your evidence table to help structure this section.

Start with an overview of the studies you found, then delve into the details. For example:

“Our search yielded 15 relevant studies: 8 randomized controlled trials, 5 cohort studies, and 2 systematic reviews. The total number of participants across all studies was approximately 2,500.

The majority of studies (12 out of 15) found that MBSR was effective in reducing pain intensity in adults with chronic lower back pain. For example, Smith et al.

(2020) conducted a randomized controlled trial with 150 participants and found that those in the MBSR group reported significantly lower pain intensity scores at both 8 weeks and 6 months compared to the control group (p < 0.01).

Regarding quality of life, 10 studies measured this outcome, with 8 reporting significant improvements in the MBSR group. Jones et al. (2019) conducted a large cohort study (n=300) and found that participants who completed an 8-week MBSR program reported improved quality of life scores at 3 months follow-up compared to those who did not participate in MBSR (mean difference = 0.5 on a 5-point scale, 95% CI: 0.3-0.7).

However, the evidence for MBSR’s effect on functional limitation was mixed. Of the 7 studies that measured this outcome, 4 reported significant improvements, while 3 found no significant difference between MBSR and control groups. The systematic review by Brown et al. (2021), which included 10 RCTs with a total of 1200 participants, concluded that while MBSR consistently showed benefits for pain intensity and quality of life, its effects on functional outcomes were less clear.

It’s worth noting that most studies focused on short-term outcomes (up to 6 months), with only 3 studies providing data on long-term effects (1 year or more). These long-term studies suggested that the benefits of MBSR may persist over time, but more research is needed to confirm this.”

Discussion

In the discussion section, you interpret the meaning of your results, compare them to existing knowledge, and discuss their implications. This section should include:

1. A summary of the main findings
2. How your findings relate to your PICO question
3. Comparison of your findings to existing literature
4. Discussion of the strengths and limitations of the evidence
5. Implications for clinical practice
6. Suggestions for future research

For example:

“Our review of the evidence suggests that MBSR is an effective intervention for reducing pain intensity and improving quality of life in adults with chronic lower back pain. This answers our PICO question positively, indicating that MBSR may indeed be more effective than conventional pain management approaches for these outcomes.

These findings are consistent with broader literature on mind-body interventions for chronic pain. For instance, a meta-analysis by Johnson et al. (2018) found that mindfulness-based interventions were effective for various chronic pain conditions, not just lower back pain.

However, the evidence for MBSR’s effect on functional outcomes is less clear. This inconsistency might be due to variations in how functional limitation was measured across studies, or it could indicate that MBSR’s primary mechanism of action is through altering pain perception and coping rather than directly improving physical function.

A key strength of the evidence is the number of high-quality randomized controlled trials available. These studies provide a high level of evidence for MBSR’s effectiveness. However, there are also limitations to consider. Most studies had relatively short follow-up periods, making it difficult to draw conclusions about the long-term effects of MBSR. Additionally, many studies were conducted in urban, Western settings, which may limit their generalizability to other populations.

From a clinical perspective, these findings suggest that MBSR could be a valuable addition to the treatment options for chronic lower back pain. Given its non-invasive nature and lack of significant side effects, MBSR could be particularly useful for patients who prefer non-pharmacological approaches or those who have not responded well to conventional treatments.

Future research should focus on the long-term effects of MBSR, its cost-effectiveness compared to other treatments, and its effectiveness in diverse populations. It would also be valuable to investigate whether certain subgroups of patients (e.g., based on pain duration or psychological factors) respond particularly well to MBSR.”

Conclusion

Your conclusion should briefly summarize the key points of your paper and provide a final answer to your PICO question. For example:

“Based on the current evidence, MBSR appears to be an effective intervention for reducing pain intensity and improving quality of life in adults with chronic lower back pain. While its effects on functional outcomes are less clear, the overall benefits and low risk of adverse effects suggest that MBSR could be a valuable addition to chronic pain management strategies. Healthcare providers should consider recommending MBSR as part of a comprehensive treatment plan for patients with chronic lower back pain, particularly those interested in non-pharmacological approaches. However, more research is needed to understand the long-term effects of MBSR and its effectiveness in diverse populations.”

References

List all the sources you cited in your paper, formatted according to the required citation style (e.g., APA, Vancouver).

