Evidence Based Practice (EBP) is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system (Newhouse, Dearholt, Poe, Pugh, & White, 2012).
A commonly used format for creating a clinical question is known as PICO(T), which refers to:
First, you need to define a problem and formulate a question. In the research process, this is the research question or statement. In the clinical setting, 'asking a question' may become part of a research study, a quality improvement project, or lead to evidence based practice.
The following Databases are ideal for finding evidence based literature:
CINAHL Complete is the world's most comprehensive nursing & allied health research database, providing full text for more than 1,350 journals indexed in CINAHL. Of those, 953 are not found with full text in any version of Academic Search, Health Source or Nursing & Allied Health Collection. This authoritative file contains full text for many of the most used journals in the CINAHL index, with no embargo. With full-text coverage dating back to 1937, CINAHL Complete is the definitive research tool for all areas of nursing and allied health literature.
MEDLINE provides authoritative medical information on medicine, nursing, dentistry, veterinary medicine, the health care system, pre-clinical sciences, and much more. Created by the National Library of Medicine, MEDLINE uses MeSH (Medical Subject Headings) indexing with tree, tree hierarchy, subheadings and explosion capabilities to search citations from over 5,400 current biomedical journals.
The Cochrane Library is a collection of six databases that contain different types of high-quality, independent evidence to inform healthcare decision-making, and a seventh database that provides information about Cochrane groups. Includes full-text Cochrane systematic reviews.
Depending on your research question, you need to address what type of study would provide the best evidence. When searching for articles, databases often have filters allowing you to acquire specific types of studies.
Below is a list of the different types of studies often seen in those filters.
Systematic Review: It is an intensive review of the literature on a given topic. It uses explicit and rigorous methods to identify the studies included in the review. It also critically appraises and synthesizes all the studies included in the review. - secondary research
Meta-Analysis: Similarly to a systematic they overview extensively the literature on a topic, but they combine the results of all the studies identified in a quantitative way. They synthesizing summaries and make a conclusion that may be used to evaluate therapeutic effectiveness. - secondary research
Randomized Controlled Trial: It is a clinical trial that involves at least one test treatment and one control treatment. There was concurrent enrollment and follows up of the test- and control-treated groups, and in which the treatments were administered by a random process.- primary research
Cohort Study: A study in which subsets of a defined population are identified and studies over a period of time to see the effects of something. - primary research
Case Control Study: A study that starts with the identification of persons with a disease of interest and a control group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group. - primary research
Case Series / Reports: Articles written about one patient or a series of patients with the same issue. Great for rare diseases, disorders, and drug/treatment reactions. Not the best source of evidence because it focuses on a small group of people, but sometimes it's the only source.
Source: "EBM Pyramid." Digital Image. Eli M. Oboler Library, 27 May 2016.
Once you have found the articles, you need to determine which ones would be worth including in your research. Appraise each article individually by carefully examining their validity, relevance, and value to your topic.
This step involves evaluating the changes needed in clinical practice and applying your clinical expertise along with your research and evidence. Applying the best evidence is arguably the step that requires the most skill. It is at this step that you synthesized the best scientific knowledge with your clinical expertise and the patient's unique values and circumstances to reach a clinical decision: Many organizations adopt an EBP model to integrate these findings and to put these changes into action!
Some examples of models include:
