Nursing Resources

Evidence-Based Practice (EBP) is the integration of  clinical experience and patient preferences with the best available research information.

• Form a focused clinical question
  • Use a PICO or PICOT form
• Efficiently find the available evidence (research studies)
  • Take keywords from your PICO/PICOT form
  • Search research article databases
• Critically appraise the evidence for internal and external relevance
  • Use article appraisal checklists
    • Some checklist questions focus on the internal validity of the research  (Was the study well-designed? Was it carried out properly?)
    • Some focus on the external validity of the research (Was the patient population from that study similar enough to your patient for the research to be relevant?).
• Make a decision / ethically apply the evidence
• Reflect on the effect of the applied evidence / the overall process
  • EBM does have its limitations - and at times, there is simply a lack of evidence.

When doing EBM, it is preferable to obtain evidence from as high up the 'hierarchy of evidence' as possible.

* Image used with the kind permission of Dr. Sam Keim.

(Below this level 5 would be evidence from research such as animal studies and 'bench science')

The 'gold standard' for EBM is the randomized controlled trial (RCT), and further, systematic reviews (often involving meta-analysis)  carried out on groups of RCTs.

Statistically-speaking, those types of studies offer better 'evidence', because when done correctly, they offer the best chance to avoid the various types of bias amd confounders that occur when carrying out research. - the type of evidence generated by RCTs and SRs make it easier to determine whether that research's data has sufficiently disproven the researchers'  'null-hypothesis'.