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Nursing

Evidence-based practice

Evidence-Based Practice (EBP) is an approach to decision-making in various fields including medicine, nursing, psychology, education, and social work. It involves using the best available research evidence, practitioner expertise, and client values and preferences, to guide decision-making and improve outcomes for individuals and populations. In some models of evidence-based practice, a fourth element of 'practice context' is included (Hoffman, 2017, p. 4 ).

The elements of evidence-based practice

The elements of evidence based practice

  • Evidence based practice.

    The best available evidence (information and data) obtained through systematic investigation and analysis that addresses a research question.

  • Practitioner expertise.

    Practitioner expertise is a combination of discipline specific skills, knowledge, and professional experience that is accumulated by practitioners over the course of their career. A practitioner may also be described as a clinician, professional, health provider, educator, depending on the discipline.

  • Client preferences.

    Client preferences relates to the unique values, circumstances, concerns, expectations, beliefs, hopes, strengths, limitations, and stresses, inherent in each client. Clients may also be known as patients, users, consumers, students, depending on the discipline area.

  • Research evidence.

    Research is conducted using various designs and methods appropriate to the research question asked.

Hierarchy of Evidence

What is the best type of evidence to answer your research question? Use the hierarchy of evidence levels to help you decide. The quality and reliability of information is highest at level 1 and decreases as you move to level 7.

The most reliable of evidence-based literature.

  • Syntheses of all primary research to answer specific questions.
  • Uses explicit methodology.
  • Presents an overall assessment of the findings.
  • Often used for policy making and establishing best practice guidelines.
  • A summary of the best available evidence on a specific question.
  • Shorter, less rigorous, and less comprehensive than a systematic review.
  • Appraisal of relevant studies on an intervention or issue.
  • The gold standard in primary research.
  • Experimental studies to examine the cause-effect relationship between intervention and outcome.
  • To minimise the risk of bias, RCTs may use randomisation of participants in groups and/or double-blind methodology.
  • Longitudinal studies that observe participants over a period of time.
  • Participants are exposed to variables of which the outcomes are measured.
  • Useful for questions of prognosis, diagnosis, frequency and aetiology, but not effects of interventions.
  • A type of retrospective observational study that includes a control group for comparison.
  • Helps ascertain if an exposure is associated with a disease or outcome of interest, though direct causal relationships are not proven.
  • Relatively quick and efficient and provides rapid results.
  • An in-depth report of an individual patient or specific group.
  • Useful where there is atypical behaviour or an unexplained outcome to treatment, or an emerging condition.
  • Based on qualitative data, for example, interviews, observations, questionnaires or notes.
  • Difficult to replicate and can’t always be generalised to a wider population.
  • The least reliable source of information.
  • Can be anecdotal, observational, and broad in scope.

Types of evidence

5 steps to EBP

The key steps of evidence-based practice are often summarised using the '5 As': Ask, Acquire, Appraise, Apply, Assess.

The 5 A's or key steps of evidence-based practice

Step 1: Ask

Ask the question. To answer a general inquiry or clinical problem you need to put together a searchable question.

TipTip: using a framework like PICO can help you formulate an effective question.

Step 2: Acquire

Acquire the evidence. Find evidence-based resources that answer the question

TipTip: explore library databases and use tips to search smarter.

Step 3: Appraise

Appraise the evidence. Critically appraise and evaluate the research to assess its validity, credibility, and relevance.

TipTip: take a look at critical appraisal tools to help you with this process.

Step 4: Apply

Apply the evidence. Integrate the best research evidence into practice.

TipTip: think about the feasibility and usefulness of applying the evidence in your professional/clinical setting. Do you have all the evidence you need? The participant’s values and expectations and also your own expertise when deciding whether to apply the evidence.

Step 5: Assess

Assess the outcomes. Continuously monitor and evaluate the outcomes of implementing steps 1 to 4 above. What evidence-based changes have you made and what is the impact of those changes?

PICO Framework

The PICO framework is a simple way to organize your search strategy and find the information you need. It helps you break your question into four key parts: Population, Patient or Problem (P), Intervention or Exposure (I), Comparison (C), and Outcome (O). This method is often used in Evidence-Based Practice (EBP) to focus on the most important concepts and make searching easier.

Example of a research question in PICO format.

P - Patient, Population or Problem

I - Intervention or Exposure

 C - Comparison O - Outcome
In patients with osteoarthritis of the knee is hydrotherapy more effective than traditional physiotherapy in relieving pain?

The problem is osteoarthritis of the knee; the intervention is hydrotherapy; the comparison is traditional physiotherapy; the outcome is relieving pain.

Frameworks other that PICO are also available. See other frameworks on our systematic review library guide.

Test your understanding

Case study

Olivia is a teenager who has been vaping regularly. She knows it's bad for her and wants to stop. She's heard that counselling can help. Another intervention she knows of is the use of smartphone apps. She wonders which intervention would be the most effective.

Photo by Olivia Hibbins on Unsplash.

Research question

For teenagers who want to cease vaping, is counselling compared to the use of smartphone apps a more effective treatment?

NoteNot all research questions will have or require a comparison.

Research methods

Researchers use different methods and tools to test theories and to collect, analyse and interpret data in the hope of validating existing knowledge, or discovering new information. These research methods are either:

  • quantitative
  • qualitative, or 
  • mixed methods. 

Understanding the application of different research methods, including best practice, to research, can help you choose the best available evidence, translate it and apply it to your practice (part of the EBP process).

 

Research methods used to explore and understand people's beliefs, experiences, attitudes, behaviour and interactions. It generates descriptive, non-numerical data. 

Qualitative research methods include:

  • focus groups
  • observation
  • in-depth interviews
  • documents (accounts of events, such as minutes of meetings).

Example:

Exploration of the contribution of physiotherapy students to the delivery of health services: A qualitative study

Research methods used to generate numerical data or data that can be converted into numbers.

Quantitative research methods include:  

  • randomised controlled trial (RCT)
  • case report or case series
  • case control study
  • cohort study.

Example:

Students’ sense of belonging and their socio-economic status in higher education: A quantitative approach

A research approach where 'mixed' (quantitative and qualitative) methods are used to collect, analyse and interpret data, within the same study.

Example: 

The content, teaching methods and effectiveness of spiritual care training for healthcare professionals: A mixed-methods systematic review

Sage Research Methods

Explore Sage Research Methods to enhance your understanding of research methodologies, including:

  • selection
  • design
  • application of research methods.
Research Methods Cases

Learn about methods application and research design, with stories from researchers.

Research Methods Videos

Develop practical skills to successfully complete your research. Coverage includes:

  • writing a research proposal
  • planning and designing a research project
  • securing ethical approval. 

References


The following resources were used to support the development of this guide: