Evidence-Based Practice (EBP) is the judicious use of the best research evidence (found in health sciences literature), clinical expertise (what the health provider knows), and patient values (what the patient wants and believes) to create a plan of action regarding patient care.
The EBP Process can be summarized in 6 steps:
Adapted from: 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. Am J Nurs, 110(1), 51-53. doi: 10.1097/01.NAJ.0000366056.06605.d2
Two additional elements of the well-built clinical question are the type of question and the type of study. This information can help focus the question and determine the most appropriate type of evidence or study.
For a definition of study types see the Useful Definitions Tab on the EBP Page.
THERAPY (treatment)
How to select treatments that do more good than harm and are worth the efforts and costs
Explanation
Type of Study
Randomized controlled trial, cohort study
DIAGNOSIS
How to select and interpret diagnostic tests
Example of a Diagnosis Question
Explanation
Type of Study
Prospective, blind comparison to a gold standard or cross-sectional
PROGNOSIS (forecast)
How to estimate the patient’s likely clinical course over time (based on factors other than the intervention) and anticipate likely complications of disease.
Example of a Prognosis Question
Explanation
Type of Study
Cohort study, case control, case series
HARM/ETIOLOGY (causation)
How to identify causes for disease (including iatrogenic forms)
Example of an Etiology Question
Explanation
Type of Study
Cohort study, case control, case series
Adapted from: Fineout-Overholt, E. & Johnston, L. (2005), Teaching EBP: asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing, 2, 157–160. doi: http://dx.doi.org/10.1111/j.1741-6787.2005.00032.x
Formulating Answerable Clinical Questions is the Foundation of EBP!
Every time we see a patient, we need new information about some element of the diagnosis, prognosis or management. Because our time to try to find this information is often limited, we need to be very efficient in our searching. To achieve this efficiency, we need to become skilled at formulating clinical questions.
Is your clinical question answerable?
Express your clinical question in the PICO format
The PICOT terms come from and should match your clinical question.
Systematic reviews or meta-analyses are regarded as the strongest level of evidence on which to base treatment decisions, however, there are different levels of evidence for each kind of PICOT question.
Refer to the PICOT page on this guide for more information.
As you move down this list, the study designs are less rigorous and allow for more bias or systematic error that may distract you from the truth.
Adapted from Duke Library's EBP Tutorial: Introduction to Evidence-Based Practice http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036002
Your textbook covers the different clinical case studies used in evaluating and informing evidence-based practice. While not exhaustive, the most common case studies are:
Review the following PowerPoint for an overview of each case study in a nutshell:
Where you look for information is determined by what kind of question you are asking. One way of classifying your question is to ask whether you are seeking background information or foreground information.
Background information is sought when a learner has general clinical questions regarding a topic such as what is the disorder; what causes it; how does it present; what are some treatment options. These questions can be answered by using "background" resources such as textbooks (both in print and electronic) and narrative reviews in journals which give a general overview of the topic.
Foreground information answers specific questions a clinician has regarding a specific patient. Foreground resources can be divided into primary sources such as original research articles published in journals; and secondary sources such as systematic reviews of the topic, and synopses and reviews of individual studies.
Critical appraisal is a systematic process of analyzing research to assess methods, validity and usefulness.
The key questions in critical appraisal are:
Why was the study done?
What type of study was done?
What are the study characteristics?
What was done to address bias?
What are the results and are the results valid?
What conclusions can you make?
Adapted from: Voutier, C. (2013). Critical appraisal. Evidence Direct: A Service of the RMH Health Sciences Library. Retrieved 17 December 2015 from: http://library.mh.org.au/index.php?option=com_content&view=article&id=272&Itemid=537