What is Evidence Based Practice and Why is it Important?

Evidence based practice (EBP) has become an integral part of healthcare and nursing in recent years. But what exactly is it, and why is it so important? In this article, we’ll take a deep dive into understanding evidence based practice

What is Evidence Based Practice?

Evidence based practice is the process of making clinical decisions based on the best available research evidence, rather than basing decisions on habits, traditions, or instinct. The goal of EBP is to deliver the highest quality care to patients by ensuring that clinical practices are supported by sound science.

EBP follows a systematic process of asking a question finding the best available evidence critically appraising the evidence, applying the evidence, and evaluating the outcomes. It integrates three key components

Best available research evidence from well-designed studies
Clinical expertise of practitioners
Patient preferences and values

By combining these three elements, EBP allows nurses and other clinicians to make the best possible decisions about patient care, leading to improved outcomes.

The Origins of Evidence Based Practice

While EBP has gained significant momentum in the past couple of decades, its origins can be traced back much farther. In the 1840s, Ignaz Semmelweis implemented hand washing protocols among doctors after finding that it dramatically decreased mortality rates of new mothers. This is one of the earliest examples of basing practice on evidence from research.

In the early 1900s, the anesthesiologist Harvey Cushing maintained detailed patient records that he used to make clinical decisions and improve outcomes. He is considered the first clinician in the United States to practice evidence based medicine.

In the 1970s, Archie Cochrane called for more emphasis on using randomized controlled trials to guide medical practice. This laid important groundwork for evidence based practice as we know it today.

By the 1990s, EBP gained widespread support and was promoted across various health disciplines as the gold standard for clinical decision making. Major health organizations endorsed EBP, cementing its place in healthcare.

The Process of Evidence Based Practice

While EBP may sound straightforward in theory, implementing it effectively requires following a systematic process. Let’s break down the key steps:

Step 1: Ask a Focused Clinical Question

This kickstarts the EBP process. The question should be specific to the clinical problem at hand and use the PICO format:

P – Patient/Problem
I – Intervention
C – Comparison intervention (if applicable)
O – Outcome

For example: “In adult patients with diabetes (P), does patient education about diet and exercise (I) compared to standard treatment alone (C) improve HbA1c levels (O)?”

Asking a well-constructed PICO question lays the groundwork for finding relevant evidence.

Step 2: Find the Best Available Evidence

Now it’s time to search the literature for evidence that can help answer the clinical question. The best evidence comes from well-designed studies such as randomized controlled trials and systematic reviews. Sources like MEDLINE, CINAHL, and the Cochrane Library are good places to search.

It’s important to use keywords and limits to find the most relevant, high-quality studies on your specific topic. Don’t rely on quick Google searches – databases like MEDLINE allow much more precision.

Step 3: Critically Appraise the Evidence

Not all evidence is created equal. Once you find research studies, you need to critically analyze them to determine if they are valid and applicable to your clinical question. Things to evaluate include:

Was the study design appropriate to answer the question?
Were patients similar to yours?
Were all important outcomes considered?
Are the study results consistent with other evidence?
Do the benefits outweigh any risks or costs?

Looking at these parameters helps determine if the study results should guide your clinical decisions.

Step 4: Integrate the Evidence

Now comes the fun part – taking the research evidence and applying it to real patient care! Consider how the evidence fits with your clinical expertise, patient preferences, and the resources available in your practice setting.

Develop an evidence-based care plan for the patient. Make sure to discuss options and get patient buy-in. This is key for optimal adherence and outcomes.

Step 5: Evaluate Outcomes

EBP is an ongoing process. After implementing evidence-based care, you must evaluate how it impacts patient outcomes. Monitoring outcomes will tell you if the new evidence-based approach should be continued or if you need to make modifications.

Critical reflection after applying evidence is key to honing clinical expertise and providing the highest quality of care. Then the cycle repeats with new clinical questions!

