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'Nurses must consider which information to use and trust'

David Bedford
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All professionals must make critical choices about what information they use to inform their practice. This is true of me as a librarian, and even more so of health professionals such as nurses. 

After all, one of the statements in the Nursing and Midwifery Council’s Code is “Always practise in line with the best available evidence”. But how do you establish what the “best available evidence” is?

Librarians refer to the skills needed to make these choices as information literacy, and we see this as being different in each professional situation – the criteria that make information useful and trustworthy are not the same for everyone.

In my work with students of nursing and other health professions, I have developed a thinking tool called BREAD. This is an easy-to-remember reminder of five key aspects to consider when thinking about information: bias. relevance. evidence. author and date.

These five points can be used when selecting information both for academic assignments and for clinical practice. Other similar tools exist of course, but this was developed with the particular concerns of healthcare in mind.

“Considering these five items is a quick and easy way to make decisions about which information to trust and use”

Bias is best thought of as a viewpoint which colours what we believe and what we say. Information can be biased if it only shows one side of a complex story, or misses out important facts to prove a point. Bias needs to be considered most carefully for nursing in terms of economic (does anyone stand to make money if I believe this information?) and political (is this piece of information trying to persuade me to take a particular side?) aspects.

Relevance is important as it can help us avoid reading things unnecessarily. Always consider whether the information actually applies to the situation at hand –whether that is an academic assignment or the care of a particular patient. No matter how ‘good’ or interesting a source of information is, if it’s not relevant, it’s not useful.

Evidence is vital in healthcare, as ‘relevant scientific evidence’ is one side of the evidence-based practice triangle. Think about what sort of evidence the author offers for what they say, and how they came by that evidence. This can be particularly important if the information quotes some statistics – where did these statistics come from, and do they really mean what the author says they mean? If no evidence at all is offered for an important statement or claim, you might want to do a little more research to find out what basis it has.

Author is the person or people responsible for a piece of information. Whether written by named people or credited to an organisation as a whole, consider why you should trust them on this topic. This might be about their experience or qualifications. For instance, I would trust a librarian colleague’s advice on managing information, but not on property law or anaesthesia – these are not our professional areas of expertise. Also consider where in the world the author is based – bear in mind that healthcare systems are very different in many nations, so information is not always easy to apply in your local context.

Date can often be the easiest thing to determine about a source of information, and if you don’t know when something was written or produced, this is an immediate signal to do a bit more investigation. If something is too old, it may not reflect current knowledge or practice, and at worst, it could make recommendations that are now illegal.

Considering these five items is a quick and easy way to make decisions about which information to trust and use. It’s not infallible, and it’s certainly not the same thing as critical appraisal of research, but it has been found very useful by nursing students and practitioners alike.

A video version of this thinking tool, developed for students, can be viewed at:

David Bedford is academic support librarian (learning and teaching), Drill Hall Library, Universities at Medway

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