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Gottlieb Memorial Hospital EBP Guide

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The Merging of Science and Art: EBP within a context of caring

EBP within a context of caring and EBP culture and environment, results in the highest quality of patient care.

Click on "Step 0: Inquire" tab above to continue.  Select each of the tabs for a step-by-step introduction to EBP.

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 Nursing27(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.  Be sure to use related search terms and keywords that have similar 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.  

Patient-Population or Problem:

Question: What are the patient characteristics?  

Concept:  Elderly at risk for falling

Related Search terms and synonyms:

Related Search Terms: Seniors, Older Adults, Aged: 65+ years ( Use as additional search terms) 

Intervention or Exposure: 

Question: What interventions will make them well?

Concept: T'ai Chi

Related Search terms and synonyms:

Related Search Concepts: Exercise, Yoga, Martial Arts., Tai Ji  (Use as additional search terms)

Comparison or Placebo:

Question: What is the intervention compared with?

Concept: No Exercise or Status Quo

Related Search Concepts:

Sedentary lifestyle (Use as additional search terms)

Outcome:

Question: What is the intended outcome of the intervention?

Concept: Reduced Falls

Related Search Concepts: 

Accidental Falls, Trip, Stumble, Falling (Use as additional search terms)

Time:

Question: What is the time frame for the intervention?

Concept: 6 months

Related Search Concepts:

Time Factors (Use as additional search terms)

 

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 Nursing28(5), 304–309.

PICO Video: Formulating Your Question Using PICO

In evidence-based nursing, it's important to have an answerable question. The PICO framework can help you identify the major elements of your topic so that you can translate them into an effective literature search.

 

"Nursing Research: Formulating Your Question Using PICO" by Carrie Price, MLS, Albert S. Cook Library, Towson University is licensed under CC BY-NC 4.0
 

Seven Steps to the Perfect PICO Search: Evidence-Based Nursing Practice:

OVERVIEW Searching for high-quality clinical research evidence can be a daunting task, yet it is an integral part of the evidence-based practice process. One way to streamline and improve the research process for nurses and researchers of all backgrounds is to utilize the PICO search strategy. PICO is a format for developing a good clinical research question prior to starting one’s research. It is a mnemonic used to describe the four elements of a sound clinical foreground question (Yale University’s Cushing/Whitney Medical Library)

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)

Type of Question Ideal Type of Study
Intervention/Therapy Randomized Controlled Trial (RCT), Systematic Review, Meta-analysis
Prevention RCT, Cohort Study, Case Control Study
Diagnosis Prospective, blind controlled trial compared to gold standard
Prognosis Cohort study, Case Control, Case series or case report
Etiology/Harm RCT, Cohort study, case control

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 Nursing18(4), 272–281.

Tucker, S. J., & Gallagher-Ford, L. (2019). EBP 2.0: From Strategy to Implementation. AJN American Journal of Nursing119(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:

  • Round Table Discussions
  • Podium/Oral Presentations
  • Webinars/Podcasts/Online Networks   
  • Journal Publishing/Journal Clubs                                                                         
  • Poster Presentations
  • Informal Conversations with others
  • Grand Round/Clinical Rounds

“Half of research evidence never reaches the clinical setting, and the other half takes 20 years to translate into clinical practice" (Boehm, 2020).

Milner, K. A. (2016). Sharing Your Knowledge: Getting Your Idea Published. Journal of Infusion Nursing39(5), 297–305. 

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 Nursing7(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 Nursing18(6), 318–319.

Disclaimer

Non-Mount Carmel organizations referenced on this website are identified for informational purposes only. Mount Carmel is not endorsing these organizations. The services these organizations provide, and the values or opinions they express, may not be consistent with the teachings of the Catholic Church and the Ethical and Religious Directives for Catholic Health Care Services. Mount Carmel makes no representations concerning the conduct or beliefs of these organizations.