NSG 348, Nursing Research & EBP: Evidence Based Practice
What is Evidence Based Practice?
Evidence based practice (EBP) is the conscientious use of current best evidence in making decisions about patient care (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000).
It is a problem solving approach to clinical practice and administrative issues that integrates:
- A systematic search for and critical appraisal of the most relevant evidence to answer a burning clinical question
- One's own clinical expertise
- Patient preferences and values (Melnyk & Fineout-Overholt, 2014)
The EBP process is a method that allows the practitioner to assess research, clinical guidelines, and other information resources based on high quality findings and apply the results to practice. (AMSN)
Additional information: https://ebm-tools.knowledgetranslation.net/
Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1
Academy of Medical-Surgical Nurses, (AMSN)
Levels of Evidence
The hierarchy of evidence is a generally accepted core principal of EBP. Studies are ranked on the basis of the rigor of research methods.
The higher a methodology ranks in the hierarchy, the more likely the results accurately represent the actual situation and the more confidence clinicians can have that the intervention will product health outcomes in similar patients or whom they care. (Melnyk, 2015)
Most experts agree that the higher up the study design is positioned, the more rigorous the methodology and hence the more likely it is that the study design can minimize the effect of bias on the results of the study. In most evidence hierarchies current, well designed systematic reviews and meta-analyses are at the top of the pyramid, and expert opinion and anecdotal experience are at the bottom. (Hoffman, 2013)
Hoffman, T., Bennett, S., & DelMar, C. (2013) Evidence-Based Practice, Across the Health Professions (2nd ed. ) Elsevier, Chatswood, NSW.
Melnyk, B., Fineout-Overholt, E., (2015) Evidence-Based Practice in Nursing Healthcare: A Guide to Best Practice (3rd ed.) Wolter Kluwer, NY.
Five Steps of Evidence Based Practice
Formulating a question in order to conduct a literature search is among the first steps in conducting the EBP process. PICO is a tool to assist in clearly stating a topic and turning a question into a searchable concept.
Critical appraisal can be a time consuming process. However, to begin the appraisal process there are several questions that can be asked. (Melnyk 2015)
- Are the results of the study valid? (Validity)
- What are the results? (Reliability)
- Will the results help me in caring for my patients? (Applicability)
Melnyk, B., Fineout-Overholt, E., (2015) Evidence-Based Practice in Nursing Healthcare: A Guide to Best Practice (3rd ed.) Wolterk Kluwer, NY