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NURS 4003 Research Utilization

Establishing a basic understanding & ability to utilize nursing research in practice.

Evidence-Based Practice

Basing Decisions on the Evidence

Evidence-based practice (EBP) is a method of solving problems in the field of medicine that involves the use of the current best practices in patient care (Melnyk & Fineout-Overholt, , p. 8). Use the resources here to explore the topic.

How It Works

The EBP movement was founded by Dr. Archie Cochrane, a British epidemiologist …. In , Cochrane published a landmark book criticizing the medical profession for not providing rigorous reviews of evidence so that policy makers and organizations could make the best decisions about healthcare.

Explore the concepts of evidence-based practice below:

The process of evidence-based practice can be summarized as seven steps, numbered 0 through 6.

  1. Cultivate a spirit of inquiry.

    Begin by wondering how care and outcomes can be improved. Observe situations and consider possible alternatives that might increase efficiency or improve outcomes.

  2. Ask clinical questions in PICOT format.

    These questions address the population of interest, the intervention, comparison with another intervention or population, the outcome, and time. This structured format allows for a rapid creation of research questions and a more efficient literature search.

  3. Search for the best evidence.

    After formulating a PICOT question, use it to approach the available literature in the research databases. Select key terms from the PICOT question and search for them in conjunction to narrow results.

  4. Critically appraise the evidence.

    Evaluate the results of the search rapidly by focusing on validity, results, and applicability. Consider whether the studies are sufficiently rigorous, whether they indicate a likelihood of similar results in other situations, and whether these results would benefit your patients.

  5. Integrate the evidence with clinical expertise and patient preferences and values.

    Evidence from the literature must be considered in light of assessments, laboratory information, and patient preferences. Real-world situations may not resemble carefully controlled trials.

  6. Evaluate the outcomes of the practice decisions or changes based on evidence.

    Pay attention to differences in outcomes resulting from any changes you make as a result of following this practice. Especially, seek to identify any flawed implementations or unexpected adverse effects so you can respond accordingly.

  7. Disseminate EBP Results

    Share the outcomes with colleagues and other organizations. Consider publishing in a journal or speaking at a conference.

Melnyk et al.,

PICO(T) is a mnemonic that stands for the four (and sometimes five) essential elements of a research question in evidence-based practice.

Patient or Problem

Describe as accurately as possible the patient, group of patients, or population of interest.


What is the treatment, therapy, or other intervention you wish to consider?


It is necessary to consider any new intervention in light of others so they can be compared. What other intervention can you use for comparison?


What is the clinical outcome? What goal are you trying to achieve, or what situation are you trying to prevent?


The time it takes to demonstrate the clinical outcome. This element of PICO(T) is not always included.

Melnyk & Fineout-Overholt, , pp. 33–52

Use the MeSH Browser Tool to find the best terminology for your PICO(T) question.

Five types of questions determine how the PICO(T) formula will be framed (Figure 1).

  1. Intervention

    Which treatment produces the best outcome? Intervention questions compare treatment options.

    Question Format:

    In , how does compared to affect within ?
  2. Prognosis or Prediction

    Dealing with complicated situations over time, such as patients with family histories of certain diseases.

    Question Format:

    In , how does compared to influence/predict over ?
  3. Diagnosis or Diagnostic Test

    Diagnosis questions are used to compare tests to determine which is more accurate in diagnosing a condition.

    Question Format:

    In are / is compared with more accurate in diagnosing ?
  4. Etiology

    Etiology questions are used to determine risk factors for or causes of a particular disease or condition.

    Question Format:

    Are , who have compared to those without at for/of over ?
  5. Meaning

    Used for qualitative studies of experiences, such as patients’ perceptions of partiicular conditions.

    Question Format:

    How do with perceive during ?

Echevarria & Walker, ; Melnyk & Fineout-Overholt, , pp. 39–51

Figure 1
The Five PICOT Questions
Five PICOT questions.

Note. From “To Make Your Case, Start with a PICOT Question,” by M. Echevarria and S. Walker, , Nursing, 44(2), p. 19 ( Copyright by Ovid | Wolters Kluwer.

EBP Essentials Channel

This video channel from Ovid | Wolters Kluwer describes the basics of evidence-based practice (Figure 2).

Figure 2
Video Channel Describing Evidence-Based Practice
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Note. From EBP Essentials by Ovid | Wolters Kluwer, , YouTube ( Copyright by Ovid | Wolters Kluwer.


These research databases focus on evidence-based practice or can limit search results to evidence-based practice.

The Cochrane Database of Systematic Reviews is the gold standard for systematic reviews, which represent the strongest level of evidence in evidence-based practice. These lengthy meta-analyses compile information and results from numerous smaller studies to arrive at recommended best practices.

CINAHL is one of the largest and oldest digital databases in nursing. As explained below, its built-in search functions allow researchers to focus on sources using evidence-based practice.


In the database, select Advanced Search. Then, to limit to evidence-based practice, select Evidence-Based Practice (Figure 3) from the available options.

This limits results to:

  • Articles from evidence-based practice journals
  • Articles about evidence-based practice
  • Research articles, including systematic reviews, clinical trials, and meta analyses
  • Commentaries on research studies
Figure 3
Evidence-Based Practice Option in CINAHL
Screenshot of CINAHL database with evidence-based practice selected.

Note. Detail of the advanced search screen in CINAHL displaying the option to limit a search to evidence-based practice.

You can also limit to Randomized Controlled Trials (Figure 4).

Figure 4
Randomized Controlled Trial Option in CINAHL
Screenshot of CINAHL database with randomized controlled trial option emphasized.

Note. Detail of the advanced search screen in CINAHL displaying the option to limit to randomized controlled trials.

MEDLINE is one of the oldest and most respected digital databases of medical literature. EBSCO’s version of this database has the ability to search for evidence-based medicine, though, as explained below, this involves limiting search results to only six sources.


In the database, select Advanced Search. To limit to evidence-based medicine, select the option EBM Reviews (Figure 5).

This will limit results to six sources:

Figure 5
Evidence-Based Medicine Reviews in MEDLINE
Screenshot of MEDLINE database with EBM Reviews selected.

Note. Detail of the advanced search screen in MEDLINE displaying the option to limit search results to evidence-based medicine.


Books about evidence-based practice, ranging from introductory to advanced.

The objective of this book is to help you make efficient use of the published literature in guiding your patient care.