Written by Cathy (CJ) Carter-Snell, AFN President, PhD, RN, SANE-A, DF-AFN

Welcome to Spring—soon, we hope! I want to take the opportunity in this corner of the newsletter to begin highlighting some of the ways that Academy of Forensic Nursing committees, its scholarly journal, and various educational offerings can support your evidence-informed practice. This month, I am highlighting activities related to the difficulty in sorting out real evidence from artificial intelligence (AI) generated hallucinations.

The increasing use of AI has significant implications for forensic nurses, since evidence-informed practice is our cornerstone. Not only do we need to know current best practices, but also the quality of the evidence behind what we do. This is key to safe clinical practice but also a requirement in court testimony. We need to know the quality of the evidence behind our testimony and the tools we use.

While AI has helped many routine healthcare processes, it may also result in dangerous or misleading health information and practices. It is increasingly difficult to assess whether or not information is real or fact based.

A group of nurse editors have described as many as 30% of the references in the papers submitted to them are non-existent (AI “hallucinations”). This increases the workload for editors, as they need to check the DOI and/or link for each reference. Many clinicians use AI tools to look for current evidence on healthcare, but using one without “boundaries” may bring in incorrect information. So how do we know what is reliable information?

There are many strategies for sorting out credible information, and AFN is assisting with this:

• Our Journal Club Committee meets monthly to examine and critique scholarly articles from a variety of sources. Their results are posted in each issue of the Journal of the Academy of Forensic Nursing (JAFN), but everyone is welcome to join and to learn how to critique the quality of evidence. Meetings are on the third Thursday of each month at 12 p.m. ET. Please reach out to Committee Chair Christine Foote-Lucero to get a meeting invitation.

• AFN’s continuing education offerings require presenters to speak to the quality of the evidence supporting their presentation. You can help contribute to the body of knowledge by volunteering to present a Wednesday Webinar, participate in planning an AFN Intensive, or be a presenter at one of our conferences. Reach out to the AFN Education Committee if you are interested.

• The AFN Research Committee is seeking members. Please reach out to me via email if you are interested in participating.

• All JAFN articles are peer-reviewed by clinical and research experts who want to ensure you have credible current information. The editors also spend considerable time checking the references. AFN members are invited to submit or become peer-reviewers for the journal. You can learn more about getting involved on the JAFN website.

Outside of AFN's resources, there are many other ways to sort out credible information:

• Identifying high-quality practice guidelines—Criteria from the Institute of Medicine recommended getting information from sources that used trustworthy guideline development procedures. Examples include Guideline Central, evidence-based practice resources from Joanna Briggs Institute, and Cochrane Collaboration for systematic reviews

• Use AI-supported apps that limit search to credible sources—Look for ones that specify the sources of their information and limit to credible medical/nursing journals. Some examples include OpenEvidence for clinicians, which only includes well-known medical journals, or search engines from well-known publishers such as UptoDate Pro Plus from Wolters Kluwer, or Heidi.

• Credible healthcare databases—Medline and CINAHL use strict criteria as to which journals and websites are included in the literature they use

• Directory of Open Access Journals (DOAJ)—This is a clearinghouse or accrediting body for journals. If they approve a journal for inclusion, it has a sustained record of successful publishing and strong criteria for peer review of articles.

• Checks you can perform when reading/viewing anything (Kington et al, 2021):

  • CRAP test – currency, credibility, reliability, authority and purpose/point of view by Molly Beestrum

  • SIFT test- Stop, investigate the source, find better coverage, trace claims/quotes to original source by Mike Caufield

Sackett (1996) introduced us to evidence-informed decision making which combines three key factors:  the best evidence available, clinical expertise, and the client’s wishes, circumstances, and values. A fourth factor suggested is the system/resources available (Gutennbrunner & Nugraha, 2020). AI is like any other tool we use in nursing: just a tool. We can use it to find some sources of evidence, but we still need to analyze the information, synthesize it with what we already know, and work with the client to find the best solution for them. Be prepared to justify why you believe the information you use to support your practice is credible.

Let your AFN Board of Directors and Executive Committee members know if there are other Special Interest Groups or committees we should consider, or activities you would like us to explore. It is your organization.