Internal and External Evidence

Differences between Internal and External Evidence in Relation to PICOT

In the field of medicine, clinicians always want to achieve impressive results in practice and sometimes may wish to carry further research and explore their anecdotal experiences. The potential to gather as much knowledge within the profession and in the entire healthcare system is compelling. PICOT research strategy is a scientific process largely used in the healthcare and nursing management to get evidence about a health situation that may be ailing the community (Aslam & Emmanuel, 2010). The strategy strictly adopts the Evidence-Based Practice to investigate and establish facts regarding a particular health condition. Virtually, the PICOT analysis usually gives rise to two types of evidence; the internal and external evidence.

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Internal evidence is usually based on research from diagnostic reasoning and patient data from hospital health records (Reiber, 2011). In this, healthcare delivery primarily relies on the knowledge and experience of the physician from previous practice. This means that the cared-for person has a significant influence on health care and nursing care decisions. External evidence relies on random clinical trials and scientific research without touching on previous hospital records about patients (Porzsolt, 2003). To gather credible scientific data that can be applied in a clinical setup, several aspects must be considered and external data examined.

Strengths and Weaknesses of Databases Vs. Web Search

Databases allow individuals to search for published information such as peer reviewed journals, articles, and magazines and may contain all disciplines or specific subjects. One of the greatest strength of a using a database is because they contain information that is more reliable as well as details required when evaluating the credibility of a source (“Compare Databases and Search Engines,” n.d). They also allow users to customize their search results using the specific criteria. Another strong point about databases is that individuals do not have to physically go to the particular library to retrieve it in person because it is available online. A major weakness about databases over web search is that most of them are not free and are sold at a cost, which may be high for some individuals. On the other hand, web search involves searching the internet through a search engine such as Google or Yahoo. Through a web search, it is easy to find information regarding governments, organizations, and statistics among others. However, most web searches do not generate reliable sources, and it is even harder to narrow down the results to get relevant materials, which is one of its biggest weaknesses.

PICOT Question

Lack of proper nutrition has been a major determinant of post-operative complications. Inadequate nutritional intake in gastrointestinal surgery patients puts these patients at a higher risk of surgical stress, and other subsequent complications. Yet, the question remains how effective is pre-operative nutrition in patients who have undergone gastrointestinal surgery as compared to the lack of nutrition?

Databases Explored

Database 1: Nutrition Journal

Database 2: The American Journal of Surgery

Database 3: Gastroenterology Research and Practice

Overview of Evidence

Nutrition Journal

Nutritional depletion in patients who have undergone gastrointestinal surgery is at a higher risk of suffering nutritional complications and other subsequent problems. Ward (2003), claims that such patients are also at greater risk of nutritional depletion. Through systematically developed literature review, the author outlines specific guidelines for specific groups, involved in patient care. The author presents a summary of evidence typically conducted by experts on the topic. The level of evidence is level one evidence.

The American Journal of Surgery

In their article Williams & Wischmeyer (2017) seek to assess the nutrition practices and attitudes of gastrointestinal surgeons in the United States. The article was selected with a high bias on after operation peri-operative care. The type of evidence displayed in the article is level six evidence. The authors adopt a systematic way through an inductive approach to explore the phenomenon, describe human experience, in this case being the surgeons, and understand meanings and patterns that are commonly narrative.

Gastroenterology Research and Practice

Preoperative malnutrition is associated with several risks for increased morbidity and mortality in gastrointestinal surgery patients (Yannick, Fabian & Alessandra, 2011). In the article, the authors seek to understand the impact of preoperative nutrition in abdominal surgery patients. The article presents a level one evidence and uses peer-reviewed journals to present a comprehensive summary of evidence.


 “Compare Databases and Search Engines.” (n.d). University Library: University of Illinois at Urbana-Champaign. Retrieved from:

Aslam, S., & Emmanuel, P. (2010). Formulating a researchable question: A critical step for facilitating good clinical research. Indian Journal of Sexually Transmitted Diseases, 31(1), pp. 47-50.

Porzsolt, F. (2003). Evidence-based decision making–the six step approach. Evidence-based Medicine, 8(6), pp. 165-166.

Reiber K. (2011). Evidence-based Nursing Education – a Systematic Review of Empirical Research. GMS Zeitschrift für Medizinische Ausbildung, 28(2), pp. 1-12.

Ward Nicola. (2003). Nutrition support to patients undergoing gastrointestinal surgery. Nutrition Journal, 2(1), pp. 1-5.

Williams, J. D., & Wischmeyer, P. E. (2017). Assessment of perioperative nutrition practices and attitudes—A national survey of colorectal and GI surgical oncology programs. American Journal of Surgery, 213(6), pp. 1010-1018.

Yannick, C., Fabian, G., Alessandra, C., Nicolas, D., Markus, S., & Martin, H . (2011). Perioperative Nutrition in Abdominal Surgery: Recommendations and Reality. Gastroenterology Research and Practice, 2011(2011), pp. 1-8.

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