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Primary literature
Primary sources are the authentic publication of an expert's new evidence, conclusions and proposals (case reports, clinical trials, etc) and are usually published in a peer-reviewed journal. Preliminary reports, congress papers and preprints also constitute primary literature.
Secondary literature
Secondary sources are systematic review articles or meta-analyses where material derived from primary source literature are inferred and evaluated.
Tertiary literature
Tertiary literature consists of collections that compile information from primary or secondary literature (eg., reference books)
Grewal A, Kataria H, Dhawan I. Literature search for research planning and identification of research problem. Indian J Anaesth. 2016;60(9):635-639. doi:10.4103/0019-5049.190618
--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: 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.
"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
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.
Boolean searching is the traditional way to search for information in most online databases and on the Internet. Boolean operators or connector words, such as AND, OR, and NOT, are used to create phrases and concepts based on specific rules of search logic.
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