EBPGuide

Inquire

The "Seven Steps" to EBP are available within this page.  Visit each of these 7 tabs sequentially for a systematic overview or use them independently to learn more about each step. Additional EBP resources are included on the left navigation menu as well. 

What is Step 0: "Spirit of Inquiry?"  Step zero is having an "ongoing curiosity about the best evidence to guide clinical decision making." Wyant, T. (2018). A Spirit of Inquiry Leads to Evidence-Based Answers to Practice Questions

Ask

Step 1: 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.

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)?

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.

Search

Step 2: 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)

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.   

Appraise

Below are recommended tools to critically appraise different types of articles.  Use these resources to help guide your EBP projects and initiatives:

Step 3: 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.  Use these resources to help guide your EBP projects and initiatives:

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.

Integrate

Step 4

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:

Search Terms, Databases and Search Strategies: Determine the terms to use by filling out a PICOT Worksheet.  Evidence-Based questions are formulated using the PICOT methodology, an effective way to define your topic and guide the search process.  Once you have a focused question, choose the most important concepts from your PICOT as search terms. 

In addition to your PICOT concepts, use related search terms and synonyms in your database searches to strengthen your findings.

As you begin to search the literature, you will notice that databases include Subject Headings, i.e., words or phrases that describe a main idea or concept.  Two examples include MeSH (Medical Subject Headings) indexed in PubMed and CINAHL Headings indexed in the CINAHL database. These are also known as Standard Terms, Main Headings and Controlled Vocabularies.  Always refer to Subject Headings indexed in each database to help you build your search strategies.