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Population Health for Nurses

11.2 Where to Find Evidence-Based Interventions

Population Health for Nurses11.2 Where to Find Evidence-Based Interventions

Learning Outcomes

By the end of this section, you should be able to:

  • 11.2.1 Identify examples of databases and registries to locate research and evidence-based prevention services.
  • 11.2.2 Identify evidence-based programs that contribute to meeting core public health functions and the 10 Essential Public Health Services.
  • 11.2.3 Understand how to use data to inform decision-making in public health nursing.

Once nurses and other health care professionals understand EBP and EBDM and when to use them, the next step is to determine where to find evidence-based practice interventions. The PICOT question guides the search for relevant evidence. This section discusses the different resources nurses may use to find research and to identify evidence-based prevention services. It discusses how the 10 Essential Public Health Services and the social determinants of health are key factors that must inform all public health and population health decision-making.

Databases and Registries

With the vast amount of research available, it is crucial to be efficient while searching for relevant evidence. Databases, collections of information organized in a systematic method, are helpful during the process of searching for sources of existing literature related to the topic of one’s inquiry. Multiple databases are available to assist nurses and other health care providers with the process of selecting evidence-based interventions. Table 11.4 provides examples of commonly used and reliable databases.

Database Description
Agency for Healthcare Research and Quality (AHRQ)
https://www.ahrq.gov/
Includes evidence summaries and clinical guidelines
Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete
https://www.ebsco.com/products/research-databases/cinahl-complete
Includes scholarly nursing journal articles
Cochrane Library
https://www.cochranelibrary.com/
Noted as a core source for EBP; includes systematic reviews that are regularly updated and clinical trials
Joanna Briggs Institute EBP Database
https://jbi.global/ebp
Database specifically designed to house EBP articles; includes systematic review, recommended practices, evidence summaries, and tools that can be used in professional EBP
Medline with Full Text
https://www.ebsco.com/products/research-databases/medline-full-text
Includes articles covering biomedical and health fields; specifically noted for public health and public policy
PubMed (National Library of Medicine)
https://pubmed.ncbi.nlm.nih.gov/
Provided by the National Library of Medicine; specifically noted for reviews of clinical effectiveness
Table 11.4 Commonly Used Databases

In addition to databases, registries are available to provide guidance and information. Registries are collections of information regarding people and typically outline a specific condition or diagnosis (National Institutes of Health [NIH], 2023). Table 11.5 provides examples of commonly used registries and resources for nurses.

Registries Description/Link
Alzheimer’s Prevention Registry Links researchers with those participating in Alzheimer’s studies and educating the public by sharing factual and reliable information.
https://www.endalznow.org
Autoimmune Registry Provides a hub for statistics, research, and client data for all autoimmune diseases. The goal of this registry is to support research and reduce time of diagnosis for clients while establishing appropriate funding for autoimmune disease treatment.
https://www.autoimmuneregistry.org
Breast Cancer Surveillance Consortium Provides a collaborative network of breast imaging and historic registries to improve screening protocols and overall outcomes in the United States.
https://www.bcsc-research.org
Clinical Trials Public Data Share Website Hosted by the National Institute on Drug Abuse (NIDA), which shares completed trials with investigators and the public. The goal of this registry is to share information and promote new research.
https://datashare.nida.nih.gov
Mother to Baby Provides evidence-based information regarding the safety of drugs and other substances for clients who are pregnant or breastfeeding. While information on exposure to chemicals, herbs, and household products is provided here, more specific observational research is conducted and shared regarding medications and vaccines.
https://mothertobaby.org/our-work/
National Amyotrophic Lateral Sclerosis (ALS) Registry Compiles research and information provided by clients who have ALS. Direct links to current clinical trials are provided for clients.
https://www.cdc.gov/als/GeneralPublic_AboutRegistry.html
The National Institutes of Health (NIH) Registry List The National Institutes of Health (NIH) has compiled a list of over 50 registries available for reference. Many of these registries are diagnosis or population specific. This is an excellent resource for nurses and other health care providers seeking specific research to support their EBP intervention.
https://www.nih.gov/health-information/nih-clinical-research-trials-you/list-registries
The Community Guide A collection of evidence-based findings from the Community Preventive Services Task Force. This informative guide helps nurses and other health care providers find interventions to prevent disease and improve health within businesses, schools, health care organizations, communities, or states.
https://www.thecommunityguide.org
Table 11.5 Commonly Used Registries

Healthy People 2030

Evidence-Based Practices Resource Center

As an additional means of finding EBP tools and information, the Healthy People 2030 initiative offers an EBP resource center to support health care providers, public health professionals, and policymakers in incorporating EBP interventions into their communities. These resources center on prevention, treatment, and support services for recovery in substance misuse and mental health disorders.

(See HHS, 2023a.)

