Q: What are the basic concepts of evidence-based practice?

A: Evidence-based practice (EBP) is a tactic for improving healthcare delivery using validated evidence, systematic decision-making, clinical expertise, and patient preference in determining the best practices. Archie Cochrane, an English physician, is viewed as the founder of EBP by many disciplines, but nursing credits Florence Nightingale with pioneering the utilization of foundational EBP components during her work in the Crimean War.1,2 The goal of healthcare is to expand access to care, improve the quality and safety of care, and improve population health. These foundations are strengthened and supported by the application of EBP. Boswell and Cannon define EBP as "the process of using confirmed evidence (research and QI), decision-making, and nursing expertise to guide the delivery of holistic patient care."3 EBP acts as the umbrella framing the inquisitive thinking that occurs throughout the patient-care process. The goal of EBP is to improve patients' inclusive care based on safe practices while decreasing costs and discrepancies in health outcomes.4

Steps for EBP

The crucial steps for a successful EBP project include:

1. Asking the best questions. Questioning processes used in the delivery of healthcare is imperative. EBP sets the stage for investigation. If nurses are having to do "work arounds" to get a job done, their process isn't working. Use the PICOT (Population, Intervention, Comparison Intervention, Outcome, Time) framework to ask the right questions. PICOT questions must be answerable. (See Did you know?)

2. Researching the current confirmed evidence. Once you know what you're investigating, take the time to research what's currently understood about the process that's being evaluated. All confirmed evidence should be considered. Confirmed evidence is that content that has been tested and validated as functional management for the question/content being investigated. It can be research articles along with quality improvement results that can be used as the foundation for best practices.

3. Analyzing the evidence. Consider whether the evidence you found in your research is applicable to the PICOT questions you're asking. Analyze the validity of the evidence you found and determine whether it relates to the issue you're addressing in your EBP project. Many different ranking tools are available to use when analyzing the evidence such as Johns Hopkins Nursing Evidence-Based Practice, the Association of periOperative Registered Nurses ranking tool, the US Preventive Services Task Force Levels of Evidence, the TRIP Medical Database, Joanna Briggs Institute FAME (feasibility, appropriateness, meaningfulness, effectiveness), and the American Association of Critical Care Nurses evidence ranking system.

4. Incorporating the findings. Once the evidence has been diligently evaluated, consider how your analysis of the research findings applies to your individual work culture and environment. Each clinical setting is unique, and factors such as your local environment and patient preferences may affect how you integrate your findings to improve your healthcare system.

Evaluation and dissemination of the EBP process

The final two steps within EBP necessitate the evaluation and dissemination of the findings from your EBP project. Without these two steps, nursing wouldn't advance its knowledge base. According to McClinton, "Nurses share a responsibility in continuing to question practice when outcomes are less than the standard of care."5 For the nursing profession to advance and embrace optimum patient care, each nurse must become proficient in asking challenging questions and seeking the safest and most beneficial care processes. Nurses don't have the time or energy to keep learning the same things repeatedly. By using EBP, nurses build on the findings of others to advance the quality of patient care.

Conclusion

Each step within the EBP process serves a distinct role in the improvement of healthcare. Carefully preparing the PICOT question to investigate a specific health challenge is imperative. Once a solid PICOT question is determined, collecting the current evidence on the subject establishes a foundation upon which the study of the subject can be expanded. Once that foundation is established, you can analyze the current evidence and begin to conceptualize what's needed to address and improve the healthcare challenge. The evaluation and dissemination of your findings from the EBP process can allow for the growth of nursing knowledge to address patient safety issues, cost issues, and health management efforts.

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