Barriers to Evidence Based Practice

While most agree that EBP is beneficial, implementing it consistently presents challenges:

Time constraints – Busy schedules make it hard to find time to search literature and appraise evidence thoroughly.
Insufficient research skills – Many clinicians lack expertise in finding and analyzing research.
Organizational barriers – Some settings lack resources to enable EBP or have cultures that resist changing practice.
Overwhelming volume of publications – The sheer amount of literature and new studies coming out daily can be daunting.
Difficulty applying group evidence to individual patients – Research studies evidence may not perfectly fit an individual patient’s specific circumstances.

Strategies to Promote Evidence Based Practice

Here are some tips to promote EBP in your organization:

Provide EBP education and mentoring, particularly for new staff.
Develop journal clubs to review and discuss relevant studies.
Make high-quality evidence resources readily available.
Allow time in schedules for literature searches and critical appraisal.
Foster a culture that supports changing practice based on new evidence.
Involve staff in identifying organizational barriers and solutions.
Recognize clinicians who consistently demonstrate EBP.

The Role of Nurses in Evidence Based Practice

Nurses are crucial to advancing evidence based practice. With their frontline clinical experience, nurses are in an excellent position to identify relevant practice questions. Nurses can spearhead efforts to find and implement evidence to improve patient care and outcomes.

Ways nurses can promote EBP include:

Asking meaningful clinical questions.
Conducting literature searches and sharing evidence with team members.
Ensuring practice changes adhere to evidence.
Collecting patient outcome data.
Acting as EBP mentors to educate colleagues.
Serving on EBP or research councils.

EBP empowers nurses to drive changes that can improve healthcare delivery and patient outcomes within their organizations.

Why Evidence Based Practice Matters

The benefits of consistently applying EBP include:

Improved quality of care – Care is more likely to be effective when based on sound science.
Better patient outcomes – Adhering to evidence can prevent complications and improve recovery.
Improved patient safety – Basing care on evidence helps avoid preventable errors and adverse events.
Better use of resources – EBP helps ensure efforts go toward care that works, avoiding waste.
Informed patient choices – Patients can make educated decisions when options are evidence-based.
Improved clinician confidence – Nurses feel more assured implementing practices backed by solid evidence.
Stimulated critical thinking – The EBP process promotes critical appraisal and clinical judgment skills.
Enhanced professional development – EBP promotes career-long learning.
Progress in quality care – EBP advances nursing’s commitment to deliver top-quality, up-to-date care.

The Future of Evidence Based Practice

While EBP has come a long way, there is still room for growth. Some emerging areas to watch include:

Expanding EBP mentoring and education for novice clinicians.
Increased focus on patient-centered outcomes research.
Promoting point-of-care access to evidence through technology like apps.
Addressing barriers to implementation and consistency of EBP.
Synthesizing different types of evidence like practice guidelines, quality metrics, and patient values.
Growing patient involvement in generating EBP questions and applying evidence.

The healthcare landscape will continue to evolve, but EBP will remain a central pillar for ensuring optimal practices and patient outcomes. Nurses play a vital role in driving EBP forward. Through asking questions, seeking evidence, and evaluating outcomes in their daily practice, nurses can realize EBP’s full potential to transform care.

Evidence based practice upends old notions of basing healthcare merely on tradition or opinion. Guided by science, EBP elevates healthcare quality, safety, and value to new levels. While barriers exist, nurses can champion EBP by honing skills in finding and applying evidence and being change agents within organizations. With their clinical expertise on the frontlines of care, nurses are perfectly positioned to propel EBP into the future. Adopting an EBP approach takes dedication, but the significant benefits for patients make the effort more than worthwhile.

what is evidence based practice

How to apply EBP in clinical practice

Evaluating all of the available evidence on a subject would be a nearly impossible task. Luckily, there are a number of EBP processes that have been developed to help health care providers implement EBP in the workplace.

