Step 1: Ask: Formulate a PICOT: Inquiry leads to question formation

Background questions: EBP initiatives often begin with background questions that are refined and adjusted throughout the literature search.  These types of questions are broad and provide an overview of a topic of interest.  Background question lay the foundation for more specific foreground questions and help identify best practices.

Foreground questions are focused and often compare two or more ideas or interventions. These types of questions are more detailed and often flow from background questions and literature reviews.

Foreground PICOT Question: In Elderly Adults (P), how does T'ai Chi (I) compared to no exercise (C) affect fall rates (O) within six months (T)? Use a grid to visualize your PICOT topic in order to prepare for searching databases using effective terms.

References:

Valatka, R., Krizo, J., & Mallat, A. (2021). A Survey-Based Assessment of “Matter of Balance” Participant Fall-Related Experience. Journal of Trauma Nursing, 28(5), 304–309.

Creating Search Strategies for School of Nursing: Stony Brook University Libraries

Step 2: Search: Search for the best evidence

Searching multiple databases will yield the best results for finding EBP literature.  Examples include CINAHL, PubMed and Cochrane.   

Use PubMed's "Clinical Queries" pre-filtered search box to find high level studies that are evidence-based.

Searching for the best literature on your PICOT begins with choosing the right type of question and matching it with an ideal study type.  For example, an Intervention/Therapy PICOT is best answered by finding Randomized Controlled Trials, Systematic Reviews and Meta-analyses.  These publications are considered some of the highest level of evidence literature or "gold standard."  For more information see the "Levels of Evidence" tab.

Databases are designed to include options for limiting or refining your searches to certain publication types like the ones listed below:

Search Tip: When beginning to search for literature on your PICOT, start out broadly with a few concepts and then begin to narrow it down.

Searching for "Higher Level" studies like RCTs, Systematic Reviews and Meta-analyses is made easier by using filtered search options in databases like PubMed.    

Step 3: Appraise: Critical Appraisal of Evidence

"Nurses at all educational levels report that they lack knowledge to critically appraise research studies and the skills to effectively implement evidence-based practice (EBP) in their clinical settings" (Moore, 2013).

Below are recommended tools to critically appraise different types of articles:

• Appraise evidence-based practice: Duke University Medical Center

• CASP Checklist

• Joanna Briggs Institute Critical Appraisal Tools

• AMSTAR

• GRADE

• PRISMA

Critical Appraisal of Research Evidence in the Health Professions:

Carrie Price, Townson University's Albert S. Cook Library

This brief video discusses four tools that can be used to critically appraise research evidence. Being able to answer the right questions will help you become more confident at finding high-quality literature as well as identifying bias and flaws.

Step 4: Integrate

Brunt BA, Morris MM. Nursing Professional Development Evidence-Based Practice. [Updated 2023 Mar 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK589676/

Cole, L. G., Turner, S., & Graves, B. A. (2019). Walking the Walk: Integrating Evidence Into Clinical Experiences. Creative nursing, 25(2), 148–153.

Gallagher-Ford EBP 2.0: From Strategy to Implementation

Snyder, M. D., Campbell, T., & DiGerolamo, K. A. (2023). Enhancing Evidence-Based Practice Integration Into Clinical Practice: Using Policy as a Tool for Culture Change in a Large Urban Academic Medical Center. Clinical nurse specialist CNS, 37(1), 14–19.

Evaluate and Disseminate

Steps 5 & 6: Evaluate and Disseminate the Outcomes

"All too often, clinicians achieve many positive outcomes...but those outcomes are not shared with others" (Melnyk, 2015).

“Sharing the results from a successful EBP project, a QI initiative, or original research increases the likelihood for replication or duplication in other practice settings” (Milner, 2016).  

Effective communication is key to disseminating new knowledge to others. Some ways to share EBP initiatives with others include:

Round Table Discussions