What is Evidence-Based Practice in Nursing? Evidence-based practice (EBP) is an approach to healthcare that utilizes the most current research available in order to improve the health and safety of patients while reducing overall costs and variation in health outcomes, according to the Journal of Nursing Administration.
It is applied problem-solving, combining best practices from the latest medical literature with clinical experience and the values and preferences of the patients under treatment (University of Main Fort Kent).
This self-paced, interactive tutorial will take you through the complete EBP process, emphasizing the elements of a well-built clinical question and the key issues that help determine the validity of evidence. This program was developed by the Medical Center Library at Duke University and the Health Sciences Library at the University of North Carolina at Chapel Hill.
The goal of this website is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for undergraduate, postgraduate, and continuing education for health care professionals from a variety of clinical disciplines. This site also serves as a support for the book entitled, Evidence-based Medicine: How to Practice and Teach EBM by Sharon E. Straus, W. Scott Richardson, Paul Glasziou, and R. Brian Haynes (3rd edition).
The BMJ's free EBM toolkit enables individuals to learn, practice, and discuss EBM, and provides EBM tools. There is information introducing the key methods of EBM such as clarifying a clinical question, designing a search and appraising, synthesizing, and assessing the quality of the evidence. Additionally, this information is intended to support and promote discussion around EBM.
This guide from the University of North Carolina at Chapel Hill introduces the PICO question framework for evidence-based practice. It explores PICO’s history, purpose, and limitations. This guide also introduces other question frameworks and provides example questions from across many health professions.
A clinical question needs to be directly relevant to the patient or problem at hand and phrased in such a way as to facilitate the search for an answer. PICO makes this process easier. It is a mnemonic for the important parts of a well-built clinical question. It also helps formulate the search strategy by identifying the key concepts that need to be in the article that can answer the question.
Clinical questions typically fall into one of four main categories:
Nursing Practice Questions
In nursing, many other questions about the practice will arise, with some of the questions resulting from the nursing principle of work with rather on a patient. These questions can be quantitative or qualitative in nature. Here are a few examples:
The definition of EBM states the importance of obtaining the "best available evidence." The evidence hierarchy is an attempt to rank the health information resource/study designs with the highest quality sitting atop and the lower levels descending below. This hierarchy is helpful to guide evidence acquisition (literature searching) as well as providing clearer communication when discussing the landscape of health literature.
When it comes to prioritizing the evidence in any specific situation, clinicians will need to understand the nuances of the evidence (reviews, studies) obtained. It is not uncommon for lower levels of evidence on the hierarchy to trump evidence sitting above a hot-off-the-press large RCT over an older meta-analysis containing small studies (UM-Madison Libraries Research Guides on Evidence-Based Medicine).
Filtered Resources-When searching for evidence-based information, begin by searching for the highest level of evidence possible, which is considered to be systematic reviews or meta-analyses where the literature on a topic has already been searched to provide the best answer to a clinical question or practice issue.
In other words, experts have 1) located all the available evidence they could find on a topic from individual studies and reports; 2) analyzed the validity and reliability of the studies to determine whether each study should be included; and 3) summarized the findings from the available research to present the data, conclusions, and recommendations for clinical questions and nursing practice based on the best available evidence.
Unfiltered Resources-Information that has not been critically appraised is considered "unfiltered". You’ll also need to search unfiltered resources (the primary literature) to locate studies that answer your question. Unfiltered resources are individual articles that provide the most recent information from clinical and practice research, such as case studies, comparative studies, or clinical trials. With unfiltered resources, it is up to the nurse to evaluate each study to determine its validity and applicability to the patient or the practice question.
Critically Appraised Articles/Topics (Evidence Syntheses)
RCTs, Cohort Studies, Case Studies/Reports
Background Information/Expert Opinion
After finding articles, we need to determine what is worth keeping and including in our research. We do this through a critical appraisal of each piece of evidence. Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, its value, and its relevance in a particular context (Daemen College Nursing Research Guide).
You want to ask:
These tools will help you interpret the clinical and statistical significance of data reported in clinical research.