Evidence-Based Practice: An Essential Foundation for Nursing and Clinical Care

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.

The Importance of a Spirit of Inquiry

Igniting a spirit of inquiry is an essential foundation for evidence-based practice because clinicians often follow outdated policies and procedures without questioning their current relevance or accuracy, or the evidence for them. Evidence-based practice must be threaded throughout nursing curricula to produce critically-thinking professional nurses who will be meeting new and significant health-care challenges. The responsibility of preparing competent nursing graduates rests not merely with the students but nurse educators and the degree to which the curriculum they teach is evidence-based.

The Process: Asking and Acquiring Evidence

To begin the process, first you need to define a problem and formulate a question. In the clinical setting, ‘asking a question’ may lead to evidence-based practice. A commonly used format for creating a clinical question is known as PICO(T). The following table identifies the components of this framework:

Key Databases for Evidence Retrieval

The following Databases are ideal for finding evidence based literature:

• CINAHL Complete (EBSCO): Limit your results before you search by checking the box next to evidence-based practice.
• Ovid MEDLINE: This covers the international literature on biomedicine, including the allied health fields and the biological and physical sciences.
• Cochrane Library (Wiley): Contains the Cochrane Database of Systematic Reviews, which focuses on the effects of healthcare.
• Trip: A clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice.

Assessing Results and Appraising Studies

Depending on your research question, you need to address what type of study would provide the best evidence. Databases often have filters allowing you to acquire specific types of studies, such as:

• Systematic Review: It is an intensive review of the literature on a given topic that uses explicit and rigorous methods to identify and synthesize studies.
• Meta-Analysis: These overview extensively the literature on a topic, but they combine the results of all the studies identified in a quantitative way.
• Randomized Controlled Trial (RCT): Utilized to provide examples of high-quality evidence for clinical scenarios.

Overcoming Implementation Barriers

Identification of nurses' readiness in implementing EBP can facilitate changes to EBP practice development and design strategies needed before adopting EBP. Findings demonstrated that education can affect the nurse’s belief/attitude and intent to use EBP. In summary, there are a variety of strategies that can be used to overcome barriers to implementing EBP in nursing, even when implementation barriers and contextual factors may have limited potential outcomes.