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4 Ways to Make Evidence-Based Practice the Norm in Health Care
- Margaret M. Luciano,
- Thomas A. Aloia,
- Joan F. Brett
Make sure to consider local context.
It takes hospitals and clinics about 17 years to adopt a practice or treatment after the first systematic evidence shows it helps patients. Why such a long delay when patient health is on the line? Part of it is the challenge of adapting practices to fit the environment. Attempting to simply “plug in” a new practice often meets resistance from care providers. But deviating from the evidence-base can weaken the effectiveness of the practice and lessen the benefits. So leaders have to balance two conflicting needs: to adhere to standards and to customize for the local context. Researcher of organizational change suggest four approaches to help health care leaders adapt evidence-based practices while staying close to the foundational evidence. These approaches are based on an organization’s 1) data; 2) resources; 3) goals; and 4) preferences.
Evidence-based practice is held as the gold standard in patient care, yet research suggests it takes hospitals and clinics about 17 years to adopt a practice or treatment after the first systematic evidence shows it helps patients.
Why such a long delay when patient health is on the line? Part of it is the challenge of adapting practices to fit the environment. Attempting to simply “plug in” a new practice to a different hospital or clinic often conflicts with existing practices and meets resistance from care providers. But deviating from the evidence-base can weaken the effectiveness of the practice and lessen the benefits. Leaders have to balance two conflicting needs: to adhere to standards and to customize for the local context.
Based on our research on organizational change and our conversations with hundreds of healthcare providers, we’ve outlined four approaches to help health care leaders adapt evidence-based practices while staying close to the foundational evidence. These approaches are based on an organization’s 1) data; 2) resources; 3) goals; and 4) preferences. Each of these approaches has its own opportunities and challenges, and for any to succeed, it is necessary to understand the local context and the people in it. It is also important to consider any legal or professional guidelines that may restrict options. In practice the move to standardization and best practices reduces rather than creates risks, as they often replace idiosyncratic or outdated practices and preferences.
Understand the data: How relevant is the evidence-base to our local context?
Sometimes you need to adapt a practice because the data behind it doesn’t match your own context. What if the evidence-base is constructed from different patient populations, hospitals with different structures or cultures, or countries with different regulatory environments and payment structures? Some practices will be more generalizable than others (e.g., the evidence to support the importance of hand hygiene applies across most contexts), and understanding the data helps to objectively determine appropriate modifications (e.g., changing certain medication dosages based on patient age and BMI). When adapting evidence-based practices to the local context, it is important to consider what is similar, what is different, and why those might matter.
Leaders should also consider whether existing data is sufficient to support implementing a new practice (either in the original or modified form), or if additional data should be collected to verify the efficacy before a widespread roll-out. For example, enhanced recovery practices advocate for early patient ambulation after surgery. However, most of the initial research was conducted on young-adult patients, as opposed to elderly patients. Therefore, additional research was needed to understand whether the practice needed to be modified for a patient population that tends to be more frail and have a higher risk for falls. Notably, even after the adapted evidence-based practice is implemented, more data should be collected to enable ongoing reassessment and making adjustments if needed.
Look at your resources: How can we make substitutes without compromising results?
Sometimes organizations need to adapt based on resources. Are the specific resources used in the original implementation not feasible or desirable in one’s local context? Resources include infrastructure, supplies, space, and staff. For example, for many smaller hospitals, costs prohibit administering the same brand name drugs as major academic research hospitals. Accordingly, they may need to substitute and/or pair other medications to achieve equivalent effects.
Resource-related adaptations shift the reactions to evidence-based practices from “we don’t have the resources to do that” to “how can we apply these practices with the resources we do have?” Adaptations require understanding the purpose or goal of the new practice to determine the appropriate substitutes. For example, hospitals lacking sophisticated electronic health records may not be able to implement electronic patient smart order sets, but could still attain similar improvements in care coordination by using paper checklists. In making resource-based adaptions, collecting additional data on the customized resources can also help assure that substitutes achieve similar results to the initial evidence-based research.
Define your goals: What are our goals and how can we meet them?
The goal of implementing an evidenced-based practice should not be the implementation itself. Defining your goals in terms of a patient-centered outcome will help you generate appropriate modifications. For example, many hospitals have the goal of reducing inpatient length of stay. If the change leaders focus just on the inpatient length of stay itself, they may create a program that rushes the patient out of the hospital before they are ready. If instead the goal is to optimize recovery from illness or surgery, the focus shifts to the patient experience, and reduction in inpatient length of stay is simply the residue of a provider and patient-friendly program.
Sometimes there’s little data to guide local adaptations, but understanding the overarching goals of the new practices can help. Take for example how innovations in dynamic pain control developed for major in-patient procedures can be adapted for minor out-patient procedures. Still focusing on the goal of dynamic pain control, providers can prescribe different preoperative pain medication for minor outpatient procedures that manage pain without the drowsiness associated with the medications used for in-patient procedures.
Identify your preferences: How can we make adoption more comfortable?
Personal preferences of powerful individuals or coalitions of care providers too often becomes the motivating force behind whether or not to adopt evidence based practices. A health care system moving to a standardized set of tools and equipment found that physicians preferred specific tools (e.g. surgical staples or scalpels) because those were what they had been trained on. Physicians continued to request those tools despite evidence showing they cost three times more and had no effect on patient outcomes.
Preferences driven by subjective, idiosyncratic reasoning inhibit adopting new approaches that can attain better health outcomes, reduce expenses, and decrease errors. So health care leaders need to determine why providers have certain preferences. Some preferences focus on how the evidence-based practice is enacted, rather than what it is.
For example, care providers may be happy to use specific equipment for a procedure if it is easily accessible. To avoid surgical site infections when inserting a central venous catheter, providers should clean the skin with chlorhexidine antiseptic, use a sterile drape/dressing, and wear a sterile mask, hat, gown and gloves. Why not help care providers use all of these items by packaging them together in an easy to access location? Similarly, offering training on new tools or techniques can give care providers the opportunity to ask questions about them and get more comfortable using them.
When leaders make compliance with the new practices as easy as possible, they can encourage adoption without unnecessarily revising the core elements of the evidence-based practices.
Adjusting your approach
When weighing if and how to adapt evidence-based practices, within legal and professional guidelines, you need to consider both the technical and human elements involved.
In our experience, start with the original source data as it has the most fidelity to the desired outcomes and will enable objective decisions about customizations. Then, guide conversations about how a given practice should be adapted locally. If responses from the providers include resistance about available resources, consider substitutes that would address these concerns, yet still attain the results the evidence supports. Engaging users in how to best utilize existing resources to implement the new practices creates ownership of the process.
If staff react to the new best practice with asking “why are we doing this,” reaffirming the higher-order goals may help explain why adopting the evidence based practice is crucial. Alternatively, if resistance is rooted in language such as “I like” and “I want”, try to understand the underlying preferences and values. For preferences related to how the practice is enacted, consider alignment with other practices and try to create innovative solutions. For preferences related to the content of the practice, discuss the higher order goals and what the research supports. Shared commitment to these goals makes users more open to how “we could achieve our goals” by using what “the research shows”.
Listen, understand the context and your people, and then revise the new practice when necessary. Leaders that can move fluidly across these approaches create a disciplined and adaptive way to implement evidence-based practice — one that fosters joint-problem solving, facilitates agreement, and relieves the tensions associated with customizing research recommendations.
- ML Margaret M. Luciano is an associate professor of management & organization in the Smeal College of Business at Pennsylvania State University.
- TA Thomas A. Aloia , MD, MHCM is the Chief Value and Quality Officer in the Office of the Chief Medical Executive and a Professor in the Department of Surgical Oncology at the University of Texas – MD Anderson Cancer Center, Houston, TX.
- JB Joan F. Brett , PhD, is an associate professor in the WP Carey School of Business at Arizona State University, Tempe, AZ.
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Johns hopkins evidence-based practice model.
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The Johns Hopkins Evidence-Based Practice model for Nurses and Healthcare Professionals is a powerful problem-solving approach to clinical decision-making and is accompanied by user-friendly tools to guide individuals or groups through the EBP process. Feedback from a wide variety of end-users, both clinical and academic, inform the continued development and improvement of the Johns Hopkins EBP model. The most recent revision highlights EBP as an interprofessional activity to enhance team collaboration and patient care coordination. As with previous editions, our goal remains constant: - to build capacity among front-line users to identify best practices and incorporate them into the everyday care we provide our patients.
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Citation for tools: Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines . 4th ed. Sigma Theta Tau International
EVIDENCE-BASED PRACTICE (EBP): THE PROBLEM-SOLVING APPROACH
Published On: January 10, 2012
Updated On:
As the nursing profession continues to evolve, the educational focus is also changing. One of the most significant emerging trends in healthcare today is the focus on evidence-based practice, also known as EBP.
Evidenced-based practice is often described as an approach to patient care that involves considering the best available research and practice guidelines associated with a specific clinical situation. Key elements in the successful implementation of evidence-based practice in nursing include:
- Reviewing research and studies that examine the best practices in clinical nursing.
- Interactive decision-making regarding care and treatment planning which integrates care team members, as well as the opinion of the patient and his or her family.
- Ongoing professional development education of nurses, including pursuit of advanced degree programs when available.
- Addressing clinical issues and critically examining possible practice changes.
- Strong emphasis on problem-solving skills, clinical judgment and the use of sound evidence to support clinical decisions based on research, experience and the environment.
