Skip to Main Content

Nursing: Evidence-Based Practice

Resource guide for Nursing: includes databases, websites, government sites.

What is Evidence Based Practice?

Evidence Based Practice (EBP) is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s experience, education and clinical skills. The patient brings to the equation his/her/their own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology (Sackett D, 2002).

EBP is a framework to inform clinical decisions using the best available evidence, clinical expertise, and individual patient preferences.   

                          Venn diagram with three circles overlapping in the middle, with the middle section marked "EBP"; one circle marked "Clinical expertise"; one circle marked "Best research evidence"; once circle marked "patient values & circumstances".

Elements of EBP Creative Commons License

Databases for EBP

To find Clinical Studies in PubMed filter by: Therapy, Clinical Predication Guides, Diagnosis, Etiology, Prognosis: 

Magnifying glass with clinical queries highlighed by red arrow

To find systematic reviews in PubMed: 

  • In PubMed: 
    • After conducting search on a topic, select Additional Filters, show Article Type Meta-Analysis or Systematic Review..

box filters for article type

 

Use the Advanced Search in CINAHL to limit by: Evidence-Based Practice, Author is Nurse, Controlled Trials, Clinical Queries, Sex, Age, etc. Scroll down to find the various limiters and filters. 

  • In CINAHL:
    • Advanced Search circled on CINHAL user interface

Systematic reviews and PICOs can also be found by searching for topics directly in the Cochrane Library Database, Joanna Briggs Institute Journals, or Trip Medical Database found below.

  • Cochrane Library PICO
    • Search directly by PICO. Some articles are summaries, some are free/open-source full-text.
  • Cochrane Library Reviews. Look for Open Access icon for full text access. 

  • JBI (Joanna Briggs Institute): Evidence Synthesis: JBI Evidence Synthesis offers, high-quality research that provides the best available evidence to inform health care policy, practice and research. Look for the "free" icon on citations for full-text access. 

  • Trip Medical Database

    Trip is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care.

Websites & Tutorials

5 Steps

The 5 A's of Evidence-Based Practice

                         

  • ASK: Form a clinical question
    • PICO: Patient/Problem, Intervention, Comparison, Outcome
  • ACQUIRE: Find the best evidence
    • Here is where you search the library databases/PubMed for journal articles related to your questions.
  • APPRAISE: Critically appraise the validity, reliability, and usefulness of the evidence.
  • APPLY: Integrate the research results with your clinical expertise and the patient values.
  • ASSESS: Evaluate the EBP process.
    • After applying what you've learned from the literature to your situation, you will need to evaluate outcomes in shorter-term and longer-term intervals.

From Red Rocks Community College Library.

The 5 A's

Using PICO to Frame Clinical Questions

To use evidence-based practice, you need a clear idea of the question you would like to answer. PICO is an acronym to help you formulate a clinical question and guide your search for evidence. Using this formula can help you find the best evidence available in a quicker, more efficient manner.

 

PICO

The PICO framework helps you identify key concepts to your clinical question, and can be used to develop a search strategy. 

PICO Questions

  • P (patient, population, problem)
    • Who is your patient? Include the type of patient or population and the setting, considering attributes such as age, gender, symptoms, and diagnosis.
  • I (Intervention)
    • What do you plan on doing for your patient (clinical treatment, education intervention, diagnostic test, procedure, medication, etc.)?
  • C (Comparison)
    • What alternatives are you considering? What has been done before in case studies, research, ect?
  • O (outcome)
    • What is the end goal (accurate diagnosis, symptom improvement, cure illness, remission, etc.)?

Acquisition = find your evidence. Use the library and government databases below to find quality, relevant literature, to begin to answer your question. See the "Databases for EBP" box for recommended resources and search strategies. 

There are two big parts of this process:

  • Deciding where you are going to search for evidence
  • Developing an appropriate search strategy

Synthesized literature aims to collect the evidence from multiple primary studies and synthesize the results in order to make recommendations for practice.  When well done, these types of articles are often considered to be a high level of evidence.  The following are common types of synthesized literature: Systematic Reviews, Meta-Analyses, Evidence-Based Clinical Practice Guideline.

If you cannot locate any high-level syntheses of evidence, you can try searching the primary literature for research articles.  Remember to consider what type of study is being presented and its methods when selecting primary literature.  See Appraise the Evidence for more information about different study types.  The following are some common study designs that you may see in the primary literature: Randomized Controlled Trial, Cohort Study, Case Study. 

Adapted from The Ohio State University Evidence-Based Practice Guide

The third step, evidence appraisal, involves taking the acquired information, and critiquing it by systematically reviewing its relevance, validity and its application to your specific clinical question.  In other words, the investigator must ask three essential questions:

     -       What are the results?

     -       Are the results valid?

     -       Will the results help to answer
             my clinical question?

(Adapted from Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.)

The fourth step, that of evidence application, involves the integration of relevant evidence with clinical experience.

During this step, you will integrate the evidence with the other components of EBP, including clinical expertise and patient values, for collaborative decision-making.

Things to consider: 

1. Are the treatment benefits worth the potential risks and costs?

2. Can this practice be implemented in this setting?

3. What are my patients' values and preferences?

4. How can I help my patient make a decision?

The effectiveness of a therapeutic intervention, based on the evidence, is determined by assessing the internal validity and external validity of a given study.

     -       Internal validity:  Is it a high quality study in terms of its methods (does it measure what it was intended to measure)?

     -       External validity:  Is the population and setting of the study similar to that of the one evaluated in the clinical question?

When these questions are answered, the evidence is applied by making a practice decision that integrates evidence, clinical expertise, and patient factors and preferences.  Usually a model of evidence based practice is used to apply research findings in nursing practice.

(Adapted from Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.)

Applying the Evidence Worksheet

Worksheet from the Dartmouth Biomedical Libraries.

The final step of EBP involves assessing the process. This includes evaluating your performance and the effectiveness of the process, refining your approach, and implementing new evidence as it becomes available. 

Self-evaluation can take many forms, but some questions you might like to reflect on include:

  • Am I asking a focused clinical question?
  • Am I using the best available evidence (or the highest level of evidence)?
  • Have I performed my searches effectively in databases?
  • How appropriate are the studies to my patient or specific context?

EPB Books