Evidence Based Practice (EBP)
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 University of Minnesota has developed a web page that provides definitions for commonly used terms in EBP.
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
"Background" Questions
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. "Asking Answerable Questions" University of Illinois' page is one model. Melynik and Fineout-Overhold use:
Fill in the blanks with information from your clinical scenario:
THERAPY
In_______________, what is the effect of ________________on _______________ compared with _________________?
ETIOLOGY
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ with/without ______________?
DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?
PREVENTION
For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?
PROGNOSIS
Does ____________ influence ______________ in patients who have _____________?
MEANING
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 Evidence
Quantitative 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 at 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.
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 HSIS.
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.
Resources
HSIS 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 HSIS website for details.- Peer Reviewed Databases
- MEDLINE (available at UAA)
- PubMed (some fulltext)
- CINAHL (available at UAA)
- Cochrane Systematic Reviews (and other EBM databases) (available at UAA)
- TRIP: Turning Research Into Practice
- American College of Physicians Pier
point-of-care delivery of up-to-date, evidence-based guidance for clinicians. - Academic Search Premier
- PsychInfo (available at UAA)
- ERIC (available at UAA)
- Books
- Best practices: Evidence-based nursing procedures. (2007). Philadelphia: Lippincott Williams & Wilkins. WY 218 B561 2007
- Bland, M. Statistical questions in evidence-based medicine. (2000). London: Oxford University Press. WA 950 B56 2002
- Forhofer, R.N. (2007). Biostatistics: a guide to design, analysis, and discovery. Boston, MA: Elsevier Academic Press. WA 950 F739i 2007
- Glantz, S.A. (2002). Primer of biostatistics. New York: McGraw-Hill. WA 950 G545p 2001
- Grove, S.K. (2007). Statistics for health care research: a practical workbook. St. Louis, MI: Saunders-Elsevier. $40
- Heneghan, C. and Badenoch, C. (2006). Evidence-based medicine toolkit. 2nd ed. Malden, MA: Blackwell Books. WB 102 H498e 2006
- Medina, J. and Puntillo, K. (2006). AACN protocols for practice: palliative care and end-of-life issues in critical care. Sudbury, MA: Jones and Bartlett. WX 218 A112 2006
- Melnyk, B.M. and Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare. Philadelphia: Lippincott Williams & Wilkins. WY 218 M526e 2005
- van Belle, G. (2004). Biostatistics: a methodology for the health sciences. Hoboken, NJ: John Wiley & Sons. QH 323.5 B562 2004
- Journals
- Evidence Based Nursing, 1998-
- Worldviews on Evidence-Based Nursing, 1994-
- Evidence-Base Medicine, 2000-
- Evidence-based CAM, 2004-
- Newsletters
- Nurse Author & Editor: a free quarterly international newsletter
- Selected Guideline Databases
- General
- National Guideline Clearinghouse
- Primary Care Clinical Practice Guidelines
- CMA InfoBase - from the Canadian Medical Association
- Health Service / Technology Assessment Text (HSTAT)
- National Institute for Clinical Excellence (NICE) - from the U.K.
- New Zealand Guidelines Group (NGZZ)
- Guidelines International Network
- Agency for Healthcare Research and Quality
- AHRQ Patient Safety Network -- online journal and forum on patient safety and health care quality
- Specific
- American College of Physicians
- American Cancer Society - Early Detection Guidelines
- American College of Cardiology
- American Association of Clinical Endocrinologists
- American Association of Respiratory Care
- American Academy of Pediatrics
- American Psychiatric Association
- Ministry of Health Services, British Columbia, Canada
- New York Academy of Medicine
- Registered Nurses Association of Ontario
- Association of Women's Health, Obstetric, and Neonatal Nurses
- National Association of Neonatal Nurses
- Oncology Nursing Society
- University of Iowa Gerontological Nursing Interventions Research Center
- Guidelines for the Nurse in School Settings - Illinois Emergency Medical Services for Children
- General
- Teaching and Learning Resources for Evidence-Based Practice
- Assessing What You Find on the Web
- Measuring Research Outcomes
- Finding Measurement Tools - University of Washington page. Locked resources may be available at UAA.
- Guide to Tests and Measurement Instruments - Taubman Medical Library
- 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.