Week 2 EBP Evidence-Based Practice (EBP) Notes

Five-Step Approach to Evidence-Based Practice (EBP)

  • Step 1: Ask an answerable practice-related question.
  • Step 2: Acquire relevant evidence to answer the question.
  • Step 3: Appraise the acquired evidence.
  • Step 4: Apply the evidence to practice.
  • Step 5: Assess your performance in executing Steps 1–4 and set learning goals.

Importance of Step 1: Asking an Answerable Question

  • Recognizing the need for information is critical.
  • Information could relate to interventions, diagnoses, aetiology of conditions, or client experiences.
  • Formulating a question accurately is essential as it impacts subsequent steps.

Using the PICO Mnemonic

  • PICO helps in developing specific questions:
    • P = Population/clinical problem of interest.
    • I = Intervention of interest (exposure, test, prognostic factor, treatment).
    • C = Comparison (alternative intervention, if relevant).
    • O = Outcome of interest for the client.

Types of Questions in Daily Practice

  • Background Questions: General knowledge about a condition.
    • Example: "What causes a stroke?"
  • Foreground Questions: Specific knowledge for managing patient circumstances.
    • Example: "Is early intensive treatment effective for adult stroke patients?"

Types of Foreground Questions

  1. Effectiveness Questions: E.g., Is bed rest more effective than exercise in improving mobility for stroke patients?
  2. Prevention Questions: E.g., Does reducing high blood pressure prevent strokes?
  3. Assessment Questions: E.g., Is picture naming an effective language assessment method?
  4. Description Questions: E.g., What are the smoking rates among adult females with and without smoking parents?
  5. Risk Questions: E.g., Are mini-strokes a risk for severe strokes?

Developing Well-Built Questions Using PICO

1. Population and Problem (P)
  • Define the primary issue, possibly including age, sex, disease, and health status.
    • Example: "In pre-school aged children who stutter…"
2. Intervention (I)
  • Identify a broad spectrum of potential interventions or factors of interest.
    • Example: In the question about stroke, the intervention can be bed rest.
3. Comparison (C)
  • Define the main alternative you’re considering; this may be optional.
    • Example: When comparing bed rest vs. exercise, identify one specific alternative.
4. Outcome (O)
  • Specify the desired results, ensuring they are measurable.
    • Outcomes may include:
    • Relieving symptoms
    • Improving function
    • Preventing conditions
  • Involvement of patients in defining outcomes can enhance shared decision-making.

Practicing PICO Elements

  • Identifying PICO components can be challenging; practice with examples helps ease this process and leads to better evidence searches.