Evidence-Based Practice in Nursing

Overview of Evidence-Based Practice (EBP)

  • Definition: A problem-solving approach to clinical practice combining the deliberate and systematic use of best evidence with a clinician's expertise, patient preferences and values, and available health care resources.

  • Benefits of EBP:

    • Decreases cost.

    • Empowers clinicians.

    • Improves patient outcomes.

    • Enhances patient experience and satisfaction.

    • Improves quality, safety, and consistency of health care.

Steps of Evidence-Based Practice

  • Seven Core Steps:

    • Step 0: Cultivate a spirit of inquiry (question current practices and support EBP culture).

    • Step 1: Ask a clinical question in PICOT format.

    • Step 2: Search for the best evidence.

    • Step 3: Critically appraise the gathered evidence.

    • Step 4: Integrate the best evidence with clinical expertise and patient preferences.

    • Step 5: Evaluate the outcomes of practice decisions and changes.

    • Step 6: Communicate the outcomes of EBP decisions or changes.

PICOT Question Framework

  • P (Population): Group of people experiencing a phenomenon or sharing a diagnosis, gender, or age range (e.g., a group of newly hired nurses).

  • I (Intervention): Planned action or treatment aimed at solving the problem (e.g., participation in an organized biweekly stress reduction program).

  • C (Comparison): Current practice, standard care, or alternative intervention (e.g., no participation in an organized stress reduction program).

  • O (Outcome): Evaluated result (e.g., retention rate of newly hired nurses).

  • T (Time): Optional element describing timeframe to reach outcome (e.g., 1 year).

Evidence Hierarchy and Article Structure

  • Sources of Knowledge:

    • Textbooks: Incorporate evidence into information, practice guidelines, and procedures.

    • Journal Articles: Peer-reviewed scientific studies providing the best scientific evidence.

  • Hierarchy of Evidence Levels:

    • Level I: Systematic review or meta-analysis of randomized controlled trials (RCTs); evidence-based clinical practice guidelines based on systematic reviews.

    • Level II: A well-designed RCT.

    • Level III: Controlled trial without randomization (quasiexperimental study).

    • Level IV: Single nonexperimental study (case control, correlational, cohort studies).

    • Level V: Systematic reviews of descriptive and qualitative studies.

    • Level VI: Single descriptive or qualitative study.

    • Level VII: Opinion of authorities and/or reports of expert committees.


Hierarchy of Evidence pyramid illustrating Level I through Level VII

  • Elements of an Evidence-Based Article:

    • Abstract

    • Introduction

    • Background

    • Purpose

    • Methods/Design

    • Analysis

    • Results

    • Clinical Implications


Diagram showing the key elements of an evidence-based article

Integrating, Evaluating, and Sustaining EBP

  • Integrating Evidence:

    • Apply research in patient care plans using evidence as rationale.

    • Plan education and pilot studies before large-scale implementation.

    • Update policies, procedures, teaching tools, and assessment tools.

  • Evaluating Outcomes:

    • Assess whether the change was effective, needs modification, or should be discontinued.

    • Never implement a practice change without evaluating its effects.

  • Communicating Outcomes:

    • Share with unit staff, nursing practice/EBP/research councils, clinicians, clinical grand rounds, and professional conferences.

  • Sustaining Knowledge Use:

    • Embed changes in practice culture using transformational leadership.

    • Utilize interprofessional EBP teams and role-model EBP behaviors.

Research Methodologies and Performance Improvement

  • The Scientific Method:

    • Make an observation.

    • Ask questions and gather information.

    • Analyze literature and form a research question or hypothesis.

    • Conduct a study using scientific rigor.

    • Analyze data and draw conclusions.

  • Types of Research Studies:

    • Quantitative Research: Systematic, objective examination of numerical data using statistical controls to eliminate bias (experimental, nonexperimental, survey, evaluation).

    • Qualitative Research: Inductive reasoning to derive generalizations or theories from observations and interviews regarding behavioral phenomena.

  • Performance Improvement (PI):

    • Formal approach to analyze healthcare processes and system functions.

    • Models: Root Cause Analysis (RCA), Six Sigma, Plan-Do-Study-Act (PDSA).

  • Comparing EBP, Research, and PI:

    • EBP: Uses existing research/sources to determine safe, effective nursing care and improve outcomes.

    • Research: Systematic inquiry generating generalizable nursing knowledge.

    • Performance Improvement: Enhances local processes and efficiency; results are generally not generalizable.

APA Formatting

  • APA Style: Standard citation format established by the American Psychological Association (APA) for social sciences.

  • Applications: Research papers, in-text citations, reference pages, and presentations.

Questions & Discussion

  • Question: What type of research should be used to answer the question "How many participants have the side effects of nausea and vomiting from a medication?"

    • Options: A. Qualitative research, B. Quantitative research, C. Translational research, D. Mixed methods research.

    • Answer: B. Quantitative research.

  • Question: What is considered the strongest evidence among all types of nursing research?

    • Options: A. Systematic Review, B. Qualitative Study, C. Randomized Controlled Study, D. Expert opinion presented at an international conference.

    • Answer: A. Systematic Review.

  • Question: A nurse presents an in-service about a practice change to reduce medication errors on a surgical unit. Which step of evidence-based practice (EBP) is the nurse taking?

    • Options: A. Sharing results, B. Examining the collected data, C. Searching for credible sources, D. Implementing recommendations.

    • Answer: A. Sharing results.