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Lesson 3
Describing the Steps of Evidence-based Practice©
Barbara B. Pieper, PhD, RN
LEARNING OBJECTIVE
The learner will be able to list the steps of EBP.
EBP is what we call a systematic process, that is, there are predefined steps that guide the clinician. This lesson will describe each of these steps in more detail, but the subsequent lessons will go into more depth. Our goal is that you can become more proficient as you move along in the series.
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EBP’s 5 critical steps:
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The first step is asking the question. Most scientists begin their inquiry by taking their curiosity or puzzlement over a situation and honing it into a scientific or researchable question. As a science-based process, EBP does the same thing. This step will give you clarity and the right focus as you begin EBP. Your question will answer: ”who” ( people of interest) , “what”(what intervention), “when”( where and when it will be applied), and “how” ( how you will measure its effects) of your topic (Houser & Bokovoy,2006). See Lesson 5 to learn how to form a question.
- Finding the best and most relevant evidence to answer your question is the next step and can take you into a variety of resources. It’s important that you find the most current and valid evidence to apply to your clinical problem. Lesson 6 will demonstrate how to search the literature for evidence. Not all evidence is equal and there’s a hierarchy of best evidence. For example, an existing guideline based on evidence; or a systematic review ( a synthesis of studies evaluating the effectiveness of an intervention), or a randomized control trial studies (RCT’s), are considered some of the best evidence. Many clinicians have the perception that this is a time consuming, endless process. It’s important that you learn to use time-efficient approaches to gathering evidence. You’ll learn more about this in Lesson 6.
- Critically appraising evidence. Even though research is published, you’ll have to evaluate the quality of the evidence before adopting it. There are 3 questions which generally guide the appraisal: what were the results of the study, are the results valid ( i.e. was it a good study ?), and will the results benefit the patients I work with (i.e., were the subjects similar to my patients and will the benefits out-weight the risks). See Lesson 7 for more information on critical appraisal of evidence.
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Integrating the evidence. Research evidence does not stand alone in practice. Here is where the clinician’s judgment and contextual understanding of your unique situation come into play. In this step, the nurse takes the information from the literature, but also considers the patient’s present clinical status, their values and life circumstances, along with the organization’s resources and makes a judgment about whether to use the intervention. This is the decision-making process of EBP. This will be discussed in greater detail in Lesson 9 and Lesson 11.
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Evaluating the effectiveness of the EBP intervention. This step is always central to practice; we learn by evaluating whether our intervention worked as planned. Outcome analysis asks whether the treatment produced the expected results, and if not, what might be an alternative explanation. Answering this question not only adds to our repertoire of clinical experience but helps us understand how the intervention worked in our population. Refer to Lesson 8 for more information about these processes.
Following the 5 step systematic plan for approaching EPB care makes it manageable and efficient. These steps are designed to facilitate bringing the best knowledge available to solve patient’s problems.
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