Skip to Main Content

NURS 5910 (MSN) & 7910 (DNP): Advanced Nursing Research & Evidence-Based Practice: Evidence-Based Practice

This library guide is designed for students in the NURS 5910 (MSN) & 7910 (DNP) Advanced Nursing Research & EBP course.

What is Evidence-Based Practice?

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."

- from Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare. Philadelphia: Wolters Kluwer Health.

All About EBP: Books on Evidence-Based Practice Available from the UToledo Libraries

American Journal of Nursing Series of Articles on EBP

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.  

Levels of Evidence

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.   

Filtered/Pre-Appraised Evidence

These resources are referred to as pre-appraised since they have undergone filtering to include high quality evidence. 

Databases for Original Research Studies and Systematic Reviews

Steps of Evidence-Based Practice

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.

  • Critical Appraisal Tools (from Centre for Evidence-Based Medicine, Oxford University)
    • Includes critical appraisal worksheets for systematic reviews and randomized controlled trials (RCTs)
  • Critical Appraisal Tools and Checklists (from Critical Appraisal Skills Programme - CASP)
    • Includes critical appraisal worksheets for systematic reviews, RCTs, qualitative studies, case control studies, cohort studies and more

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:

  • Identifies positive outcomes so that they can continue to be supported
  • Identifies negative outcomes so that they can be improved upon
  • Identifies which patients are likely to benefit from the practice change

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:

  • Presentation of findings at EBP rounds at your institution
  • Paper or poster presentations at professional conferences
  • Published articles in professional journals

To read more about dissemination of EBP results, 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.

What are Systematic Reviews?