The American Nurses Association defines evidence-based practice (EBP) as:
Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs.
Evidence-based nursing draws upon critical reasoning and judgment skills developed through experience and training. You can practice evidence-based nursing interventions by following five crucial steps that serve as guidelines for making patient care decisions. This process includes incorporating the best external evidence, your clinical expertise, and the patient's values and expectations.
- Ask a clear question about the patient's issue and determine an ultimate goal, such as improving a procedure to help their specific condition.
- Acquire the best evidence by searching relevant clinical articles from legitimate sources.
- Appraise the resources gathered to determine if the information is valid, of optimal quality compared to the evidence levels, and relevant for the patient.
- Apply the evidence to clinical practice by making decisions based on your nursing expertise and the new information.
- Assess outcomes to determine if the treatment was effective and should be considered for other patients.
You are likely already practicing some tenets of EBP in your coursework and research without even knowing it. However, there are a few things specific to EBP that you may not have explicitly discussed before. Read on.
In evidence-based research, clear questions are often developed using the PICO(T) model, which helps define your research goals and form a search strategy.
PICO(T) is a mnemonic used to describe the four elements of a good clinical foreground question.
P = Population/Problem: How would I describe the problem or a group of patients similar to mine?
I = Intervention: What main intervention, prognostic factor or exposure am I considering?
C = Comparison: Is there an alternative to compare with the intervention?
O = Outcome: What do I hope to accomplish, measure, improve or affect?
T = Time (Sometimes): Over what period of time will the intervention take place or be assessed?
Once you've defined your research question, your next step is to look for appropriate sources and articles. You have experience doing this in previous courses, but something new that you may encounter are the terms filtered and unfiltered sources. Unfiltered information encompasses the primary source articles that you may have discussed before, while filtered information encompasses the secondary sources. In EBP, filtered information is the best source for clinical decision-making.
Here's the Evidence Pyramid, with each level of evidence explained in more detail below:
| Systematic Reviews/Meta-Analyses: multiple studies are evaluated and synthesized to sum up the research across studies. |
| Critically Appraised Topics: multiple research studies are evaluated and synthesized. |
| Critically Appraised Individual Articles: evidence-based journal articles. |
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Randomized Controlled Trials (RCTs): patients randomly assigned to one of two groups: a treatment group and a control group. |
| Cohort Studies: patients who have a condition are followed over time and compared with another group who are not affected. |
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Case Control Studies: patients with a certain condition are compared with people without the condition. Case Series: analysis of series of people with the disease (there is no comparison group in case series). |
| Background Information/Expert Opinion: includes information from textbooks or encyclopedias that is widely known or well-accepted in the nursing community. |
Now that you know what kinds of information is available, your next step is to search and find it. Some of our regular library databases that you've used for other courses include EBP material. These databases have some features that you may not have used before and will be helpful for this project:
There are also several websites that contain EBP information that may not be available in the library databases:
For more training in EBP research, view the following tutorials from other institutions:
