1. Drake, Kirsten DNP, RN, OCN, NEA-BC

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Decision making and EBP

Q Do you have to follow the evidence-based practice (EBP) process for every decision?

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Nurses may have misconceptions about using EBP, which can be a challenge for nurse leaders. Common misunderstandings include that EBP is solely research-based and it's "cookbook" nursing that disregards individualized patient care.1 As nurse leaders, we need to be educated so that we can decrease these misconceptions.


For the purposes of this discussion, we'll use a widely accepted definition of EBP: the "integration of best research evidence with clinical expertise and patient values."2 The EBP process is a problem-solving method for clinical decision making. For example, consider the following six steps:3


1. Assess the patient and determine the care problem.


2. Ask a clinical question using the PICO format (patient, population, or problem of interest; intervention or prognostic factor being considered; comparison or intervention; outcome measured).


3. Acquire evidence by selecting resources and research.


4. Appraise the evidence for validity and usefulness for the patient situation.


5. Apply the information in practice. This collaboration occurs using the nurse's clinical knowledge and the patient's preferences or values.


6. Evaluate the intervention.



The attractiveness of this model is that it revolves around the patient. Nurse leaders needing to make decisions about the patient care provided in their area can easily use this model. An important factor to remember is that this is a process and processes take time. Plan ahead by asking nurses to develop PICO questions based on their patient assessments. Then, as a team working through the EBP process, several staff members can apply the new practice. Evaluation of the intervention can be discussed with the team to determine whether it was successful. If the intervention or change wasn't successful, the question can be reasked or other resources examined. If it was successful, the practice can be disseminated for all patients to benefit.


But do you have to follow the EBP process for every decision? The answer is actually "no." Let's look at some examples. Making a financial decision for your work environment may require a cost-benefit analysis technique. In this process, you brainstorm the costs and benefits, assign both monetary values, compare the two, and then make a decision. If you're a new leader in an area where you were "gifted" with multiple problems, using a Pareto Analysis may assist with decision making. This is also a six-step process: 1. identify and list problems; 2. complete a root cause analysis (RCA) of the problems; 3. score the problems; 4. group the problems by RCA; 5. add the scores within the RCA groups; and 6. decide which problem to address based on the highest score and take action.


As nurse leaders, we're challenged with many different decision-making situations. When faced with clinical decision making, the EBP process is a prevailing standard; the more complex the clinical problem, the more appropriate the use of the EBP process. When making nonclinical decisions, evaluate each situation and use the most suitable tool(s).




1. DiCenso A, Cullum N, Ciliska D. Implementing evidence-based nursing: some misconceptions. Evidence-Based Nursing. 1998;1(2):38-39. [Context Link]


2. Sackett DL, Straus SE, Richardson SW, Rosenberg, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Edinburgh: Churchill Livingstone; 2000. [Context Link]


3. Duke University Medical Center. What is evidence-based practice (EBP)? [Context Link]