MercyOne Iowa: EBP Guide

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

The first and essential step to Evidence-Based Practice is "Inquiry", also known as Step Zero: "Having a consistently questioning attitude toward practice" (Melnyk, 2019).  

Importance of Nurse Engagement: (Applied Curiosity and Creative Inquiry) 

"Healthcare organizations that provide opportunities for personal growth and inquiry are better able to embrace Evidence-Based Practice."

"New nurses feel comfortable in seeking advice from individuals who demonstrate a level of caring and approachability" (Blevins, 2018).

References: 

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare : a guide to best practice (Fourth edition.). Wolters Kluwer.

Blevins, S. (2018). From Nursing Student to Registered Nurse: The Challenge of Transition. MEDSURG Nursing, 27(3), 199–200.

Evidence-Based Practice Series: Step by Step: This landmark collection of articles was published and authored by faculty from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. 

Step 1: Formulate a PICOT Question

Evidence-Based Questions are formulated using the PICOT methodology, an effective way to define your topic and to guide the search process. Before searching appropriate databases for literature, it is helpful to create a PICOT question. Once you have a well-defined question, choose the best concepts to use as search terms.  Also be sure to write down related search terms that are similar in meaning to your chosen PICOT concepts. 

As you begin to search the literature, you will notice that databases provide Subject Headings, i.e., words or phrases that describe a main idea.  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 or Controlled Vocabularies.  Always look at the Subject Headings indexed in each database to help you build your search strategies.  

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.

Step 2: Search for the best evidence

EBP requires searching multiple databases in order to find as much as possible on a given topic.  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.   

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:

Appraise Evidence-Based Practice: Duke University Medical Center

CASP Checklists

Joanna Briggs Institute Critical Tools

AMSTAR: A Measurement Tool to Assess Systematic Reviews

The Grading of Recommendations Assessment, Development and Evaluation (GRADE)

PRISMA Statement

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. (Towson University Albert S. Cook Memorial Library).

Step 4: Integrate the Evidence

Integrating EBP into clinical practice is often one of the most challenging tasks faced by clinicians and leaders in healthcare settings" (Hockenberry, 2007).

This E-Book provides a step-by-step approach to understanding how to integrate and sustain EBP in organizations.  Included are realistic case scenarios.

Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare serves as a guide for clinicians, leaders, faculty, EBP mentors, and students in achieving EBP competency, facilitating evidence-based decision making in daily practice, and accelerating the speed at which research knowledge is translated into real-world settings to improve health outcomes and decrease health care costs."

Melnyk, B. M., Tan, A., Hsieh, A. P., & Gallagher, F. L. (2021). Evidence‐Based Practice Culture and Mentorship Predict EBP Implementation, Nurse Job Satisfaction, and Intent to Stay: Support for the ARCC© Model. Worldviews on Evidence-Based Nursing, 18(4), 272–281.

Tucker, S. J., & Gallagher-Ford, L. (2019). EBP 2.0: From Strategy to Implementation. AJN American Journal of Nursing, 119(4), 50–52.

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:

EBP cannot exist in a vacuum!  In order to be effective over time, EBP must be meaningful and sustainable within organizations.  

"We must make it easy for clinicians to translate evidence-based interventions and guidelines quickly and efficiently into their clinical practices, all within a culture that supports EBP."

Tucker, Sharon J. PhD, RN, FAAN; Gallagher-Ford, Lynn PhD, RN, NE-BC, DPFNAP, FAAN. EBP 2.0: From Strategy to Implementation. AJN, American Journal of Nursing 119(4):p 50-52, April 2019. | DOI: 10.1097/01.NAJ.0000554549.01028.af 

Advancing understanding and identifying strategies for sustaining evidence-based practices: a review of reviews.

EBP 2.0: Implementing and Sustaining Change: The Evidence-Based Practice and Research Fellowship Program

Tucker, Sharon J.; Gallagher-Ford, Lynn; Jang, Elisa  AJN, American Journal of Nursing. 120(2):44-48, February 2020.

Worldviews on Evidence-Based Nursing, 7(1), 51–53. https://doi.org/10.1111/j.1741-6787.2010.00185.x

The Current Research to Evidence‐Based Practice Time Gap Is Now 15 Instead of 17 Years: Urgent Action Is Needed. (2021). Worldviews on Evidence-Based Nursing, 18(6), 318–319.