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Nursing Practice: Evidence-Based

Quality of Evidence

According to Mosby's Dictionary of Medicine, Nursing and Health Professions:

Evidence-based practice is "the practice of health care in which the practitioner systematically finds, appraises, and uses the most current and valid research findings as the basis for clinical decisions".

In order to promote the principles, teaching and implementation of evidence-based practice, a consensus statement was agreed by delegates at the second international conference of Evidence-Based Healthcare Teachers and Developers held in Sicily in September 2003. The group agreed that evidence-based practice (EBP) requires that decisions about healthcare are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources (Margaret Edwards, Key Concepts in Nursing, 2012).

EBP ranks the quality of evidence by levels as seen in the image to the right. As you move from Level VII at the bottom to Level I at the top, the quality of the evidence increases. For more information on the different Levels of Evidence, see the image to the right and the link below.

Evidence-Based Keyword Search

To find EBP articles in the CCBC databases, use these keywords in addition to your topic. For example, you can search Lumbar Stenosis AND Clinical Trial together.

Qualitative Keywords Quantitative Keywords
Case Study Survey
Interview Sampling
Focus Group Experiment
Observation Clinical Trial
Narrative Statistics

Evidence-Based Nursing Research Question

Your question needs to identify the key problem of the patient, what treatment or tests you are considering for the patient, what alternative treatment or tests are being considered (if any) and what is the desired outcome to promote or avoid. Remember PICO!

P= Patient Problem:

How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the gender, age or race of a patient might be relevant to the diagnosis or treatment of a disease.

I= Intervention, prognostic factor or exposure: 

Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery? Or what factor may influence the prognosis of the patient - age, co-existing problems, or previous exposure? 

C= Comparison: 

What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests? Your clinical question may not always have a specific comparison.

O= Outcome: 

What can you hope to accomplish, measure, improve or affect? What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events? Improve function or test scores?

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