Nursing - Subject Guide

Evidence-based practice (EBP) "requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances" (Sharon, Glasziou, Richardson, & Haynes, 2018).

For more information, please read: Evidence based medicine: what it is and what it isn't.

The following video provides a brief overview of EBP:

(Courtesy of Idaho State University Libraries)

Reference

Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2018). Evidence-based medicine: How to practice and teach EBM. Retrieved from https://ebookcentral.proquest.com/

Evidence-based practice is a 5-step process:

1. Ask a question
2. Access the evidence
3. Appraise the evidence
4. Apply the evidence
5. Audit or evaluate its effectiveness.

The 5As of EBP

Please refer to the sections below for more information on each step.

The first step in evidence-based practice is to define your clinical question. There are many frameworks that you can use in formulating your question, such as PICO.

Find out more about clinical questions on the following pages:

Once you have a well-formulated clinical question, you can start searching the literature. Refer to the 'Journals and Databases' page for databases related to your topic.

You should also look at the following of databases with evidence based materials:

Once you have located some relevant literature, you will need to critically appraise the evidence.

There are many different types of study designs, which would affect how you would appraise the individual studies, and thus the weight you give each study. This is commonly represented in what is know as the Level of Evidence hierarchy.

Hierarchy of evidence pyramid. (Aslam, Georgiev, Mehta & Kumar, 2012)  CC BY-NC-SA 3.0

Some key resource for appraising literature are:

• Chapters 3-7 in Evidence-based medicine: How to practice and teach EBM by Straus, Glasziou, Richardson and Haynes
• How to Read a Paper by Trisha Greenhalgh

For more information and tools on critical appraisal of the literature, please go to:

Reference

Aslam, S., Georgiev, H., Mehta, K., & Kumar, A. (2012). Matching research design to clinical research questions. Indian Journal of Sexually Transmitted Diseases and AIDS, 33, 49-53. Retrieved from: http://www.ijstd.org/text.asp?2012/33/1/49/93829

The key elements of evidence-based practice are:

• Best research evidence
• Clinical expertise
• Patient values and circumstances.

Elements of EBP

When applying the studies you have found in practice, it is important to do so in the context of the other two elements.

Once you have implemented your evidence-based practice, you need to audit and evaluate it to see if it is effective.

Please refer to Chapter 8 of Evidence-based medicine: How to practice and teach EBM by Straus, Glasziou, Richardson and Haynes for guidance on how to do this.

A 'structured literature review' is a narrative literature review with "a clearly articulated search strategy" (Kable, Pich & Maslin-Prothero, 2012, p. 878). It has many elements similar to a systematic review (see below), but is a different methodology. The emphasis is on developing and documenting a precise and transparent search strategy.

Please refer to the article by Kable, Pich and Maslin-Prothero (cited below) for a detailed explanation of the methodology.

Reference

Kable, A. K. , Pich, J., & Maslin-Prothero, S. (2012). A structured approach to documenting a search strategy for publication: A 12 step guideline for authors. Nurse Education Today, 32(8), 878-886. doi: 10.1016/j.nedt.2012.02.022

Please see our Systematic Reviews guide, if you are looking for systematic reviews or undertaking a systematic review.

OpenTrials is a collaboration between Open Knowledge International and Dr Ben Goldacre from the University of Oxford DataLab. It aims to locate, match, and share all publicly accessible data and documents, on all trials conducted, on all medicines and other treatments, globally.  To find out more read this paper.