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Evidence Based Nursing Research

A guide to Library and Web resources focused on the field of nursing, as well as broader medical topics.

Table 1. The Seven Steps of Evidence-Based Practice

7 Steps to the Perfect PICO Search in EBSCO Databases - PICO and Levels of Evidence

Step 0: Cultivate a spirit of inquiry along with an EBP culture and environment
Step 1: Ask the PICO(T) question
Step 2: Search for the best evidence (Ask a Librarian for Expert Assistance)
Step 3: Critically appraise the evidence
Step 4: Integrate the evidence with clinical expertise and patient preferences to make the best clinical decision
Step 5: Evaluate the outcome(s) of the EBP practice change
Step 6: Disseminate the outcome(s) (Melnyk & Fineout-Overholt, 2011)

American Journal of Nursing - Free online articles on nursing evidence-based practice methodologies.

Source: Melnyk, B.M., Gallagher-Ford, L., Long, L.E. & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews On Evidence-Based Nursing, 11(1), 5-15. https://doi.org/10.1111/wvn.12021

Table 1. Evidence-Based Practice Competencies for Practicing Registered Nurses (Copyright: Melnyk, Gallagher-Ford, Long, & Fineout-Overholt 2014))

1. Questions clinical practice for the purpose of improving the quality of care.
2. Describes clinical problems using internal evidence.* (internal evidence* = evidence generated internally within a clinical setting, such as patient assessment data, outcomes management, and quality improvement data)
3. Participates in the formulation of clinical questions using PICOT* format. (*PICOT = patient population; intervention or area of interest; comparison intervention or group; outcome; time). 
4. Searches for external evidence* to answer focused clinical questions. (external evidence* = evidence generated from research).
5. Participates in critical appraisal of preappraised evidence (such as clinical practice guidelines, evidence-based policies and procedures, and evidence syntheses).
6. Participates in the critical appraisal of published research studies to determine their strength and applicability to clinical practice
7. Participates in the evaluation and synthesis of a body of evidence gathered to determine its’ strength and applicability to clinical practice.
8. Collects practice data (e.g., individual patient data, quality improvement data) systematically as internal evidence for clinical decision making in the care of individuals, groups and populations.
9. Integrates evidence gathered from external and internal sources in order to plan evidence-based practice changes.
10. Implements practice changes based on evidence and clinical expertise and patient preferences to improve care processes and patient outcomes
11. Evaluates outcomes of evidence-based decisions and practice changes for individuals, groups and populations to determine best practices.
12. Disseminates best practices supported by evidence to improve quality of care and patient outcomes.
13. Participates in strategies to sustain an evidence-based practice culture.

Source: Melnyk, B.M., Gallagher-Ford, L, Zellefrow, C., Tucker, S., Thomas, Bl, Sinnott, L.T., & Tan, A.  (2018) The first U.S. Study on Nurses' Evidence-Based Practice Competencies Indicates Major Deficits That Threaten Healthcare Quality, Safety and Patient Outcomes. Wordviews On Evidence-Based Nursing, 15(1), 16-25. https://doi.org/10.1111/wvn.12269