Challenges to Evidence-Based Practice
Some of the impediments to evidence-based practice include a resistance to change practice and habits within the nursing community, the lack of ongoing education programs and poor administrative support. Although barriers exist, the successful patient outcomes from evidence-based practice have helped win support for this model of care among the medical profession as a whole.
Increased Responsibilities for Nurses Today
Because evidence-based practice places an emphasis on the knowledge, skills and experience of nurses, today’s nurses are being given more responsibility and respect than ever before. EBP focuses on specific nursing skills including critical decision-making founded in evidence and research, with a move away from traditional treatment regimes and habits that had been the hallmark of nursing for generations. Registered nurses now need strong analytic and academic research skills to complement clinic skills and hands-on patient care.
Options for Evidence-Based Practice Education
Nurses who are seeking to improve their clinical skills and expand both their knowledge base and career options should consider obtaining additional nursing education in programs that focus on EBP. Professional nursing today demands that nurses have a solid understanding of how to conduct research, critically review studies and medical reviews, and an EBP-focused education program will teach nurses these vital skills.
Some of the most accessible educational programs that include an emphasis on EBP the knowledge are the online nursing programs offered at the University of Texas at Arlington, including an RN to BSN and a Master of Science in Nursing Administration . The University of Texas at Arlington’s College of Nursing and Health Innovation, named one of the “Best of the West” by Princeton Review , offers a specialized program to allow RNs to obtain their BSN in just over a year. By pursuing an advanced nursing degree with a focus on evidence-based practice, working nurses will have access to a variety of career options in both clinical and administrative roles.
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Nurses' guide to evidence-based practice
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Links to Models and Frameworks - An Overview
Models and Frameworks for Implementing Evidence- Based Practice: Linking Evidence to Action
- Johns Hopkins Model a powerful problem-solving approach to clinical decision-making, and is accompanied by user-friendly tools to guide individual or group use. It is designed specifically to meet the needs of the practicing nurse and uses a three-step process called PET: practice question, evidence, and translation. The goal of the model is to ensure that the latest research findings and best practices are quickly and appropriately incorporated into patient care.
- Iowa Model of Evidence-Based Practice: Revisions and Validation "The Iowa Model is a widely used framework for the implementation of evidence-based practice (EBP). Changes in health care (e.g., emergence of implementation science, emphasis on patient engagement) prompted the re-evaluation, revision, and validation of the model..... This user driven revision differs from other frameworks in that it links practice changes within the system. Major model changes are expansion of piloting, implementation, patient engagement, and sustaining change. Linking Evidence to Action The Iowa Model-Revised remains an application-oriented guide for the EBP process. Intended users are point of care clinicians who ask questions and seek a systematic, EBP approach to promote excellence in health care.
- Caledonian Development Model (Tolson, Booth, & Lowndes, 2008) The model features practice-development activities, benchmarking, knowledge pooling and translation through membership of a community of practice and a virtual college
- Evidence-Based Practice Model for Staff Nurses (Reavy & Tavernier, 2008) This article describes a new model and process to implement evidence-based practice. This model builds on concepts from the Iowa Model of Evidence-Based Practice, the Stetler model, and Rosswurm and Larrabee's model. The new model focuses on the centrality and involvement of staff nurses in making evidence-based practice clinical changes. Two figures illustrate the model and the implementation process. A detailed case study based on the model is included. Barriers identified in the literature review are addressed in the case study. Implementation of this model creates opportunities for staff nurses to recognize ownership of their practice and their role in changing the practice setting to a culture of evidence-based practice..
- A Model for Change... Rosswurm and Larrabee (1999) The model is based on theoretical and research literature related to evidence‐based practice, research utilization, standardized language, and change theory. In this model, practitioners are guided through the entire process of developing and integrating an evidence‐based practice change. The model supports evidence‐based practice changes derived from a combination of quantitative and qualitative data, clinical expertise, and contextual evidence.
- Stetler Model (Stetler, 2001) " ...a searchable, online collection of evidence-informed methods and tools for knowledge translation in public health.".
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Why Choose Evidence-based Practice?
“Evidence-based practice is key to achieving the quadruple aim in health care.” — Bernadette Melnyk, PhD, RN, APRN-CNP, FNAP, FAANP, FAAN, AANP member since 2012.
Evidence-based practice (EBP) is defined by Duke University Medical Center as "the integration of clinical expertise, patient values and the best research evidence into the decision-making process for patient care."
EBP strategies allow nurse practitioners (NPs) and other health care providers to translate research findings into clinical practice. With efficient literature-searching skills and the application of formal rules of evidence in evaluating research findings, providers can apply existing scientific knowledge in their clinical practice for each individual patient.
“The Institute for Healthcare Improvement said we should target the triple aim in health care: improving the patient experience, improving population health outcomes and decreasing health care costs,” says Dr. Melnyk. “Some years after the triple aim goal came out, a fourth aim was added: improving the work life of clinicians and their well-being. EBP is the secret sauce to enable us to get to that quadruple aim.”
In a time when NPs and many other providers experience symptoms of burn out, EBP can be empowering. While it may require a different skillset, research has shown that when providers deliver evidence-based care, patient outcomes are markedly improved. For example, in a 2020 Journal of the American Association of Nurse Practitioners (JAANP) article , a free clinic launched a quality improvement project to increase influenza vaccination rates and found that evidence-based interventions led to a 597% increase.
Unfortunately, even when health care providers hold positive opinions about EBP, many do not actively implement EBP strategies due to a lack of time, lack of leadership buy-in and investment or lack of understanding.
“We conducted a study of 276 chief nurse executives from across the U.S. and found that, although they believe in value of EBP, they didn’t invest in it for their clinicians. Although they identified quality and safety as key priorities, EBP was at the bottom,” says Dr. Melnyk.
“This tells us they don’t understand EBP is the direct pathway to getting to health care quality and safety. EBP is all about using the best evidence to make the best clinical decisions to achieve the best clinical outcomes.”
Additional EBP Resources
- Foundations of Evidence-based Practice in Health Care : Learn the seven steps of the EBP process from renowned experts in the field. This free, massive open online course (MOOC) will guide you through current trends, provide strategies to overcome barriers and help you create system change in your practice setting.
- The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare : Gain online learning and research from this national hub for all things EBP, including free webinars , EBP Competencies and publications . An EBP Certificate and other programs are also available.
EBP Resources From AANP
- AANP-accredited Continuing Education (CE) : Search for education on a variety of topics, including cardiovascular disease ( case study 1 , case study 2 ), infectious disease ( pneumonia case study , urinary tract infection case study ), dermatologic illnesses ( case study 1 , case study 2 ), Type 2 diabetes ( case study 1 , case study 2 ) and pain management ( case study 1 , case study 2 ).
- JAANP EBP Article Series : Read a four-part series published in JAANP for an introductory overview to the EBP process, including relevance to clinical practice , the search for evidence , the critical appraisal process and integration into practice .
- AANP Clinical Practice Briefs : Developed by the AANP Practice Committee, these members-only briefs share evidence-based guidelines from leading organizations, including the Centers for Disease Control and Prevention (CDC) and the Agency for Quality Healthcare Research and Quality (AHRQ), among others.
This article was updated on April 1, 2021, to add current CE activities and resources.
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Evidence-Based Practice
Levels of evidence.
Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a clinician's expertise in making decisions about a patient's care. Unfortunately, no standard formula exists for how much these factors should be weighed in the clinical decision-making process. However, there are a variety of rating systems and hierarchies of evidence that grade the strength or quality of evidence generated from a research study or report. Being knowledgeable about evidence-based practice and levels of evidence is important to every clinician as clinicians need to be confident about how much emphasis they should place on a study, report, practice alert or clinical practice guideline when making decisions about a patient's care.
Rating System:
The levels of evidence listed here have been developed with the help of nurse experts and other industry resources. We thank those who have contributed to making our system relevant and applicable to determining the levels of evidence that support our CE publications.
Evidence-based information ranges from Level A (the strongest) to Level C (the weakest). In 2013, Level ML, multilevel, was added to identify clinical practice guidelines that contain recommendations based on more than one level of evidence:
LEVEL A: Evidence obtained from:
- Randomized control trials: the classic "gold standard" study design. In RCTs, subjects are randomly selected and randomly assigned to groups to undergo rigorously controlled experimental conditions or interventions.
- Systematic review or meta-analysis of all relevant RCTs. A systematic review is a critical assessment of existing evidence that addresses a focused clinical question, includes a comprehensive literature search, appraises the quality of studies and reports results in a systematic manner. Meta-analysis is a study design that uses statistical techniques to combine and analyze data from many RCTs.
- Clinical practice guidelines: based on systematic reviews of RCTs. Evidence-based clinical practice guidelines provide the strongest level of evidence to guide clinical practice because they are based on rigorous reviews of the best evidence on specific topics.
LEVEL B: Evidence obtained from:
- Well-designed control trials without randomization: In this type of study, random assignment is not used to assign subjects to experimental and control groups. Therefore, this type of research is less strong in internal validity because it can't be assumed the subjects in the study are equal on major demographic and clinical variables at the beginning of the trial. Frequent problems with this type of study include intentional or unintentional bias in sample enrollment; nonblinding, unclear criteria for participant selection; or unreliable or invalid tools.
- Clinical cohort study: an examination of groups of people who have common characteristics or exposure experiences to compare outcomes in those exposed vs. outcomes in those not exposed (e.g., development of heart disease after exposure or nonexposure to 10 years of secondhand smoke).
- Case-controlled study: use of an observational approach in which subjects known to have a disease or outcome are compared with subjects known not to have that disease or outcome. Subjects are matched on characteristics so that they are as similar as possible except for the disease or outcome. Case-control studies are generally designed to estimate the odds (using an odds ratio) of developing the studied condition or disease and can determine if an associated relationship exists between the condition/disease and risk factors.
- Uncontrolled study: studies that do not control participant selection or interventions (e.g., a convenience sample, such as patients on a given unit, may be studied because it's the only group reasonably available).
- Epidemiological study: studies that observe people over a long time to determine risk or likelihood of developing diseases. These studies include retrospective database searches or prospective studies that follow a population over time.
- Qualitative study/quantitative study: descriptive, word-based phenomena, such as symptoms, behaviors, culture and group dynamics. Quantitative studies use statistical methods to establish numerical relationships that are correlational or cause and effect.
LEVEL C: Evidence obtained from:
- Consensus viewpoint and expert opinion: a study that obtains agreement about specific practices from all clinical experts on a review panel. Expert opinion involves obtaining agreement from a majority of clinical experts on a review panel. Note: This level of evidence is used when there are no quantitative or qualitative studies in a particular area.
- Meta-synthesis: a systematic review that synthesizes findings from qualitative studies using an interpretive technique to bring small study findings, such as case studies, to clinical application.
LEVEL ML (multilevel): clinical practice guidelines, recommendations based on evidence obtained from:
- More than one level of evidence as defined in the rating system.
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Evidence-based practice resources:.
- Agency for Healthcare Research and Quality Evidence-based Practice Centers ( https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html )
- Cochrane Reviews ( http://www.cochrane.org/what-is-cochrane-evidence )
- Evidence-based healthcare ( http://www.cochrane.org/what-is-cochrane-evidence )
- National Guideline Clearinghouse: ( https://www.guideline.gov/ )
References for EBP:
Alfaro-LeFevre R. Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach . 5th ed. St. Louis, MO: Elsevier-Saunders; 2013.
Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient centered approach to grading evidence in the medical literature. Am Fam Physician . 2004;69(3):548-556. http://www.aafp.org/afp/2004/0201/p548.html . Published February 1, 2004. Accessed November 11, 2015.
Evidence-based medicine toolkit. American Academy of Family Physician Web site. http://www.aafp.org/journals/afp/authors/ebm-toolkit.html . Accessed November 11, 2015.
What is evidence based medicine? University of Illinois at Chicago University Library Web site. http://researchguides.uic.edu/ebm . Updated March 7, 2008. Accessed November 11, 2015.
Levels of evidence. Oxford Centre for Evidence-Based Medicine Web site. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ . Published March 2009. Updated April 15, 2011. Accessed November 11, 2015.
Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare. A Guide to Best Practice . Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
Newhouse RP, Dearholt SL, Poe SS, Pugh LC, White KM. Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines . Indianapolis, IN: Sigma Theta Tau International; 2007.
Strength of recommendation taxonomy (SORT). American Academy of Family Physicians Web site. http://www.aafp.org/dam/AAFP/documents/journals/afp/sortdef07.pdf . Accessed November 11, 2015.
Understanding research study designs. University of Minnesota Bio-Medical Library Web site. http://www.biomed.lib.umn.edu/guides/understanding-research-study-designs . Accessed November 11, 2015.
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Home » Online Programs » Healthcare » Registered Nurse to Bachelor of Science in Nursing » What Is Evidence-Based Practice?
What Is Evidence-Based Practice?
- Published On: January 24, 2017
The International Council of Nurses defines evidence-based practice as “A problem solving approach to clinical decision making that incorporates a search for the best and latest evidence, clinical expertise and assessment, and patient preference values within a context of caring.”
Evidence-based practice (EBP) officially became a part of healthcare practice in the early 1990s. However, a 2001 report, Crossing the quality chasm: A new health system for the 21st century from the Institute of Medicine (IOM) accelerated the push for the implementation of EBP. The report stated that there was an “unacceptable gap between what we know and what we do in the care of patients.” A major part of the solution to that problem, according to the report, is EBP.
Studies support that conclusion, according to a 2016 article in Worldviews on Evidence-Based Nursing. Findings from multiple studies provide “irrefutable evidence” that indicates EBP, compared to patient care based on tradition, leads to the following:
- Higher quality and reliability of healthcare.
- Improved population health and patient outcomes, including the patient care experience.
- Reduced costs.
What Is EBP?
Evidence-based nursing practice is not the same as nursing research or quality improvement, although the processes interrelate, according to Evidence-Based Practice In Nursing: A Guide To Successful Implementation .
Quality improvement focuses on systems and processes as well as functional, clinical and financial outcomes. Nursing research is a systematic inquiry designed to develop, refine and extend nursing knowledge.
EBP goes beyond research to include clinical expertise and patient preferences as part of the decision-making process: “The use of EBP takes into consideration that sometimes the best evidence is that of opinion leaders and experts, even though no definitive knowledge from research results exists” ( American Nurse Today ). “Whereas research is about developing new knowledge, EBP involves innovation in terms of finding and translating the best evidence into clinical practice.”
EBP and Nursing Education
EBP is a paradigm shift that requires nurses to rely on more than what they have memorized. They must learn to ask questions and to retrieve, evaluate, integrate and use new evidence to make clinical decisions. Learning this process is an important part of nursing education.
One of the nine essential outcomes for a bachelor’s degree (BSN) education defined by the American Association of Colleges of Nursing (AACN) is “scholarship for evidence-based practice.” AACN states that, “[Graduates] will be able to recognize safety and quality concerns and apply evidence¬ based knowledge from the nursing profession and other clinical sciences to their practice.”
Integrating EBP into nursing education is an ongoing process. Some nursing programs, such as the Lamar University online RN to BSN program , include EBP in all nursing courses. Further, Lamar requires students to complete a specific course in nursing inquiry and evidence-based practice. This immersion prepares students to implement EBP in their jobs.
A Process for Evidence-Based Practice
Understanding processes for implementing EBP can guide nurses in their practice. Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice outlines the following steps for a successful EBP process:
- Nurture a spirit of inquiry that leads to questions about how to improve delivery of healthcare.
- Patient population of interest (P).
- Intervention or area of interest (I).
- Comparison intervention or group of interest (C).
- Outcome of interest (O).
- For example, a vague question such as “How effective is CPR?” is unlikely to yield good search results. A better question would be “In adults living in the community, what is the effectiveness of hands-only CPR compared to hands plus breathing?”
- Search for the best evidence using key words or phrases. Research databases such as MEDLINE or CINAHL are extensive. The more focused the search, the better the results.This step also involves recognizing that the strongest evidence usually comes from a systematic review, a meta-analysis, or an established evidence-based clinical practice guideline based on a systematic review. Other, but weaker, sources of evidence include randomized controlled trials (RCTs) and other types of quantitative studies, qualitative studies, and expert opinion and analyses.
- What are the results and are they important?
- Are the results of the study valid?
- Will the results help me care for my patients?
- After appraising each study, determine if the studies come to similar conclusions, thus supporting an EBP decision or change.
- Combine the evidence with clinical expertise — based on patient assessments, laboratory data and data from outcomes management programs — and patient preferences. According to the article, “There is no magic formula for how to weigh each of these elements; implementation of EBP is highly influenced by institutional and clinical variables.”
- After making practice decisions or changes based on evidence, evaluate the outcomes. An intervention that worked in a rigorously controlled trial may not work the same way in a clinical setting. Monitoring the effect of an EBP change can help nurses recognize implementation flaws and better identify which patients are most likely to benefit from EBP changes.
- Distribute EBP results. By sharing the results of an EBP implementation, nurses can prevent needless duplication. Ways to share these results include EBP rounds in the institution; presentations at professional conferences; and reports in peer-reviewed journals, professional newsletters and other publications.
Although this process may sound complicated, it does not have to be. The ABCs of Evidence-Based Practice in Nursing provides an example of how to use EBP in individual nursing practice. If a patient has a disease that their nurse isn’t familiar with, the nurse can search that disease online. If they find important information not mentioned in the patient’s chart, the nurse “can print the article and share it with colleagues, write about it in the nurse’s notes section of the patient’s chart, and then resume nursing duties. Using EBP at the bedside is the equivalent of looking up a medication in the formulary or a medication book to make sure the patient is receiving the correct medication.”
The implementation of evidence-based nursing is one of the most important changes in nursing practice of the twenty-first century. Nurses who make this shift can help improve patient care and outcomes.
Learn about the Lamar University online RN to BSN program .
(2008). The Essentials of Baccalaureate Education For Professional Nursing Practice. American Association of Colleges of Nursing
Beyea, S. C., and Slattery, M. J. (2006). Evidence-Based Practice In Nursing: A Guide To Successful Implementation. HCPro Healthcare Marketplace
Conner, B. T. (2014 June). Differentiating research, evidence-based practice, and quality improvement. American Nurse Today
(2012). Closing the Gap: From Evidence to Action. International Council of Nurses
Johansen, C. (2014, August 25). The ABCs of Evidence-Based Practice in Nursing. NurseTogether
Melnyk, B. M. et. al. (2010 January). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. American Journal of Nursing
Melnyk, B. M. et. al. (2016 February). A Study of Chief Nurse Executives Indicates Low Prioritization of Evidence-Based Practice and Shortcomings in Hospital Performance Metrics Across the United States. Sigma Theta Tau International
Stevens, K. (2013 May). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. The Online Journal of Issues in Nursing
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Evidence-Based Practice Toolkit for Nursing
Evidence based practice models and using the guide.
- Getting Started
- Asking Your Question
- Searching for Articles, Guidelines, and Resources
- Appraising Evidence
- Tools for Translation
- EBP Nursing Fellowship Projects
Contact Us!
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- What is EBP?
- The 3 Phases of EBP
- Navigating this Guide
In 2015, OHSU Healthcare adopted the Johns Hopkins Evidence-Based Practice Model (JHEBP) to frame clinical inquiry initiatives.
Image: Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. 4th ed. Sigma Theta Tau International
EBP is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system (Newhouse, Dearholt, Poe, Pugh, & White, 2007).
Dearholt, Sandra L., and Dang, Deborah. Johns Hopkins Nursing Evidence-Based Practice : Models and Guidelines (2nd Edition).
The JH Evidence-based Practice Model occurs in three phases: Practice Question, Evidence, and Translation.
Practice Question: The first phase includes forming a team and developing an EBP answerable question.
Evidence: The second phase includes searching for, evaluating, and synthesizing the best available evidence.
Translation: In the third phase, team members identify setting-specific recommendations, create and implement an action plan, evaluate outcomes, and disseminate findings.
Image: https://www.vumc.org/nursingebp/evidence-based-practice-ebp
With the JHEBP in mind, use the sections in this guide to learn:
- More about EBP and how it is implemented
- How to ask a searchable EBP question
- What types of evidence to look for
- Where to search for the best evidence
- How to appraise the evidence you find
- How to get help and additional support
- Next: Getting Started >>
- Last Updated: Feb 24, 2023 2:56 PM
- URL: https://libguides.ohsu.edu/ebptoolkit
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What is evidence-based practice in nursing?
In addition to caring for fallen soldiers in the 1800s, Florence Nightingale, iconic founder of modern nursing, was also recognized for being an outspoken social reformer and steadfast statistician. The “Lady with the Lamp” kept careful record of medical stats connecting illnesses to injuries. From this chronicling, Nightingale was able to draw conclusions that would have a profound effect on modern medicine, such as linking unsanitary conditions and poorly ventilated spaces to a patient’s failing health. Her efforts comprise a prime example of evidence-based practice (EBP), the process of collecting, processing, and implementing research findings to improve clinical practice and patient outcomes. The ultimate goal of the evidence-based nursing problem-solving approach is to help nurses provide the highest-quality, most cost-efficient care possible. Today, evidence-based nursing practice is part of the curriculum for most nursing degrees , including RN-to-BSN programs .
Why is evidence based practice important?
Knowledge of evidence-based practice and its tenets, also known as “levels of evidence,” is of significant importance to every clinician, including nurses. According to nurse.com, EBP guides nurses and other clinicians in how much they should draw from “a study, report, practice alert, or clinical practice guideline in making decisions about a patient’s care.”
The benefits of EBP in nursing include:
Providing nurses with the scientific research to make well-informed decisions.
Encouraging nurses to provide individualized patient care.
Improving time management by driving efficiency in nursing.
Guiding implementation of new technologies into healthcare practice.
Helping nurses determine an effective course of action for care delivery.
Helping nurses stay updated about new medical protocols for patient care.
Increasing patients’ chances for recovery because decisions are based on documented interventions that align with patient profiles.
Enabling nurses to evaluate research so they can best understand the risks or effectiveness of treatments or diagnostic tests.
Improving patient outcomes, which can lead to decreasing demand for healthcare resources and reducing expenses.
The five steps of evidence-based practice.
Evidence-based practice in nursing is a lifelong learning technique driven by the following steps. Thorough, mindful application of these five steps has the potential to complete a cycle that’s destined to improve clinical practice and patient care.
Pose a question. Formulating a well-detailed, clearly worded question is the catalyst for EBP problem-solving. It sets forth what the ultimate goal is. Perhaps the goal is to improve a procedure that will help a patient with a particular condition. This step is crucial to the EBP process because the key words within the question will help pinpoint a course of treatment for clinicians to administer. The more detailed the question, the better—because it makes it easier and more likely to be found in a medical database. Here’s an example question: What are the treatment options and challenges to consider for a COVID-19 patient who has also been diagnosed with Bell’s Palsy?
Gather the best evidence. It is important to broadly seek out the best available evidence, including high-quality articles from legitimate sources and other supporting materials containing the highest possible levels of evidence. For instance, if it comes to choosing between evidence from a case report and evidence from a high-quality systematic review of prospective cohort studies, definitely move forward with the latter.
Analyze the evidence. Now it’s time to take a closer look at all of the evidence that’s been gathered to ensure it is indeed of optimal quality. In addition to providing a critical appraisal of gathered resources, this step also helps determine if the information or data is pertinent to the patient a nurse is treating and/or the clinical setting at which they work. Perhaps two sources both report on the findings of estrogen inhibitors to treat metastatic breast cancer. Let’s say both offer similar new information but draw dramatically different conclusions. In this case, it would be best to draw from one’s clinical experience in these treatments and conditions to identify which source to proceed with in moving on to the next step.
Apply the evidence to clinical practice. Now that the information has been carefully gathered and thoroughly analyzed, it’s time to put it into action. This step is all about integration, involving a combination of new information obtained with the nurse’s clinical experience to draw conclusions on how to apply the research findings to patients. At this point, the clinician should be especially mindful of patient profiles, individual preferences, and values. For instance, would a breast cancer patient want to proceed with more aggressive treatment like chemotherapy and surgery based on the conclusions of the information gathered?
Assess the result. This final step completes a cycle whose mission is continuous quality improvement in clinical care and practice. Let’s say a patient did decide to proceed with more aggressive breast cancer treatment and it turned out to be effective. This positive outcome naturally spawns further questions. Should this EBP then be applied to other patients with the same condition? Was the application of the new information or procedure effective? And how does this outcome relate back to the original question that inspired the path to reach this outcome?
Levels of evidence.
Along with the five steps, the EBP framework also employs four levels of evidence in its quest for quality improvement in a healthcare setting.
Level A: The most reliable level of evidence because evidence is acquired from randomized control trials. Example: administering convalescent plasma or placebo to determine the former’s effectiveness on COVID-19 patients with severe pneumonia.
Level B: Evidence is acquired from quality-designed control trials without randomization, clinical cohort studies, case-controlled studies, uncontrolled studies, epidemiological studies, and qualitative/quantitative studies. Example: studying the development of heart disease after exposure or nonexposure to 10 years of secondhand smoke.
Level C : Evidence is acquired from consensus viewpoint, expert opinion, and meta-synthesis. Typically used when there is no quality and quantity data yet available about a specific condition. Experts reach agreement by reviewing the limited evidence available. Example: determining treatment for an exceptionally rare condition; since there have been so few cases, there is very limited information to reference.
Level ML (multilevel) : Evidence is acquired from more than one level of evidence as defined in the rating system. This level is usually applied to more complex cases. Example: concluding that invasive surgery to remove a malignant mass from an elderly patient’s pancreas would be extremely high risk not only due to the patient’s age but also because of the unusual position of the mass. While surgery risk in elderly patients has been studied extensively (Level B), information about a rare form of pancreatic tumor could be as rare as the condition itself, hence the course of treatment would have to rely heavily on consensus viewpoint (Level C).
What are examples of evidence-based practice.
For patient health and safety, it is essential that nurses follow evidence-based practice. Here are some examples of its application:
Infection control. Evidence-based infection-control policies exist in every medical setting and its importance has been continually reiterated during the COVID-19 pandemic. This EBP includes keeping the healthcare environment clean and disinfected, wearing personal protective clothing, using barrier precautions, and practicing correct handwashing.
Oxygen use in COPD patients. Based on well-researched evidence, the correct treatment to help prevent hypoxia (low oxygen in the blood) and organ failure in patients with chronic obstructive pulmonary disease (COPD) is to administer oxygen.
Treatment for angina. Extensive research has concluded multiple treatment options to effectively manage angina, including nitrates, clot-preventing drugs, beta blockers, statins, and aspirin.
The impact of evidence-based practice in healthcare.
EBP is a crucial component of safe, quality patient care. Utilizing the EBP approach helps nurses and other clinicians provide the highest-quality and most cost-efficient patient care possible. It is highly essential that nurses know the current practices so that they can provide care to patients with complex and debilitating conditions. Online degree programs provide EBP in their curriculum whether you’re just starting out in your nursing education or already working in nursing and looking to expand your EBP knowledge. From EBP courses, students in RN-to-BSN programs learn the role of research in the nursing practice, including its design, methodologies, process and ethical principles. They also learn to use critical thinking skills to evaluate research studies so that they can apply the findings to their nursing practice, and ultimately help our healthcare system for the better.
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Problem-solving skills, solving problems and problem-based learning
Affiliation.
- 1 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
- PMID: 3050382
- DOI: 10.1111/j.1365-2923.1988.tb00754.x
This paper reviews the empirical evidence in support of the three concepts in the title. To the extent that a skill should be a general strategy, applicable in a variety of situations, and independent of the specific knowledge of the situation, there is little evidence that problem-solving skills, as described and measured in medical education, possess these characteristics. Instead there is an accumulation of evidence that expert problem-solving in medicine is dependent on (I) a wealth of prior specific experiences which can be used in routine solution of problems by pattern recognition processes, and (2) elaborated conceptual knowledge applicable to the occasional problematic situation. The use of problem-based learning (PBL) as an educational strategy is explored. In particular, the evidence suggesting the compatibility of PBL with this theory of expertise is discussed. Finally, I review some issues in the design of PBL curricula from the perspective of the proposed model of expertise.
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- Attitudes and perceptions towards hypoglycaemia in patients with diabetes mellitus: A multinational cross-sectional study. Naser AY, Wong ICK, Whittlesea C, Alwafi H, Abuirmeileh A, Alsairafi ZK, Turkistani FM, Bokhari NS, Beykloo MY, Al-Taweel D, Almane MB, Wei L. Naser AY, et al. PLoS One. 2019 Oct 24;14(10):e0222275. doi: 10.1371/journal.pone.0222275. eCollection 2019. PLoS One. 2019. PMID: 31647820 Free PMC article.
- Assessment in the context of problem-based learning. van der Vleuten CPM, Schuwirth LWT. van der Vleuten CPM, et al. Adv Health Sci Educ Theory Pract. 2019 Dec;24(5):903-914. doi: 10.1007/s10459-019-09909-1. Epub 2019 Oct 2. Adv Health Sci Educ Theory Pract. 2019. PMID: 31578642 Free PMC article.
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Evidence-based practice for effective decision-making.
Effective HR decision-making is based on considering the best available evidence combined with critical thinking.
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Introduction, what is evidence-based practice, the four sources of evidence, combining the evidence, misconceptions in evidence-based practice decision-making, evidence of evidence-based practice effectiveness, how to carry out evidence-based practice, useful contacts and further reading, explore our related content.
Evidence-based practice is about making better decisions, informing action that has the desired impact. An evidence-based approach to decision-making is based on a combination of using critical thinking and the best available evidence. It makes decision makers less reliant on anecdotes, received wisdom and personal experience – sources that are not trustworthy on their own. It’s important that people professionals to adopt this approach because of the huge impact management decisions have on the working lives and wellbeing of people in all sorts of organisations worldwide.
This factsheet outlines the four sources of evidence considered key to effective evidence-based practice, before highlighting the importance of combining these to ensuring actions have the greatest chance of success. It outlines and refutes a number of misconceptions about evidence-based practice, before looking at literature which demonstrates the effectiveness of evidence-based practice. Finally, the factsheet explains the practical implications of applying evidence-based practice to real-life organisational scenarios.
See the full A-Z list of all CIPD factsheets .
At the heart of evidence-based practice is the idea that good decision-making is achieved through critical thinking and drawing on the best available evidence. Evidence-based practice leads to decisions and actions that are more likely to have the desired effect and are less reliant on anecdotes, received wisdom and personal experience – sources that are not trustworthy on their own. Evidence-based HR practice draws together published research and people analytics with professional expertise and stakeholder opinions.
Why is evidence-based practice important?
In their report Evidence-based management: the basic principles , Barends, Rousseau and Briner of the Center for Evidence-Based Management (CEBMa) outline the challenge of biased and unreliable management decisions. They show that it’s common in decision-making for popular ideas of management, and personal experience which is highly susceptible to errors and bias, to be prioritised ahead of sound, critically-appraised evidence. They argue that individuals at all levels of employment have a moral obligation to use the best available evidence when making important decisions.
Assessing the reliability and validity of evidence becomes more important as the mass of opinion and claims continue to grow. As discussed in our reports Cognition, decision and expertise and Our minds at work: the behavioural science of HR , because people have limited cognitive resource and time, our minds use mental shortcuts or ‘heuristics’ to make decisions easier: our brains are less able to multi-task than we expect. This opens us to various types of bias. For example, the ‘availability heuristic’ means we judge the likelihood of an event based on how readily a memory of that event comes to mind. More specifically, ‘ confirmation bias ’ can lead recruiters to form an early opinion of a candidate, based on a personal characteristic that won’t affect their performance, and then look for examples that align with this positive or negative impression.
Received wisdom and the notion of ‘best practice’ also creates bias. One organisation may look to another as an example of sound practice and decision-making, without critically evaluating the effectiveness of their actions. And while scientific literature on key issues in the field is vital, there’s a gap between this and the perceptions of practitioners, who are often unaware of the depth of research available.
Even when looking at research, we can be naturally biased. In our In search of the best available evidence report, we note the tendency to ‘cherry-pick’ research that backs up a perspective or opinion and ignores research that does not, even if it gives stronger evidence on cause-and-effect relationships. This bad habit is hard to avoid – it's even common among academic researchers. So we need approaches that help us determine which research evidence we should trust.
Our ‘insight’ article When the going gets tough, the tough get evidence explains the importance of taking an evidence-based approach to decision making in light of the COVID-19 pandemic. It emphasises and discusses how decision makers can and should become savvy consumers of research.
In search of best available evidence
The reasons why evidence-based practice is so important, the principles that underpin it, how it can be followed and how challenges in doing so can be overcome.
Barends, Rousseau and Briner define evidence as information, facts or data supporting (or contradicting) a claim, hypothesis or assumption.
The issues above demonstrate the limitations of basing decisions on personal experience alone. It’s important to consider other factors that will most benefit an organisation and its employees. Decision-makers should find out what is known by analysing four key sources.
Scientific literature on management has become more readily available in recent years, particularly in academic journals. Other topics, such as psychology and sociology, also apply to many issues facing managers. Their ability to search for and appraise research for its relevance and trustworthiness is essential.
Organisational data must be examined as it highlights issues needing a manager’s attention. This data can come externally from customers or clients (customer satisfaction, repeated business), or internally from employees (levels of job satisfaction, retention rates). There’s also the comparison between ‘hard’ evidence, such as turnover rate and productivity levels, and ‘soft’ elements, like perceptions of culture and attitudes towards leadership. Gaining access to organisational data is key to determining causes of problems, solutions and implementing solutions.
Expertise and judgement of practitioners, managers, consultants and business leaders is important to ensure effective decision-making. This professional knowledge differs from opinion as it’s accumulated over time through reflection on outcomes of similar actions taken in similar contexts. It reflects specialised knowledge acquired through repeated experience of specialised activities.
Stakeholders , both internal (employees, managers, board members) and external (suppliers, investors, shareholders), may be affected by an organisation’s decisions and their consequences. Their values reflect what they deem important, which in turn affects how they respond to the organisation’s decisions. Acquiring knowledge of their concerns provides a frame of reference for analysing evidence.
One very important element of evidence-based practice is collating evidence from different sources. There are six ways – depicted in our infographic below – which will encourage this.
- Asking – translating a practical issue or problem into an answerable question.
- Acquiring – systematically searching for and retrieving evidence.
- Appraising – critically judging the trustworthiness and relevance of the evidence.
- Aggregating – weighing and pulling together the evidence.
- Applying – incorporating the evidence into a decision-making process.
- Assessing – evaluating the outcome of the decision taken so as to increase the likelihood.
Through these six steps, practitioners can ensure the quality of evidence is not ignored are able to evaluate the trustworthiness of evidence available. Appraisal varies depending on the source of evidence, but generally involves the same questions:
- Where and how is evidence gathered?
- Is it the best evidence available?
- Is it sufficient to reach a conclusion?
- Might it be biased in a particular direction? If so, why?
Evidence based practice infographic
There are some misconceptions and barriers which prevent the uptake of an evidence-based approach. However, each can be rebuffed:
Evidence-based practice ignores practitioner’s professional experience : This simply contradicts the above arguments. Evidence-based practice does not prioritise one source of evidence over any other. Rather, accumulating evidence from the four sources discussed is most important.
Evidence-based practice is all about numbers and statistics : While critical and statistical thinking is important, the process is not exclusively about numbers and quantitative methods.
Managers need to make decisions quickly and don’t have time for evidence-based practice : Even quick decisions require the most robust and trustworthy evidence.
The unique nature of each organisation means evidence from scientific literature does not apply : Different organisations tend to face similar issues and respond in similar ways.
Briner argues that barriers exist in both academic and organisational spheres. He claims that students are often taught to learn theories, which may be questionable. Instead, they should be taught to think critically and for themselves, while questioning the quality of information. In organisations, political and career incentives may once again encourage sticking with the status quo, or current processes, which may not be effective.
CEBMa research indicates that an evidence-based approach is more effective in various ways than less structured decision-making processes which often favour personal experience over sound research:
Risk assessments based on the accumulated experience of many people are generally more accurate than those based on one person’s experience, ensuring forecasts are made independently before being combined.
Judgements based on hard data and statistics are more accurate than those based on individual experience.
Knowledge from scientific literature is more accurate than expert opinions.
Decisions made through a combination of critically-appraised evidence from multiple sources yield more effective outcomes than those based on a single source of evidence.
These points reinforce the value in adopting a critical mindset – questioning assumptions and trustworthiness – with the goal of answering the question ‘Is this the best available evidence?’
Pietro Marenco of ScienceForWork states that much research on evidence-based practice has focused on what it is and why it is needed, rather than how to do it. However, a more practical approach has been encouraged in recent years, with practitioners in organisations being trained on the principles and know-how to make evidence-based decisions. A three-day training course on evidence-based management, the first of its kind, took place in Belgium in 2017 and focused on applying the theory of the evidence-based approach to real-life management decisions.
As the professional body for HR and people development, the CIPD takes an evidence-based view on the future of work – and, importantly, what this means for our profession. By doing this, we can help prepare professionals and employers for what’s coming, while also equipping them to succeed and shape a changing world of work.
Our Profession Map has been developed to do this. It defines the knowledge, behaviours and values which should underpin today’s people profession. It’s been developed as an international standard against which an organisation can benchmark its values. At its core are the concepts of being principles-led, evidence-based and outcomes driven. This recognises the importance of using the four forms of evidence in a principled manner to develop positive outcomes for stakeholders. As evidence is often of varying degrees of quality, it’s important that people professionals consider if and how they should incorporate the different types of evidence into their work.
Evidence-based practice is a useful concept for understanding whether practices in HR lead to the desired outcomes, and whether these practices are being used to the best effect. Listen to our podcast Evidence-based practice for HR: beyond fads and fiction which features a discussion on what evidence-based practice is, why it matters, and how to apply it at work.
One example of evidence-based practice could be the decision to implement a performance management system. In this situation, performance management data from the business, scientific evidence, insights from key stakeholders, and professional HR expertise would be used to develop the best performance management system for the specific organisational context. Examples of evidence for and against forms of performance management is given in our report Could do better? Assessing what works in performance management .
We’ve also published evidence reviews on a number of other topics, including employee engagement , employee resilience and flexible working and diversity . All our evidence reviews will be featured on our Evidence Hub page, launching soon. For a learning and development perspective, listen to our Evidence-based L&D podcast. There's also Using evidence in HR decision-making: 10 lessons from the COVID-19 crisis , part of our coronavirus webinar series.
Center for Evidence-Based Management (CEBMa)
ScienceForWork - Evidence-based management
Books and reports
BARENDS, E. and ROUSSEAU, D. (2018) Evidence-based management: how to use evidence to make better organizational decisions . Kogan Page: London
RANDELL, G. and TOPLIS, J. (2014) Towards organizational fitness: a guide to diagnosis and treatment . London: Gower.
Visit the CIPD and Kogan Page Bookshop to see all our priced publications currently in print.
Journal articles
BRINER, R. (2019) The basics of evidence-based practice . People + Strategy . Vol 42, No 1. pp16-21.
LAGUNA, L., POELL, R. and MEERMAN, M. (2019) Practitioner research for the professionalization of human resources practice: empirical data from the Netherlands. Human Resource Development International . Vol 22, No 1. pp68-90. Reviewed in In a Nutshell, issue 84 .
ROUSSEAU, D. (2020) Making evidence based-decisions in an uncertain world. Organizational Dynamics . Vol 49, Issue 1, January-March. Reviewed in In a Nutshe ll, issue 96 .
SEVERSON, E. (2019) Real-life EBM: what it feels like to lead evidence-based HR. People + Strategy . Vol 42, No 1. pp22-27.
WRIGHT, P.M. and ULRICH, M.D. (2017) A road well traveled: the past, present, and future journey of strategic human resource management . The Annual Review of Organisational Psychology and Organisational Behaviour . Vol 4. pp45-65.
CIPD members can use our online journals to find articles from over 300 journal titles relevant to HR.
Members and People Management subscribers can see articles on the People Management website.
This factsheet was last updated by Jake Young: Research Associate, CIPD
Jake’s research interests cover a number of workplace topics, notably inclusion and diversity. Jake is heavily involved with CIPD’s evidence reviews, looking at a variety of topics including employee engagement, employee resilience and virtual teams.
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Evidence reviews
The CIPD’s vision is for the HR and people profession to be principles-led, evidence-based and outcomes-driven . Evidence reviews are a crucial way of asking critical questions and gathering evidence to enable better decision-making.
People analytics
Understand what people analytics is, why it’s important and how it’s used
Learn how to use data and research evidence to drive effective decision-making and performance
Evidence-based practice for HR: beyond fads and fiction
Episode 148: Fads, anecdotes, fake news and gut instinct aren't reliable tools for HR practitioners. In this episode we explore evidence-based practice and discuss what it is, how it works, and why it's important for people professionals.
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Open Access
Peer-reviewed
Research Article
Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture
Contributed equally to this work with: Jae Yong Yoo, Jin Hee Kim, Jin Sun Kim, Hyun Lye Kim
Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Writing – original draft, Writing – review & editing
Affiliation Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Validation, Writing – original draft, Writing – review & editing
* E-mail: [email protected]
Roles Conceptualization, Investigation, Methodology, Validation, Writing – original draft, Writing – review & editing
Roles Data curation, Investigation, Resources, Supervision, Writing – review & editing
Affiliation Department of Nursing, Chosun University Hospital, Gwangju, South Korea
- Jae Yong Yoo,
- Jin Hee Kim,
- Jin Sun Kim,
- Hyun Lye Kim,
- Jung Suk Ki
- Published: December 26, 2019
- https://doi.org/10.1371/journal.pone.0226742
- Reader Comments
This study aimed to identify clinical nurses’ evidence-based practice (EBP) knowledge, beliefs, organizational readiness, and EBP implementation levels, and to determine the factors that affect EBP implementation in order to successfully establish EBP. This study was conducted at a university-affiliated tertiary hospital located in a provincial area in Korea. The research design was based on Melnyk and Fineout-Overholt’s Advancing Research & Clinical Practice through Close Collaboration model as the first step.
A descriptive and cross-sectional design was conducted and a convenience sample of 521 full-time registered nurses from an 849-bed tertiary hospital were included. Structured questionnaires were used to assess EBP knowledge, EBP beliefs, organizational culture & readiness and EBP implementation. Data were analyzed using SPSS V 25.0 by using descriptive and inferential statistics and hierarchical multiple regression was performed to determine the factors affecting the implementation of EBP.
Our findings showed that the clinical nurses had a positive level of EBP beliefs, but the level of EBP knowledge, organizational readiness and EBP implementation were insufficient. EBP knowledge, beliefs, and organizational readiness were significantly positively correlated with EBP implementation. In the final model, EBP knowledge and organizational readiness were significant predictors of EBP implementation; the model predicted 22.2% of the variance in implementation.
Conclusions
Based on these results, the main focus of the study was the importance of individual nurses' efforts in carrying out EBP, but above all efforts to create an organizational culture to prepare and support EBP at the nursing organization level. In the initial process of introducing and establishing EBP, nurse administrators will need to minimize expected barriers, enhance facilitators, and strive to build an infrastructure based on vision, policy-making, budgeting, excellent personnel and facilities within the organization.
Citation: Yoo JY, Kim JH, Kim JS, Kim HL, Ki JS (2019) Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PLoS ONE 14(12): e0226742. https://doi.org/10.1371/journal.pone.0226742
Editor: Tim Schultz, University of Adelaide, AUSTRALIA
Received: October 23, 2018; Accepted: December 3, 2019; Published: December 26, 2019
Copyright: © 2019 Yoo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: This study was supported by research fund from Chosun University (2016, PI: Jaeyong Yoo). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Evidence-based practice (EBP) is a problem-solving approach to clinical care that incorporates the conscious use of the best available scientific evidence, clinicians’ expertise, and patients’ values [ 1 ]. This leads to safe patient care and positive patient outcomes, reduces nursing time and medical costs through standardization of nursing practice [ 2 – 5 ]. It also improves professional autonomy and job satisfaction for clinical nurses, ultimately bringing potential benefits to patients, nurses and the health care system [ 6 – 8 ]. For this reason, EBP has emerged as a central concept in the planning and implementation of healthcare systems worldwide. As EBP rapidly replaces the traditional paradigm of authority in healthcare decision-making, health professionals have an obligation to access knowledge, apply it in practice, and lead others to use it appropriately [ 8 – 10 ].
Western countries, such as the United States (US), United Kingdom (UK), and Australia, have emphasized nursing through EBP since the 1990s, and there are active movements such as developing evidence-based guidelines providing various resources related to EBP from organizations specialized in EBP (Cochrane, Joanna Briggs Institute, etc.) [ 11 , 12 ]. In addition, the Institute of Medicine presented EBP competency as one of the five core competencies of healthcare professionals [ 13 ], and the American Association of Colleges of Nursing also presented EBP as one of the nine essential elements of professional nursing practice [ 14 ]. Over the past 30 years, there has been marked theoretical and practical growth associated with EBP, including education and training for EBP in nursing practice, and research conducted including various facilitation strategies [ 9 , 15 ].
In Korea, however, EBP in nursing was first introduced in the early 2000s [ 16 ]. Awareness on the importance of EBP has spread around major large tertiary hospitals in Seoul, but the actual performance of EBP has been reported to be poor outside of the metropolitan area [ 17 – 19 ]. A study involving 437 nurses at tertiary hospitals conducted in 2004, which was the very first time the concept of EBP was introduced in Korea, found that 58% of nurses did not perform nursing practice according to the latest guidelines [ 20 ]. Korean nurses were reported to be underperforming EBP until recently [ 19 ]. In 2013, only 12 of the 30 tertiary hospitals surveyed (40.0%) were organized by EBP committees and were conducting EBP-related clinical nursing studies [ 18 ]. Although various efforts have been made to promote EBP in Korea in recent years, it is apparent that institutional support for EBP is not systematic and insufficient throughout the country.
Barriers to conducting EBP for Korean nurses include: the lack of knowledge and skills, lack of belief and capacity, lack of database access and utilization, and insufficient critical thinking and motivation [ 20 – 22 ]. The barriers to conducting EBP in Korea at the organizational level are organizational culture, insufficient education programs, lack of well-trained EBP experts, lack of time, and inadequate communication [ 20 , 21 , 23 ]. While EBP is a valuable concept, it is difficult for a nurse to implement it first before a nursing organization embraces this new concept [ 24 ]. Therefore, for a successful implementation of EBP, the readiness of an individual nurse and organization must be assessed.
First, EBP implementation is influenced by the knowledge, skills, and beliefs of the individual nurse on EBP [ 22 , 25 , 26 ]. At the organizational level, it is necessary to create an organizational culture that strengthens and supports the nurse’s values and beliefs on EBP, and to share the common beliefs or values of its members to achieve the common goal of successful implementation of EBP [ 12 , 27 ]. It is also important to provide training programs for nurses to strengthen their EBP capabilities and to foster leaders who can effectively lead EBP implementation [ 7 , 28 , 29 ]. There are various strategic models for successful EBP implementation [ 15 ]. The Advancing Research and Clinical Practice through Close Collaboration (ARCC © ) model proposed by Melnyk and Fineout-Overholt [ 24 ] is a representative strategic model that emphasizes personal and organizational elements. The ARCC © , a strategic model developed by the EBP center of the University of Arizona in the US, proposes the use of methodological strategies to promote the implementation of EBP based on the close cooperation between clinical nurses and researchers [ 24 ]. The first step in the ARCC © model is to assess the organizational culture and readiness of the medical institution to successfully establish EBP. This will help identify the strengths and barriers of the organization and improve the nurses’ knowledge on, belief regarding, and capacity to adopt and implement EBP through education and training, environmental improvement, and organizational support while focusing on mentors who act as facilitators in the performance of EBP [ 24 , 30 ]. Successful implementation of EBP can increase the job satisfaction of professional nurses and ultimately improve nursing-sensitive outcomes [ 6 , 7 , 31 , 32 ]. The conceptual framework in this study was constructed based on the ARCC © model.
To date, only a few studies have evaluated the level of preparation, correlation, and influencing factors of EBP implementation among individual nurses and organizations in Korea. This study was conducted at a university-affiliated tertiary hospital located in a provincial area in Korea, as the first step in implementing EBP in accordance with the ARCC © model. This study aimed to identify the clinical nurses’ EBP knowledge, beliefs, organizational readiness, and EBP implementation levels, and to determine the factors that affect EBP implementation in order to successfully establish EBP. The specific objectives of this study were as follows:
- To identify the clinical nurses’ EBP knowledge, beliefs, organizational readiness, and EBP implementation levels
- To examine the differences in clinical nurses’ EBP knowledge, beliefs, organizational readiness, and EBP implementation levels based on the general and research-related characteristics of participants and explore the relationships among these variables
- To identify the factors that affect EBP implementation
Study design and participants
This was a cross-sectional, descriptive study. The participants were recruited from an 849-bed acute care tertiary hospital in South Korea. Convenience sampling was used to select full-time registered nurses employed at this hospital. The sample size required for the multiple regression analysis was calculated using G-Power 3.1 [ 33 ], with an effect size of 0.02, significance level of 0.05, and test power of 0.80 with 14 predictors. It was determined that at least 485 participants were required for analysis. However, this study was the first step involved in the ARCC © model, and all nurses were surveyed to identify the current state of nurses belonging to the abovementioned hospital. Among the 632 registered nurses, 82 of the following nurses were excluded from the survey: 1) part-time nurses, 2) nurses participating in training for new nurses without full-time assignments in the hospital, and 3) laboratory and research nurses not involved with direct patient care. A total of 550 questionnaires were distributed; 521 were returned (94.7% response rate). Finally, 521 who fully understood the purpose of this study and voluntarily consented to participate were included. Participants included clinical nurses working in the wards and special units, clinical nurse specialists, nurse managers, and nurse administrators.
Measurements
This study used structured questionnaires, consisting of the following items: general and research-related characteristics (13), EBP knowledge (14), EBP beliefs (16), organizational readiness for EBP (25), and EBP implementation (18). The measurements used in this study were approved by the original authors and translated versions into Korean have already been used in the previous studies [ 19 , 22 , 34 ]. However, researchers have modified and supplemented some of the items with words or expressions that are commonly used by nurses in this hospital where the study was conducted. Prior to the survey, a pilot test of five clinical nurses identified and revised problematic questionnaire items. The details of the measurements for each variable are as follows.
EBP knowledge.
Participants’ knowledge in implementing EBP was measured using knowledge-related questions from the Evidence-based Practice Questionnaire, developed by Upton & Upton [ 35 ]. This tool consists of 14 items, including “converting your information needs into a research question” and “ability to analyze critically, evidence against set standards.” Response scores on the scale range from 1 (very lacking) to 7 (excellent). Possible total scores range from 14 to 98 points, with higher scores indicating higher levels of knowledge regarding EBP. At the time of its development, the Cronbach’s alpha of the tool was 0.91 [ 35 ] and 0.93 for Korean nurses [ 19 ]. In this study, the Cronbach’s alpha was found to be 0.83.
EBP beliefs.
Participants’ beliefs in valuing EBP were measured using the Evidence-based Practice Beliefs (EBPB) tool, developed by Melnyk and colleagues [ 36 ]. This tool consists of 16 questions. Examples of the items in the EBPB include “I am sure that I can implement EBP in a time efficient way” and “I am sure about how to measure the outcomes of clinical care.” Each question is rated on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree), but scoring for items 11 and 13 was reversed. Possible total scores range from 16 to 80 points, with higher scores indicating positive EBP beliefs. At the time of its development, the Cronbach’s alpha of the tool was 0.90 [ 36 ] and 0.88 for Korean nurses [ 34 ]. In this study, the Cronbach’s alpha was found to be 0.81.
Organizational readiness for EBP.
The organization’s culture and its readiness for system-wide EBP implementation were measured using the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice (OCRSIEP) [ 27 ]. The OCRSIEP scale was developed to measure the levels of readiness in performing EBP, at the organizational level, and consists of 25 questions that offer insights into the strengths of and opportunities related to fostering EBP. Possible total scores range from 25 to 125 points, indicating that the higher the score, the better the organizational readiness and cultural cultivation for implementing EBP. The following questions are asked: “To what extent is EBP clearly described as central to the mission and philosophy of your institution?” and “To what extent is the nursing staff with whom you work committed to EBP?” At the time of its development, the Cronbach’s alpha of the tool was 0.94 [ 27 ] and 0.95 for Korean nurses [ 22 ]. In this study, the Cronbach’s alpha was found to be 0.87.
EBP implementation.
The frequency of performing EBP-related activities was measured using the Evidence-Based Practice Implementation tool, developed by Melnyk and colleagues [ 36 ]. This tool consists of 18 questions pertaining to how often, in the last 8 weeks, participants performed certain EBP activities, such as “Generated a PICOT (P = patient, I = intervention, C = comparison, O = outcome, T = time) question about my clinical practice,” “Accessed the National Guidelines Clearinghouse,” and “Evaluated a care initiative by collecting patient outcome data.” Responses on the scale range from 0 (0 times) to 4 (over 8 times). The possible total scores range from 0 to 72 points, with higher scores indicating higher levels of commitment to implementing EBP-related activities. At the time of its development, the Cronbach’s alpha of the tool was 0.96 [ 36 ] and 0.95 for Korean nurses [ 22 ]. In this study, the Cronbach’s alpha was found to be 0.81.
Data collection and ethical considerations
The Institutional Review Board (IRB) approval was obtained prior to data collection from the authors’ institution (no. 2-1041055-AB-N-01-2018-10, Chosun University Institutional Review Board). Data were collected from December 2017 to January 2018. For data collection, we contacted a nurse administrator at Chosun University Hospital and explained the purpose of this study. Chosun University Hospital is a private university-affiliated, tertiary care hospital located in Gwangju city, South Korea. It is located in Gwangju Metropolitan City in the southern district of Korea and is in charge of medical services in Jeolla province. The hospital consists of 849 beds, with 25 medical departments in operation, including 15 general wards, 4 intensive care units, regional emergency medical center, operating rooms, outpatient departments, and laboratories. A researcher visited the hospital to explain the purpose of this study as well as the inclusion criteria to the nurse unit managers, during a supervisor meeting. The questionnaires were enclosed in different envelopes for each ward and distributed by the staff and assistants of the nursing education team who did not participate in this survey. The collection boxes were made and distributed to each ward, and nurses were allowed to submit questionnaires voluntarily at any time. To ensure anonymity of the participants, the consent form was given in writing with a mark or numbers that could only be known to themselves. Therefore, all nurses, whose questionnaires were collected, were considered to have participated in this study of their own will.
Statistical analysis
Data analysis was performed using SPSS V 25.0. Descriptive statistics, including the means, standard deviations, frequencies, and percentages, were used to describe the participants’ general and research-related characteristics, and EBP-related variables. Differences between major variables, by participants’ characteristics, were analyzed through independent t-tests, analysis of variance, and Scheffe test. The relationships between major variables were analyzed using Pearson’s correlation coefficient. Hierarchical multiple regression was performed to determine the factors affecting the implementation of EBP.
General and research-related characteristics of the participants
Table 1 presents the participants’ characteristics. The mean age of all participants was 31.9±9.2 years, with 58.9% aged 21 to 30. Their overall clinical experience was 9.0+4.2 years, with 80.1% working as staff nurse. Approximately 80.5% of the participants had an associate or bachelor’s degree in nursing, 80.1% worked as staff nurses, and 59.1% worked in a general ward. Approximately 73.5% and 59.7% of nurses completed nursing research and statistics classes, respectively, but most of them answered that they only completed their undergraduate courses. While 46.6% of nurses had experience taking EBP classes, only 25.7% were familiar with EBP-related terms.
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Level of EBP knowledge, beliefs, organizational readiness, and EBP implementation
The level of EBP knowledge was 52.5 ± 11.1 points out of 98. Participants were highly knowledgeable on the use of information technology to search for and use data (4.3 ± 0.9) and shared these ideas and information with colleagues (4.3 ± 1.0). However, they have less knowledge on how to convert these data into research problems (3.8 ± 1.0) and critically analyze existing evidence (3.8 ± 0.9).