Step 7: Cite Your Sources

Proper citation is crucial in evidence-based writing. It allows readers to verify your sources and gives credit to the original researchers. Common citation styles in healthcare include:

1. APA (American Psychological Association)
2. Vancouver
3. AMA (American Medical Association)

Check with your institution or the journal you’re submitting to for their preferred citation style. Most word processing software and reference management tools (like Zotero or Mendeley) can help you format your citations correctly.

Step 8: Review and Revise

After you’ve written your first draft, set it aside for a day or two if possible. Then, come back and review it with fresh eyes. Look for:

1. Clarity of writing: Is your paper easy to understand?
2. Logical flow: Does your argument progress logically?
3. Proper use of evidence: Have you represented the studies accurately?
4. Consistency: Are your terms and abbreviations used consistently?
5. Grammar and spelling: Are there any errors?
6. Formatting: Does your paper adhere to the required format?

It can be helpful to have a colleague or mentor review your paper as well. They might catch things you’ve missed or have suggestions to improve your paper.

Tips for Writing a Great Evidence-Based Paper

1. Start early: Give yourself plenty of time for research and writing.
2. Stay organized: Keep good notes and use a reference management tool.
3. Be objective: Present all relevant evidence, even if it doesn’t support your initial hypothesis.
4. Use clear, precise language: Avoid jargon and explain any technical terms you use.
5. Be critical: Discuss the strengths and limitations of the evidence you’ve found.
6. Use tables and figures: These can help present complex information clearly.
7. Keep your PICO question in focus: Ensure everything in your paper relates back to your question.
8. Be concise: While you want to be thorough, avoid unnecessary repetition or irrelevant information.
9. Follow formatting guidelines: Pay attention to requirements for headings, spacing, font, etc.
10. Proofread carefully: Typos and grammatical errors can detract from your credibility.

Common Challenges and How to Overcome Them

1. Finding relevant evidence: If you’re struggling to find studies, try broadening your search terms or consult with a librarian.
2. Evaluating complex statistics: If you’re not confident with statistics, consider taking a basic stats course or asking a colleague for help.
3. Dealing with conflicting evidence: If studies disagree, discuss possible reasons why (e.g., different populations, methods) in your paper.
4. Writer’s block: Try freewriting or discussing your ideas with a colleague to get unstuck.
5. Time management: Break the writing process into smaller tasks and set deadlines for each.
6. Staying motivated: Remember the importance of your work in improving patient care

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FAQs about Writing Evidence-Based Papers

Q: How long should an evidence-based paper be? A: This can vary depending on the requirements of your class or the journal you’re submitting to. Generally, papers range from 3,000 to 8,000 words, but always check the specific guidelines you’re following.

Q: How many sources should I use? A: There’s no set number, but aim for a thorough review of the available evidence. This might mean 20-30 high-quality sources for a typical paper. Quality is more important than quantity!

Q: What if I can’t find much research on my topic? A: If you’re struggling to find evidence, you might need to broaden your search terms or look at related topics. If there truly isn’t much research, discussing this gap in the literature can be valuable in itself.

Q: Do I need to include every study I find? A: No, focus on the most relevant and highest quality studies. It’s better to discuss a few studies in depth than to superficially mention many.

Q: How do I know if a source is reliable? A: Look for peer-reviewed journals and well-known medical or nursing organizations. Be cautious of websites ending in .com, as these may be biased. If you’re unsure, ask your instructor or a librarian.

Q: Can I use my own clinical experience in an evidence-based paper? A: While your experience is valuable, an evidence-based paper should focus on published research. You might mention your experience briefly in the discussion section if it’s relevant, but it shouldn’t be a main source of evidence.

Q: What if the evidence doesn’t support what I thought was true? A: That’s okay! In fact, it’s a great learning opportunity. Present the evidence objectively and discuss why it might differ from common beliefs or practices. This is how healthcare improves over time.

Q: How often should I use direct quotes? A: Use direct quotes sparingly. It’s usually better to paraphrase and cite the source. Save quotes for when the exact wording is particularly important or impactful.

Q: Can I use the same evidence-based paper for different classes? A: This depends on your school’s policies. Always check with your instructors first. Even if it’s allowed, you’ll probably need to modify the paper to fit each class’s specific requirements.

Q: How do I stay up-to-date with new evidence after I’ve written my paper? A: Consider setting up alerts on databases like PubMed for your topic. Attending conferences and reading nursing or medical journals regularly can also help you stay current.