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Nursing -- Graduate Studies Research Guide

What is Evidence Based Practice

 

EBP is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system (Newhouse, Dearholt, Poe, Pugh, & White, 2007).

Dearholt, Sandra L., and Dang, Deborah. Johns Hopkins Nursing Evidence-Based Practice : Models and Guidelines (2nd Edition).

 

Practice - Develop and refine your question and your team

Evidence - Search, appraise, summarize and synthesize internal and external sources of evidence.

Translation - Create and implement an action plan, evaluate outcomes, disseminate findings.

Evidence Based Practice

Centre Evidence Based Medicine

Assess the quality of systematic reviews, diagnostic studies and randomized controlled studies.

Levels of Evidence

Descriptions of Levels of Evidence by clinical study category, and Grades of Recommendations

Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence 

PDF Levels of Evidence Table

Asking Focused Clinical Questions

Use to help you build a PICO question.

The Well Built Clinical Question

From the Introduction to Evidence Based Practice from Duke University Medical Center and Health Sciences Library At UNC, Chapel Hill.

Study Design

Clinical Question

Suggested Research Design(s)

All Clinical Questions

Systematic review, meta-analysis

Therapy

Randomized controlled trial (RCT), meta-analysis
Also: cohort study, case-control study, case series

Etiology

Randomized controlled trial (RCT), meta-analysis, cohort study
Also: case-control study, case series

Diagnosis

Randomized controlled trial (RCT)
Also: cohort study

Prevention

Randomized controlled trial (RCT), meta-analysis
Also: prospective study, cohort study, case-control study, case series

Prognosis

Cohort study

Also: case-control study, case series

Meaning

Qualitative study

Quality Improvement

Randomized controlled trial (RCT)
Also: qualitative study

Cost

Economic evaluation

Evidence Based Pyramid

The "evidence pyramid" is often used to illustrate the levels of evidence in the literature. When beginning your search for evidence, begin at the highest possible tier. 

Filtered information is "pre-appraised." This means that the content has been filtered to include studies and reviews that are of higher quality. Keep in mind that the amount of available literature and the number of problems covered gets smaller as you move up the pyramid.

Unfiltered information represents the original studies. These tiers may not contain studies of high quality and strong evidence, but they cover a much broader range of clinical problems and are much more available.

Levels of Evidence

 Nursing EBP: Levels of Evidence

Level I
Experimental study, randomized controlled trial (RCT)
Systematice review of RCTs, with or without meta-analysis

Level II
Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.

Level III
Non-experimental study
Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis.
Qualitative study or systematice review, with or without meta-analysis

Level IV
Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
    Includes:
         - Clinical practice guidelines
         - Consensus panels

Level V
Based on experiential and non-research evidence.
    Includes:
      - Literature reviews
      - Quality improvement, program or financial evaluation
      - Case reports
      - Opinion of nationally recognized expert(s) based on experiential evidence

From Johns Hopkins nursing evidence-based practice : Models and Guidelines
Dearholt, S., Dang, Deborah, & Sigma Theta Tau International. (2012). Johns Hopkins Nursing Evidence-based Practice : Models and Guidelines.

PICO

PICO is a mnemonic used to describe the four elements of a good clinical foreground question:

P = Population/Problem - How would I describe the problem or a group of patients similar to mine?

I = Intervention - What main intervention, prognostic factor or exposure am I considering?

C = Comparison - Is there an alternative to compare with the intervention?

O = Outcome - What do I hope to accomplish, measure, improve or affect?