Data to Inform Decision-Making in Public Health

As discussed previously, public health nurses and other health care providers must consider multiple data points while searching for background and support, including surveillance, interviews, focus groups, and qualitative or quantitative research articles. While considering this information, nurses must also consider the makeup of their community and the overall functions of public health. The World Health Organization (WHO) is the United Nations agency dedicated to global safety and health. The WHO provides multiple sources to help nurses and other health care professionals achieve their public health goals. Within these resources, the WHO has created Essential Public Health Functions (EPHF) for population health, deemed an indispensable set of actions to achieve the goal of public health. These include (WHO, 2021, p. xii):

  1. Monitoring and evaluating the population’s health status, health service utilization, and surveillance of risk factors and threats to health
  2. Public health emergency management
  3. Ensuring effective public health governance, regulation, and legislation
  4. Supporting efficient and effective health systems and multisectoral planning, financing, and management for population health
  5. Protecting populations against health threats, including environment and occupational hazards, communicable disease threats, food safety, and chemical and radiation hazards
  6. Promoting prevention and early detection of diseases, including noncommunicable and communicable diseases
  7. Promoting health and well-being and actions to address the wider determinants of health and inequity
  8. Ensuring community engagement, participation, and social mobilization for health and well-being
  9. Ensuring adequate quantity and quality of the public health workforce
  10. Ensuring quality of and access to health services
  11. Advancing public health research
  12. Ensuring equitable access to and rational use of essential medicines and other health technologies

The function of public health can be summarized as monitoring the health status of the community to identify and investigate health problems and hazards and to educate and empower people to address them (WHO, 2023). To do so, public health nurses should use multiple forms of data to gather the best available information and apply this to program planning frameworks. This evidence may be research articles, community needs assessments, and statistics on medical risk, morbidity, mortality, and the social determinants of health. Examples of programs that align with the EPHF include cancer prevention and screenings, behavioral risk factor surveillance systems, injury prevention campaigns, sudden infant death syndrome (SIDS) education and prevention programs, and smoking cessation campaigns.

Along with the EPHF, public health services must also be considered in decision-making. In order to achieve public health goals to protect and enhance the health of people and the communities in which they live, work, and play, the CDC has outlined 10 Essential Public Health Services (EPHS) that describe the activities all communities should undertake (CDC, 2023b); see Foundations of Public/Community Health for more information. Originally published in 1994, the EPHS framework was revised in 2020. Foundationally, the 10 EPHS actively promote systems, policies, and overall environments to enable optimal health for all who seek to eradicate barriers that have resulted in health inequities. Examples of possible barriers to equity in health care are those based on socioeconomic status, education level, age, sex, disability, location, race, and ethnicity. The 10 EPHS strongly state that all members of the community should have just and fair opportunity to attain optimal health and overall well-being. The 10 EPHS center on monitoring the status of the population’s health, identifying problems for the population, and educating people accordingly about these problems. The foundations of public health center on creating policies, programs, and interventions to address these problems. Additionally, these steps help outline a pathway for nurses and other health care providers to increase equity across the population by building support and organizations to support a diverse population of clients and health care providers.

The decision-making process must also consider the social determinants of health (SDOH) and how they may impact public health functions. See Social Determinants Affecting Health Outcomes for more information. The SDOH ultimately contribute to personal and community-wide disparities and inequities. For example, if clients lack access to stores with nutrient-rich foods or the economic means to obtain them, they are less likely to make healthier food choices, which will then likely increase their risk of conditions such as type 2 diabetes, obesity, metabolic disorders, or heart disease. This will impact their quality of life as well as life expectancy.

All of these factors must be considered in the decision-making process as they impact one another and how interventions may ultimately succeed or fail. While one public health nurse may go through the EBDM process and eventually implement a successful program in their specific community, the success of that program may not translate to other communities or populations. For example, in a community where members do not feel safe or where distance and transportation are a concern, a program or intervention that relies heavily on the whole community participating in one physical space may not work well.

Ethical and Equitable Research

If nurses cannot find the information they need in the existing literature, they must do their own research or data extraction to inform their decisions. It is not uncommon for public health nurses to fail to find information fitting a specific population as the literature often has large gaps in representation. A significant factor to consider is research ethics. Nurses should already be familiar with the ethical codes that govern nursing practice. These ethical standards direct nursing conduct and allow for trust within the community. Similarly, there are ethical considerations related to research and those who conduct it. Research ethics employ fundamental principles guiding the design and implementation of research. These ethics center on respect for society and participants, resources, and regulation of research to prevent misconduct. These are especially important when research impacts human or animal subjects directly. In this process, there are multiple steps and checkpoints researchers need to make to follow safe channels.

