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Evidence Based Practice: Overview

The EBP Process

The EBP Process

--Bernadette Mazurek Melnyk, Lynn Gallageher-Ford, Ellen Fineout-Overholt, Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare: a Practical Guide for Improving Quality, Safety, and Outcomes, 2016.

Click the tabs below to find articles about each step in the process.

Step 0: Cultivate a spirit of inquiry within an EBP culture and environment

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-Based practice:  Step by Step: Igniting a spirit of inquiry. AJN The American Journal of Nursing, 109(11), 49-52.
 

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: step by step: Is accessing articles from off -campus you will need a MCW email account or a MCW Libraries Proxy ID to sign in.the seven steps of evidence-based practice AJN The American Journal of Nursing, 110(1), 51-53.

 

Step 1: Ask the burning question in  PICO(T) format.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Asking the clinical question: a key step in evidence-based practice..AJN The American Journal of Nursing, 110(3), 58-61.

Step 2: Search for and collect the most relevant best evidence.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010).  Evidence-based practice, step by step: searching for the evidence.AJN The American Journal of Nursing, 110(5), 41-47.

Step 3: Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, synthesis, and recommendations)

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. AJN The American Journal of Nursing, 110(7), 47-52.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence: Part II: Digging deeper—examining the" keeper" studies. AJN The American Journal of Nursing, 110(9), 41-48.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence Part III. AJN The American Journal of Nursing, 110(11), 43-51.

Armola RR, Bourgault AM, Halm MA, Board RM, Bucher L, Harrington L, Heafey CA, Lee R, Shellner PK, Medina J. (2009) AACN levels of evidence: what's new?  J.Crit Care Nurse. Aug;29(4):70-3.

 

Step 4: Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change.

Fineout-Overholt, E., Williamson, K. M., Gallagher-Ford, L., Melnyk, B. M., & Stillwell, S. B. (2011). Evidence-based practice, step by step: following the evidence: planning for sustainable change. AJN The American Journal of Nursing, 111(1), 54-60.

Gallagher-Ford, L., Fineout-Overholt, E., Melnyk, B. M., & Stillwell, S. B. (2011). Evidence-based practice, step by step: implementing an evidence-based practice change. AJN The American Journal of Nursing, 111(3), 54-60.

Gallagher-Ford, L., Fineout-Overholt, E., Melnyk, B. M., & Stillwell, S. B. (2011). Evidence-Based Practice, Step by Step: Rolling Out the Rapid Response Team. AJN The American Journal of Nursing, 111(5), 42-47.

Brown CG.(2014) The Iowa Model of Evidence-Based Practice to Promote Quality Care: an illustrated example in oncology nursing. Clin J Oncol Nurs. Apr;18(2):157-9.

Step 5: Evaluate outcomes of the practice decision or change based on evidence.

Fineout-Overholt, E., Gallagher-Ford, L., Melnyk, B. M., & Stillwell, S. B. (2011). Evidence-based practice, step by step: evaluating and disseminating the impact of an evidence-based intervention: show and tell. AJN The American Journal of Nursing, 111(7), 56-59.

Armola RR, Bourgault AM, Halm MA, Board RM, Bucher L, Harrington L, Heafey CA, Lee R, Shellner PK, Medina J. (2009) AACN levels of evidence: what's new?  J.Crit Care Nurse. Aug;29(4):70-3.

Step 6: Disseminate the outcomes of the EBP decision or change.

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Stillwell, S. B. (2011). Evidence-based practice, step by step: sustaining evidence-based practice through organizational policies and an innovative model. AJN The American Journal of Nursing, 111(9), 57-60.

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What is Evidence Based Medicine?

EBM"The integration of individual clinical expertise with the best available clinical evidence from systematic research."
David L Sackett, W Scott Richardson, William Rosenberg, Brian Haynes, Evidence Based Medicine--How to Practice and Teach EBM, 2000.
 

The process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions. Evidence-based medicine (EBM) follows four steps: formulate a clear clinical questions from a patient's problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful findings in clinical practice. 
Rosenberg W, Donald A. Evidence based medicine: An approach to clinical problem-solving. BMJ. 1995;310:1122-1126

EBM method (5 steps)

Step 1: Assess your patient and determine the pertinent issues. You may be looking for evidence about therapy options, prognosis or diagnostic techniques.

Step 2: Ask a clinical question. Use the PICO model to formulate a clear and concise clinical question.

Step 3: Acquire the best evidence. Search the appropriate databases and resources to find the best evidence.

Step 4: Appraise the evidence. Determine whether the information you found is relevant, valid and applicable to your patient.

Step 5: Apply the evidence to your patient. Ensure that the evidence and recommendations meet your patient's values and expectations.  

 

 

EBM Method

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