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.
- ACCESSSS Smart Search
ACCESSSS is a service to help provide current best evidence for clinical decisions. It conducts searches simultaneously in several evidence-based information services (online evidence-based texts, evidence-based guidelines and pre-appraised journal publications).
- Centre for Evidence-Based Medicine
The Centre for Evidence-Based Medicine develops, promotes and disseminates better evidence for healthcare.
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:
Seven Steps
The process of evidence-based practice can be summarized as seven steps, numbered 0 through 6.
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.
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.
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.
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.
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.
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.
Disseminate EBP Results
Share the outcomes with colleagues and other organizations. Consider publishing in a journal or speaking at a conference.
PICO(T)
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.
- Intervention
What is the treatment, therapy, or other intervention you wish to consider?
- Comparison
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?
- Outcome
What is the clinical outcome? What goal are you trying to achieve, or what situation are you trying to prevent?
- Time
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.
- MeSH Browser Tool
The U.S. National Library of Medicine’s online browser allows you to search the official Medical Subject Headings used in databases such as PubMed and MEDLINE.
Five Questions
Five types of questions determine how the PICO(T) formula will be framed (Figure 1).
Intervention
Which treatment produces the best outcome? Intervention questions compare treatment options.
Question Format:
In , how does compared to affect within ?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 ?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 ?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 ?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
The 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 (https://
- Seven Steps to the Perfect PICO Search(PDF document)
A whitepaper from EBSCO Health, in PDF format, on designing an effective database search for evidence-based information.
EBP Essentials Channel
This video channel from Ovid | Wolters Kluwer describes the basics of evidence-based practice (Figure 2).
Note. From EBP Essentials by Ovid | Wolters Kluwer, , YouTube (https://
Databases
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.
- Cochrane Database of Systematic Reviews
- Why search here? Systematic reviews are exhaustive meta-studies that arrive at best medical practices based on available research. This is a vital database for the Division of Nursing.
- What’s included? Over 4,800 full-text reviews are included. The database updates quarterly, and reviews are sometimes altered when new information becomes available.
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.
- CINAHL with Full Text
- Why search here? This is one of our most important and exhaustive nursing databases.
- What’s included? It contains 603 full-text journals and citations for over 3,000 more. Books, dissertations, and conference proceedings are also included.
Instructions
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
Evidence-Based Practice Option in CINAHL
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).
Randomized Controlled Trial Option in CINAHL
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.
- MEDLINE
- Why search here? This is one of the oldest and most important electronic databases for medicine and nursing.
- What’s included? It indexes over 5,000 peer-reviewed medical journals.
Instructions
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:
Evidence-Based Medicine Reviews in MEDLINE
Note. Detail of the advanced search screen in MEDLINE displaying the option to limit search results to evidence-based medicine.
Books
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.
Books
Evidence-Based Practice in Nursing and Healthcare, 4th Edition, by Call Number: 610.73 M491e4ISBN: 9781496384539Publication Date:Develop the skills and knowledge you need to make evidence-based practice (EBP) an integral part of your clinical decision-making and everyday nursing practice with this proven, approachable text. Written in a straightforward, conversational style, Evidence-Based Practice in Nursing & Healthcare delivers real-world examples and meaningful strategies in every chapter to help you confidently meet today’s clinical challenges and ensure positive patient outcomes.
Users’ Guides to the Medical Literature: a Manual for Evidence-Based Clinical Practice, 3rd Edition, by Call Number: 610 U845e3ISBN: 9780071790710Publication Date:Practical focus and organization to guide clinicians through the fundamentals of using the medical literature to the more advanced strategies and skills for use in patient care, using the key questions to assess any new research.
eBooks
The Advanced Handbook of Methods in Evidence Based Healthcare by Call Number: eBookISBN: 9781847876751Publication Date:How far can observational methods, routine data, and qualitative methods be used in health care evaluation? What cost and outcome measures are appropriate, and how should data be gathered? With the support of over two million pounds from the British Health Technology Assessment Research Programme, the research project for this handbook has led to both a synthesis of all of the existing knowledge in these areas and an agenda for future debate and research.
Clinical Epidemiology and Evidence-Based Medicine by Call Number: eBookISBN: 9781452264318Publication Date:Using clinical examples and citing liberally from the peer-reviewed literature, the book shows how statistical principles can improve medical decisions.
Fast Facts for Evidence-Based Practice in Nursing, 2nd Edition, by Call Number: eBookISBN: 9780826194077Publication Date:This is a pithy, pocket-sized resource for students and practicing nurses alike that delivers the foundations of Evidence-Based Practice (EBP) and basic nursing research concepts in an easy-to-read, quick access format. It demystifies the research process with straightforward information presented in short sentences and bullet points.
How to Read a Paper: The Basics of Evidence-Based Medicine by Call Number: eBookISBN: 0727915789Publication Date:In this lucid, readable book, Trisha Greenhalgh provides the basics of evidence based medicine: How to find a medical research paper, assess it for its scientific validity, and—where relevant—put the findings into practice.
Painless Evidence-Based Medicine by Call Number: eBookISBN: 9780470985830Publication Date:This concise book presents evidence-based medicine to neophytes in simplified, friendly language. Basic concepts and application of research statistics are presented in simple sequences that are non-threatening even to the mathematically challenged.