The emphasis on research ethics can be traced to the National Research Act of 1974, which created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. In response to the unethical research practices used in the U.S. Public Health Service’s Syphilis Study, known as the Tuskegee Syphilis Study, this commission identified basic ethical principles that should inform the conduct of biomedical and behavioral research involving human subjects and developed guidelines to ensure that such research is conducted in accordance with those principles (CDC, 2021). The Tuskegee study sought to evaluate the natural course of untreated syphilis in Black men. Participants were not informed of the study’s true nature and thus did not give informed consent. Although penicillin became available as a treatment for syphilis during the study, it was never offered to study participants (Brandt, 1978; CDC, 2022). In 1976, the commission published the Belmont Report outlining three basic ethical principles to protect subjects in research studies and/or clinical trials—respect for persons, beneficence, and justice—as well as applications of these principles, including informed consent, assessment of risk and benefits, and selection of subjects (U.S. Department of Health and Human Services [USDHHS], n.d.). These principles work to protect participants from harm, maintain their autonomy, and distribute benefits from the research. Nurses in public health settings must obtain information regarding these steps and follow them accordingly. This may look different depending on the community setting and level of research. Research must be conducted with the goal of promoting health equity. Health equity means allowing everyone to have a fair and just opportunity to attain their highest level of health. As public health considers a group of people or a community as a whole, there are many facets to consider while seeking equity of care.

Healthy People 2030

Health Equity in Healthy People 2030

As Healthy People has evolved over the decades to reflect the most current science and address the latest public health priorities, it has strengthened its focus on health equity (USDHHS, 2023b, para. 1). To find out more about Health Equity within Health People 2030, click on the link above and explore.

Equity in health research specifically means all who are affected by research and/or who may benefit from its outcomes should have an equal opportunity to contribute to the research. These equity concerns can exacerbate already-existing health dipartites. Nurses must consider their role in protecting the population being researched and promoting equity in research to better serve their communities. Unfortunately, nurses and other health care providers have not always conducted research and trials in an ethical manner. One historical example of unethical medical research is the participation of nurses and doctors in the ill-treatment and execution of tens of thousands of German citizens who were mentally, physically, and emotionally ill both before and during the Holocaust (Copeland, 2021). Another example is the role public health nurse Eunice Rivers Laurie played in the previously mentioned Tuskegee Syphilis Study conducted from 1932 to 1972. Rivers worked for the study, forming a relationship with the men, providing them with transportation and hot meals, and giving them noneffective treatments. As a Black nurse, she was trusted by the men and provided continuity of care for the duration of the study (Brandt, 1978).

Interview with Tuskegee Study Nurse Eunice Rivers Laurie

This 1972 interview from National Public Radio (NPR) features Eunice Rivers Laurie, a public health nurse who worked for the Tuskegee Syphilis Study for 39 years. Laurie discusses her experience working with patients and answers questions about what patients were told.

Listen to the interview, and then respond to the following questions.

  1. What was Nurse Laurie’s role as a public health nurse in the Tuskegee Syphilis Study?
  2. Why were the men in the study not told they had syphilis, according to Nurse Laurie?
  3. If you had an opportunity to ask Nurse Laurie about her experience in the Tuskegee Syphilis Study, what would you ask her?

Research equity in health care is imperative to improve community health and promote social change. Diverse perspectives and backgrounds must be represented in research to broadly provide effective and efficient care to all. Health interventions and policies that do not represent these perspectives and backgrounds are likely to fail to meet the needs of marginalized communities. The biases and perspectives of those conducting research combined with the historical lack of focus on marginalized communities in health care result in notable gaps in information and thus gaps in solutions for these populations. Researchers must identify biases within the data they are using as well as the power dynamics at each step of the decision-making process to support those who may otherwise be overlooked. Accessibility must be considered within each step of the process regarding appropriate education and information sharing per population. This may mean catering to health literacy level, cultural perspectives, and/or resource availability. Foundationally, participants should receive fully transparent information regarding the intent of the research and how this information will be used. Informed consent incorporates fully transparent direction with the option to opt out at any point. As trusted care providers, nurses have a responsibility to advocate for ethical and equitable research. They have a duty to question practices they feel are not following ethical or equitable standards and to seek to rectify these gaps in research and care. They also have a duty to obtain proper approval before conducting any of their own research and to report any researchers who violate the rights of participants.

What is public health ethics and why is it important?

This video reviews basic concepts related to public health ethics.

Watch the video, and then respond to the following questions.

  1. What are the four principles of medical ethics?
  2. What distinguishes public health ethics from medical ethics?
  3. Why do public health and community health nurses need to be aware of issues related to public health ethics?

Unfolding Case Study

Part B: Evidence-Based Decision-Making

Read the scenario, and then answer the questions that follow based on all the case information provided in the chapter thus far. This case study is a follow-up to Case Study Part A.

Amari and Milo have developed the following PICOT question: Does daily exercise have an impact on anxiety rates in adolescents compared to those who do not engage in daily exercise over 3 months? They are now ready to move on to the next step of the evidence-based decision-making process.

3.
After developing their PICOT question, what is the next step that Amari and Milo will take?
  1. Begin to develop an exercise program for adolescents
  2. Critically appraise the evidence found in the literature
  3. Search the literature for supporting research
  4. Implementing the intervention of daily exercise
4.
Amari and Milo are ready to start searching the databases and want to find one specific to public health and public policy. Which database would serve them best regarding these specifications?
  1. PubMed
  2. AHRQ
  3. Cochrane Library
  4. Medline Full Text
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