What is Evidence Based Practice (EBP)
A problem-solving approach to clinical practice that integrates the conscientious use of the best available research evidence, clinical expertise, and patient preferences and values.
The 5 Steps in the EBP Process:
- Ask the clinical question.
- Collect the most relevant and best evidence.
- Critically appraise and synthesize the evidence.
- Integrate all evidence with personal clinical expertise, as well as patient preferences and values, and make a practice decision or change.
- Evaluate the practice decison or change.
Well-Built Clinical Queries
Depending on your experience, you may first need to ask background questions to acquire general knowledge about a condition or thing. These commonly take the form of a question: who, what, where, when, how, why and a verb. Example: What causes SARS?
"Foreground" Questions use PICOS to seek specific knowledge (causal or predictive) to assist in clinical decisions or actions.
Using PICOS to Ask Your Question
PICOS is an mnemonic for Patient Population or Problem, Intervention (treatment/test), Comparison (group or treatment), Outcomes, and Setting or Study type. PICOT is also used where the T stands for Time.
Various templates and web pages have been developed to help you frame your question. Using the Melynik and Fineout-Overhold model, fill in the blanks with information from your clinical scenario:
In_______, what is the effect of ________on ________ compared with _________?
Are ___ who have ___ at ___ risk for/of ___ compared with ___ with/without ___?
DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) __________ more accurate in diagnosing _______ compared with ________?
For _____ does the use of ______ reduce the future risk of _____ compared with ____?
Does _______ influence _________ in patients who have __________?
How do ________ diagnosed with ________ perceive ______________?
Above information from "Evidence-based practice in nursing & healthcare: a guide to best practice" by Bernadette M. Melnyk and Ellen Fineout-Overholt. 2005, page 31.
Levels of EvidenceQuantitative Pyramid showing relative usefulness of different types of evidence to answer cause and effect questions. Qualitative Pyramid showing relative usefulness of different types of evidence to answer meaning or experience questions.
Rating System for the Hierarchy of Evidence: Quantitative Questions
- Level 1: Systematic review or meta-analysis of all relevant randomized controlled trials (RCTs), or evidence-based clinical practice guidelines based on systematic reviews of RCTs
- Level 2: Evidence from at least one well-designed RCT
- Level 3: Evidence from a well-designed controlled trial without randomization
- Level 4: Evidence from well-designed case-control and cohort studies
- Level 5: Evidence from systematic reviews of descriptive and qualitative studies
- Level 6: Evidence from a single descriptive or qualitative study
- Level 7: Evidence from the opinion of authorities and / or reports of expert committees
Above information from "Evidence-based practice in nursing & healthcare: a guide to best practice" by Bernadette M. Melnyk and Ellen Fineout-Overholt. 2005, page 10.
Finding Qualitative Research ArticlesStrategies and Search Tips developed by the University of Washington librarians
Choose the Best Research Design to Answer the Question
Many different research designs exist, each with a specific purpose and with strengths and limitations. Try to choose the most rigorous one for your question. Below are two editorials that concisely outline this process. Access both online at the Consortium Library, or request them from AML.Identifying the best research design to fit the question. Part 1. Quantitative Designs By Jackie Roberts. Evidence-Based Nursing, 2(1):4-6, 1999.
Identifying the best research design to fit the question. Part 2. Qualitative Designs. By Jenny Ploeg. Evidence-Based Nursing, 2(2):36-37, 1999.
- AML Library Services
- Expert database searches, current awareness searches sent to your email regularly, articles from our collection or obtained from other libraries, training, etc. See the AML website for details.
- Peer Reviewed Databases
- Search freely available databases listed below by clicking their name. Request a librarian-mediated search for databases without a link:
- PubMed (some fulltext)
- CINAHL (available at UAA)
- Cochrane Systematic Reviews (and other EBM databases) (available at UAA)
- Cochrane Library - (free access to abstracts only)
- DynaMed (available at UAA)
- Academic Search Premier
- PsychInfo (available at UAA)
- ERIC (available at UAA)
- Books (Selected titles)
- Community and public health nursing: evidence for practice. 2016. WA90 H373 2016
- Evidence-based practice in nursing & healthcare: a guide to best practice. 2011. WY218 M527e 2011
- Forensic nursing: evidence-based principles and practice. 2013. W690 C66 2013
- Johns Hopkins nursing evidence-based practice: models and guidelines. Online
- Maternal-newborn nursing care: best evidence-based practice. 2014. Online.
- Nursing diagnosis handbook: and evidence-based guide to planning care. 2014. WY205 N9745 2014
- Orthopaedic and trauma nursing: an evidence-based approach to musculoskeletal care. 2014. Online
- Pediatric nursing care: best evidence-based practices. 2014. WS90 W263 2014
- Psychiatric mental health nursing: concepts of care in evidence-based practice. 2015. Online.
- Evidence-based care, 2012-
- Evidence-based CAM, 2004-
- Evidence Based Nursing, 1998-
- Worldviews on Evidence-Based Nursing, 2004-
- Evidence-Base Medicine, 2000-2005
- Selected Guideline Databases
- National Guideline Clearinghouse
- Health Service / Technology Assessment Text (HSTAT)
- National Institute for Clinical Excellence (NICE) - from the U.K.
- Agency for Healthcare Research and Quality
- AHRQ Patient Safety Network -- online journal and forum on patient safety and health care quality
- American College of Physicians
- American Cancer Society - Early Detection Guidelines
- American Association of Respiratory Care
- American Academy of Pediatrics
- Ministry of Health Services, British Columbia, Canada
- Registered Nurses Association of Ontario
- National Association of Neonatal Nurses
- Oncology Nursing Society
- Guidelines for the Nurse in School Settings - Illinois Emergency Medical Services for Children
- Assessing What You Find on the Web
- Measuring Research Outcomes
- Tests & Measurement Instruments - Consortium Library guide.
- Health Outcomes Core Library Recommendations, 2004 - from the National Library of Medicine. Links are at the bottom of this page.
- Stanford Patient Education Research Center - research instruments developed, adapted or used by this group.