Evidence-based practice is defined as "a problem solving approach to clinical decision making that incorporates a search for the best and latest evidence, clinical expertise and assessment, and patient preferences and values within a context of caring."
For details on evidence-based nursing practice, including real world examples of EBP implementation, read the classic series of articles Evidence-Based Practice Step-by-Step from the American Journal of Nursing. Authored by EBP experts Bernadette Mazurek Melnyk, Ellen Fineout-Overholt and other faculty from Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice, these articles provide nurses with the foundational knowledge and skills necessary to implement EBP.
|Level I Systematic review and meta-analysis|
|Level II Randomized controlled trial (RCT) or experimental study|
|Level III Quasi-experimental study|
|Level IV Descriptive correlational, predictive correlational, and cohort studies|
|Level V Mixed methods systematic review and qualitative meta-synthesis|
|Level VI Descriptive study and qualitative study|
|Level VII Expert opinion|
|- from Gray, J., Grove, S. K., & Sutherland, S. (2017). Burns and Grove's the practice of nursing research: Appraisal, synthesis, and generation of evidence. St. Louis: Elsevier.|
These resources are referred to as pre-appraised since they have undergone filtering to include high quality evidence.
Step 1: Ask a clinical question using PICOT
The first step in EBP is to develop a focused clinical question. This is best accomplished by utilizing the PICOT framework.
P - patient/population/problem
I - intervention
C - comparison (if any)
O - outcome
T - time
Example: In long-term care patients with dementia (P), do exercise programs (I), compared to no exercise programs (C), reduce the number of falls (O) in a six month period (T)?
The steps in this table are referenced from Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step: The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53.
Step 2: Search for the best evidence
The next step in EBP is to search for evidence. Your PICOT question (Step 1) can help you generate good search terms for locating high quality evidence.
See the Levels of Evidence box for an explanation of types of evidence within the EBP hierarchy.
The Mulford Library's Evidence-Based Practice LibGuide can be consulted for a comprehensive listing of resources for finding the best evidence.
Step 3: Critically appraise the evidence
After locating the best evidence, the next step is critical appraisal to determine the quality and applicability of the evidence to your clinical question.
Various critical appraisal worksheets are freely available on the web to make this step in the EBP process more streamlined and efficient.
Step 4: Integrate the evidence with clinical expertise and patient preferences/values
After critical appraisal of the evidence, the next EBP step is to integrate that evidence with your own clinical expertise and the unique preferences and values of your patient.
For an overview of the important elements involved in incorporating patient preferences into EBP, see the following article:
Burman, M. E., Robinson, B., & Hart, A. M. (2013). Linking evidence-based nursing practice and patient-centered care through patient preferences. Nursing Administration Quarterly, 37(3), 231-241. doi:10.1097/NAQ.0b013e318295ed6b
Step 5: Evaluate the outcomes of the practice change
After implementing EBP, it is essential to evaluate the outcomes. Evaluation, which includes monitoring the effects of EBP, is beneficial for the following reasons:
For a thorough discussion of the evaluation process, see the following article:
Fineout-Overholt, E., Gallagher-Ford, L., Melnyk, B. M., & Stillwell, S. B. (2011). Evaluation and disseminating the impact of an evidence-based intervention: Show and tell. American Journal of Nursing, 111(7), 56-59.
Step 6: Disseminate EBP results
The final EBP step is dissemination, or the sharing of successful EBP initiatives. Dissemination can take the following forms:
To read more about dissemination of EBP results, see the following article: