Evidence-Based Practice (EBP)

Definition of EBP

  • Integration of individual clinical expertise, best available research, and patient preferences

  • Serves as a decision-making model for nursing practice; promotes conscientious, evidence-based choices

Core Components (4)

  • Evidence: research findings

  • Expertise: clinician’s experience & skills

  • Decision-Making: patient values/goals and use of evidence when making clinical decisions.

  • Context: unit or hospital policies

Major EBP Models

  • Iowa Model

  • Johns Hopkins Model

  • Stetler Model

  • ACE Star Model

  • ARCC Model (Close Collaboration)

Research vs. Quality Improvement (QI)

  • Research: generates new knowledge or advances existing knowledge; asks “Is there a better way?”

  • QI: analyzes current processes; seeks immediate performance improvements

Common Practices Lacking Strong Evidence

  • Oxygen use may abolish hypoxic drive in COPD patients

  • Routine use of large-bore IVs for blood transfusion

  • Scheduled IV-site changes rather than clinically indicated changes

Key Questions to Spur Inquiry

  • Why do we do it this way?

  • Is there a better way?

  • What evidence supports what we are doing?

  • Do guidelines/policies match current research?

Five Steps of EBP (FAACE → not in order)

  • 11. Formulate a focused, searchable clinical question.

  • 22. Choose the best available evidence (assess validity & reliability)

    • Must be reliable and valid.

  • 33. Analyze the evidence

  • 44. Apply findings in practice setting

  • 55. Evaluate outcomes and adjust as needed

PICOT Framework for Question Building

  • Population

  • Intervention

  • Comparison

  • Outcome

  • Time (sustainability)

Validity vs. Reliability

  • Reliability: consistent, replicable results across time/observers

  • Validity: study truly measures intended concept; minimizes bias

Hierarchy of Evidence (Highest → Lowest)

  • Systematic Reviews & Meta-Analyses

  • Randomized Controlled Double-Blind Studies

  • Cohort Studies

  • Case-Control Studies

  • Case Series

  • Case Reports

  • Ideas, Editorials, Opinions

  • Animal Research

  • In-vitro ("test-tube") Research

Benefits of EBP

  • Links scientific research to clinical decisions

  • Improves patient outcomes; historically demonstrated by Nightingale’s sanitation reforms

  • Integral to safe, high-quality, cost-effective care

Common Barriers

  • 1010–2020-year lag from evidence to practice

  • Tradition & outdated policies

  • Limited research literacy among nurses

Nurse’s Role in Advancing EBP

  • Maintain a "spirit of inquiry"—read, question, stay current

  • Join professional organizations & attend CE/conferences

  • Participate in research/EBP or QI committees

  • Aim for the triple focus: effective, efficient, patient-centered care