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Library Homepage: Evidence Based Practice

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Evidence Based Practice

Evidence based practice (EBP) has many definitions. A widely cited definition is adapted from this definition of evidence based medicine (EBM):
"the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research"     (Sackett et al, 1996)

However, many have argued that this definition has flaws, and have offered alternatives. This one highlights the need for nurses to integrate the evidence with their own professional judgement with the patient's preferences:
"an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best"   (Muir Gray, 1997)

The practice of Evidence-Based Practice is generally based on five fundamental steps.

Step 1: Formulating a well-built question
Step 2: Identifying articles and other evidence-based resources that answer the question (Finding the evidence)
Step 3: Critically appraising the evidence to assess its validity
Step 4: Applying the evidence
Step 5: Re-evaluating the application of evidence and areas for improvement

 

Levels and quality of evidence

Levels of evidence

Reference: Evidence-Based Practice in the Health Sciences: Evidence-Based Nursing Tutorial, Information Services Department of the Library of the Health Sciences-Chicago, University of Illinois at Chicago. Creative Commons License

 


Sources:
Muir Gray, J.A. (1997) Evidence-based health care: how to make health policy and management decisions. London: Churchill Livingstone.

Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence based medicine: what it is and what it isn't. British Medical Journal, 312(7023), 71-72.

PICO
The first stage of any evidence-based practice process is formulating an answerable question. This forms the foundation for quality searching. A well-formulated question will facilitate the search for evidence and will assist you in determining whether the evidence is relevant to your question.
An answerable question has a format that follows the PICO concept. The acronym translates to:

P – populations/people/patient/participants/problem

I – intervention(s)

C – comparison

O – outcome

Now that you have formulated your question, and have your search strategy, where do you go to find your information?

Refer to notes on literature searching under Research Help for guidance on searching the Databases at St Vincent's Hospital Melbourne.

Need assistance in doing a literature search?
Ask a Librarian to book a tutorial on searching the databases on a particular topic of interest to you.
Fill out a Literature Search request form and a Librarian will carry out a search of the databases on your behalf.
Your search results will be sent to you as an EndNote file, learn about using EndNote to organise your references.

Critical appraisal uses intrinsic (e.g. research design) not extrinsic (e.g.author, journal, institution) factors which is more commonly used in evaluating web sites.

When appraising an article, it needs to meet the following three requirements:

  • Quality (the methodology should include trials that are randomised and double blind to avoid selection and observer bias)
  • Validity (trials need to mimic clinical practice, or used in clinical practice, with outcomes that make sense)
  • Reliability (trials are credible and repeatable)

There are a number of checklists / tools available on the Internet to assist you in undertaking critical appraisal of evidence. Some examples:

How to use the evidence: assessment and application of scientific evidence (Australian Medical Research Council)
This handbook focuses on how to evaluate and use the evidence gathered from a systematic literature review to inform the development of evidence-based clinical guidelines.

 

Books in the Carl de Gruchy Library (a selection)

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