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Roseman University Library - Evidence Based Practice
Evidence-Based Practice Definition
The most commonly cited is that EBP is
“the conscientious, explicit, and judicious
use of current best evidence in making
decisions”(Sackett, Rosenberg, Gray, Haynes,
& Richardson, 1996).
Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based
medicine: what it is and what it isn't. British Medical Journal, 312(7023), 71-72. Retrieved from
History of EBP
• Evidence-Based Practice has its roots in Evidence Based
Medicine (also referred to as Evidence –Based Health Care).
• EBM was created in the 1980s and popularized in the early
1990s as a response to medical textbooks being unable to
keep up with rapid changes in medicine and being frequently
based on the interpretations of a small number of people in a
• At the same time, the medical literature in journals was being
produced in record numbers, but at the same time was
EBP vs. Evidence-Based Medicine (EBM)
• EBM is primarily limited to the health care field
and focuses on a specific patient or population.
• Evidence Based Practice can be applied to
many fields. EBP is constantly being modified
to best suit the subject to which it is being
• In all cases, you want to use the best evidence
to inform your practice.
Common questions in everyday practice:
• Which combination and sequence of
treatments is most effective?
• Which patient symptoms predict better or
• What is the experience of illness for a patient
with this diagnosis?
• Which treatment is most effective and will
produce the best patient outcome?
• If a diagnosis is left untreated, what might be
The Evidence Based Practice Process
The EBP process is comprised of 5 steps:
1. Defining a question that needs to be answered.
2. Acquiring the literature that will be analyzed.
(building and executing the search)
3. Conducting a formal evaluation of the results, also
referred to as critical appraisal.
4. Integrating the evaluated evidence into practice.
5. Re-evaluating the process to assess its efficacy and
improve it in the future.
Defining the Question (PICO)
P – Patient/Population/Problem
I – Intervention (drug, diagnostic test, etc.)
C – Comparative Intervention (what, if anything are we
comparing it to)
O – Outcome (what is our desired result)
• The PICO format is used to construct the clinical
question in a specific manner
• Using PICO format helps you identify the most
important parts of your question
• Consideration of the patient and population of
• Limit to age group, gender, or other group if
• Could be true control, such as placebo or
• Could be another treatment
• Sometimes it is the usual standard of care
• Outcome may be very specific
• Outcome may be something that has a variety
• Outcome may be inconclusive
In a 52 year old African American male with
Type II diabetes, is metformin better than
insulin at regulating blood sugar?
• Patient - 52 year old African American male
• Problem - Type II diabetes
• Intervention – metformin
• Comparative Intervention – insulin
• Outcome – Blood sugar levels
Critical Appraisal involves carefully and systematically examining research to
judge its validity, reliability, and the relevance to a particular context.
Things to Consider:
1. Pyramid of Evidence
2. Placement on the Pyramid does not equate to importance of the work
3. Placement on the Pyramid does rank research by:
• Subject area
• Type of research done within subject area
• Committees / organizations who create guidelines
• Complexity and Content of the work
Types of Study Designs
Experimental – controlled study design
Observational – experiential and anecdotal
Quantitative – results defined by numbers
Qualitative – results defined by words
Synthetic – reviews of multiple studies
Study designs are driven by the research
question being asked, the population being
studied, and the desired results of the study.
Part of critical appraisal is to identify potential biases in order to evaluate the
validity of a study.
Common Types of Bias
Conflict of Interest Bias – researcher benefits from results
or funding entity benefits from results
Wrong Sample Size – usually due to small sample size
Positive Results Bias – results are more likely to be
published because they are positive
Correlation Bias – results appear to correlate but actually
do not, statistically
Missing Clinical Data Bias – data can be erroneously or
Searching for the Best Evidence
• CINAHL – Nursing literature
• Cochrane – Systematic Reviews
• PubMed – Clinical Queries
• National Guidelines Clearinghouse:
• Agency for Healthcare Research and Quality:
• National Institute of Nursing:
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