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Center for Nursing Excellence: EBP

Evidence Based Practice and Research Guide for Nursing Practice

Definition of Evidence Based Nursing Practice

Evidence Based Nursing Practice is the process by which nurses make clinical decisions using

  • the best available research evidence
  • their clinical expertise
  • patient preferences

7 Steps for Evidence Based Practice

Follow these 5 steps for evidence based practice:

1.  Cultivate a spirit of inquiry

2.  Ask the burning clinical question in a PICOT format

3.  Search for the best evidence

4. Critically appraise the evidience

5.  Integrate the information to make a practice decision or change

  • Best evidence, clinical experience, patient preferences, values

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

7. Disseminate EBP results

PICOT Format

  • What is a PICOT Question?
     
  • The PICOT question format is a consistent "formula" for developing answerable, research-able questions. It helps you focus on the key points of your questions and once created,d can be used to help you search the literature.  The focus of the PICOT question is to equip you with terms to search the literature: a focused, answerable question!
     
  • PICOT stands for:
    • Population/Patient Problem: Who is your patient? (Disease of Health status, age, race, sex)
    • Intervention: What do you plan to do for the patient? (Specific trends, therapies, medications)
    • Comparison: What is the alternative to your plan? (I.e. no treatment, different type of treatment, etc.)
    • Outcome: What outcome do you seek?  (Less symptoms, no symptoms, full health, etc.)
    • Time: What is the time frame?  (This element is not always included.)
       
  • Samples of PICOT question structure:
    • For an Intervention:
    • In _______  (P), how does _______ (I) compared to _______ (C) affect _______ (O) within  _______(T)?
    • For etiology:
    • Are _______ (P), who have _______ (I) at _______ (increased/decreased risk for for/of _______ (C) compared with (P) with/without _____ (C)?
    • Diagnosis or diagnostic test:
    • Are (is) _______ (I) more accurate in diagnosing ______ (P) compared with _______(C) for _______ (O)over _______ (T)?
    • Prevention:
    • For _______ (P) does the use of _______ (I) reduce the future risk of _______ (O) compared with _______ (C)?
    • Prognosis:
    • Does _______ (I) influence _______ (o) in patients who have _______ (P)
    • Meaning:
    • How do _______ (P) diagnosed with _______ (I) perceive _______ (O) during _______ (T)

Based on Melnyk B. & Fineout-Overhold E. (2005) Evidence-based practice in nursing and healthcare. New York: Lippincott Williams & Williams.

 

Resources for EBP

Check out these articles on Evidence Based Practice from the American Journal of Nursing:

Fineout-Overholt, E., Williamson, K.M., Gallagher-Ford, L., Melnyk, B.M., & Stillwell, S.B. (2011). Evidence-based practice, step by step: Following the evidence: Planning for sustainable change. American Journal of Nursing, 111, 54-60.  Read the article.

Fineout-Overholt, E., Melnyk, B.M., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice, step by step: Critical appraisal of the evidence part III. American Journal of Nursing, 110, 43-51.  Read the article.

Fineout-Overholt, E., Melnyk, B.M., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper-examining the "keeper" studies. American Journal of Nursing, 110, 41-48.  Read the article.

Fineout-Overholt, E., Melnyk, B.M., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110, 47-52.  Read the article.

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 Nursing110, 51-53.  Read the article.

Shirey, M. R., Hauck, S. L., Embree, J. L., Kinner, T. J., Schaar, G. L., Phillips, L. A., & ... McCool, I. A. (2011). Showcasing Differences Between Quality            Improvement, Evidence-Based Practice, and Research. Journal of Continuing Education in Nursing, 42(2), 57-70. doi:10.3928/00220124-    20100701-01  Read the article

Stillwell, S.B., Fineout-Overholt, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110, 41-47.  Read the article.

Stillwell, S.B., Fineout-Overholt, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110, 58-61.  Read the article.

 

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