The most common process follows these six steps:

1. ASK a question. Is there something in your clinical setting that you are wondering about? Perhaps you wonder if a new intervention is more effective than the one currently used. Ask yourself: What works well and what could be improved? And, more importantly, WHY? Evaluate the processes and workflow that impact, or are impacted by, the identified practice gap. We’ll use a format called PICO(T) (pronounced “pee ko”). Learn more about PICOT questions in the next module.

2. ACQUIRE the current evidence. You’ll do this by conducting a literature search. Your search will be guided by your clinical question.

3. APPRAISE the literature. Or, in other words, sort, read, and critique peer-reviewed literature.

4. APPLY your findings to clinical decision-making. Integrate the evidence with clinical expertise and patient preferences and values. Then make evidence-based recommendations for day-to-day practice.

5. EVALUATE your outcomes. Review data and document your approach. Be sure to include any revisions or changes. Keep close tabs on the outcomes of your intervention. Evaluate and summarize the outcome.

6. DISSEMINATE the information. Share the results of your project with others. Sharing helps promote best practices and prevent duplicative work. It also adds to the existing resources that support or oppose the practice.

Though we may learn how to apply EBP by participating in project-based work, integrating EBP in our daily practice can help us strive to achieve the best possible patient outcomes. It requires us to be thoughtful about our practice and ask the right questions.

Its important to note that although applying evidence at the bedside can be conducted individually, working collaboratively as a team is more likely to result in lasting improvement.

As health care providers, delivery of patient care should stimulate questions about the evidence behind our daily practice.

For instance, there was a time when neutropenic patients were placed in strict isolation to protect them from developing life-threatening infections. Research findings were evaluated for best evidence and it was noted that using strict isolation precautions did not result in more favorable patient outcomes when compared to proper handwashing procedures coupled with standard precautions—and it seemed that we unnecessarily subjected patients to the negative psychological effects caused by extreme isolation.

As clinicians, we sometimes follow outdated policies or practices without questioning their relevance, accuracy, or the evidence that supports their continued use.

What’s the difference between research and EBP?

There is a common misconception that EBP and research are one in the same. Not true! While there are similarities, one of the fundamental differences lies in their purpose. The purpose of conducting research is to generate new knowledge or to validate existing knowledge based on a theory. Research involves systematic, scientific inquiry to answer specific questions or test hypotheses using disciplined, rigorous methods. For research results to be considered reliable and valid, researchers must use the scientific methods in orderly, sequential steps.

Research	Evidence-based Practice
To generate new knowledge or validate existing knowledge based on theory.	To use best available evidence to make informed patient-care decisions.

In contrast, the purpose of EBP isn’t about developing new knowledge or validating existing knowledge—it’s about translating the evidence and applying it to clinical practice and decision-making. The purpose of EBP is to use the best available evidence to make informed patient-care decisions. Most of the best evidence stems from research, but EBP goes beyond research and includes the clinical expertise of the clinician and healthcare teams, as well as patient preferences and values.

What is Evidence-Based Practice?

What is evidence-based practice?

Int J Environ Res Public Health. 2021 Jan; 18 (1): 293. Evidence-based practice (EBP) prevents unsafe/inefficient practices and improves healthcare quality, but its implementation is challenging due to research and practice gaps. A focused educational program can assist future nurses to minimize these gaps.

What is evidence based practice (EBP)?

1. Introduction Evidence-based practice (EBP) is defined as “clinical decision-making that considers the best available evidence; the context in which the care is delivered; client preference; and the professional judgment of the health professional” [ 1] (p. 2).

What is evidence-based medicine?

Evidence-based medicine is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research.

Where can I find evidence based practice?

Contact the Evidence-based Practice Council (U of U Health) An interprofessional collective dedicated to incorporating evidence-based practice into daily work. Clinical Skills: Clinical Staff Education (U of U Health) The “Clinical Skills” tab offers a host of evidence-based practice changes to start applying today.