What is EBP?

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."

"The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
From: Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ 1996 Jan 13;312(7023):71-2.

Image from: Florida State University, College of Medicine

Steps in the EBP Process

Five-Steps of the Evidence Cycle

Ask: Formulate a clinical question "
Acquire: Search for the best evidence to answer your question
Appraise:Critically review the evidence for validity and applicability
Apply:Implement findings with your patient
Assess: Evaluate the results

Glossaries
Summary of the EBP Process
AJN Articles on Evidence-Based Practice

1. Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM. Evidence-based
practice step by step: Critical appraisal of the evidence: part I. Am J Nurs.
2010 Jul;110(7):47-52. doi: 10.1097/01.NAJ.0000383935.22721.9c. PubMed [citation]
PMID: 20574204

2. Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Evidence-based
practice, step by step: asking the clinical question: a key step in
evidence-based practice. Am J Nurs. 2010 Mar;110(3):58-61. doi:
10.1097/01.NAJ.0000368959.11129.79. PubMed [citation] PMID: 20179464

3. Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM. Evidence-based
practice, step by step: critical appraisal of the evidence: part II: digging
deeper--examining the "keeper" studies. Am J Nurs. 2010 Sep;110(9):41-8. doi:
10.1097/01.NAJ.0000388264.49427.f9. Erratum in: Am J Nurs. 2010 Nov;110(11):12.
PubMed [citation] PMID: 20736710

4. Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM. Evidence-based
practice, step by step: Critical appraisal of the evidence: part III. Am J Nurs. 
2010 Nov;110(11):43-51. doi: 10.1097/01.NAJ.0000390523.99066.b5. PubMed
[citation] PMID: 20980899

5. Fineout-Overholt E, Gallagher-Ford L, Mazurek Melnyk B, Stillwell SB.
Evidence-based practice, step by step: evaluating and disseminating the impact of
an evidence-based intervention: show and tell. Am J Nurs. 2011 Jul;111(7):56-9.
doi: 10.1097/01.NAJ.0000399317.21279.47. PubMed [citation] PMID: 21709484

6. Gallagher-Ford L, Fineout-Overholt E, Melnyk BM, Stillwell SB. Evidence-based
practice, step by step: implementing an evidence-based practice change. Am J
Nurs. 2011 Mar;111(3):54-60. doi: 10.1097/10.1097/01.NAJ.0000395243.14347.7e.
PubMed [citation] PMID: 21346469

7. Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Evidence-based
practice, step by step: searching for the evidence. Am J Nurs. 2010
May;110(5):41-7. doi: 10.1097/01.NAJ.0000372071.24134.7e. PubMed [citation] PMID: 20520115

8. Melnyk BM, Fineout-Overholt E, Gallagher-Ford L, Stillwell SB. Evidence-based
practice, step by step: sustaining evidence-based practice through organizational
policies and an innovative model. Am J Nurs. 2011 Sep;111(9):57-60. doi:
10.1097/01.NAJ.0000405063.97774.0e. PubMed [citation] PMID: 21865934

9. Melnyk BM, Fineout-Overholt E, Stillwell SB, Williamson KM. Evidence-based
practice: step by step: igniting a spirit of inquiry: an essential foundation for
evidence-based practice. Am J Nurs. 2009 Nov;109(11):49-52. doi:
10.1097/01.NAJ.0000363354.53883.58. PubMed [citation] PMID: 19858857

10. Melnyk BM, Fineout-Overholt E, Stillwell SB, Williamson KM. Evidence-based
practice: step by step: the seven steps of evidence-based practice. Am J Nurs.
2010 Jan;110(1):51-3. doi: 10.1097/01.NAJ.0000366056.06605.d2. PubMed [citation] 
PMID: 20032669

11. Fineout-Overholt E, Williamson KM, Gallagher-Ford L, Melnyk BM, Stillwell SB.
Following the evidence: planning for sustainable change. Am J Nurs. 2011
Jan;111(1):54-60. doi: 10.1097/01.NAJ.0000393062.83761.c0. No abstract available.
PubMed [citation] PMID: 21191236

12. Gallagher-Ford L, Fineout-Overholt E, Melnyk BM, Stillwell SB. Rolling out the
rapid response team. Am J Nurs. 2011 May;111(5):42-7. doi:
10.1097/01.NAJ.0000398050.30793.0f. PubMed [citation] PMID: 23722382

What is PICO?

To formulate a clinical question, use the PICO format.
PICO or PICOT stands for the following:

P= Patient or Problem

I= Intervention

C= Comparison

O= Outcome

T= Time (optional)

Question Types

Different types of questions are answered best by different types of studies.
The following table will help you identify the best studies for your clinical question.

Question Type Best Type of Study
Treatment Systematic Review / RCT
Diagnosis Systematic Review / Cross-sectional
Etiology / Harm Systematic Review / Cohort / Case-control
Prognosis Systematic Review / Cohort

 

View definitions for these study types in the Glossary.

Levels of Evidence

Levels of Evidence and Grades of Recommendation
Guidelines
Critically Appraised Sources of Information
Search for Research Articles
Quantitative vs Qualitative Research

1: Hoe J, Hoare Z. Understanding quantitative research: part 1. Nurs Stand. 2012
Dec 12-2013 Jan 1;27(15-17):52-7; quiz 58. doi:
10.7748/ns2012.12.27.15.52.c9485. PMID: 23346707.

2: Hoare Z, Hoe J. Understanding quantitative research: part 2. Nurs Stand. 2013
Jan 2-8;27(18):48-55; quiz 57. doi: 10.7748/ns2013.01.27.18.48.c9488. PMID:
23431654.

3: Sorrell JM. Qualitative research in clinical nurse specialist practice. Clin
Nurse Spec. 2013 Jul-Aug;27(4):175-8. doi: 10.1097/NUR.0b013e3182990847. PMID:
23748988.

4: Miller WR. Qualitative research findings as evidence: utility in nursing
practice. Clin Nurse Spec. 2010 Jul-Aug;24(4):191-3. doi:
10.1097/NUR.0b013e3181e36087. PMID: 20526118; PMCID: PMC3021785.

Outcome Measures
  • Absolute Risk Reduction (ARR) 
    • The difference in the rate of outcomes between the control group of a study and the intervention group. For example, if 30% of people experience a serious event in the control group and 20% in the intervention group, the ARR is 10% (30%-20%).
  • Relative Risk Ratio (RRR)  
    • A measure expressed by the risk of an event in the group receiving the intervention divided by the risk in the control group. A value of one implies no effect of treatment; less than one that the intervention reduced the risk of an event; and greater than one that the occurrence of the event is increased.This measure of risk is often expressed as a percentage increase or decrease, for example ‘a 20% increase in risk’ of treatment A compared to treatment B. If the relative risk is 300%, it may also be expressed as ‘a three-fold increase’.
  • Number Needed to Treat (NNT) 
    • A statistical measure of the number of people who need to be given an intervention in order to observe a beneficial effect for one extra person. It is calculated from the risk difference. It is the inverse of the absolute risk difference.
Critical Appraisal Worksheets
EBP Calculators
Quality of Evidence

Apply
Assess