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School of Nursing: Evidence-Based Practice

Evidence-Based Practice

Evidence-Based Practice (EBP) is the integration of best research evidence with clinical expertise and patient values.

"An ongoing process by which evidence, nursing theory and the practitioners’ clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide delivery of optimum nursing care for the individual."
- Scott, K. & McSherry, R. "Evidence Based Nursing: clarifying the concepts for nurses in practice." Journal of Clinical Nursing 2009; 18(8): 1085-95.

How to put EBP into practice:

1.    Examine the patient and make note of the following:

  • Patient's current diagnosis
  • Complete medical history
  • Other health conditions
  • Current medications the patient is taking
  • Factors about the patient which may influence the treatment plan (age, current medications, risk factors, etc.)

 2.    Formulate a well-constructed question using the PICO formula:

  • Patient
  • Intervention
  • Comparison (of two or more treatments if appropriate)
  • Outcome

3.   Conduct a comprehensive search for the most recent, best evidence or research on your patient's condition.

4.   Appraise the research you found for validity and usefulness and relevance to your particular patient.

5.   Use the results from your literature search and appraisal in clinical practice.

6.   Evaluate the outcome of the clinical application.

7.   If necessary, collect further evidence.

Types of Evidence

  • Systematic Review- A literature review in which the literature on a specific topic is systematically searched, critically appraised, and summarized.
     
  • Meta-Analysis- A systematic review that uses quantitative methods to summarize the results. Systematic reviews and meta-analyses are often published together.
     
  • Randomized Controlled Trial- A randomized sampling of patients divided into an experimental group and a control group. The groups are studied for the variable or outcome of interest.
     
  • Cohort Study- One or more groups (cohorts) of patients with differing exposures to a common variable are identified and observed for a determined period of time.
     
  • Case Control Study- Compares patients with an outcome or disease of interest with patients who do not have the outcome or disease. Frequency of exposure to a risk factor is compared in order to determine the relationship between risk factor and outcome.
     
  • Case Series- A study that tracks patients with a known exposure or outcome.
     
  • Case Report- A report of a patient's symptoms (generally unusual), diagnosis, treatment, and follow-up.
     
  • Expert Opinion- Handbooks, encyclopedias, and textbooks that provide the background and generalized information about a subject.
     
  • Animal Research/Test Tube Research- Laboratory research that turns into therapies and diagnostic tools, which are tested on animals and with lab models.

File:Hierarchy of Evidence.png - Wikimedia Commons