The level of EBP beliefs, among the participants, was relatively positive, with a total score of 51.7 ± 5.9 points out of 80. The items with the highest score were “I am sure that evidence-based guidelines can improve clinical care” (3.8 ± 0.6) and “I am sure that implementing EBP will improve the care that I deliver to my patients” (3.7 ± 0.6). The items with the lowest scores were “I believe EBP is difficult” (2.5 ± 0.6) and “I believe that EBP takes too much time” (2.7 ± 0.6).
The level of the organizational readiness to perform EBP perceived by nurses was 76.4 ± 13.0 points out of 125. The participants demonstrated lowest level of readiness on the following aspects: “To what extent are decisions generated from direct care providers” (2.7 ± 0.8) and “To what extent are librarians used to search for evidence” (2.7 ± 0.7). The participants demonstrated high levels of readiness on the following aspect: “To what extent are decisions generated from upper administration” (3.7 ± 0.8) and “To what extent are there EBP champions in the environment among administrators” (3.3 ± 0.7).
The level of EBP implementation was 15.0 ± 3.2 points out of 72. The items with the lowest scores were “accessed the National Guideline Clearinghouse” (0.4 ± 0.2) and “accessed the Cochrane database of systematic reviews” (0.4 ± 0.2). Participants had low levels of engagement in the following activities: “used an EBP guideline or systematic review to change clinical practice where I work” (0.6 ± 0.2) and “shared evidence from studies to over 2 colleagues” (0.7 ± 0.2). Items were listed in order, and details are given in Table 2 and S1 Appendix .
https://doi.org/10.1371/journal.pone.0226742.t002
Differences in the levels of EBP knowledge, beliefs, organizational readiness, and EBP implementation according to participant characteristics
Table 3 presents the differences in EBP variables according to the participants’ characteristics. The level of EBP knowledge significantly differed by age (F = 5.542), clinical experience (F = 4.545), position (F = 9.292), educational level (F = 5.084), and research-related activities. The level of EBP beliefs significantly differed by age (F = 5.370), clinical experience (F = 2.653), position (F = 9.142), educational level (F = 4.585), and research-related activities. Organizational readiness significantly differed by age (F = 13.149), clinical experience (F = 12.814), educational level (F = 5.132), attendance to EBP lectures (t = 2.191), research conducted or research participation (t = 4.033), and familiarity to EBP terminologies (t = 4.062). In terms of characteristics by units, nursing administrators with decision-making authority recognized that the organization’s readiness (F = 3.626) was relatively low compared with that of staff nurses. The level of EBP implementation was mainly related to the experience of statistics courses (t = 2.004), attendance to EBP lectures (t = 2.069), research conducted or research participation (t = 2.953), and familiarity to EBP terminologies (t = 2.508). In terms of characteristics by units, nursing administrators recognized that the level of EBP implementation (F = 2.385) were relatively low compared to staff nurses.
https://doi.org/10.1371/journal.pone.0226742.t003
Relationship among EBP knowledge, beliefs, organizational readiness, and EBP implementation
Bivariate Pearson’s correlation analysis showed that EBP implementation had a significantly positive correlation with EBP knowledge (r = .304, p < .001), beliefs (r = .272, p < .001), and organizational readiness (r = .430, p < .001). In addition, EBP knowledge were statistically positively correlated with EBP beliefs (r = .555, p < .001) and organizational readiness (r = .314, p < .001). EBP beliefs and organizational readiness were statistically positively correlated (r = .406, p < .001) ( Table 4 ).
https://doi.org/10.1371/journal.pone.0226742.t004
Factors affecting EBP implementation
In the final model, EBP knowledge (β = .15) and organizational readiness (β = .36) were significant predictors of EBP implementation; the model predicted 22.2% of the variance in EBP implementation (F = 10.098, p < .001) ( Table 5 ). Age was highly correlated with clinical experience and was excluded from independent variables. Prior to the regression analysis, the data were checked for multicollinearity using tolerance (0.366–0.911) and the variance inflation factor (1.183–2.733). Variance inflation factor values greater than 10 and tolerance-values smaller than 0.10 may indicate multicollinearity. The Durbin-Watson value was 1.905, and each model demonstrated good statistical values.
https://doi.org/10.1371/journal.pone.0226742.t005
EBP knowledge, beliefs, and organizational readiness were significantly correlated with EBP implementation and hierarchical regression presented them as major predictors. Model 1 of regression shows that completing a postgraduate or higher curricula and conducting or participating in research had a significant impact on the level of EBP implementation. In Models 2 and 3 of EBP knowledge, beliefs, and organizational readiness, each variable had a significant effect. In Model 4, EBP knowledge and organizational readiness were the main influencing factors on EBP implementation. Based on these findings, the successful implementation of EBP should prioritize efforts to establish an education strategy to improve EBP knowledge and to create an organizational culture for preparing and supporting EBP at the nursing organization level.
In this study, the EBP implementation level was 15.0 out of 72 points. Melnyk et al.’s study [ 37 ] reported an implementation level of 18.9 points, while that in Korea study [ 26 ] was 33.0 points, which were relatively higher than that reported in this study. A previous study of 410 nurses working at 10 tertiary hospitals in Korea also showed an average implementation level of 0.95 points [ 22 ]. Considering that the EBP implementing scores in this study ranged from zero (when there has been no EBP-related activity over the past 8 weeks) to 1 point (when EBP-related activities were performed one or three times) [ 36 ], suggests that EBP implementation has not been activated at the actual clinical setting. This shows that in South Korea, EBP are only implemented around major large-scale tertiary hospitals located in the Seoul metropolitan area, and the spread and implementation of EBP to a wide range of areas and smaller hospitals, including provincial cities, is insufficient [ 17 – 19 , 22 ]. Previous studies in South Korea also pointed out the spread of EBP concentrated only in Seoul and its surrounding metropolitan areas and stressed the need for efforts to overcome these limitations [ 17 , 18 ].
In recent studies [ 18 , 22 , 23 ], the lack of knowledge among nurses regarding research and statistical methods, education, and lack of experience in research and statistics are reported as important predictors of a nurse’s poor performance of EBP. These studies also point out the overall lack of clinical inquiry creation, accessing and searching for evidence, and critical appraisal and practical application by nurses. EBP experts emphasize that nurses should be sensitive to the continuously generated scientific knowledge and have sufficient knowledge to make critical judgments about such research in order to perform EBP [ 12 , 15 , 24 , 25 ]. However, EBP knowledge is difficult to improve by nurses' personal efforts alone, so organizational support is needed [ 34 ]. Several previous studies suggest the necessity of learning atmospheres and facilities for successful EBP establishment in nursing organizations [ 12 , 21 , 38 , 39 ]. Beyond acquiring knowledge at the individual level, in order to efficiently acquire the knowledge necessary for decision making at the clinical setting, organizations need a system of knowledge management, information systems and databases related to nursing. Encouraging organizational team learning and continuing learning opportunities to improve nurses’ EBP knowledge can be used as an educational strategy. Cho et al. [ 38 ] emphasized using a learning organization as an alternative rather than traditional lecturing methods as a way of delivering knowledge. To do this, it is necessary to operate a ward-level education program in the form of workshops, which includes discussions and brainstorming sessions, rather than a lecture-style education. It is also necessary to establish customized education strategies, such as the operation of journal clubs in wards considering clinical topics specified by each ward. A learning organization that includes an EBP preceptor or EBP mentoring program may also be considered. Introducing and providing the EBP concept in the preceptor training program at the organizational level, helps to have knowledge and positive beliefs about EBP. In addition, it will be necessary to motivate nurses to participate in the conference and to provide incentives for them to present at the conference. Human resources such as EBP mentors will need to be trained so that they can serve as EBP facilitators and EBP champions in wards. In addition, when developing EBP education programs, a hands-on education must be developed and implemented in collaboration with librarians so that practical performance can now be carried out beyond the EBP concept or its importance should be emphasized. Nam et al. [ 39 ] reported that EBP education programs, which include intensive training such as a four-hour workshop per day, computer-based training consisting of a total of three modules that take 15–20 minutes per module, and team-based training programs of 2–3 hours per week, were effective in improving EBP knowledge. One option would be to develop EBP-related cases for each clinical scenario, and to operate a simulation-based EBP training program.
Along with educational strategies for improving EBP knowledge, the establishment of organizational cultural development and support strategies should be considered [ 10 , 24 ]. Organizational readiness for EBP in this study (76.4 points out of 125) was relatively low compared to a recent large online survey conducted in the US (80.2 points) [ 37 ]. In Korea, direct comparisons are limited due to the use of different tools. In the study of Cho et al. [ 17 ], the level of organization support was 3.7 points out of a 5-point scale and 3.3 points as reported by Kim et al. [ 40 ]. In particular, the items with the lowest level of organizational readiness in this study reported lack of the decision-making authority of clinical nurses who perform direct care, lack of support personnel such as librarians, and lack of budget support of nursing organizations to perform EBP. These results suggest that it is urgent to create a nursing organizational culture that facilitates access and utilization of EBP within clinical settings, and prepare all clinical nurses for the successful implementation of the EBP [ 8 , 41 ]. The ARCC © model emphasizes that in order to establish the concept of EBP in organizational culture, the contents of EBP must be clearly stated in the organization’s mission and vision, and consensus on common values. It also emphasizes the need for human resources such as EBP mentors to facilitate EBP, along with improvements in the physical environment [ 24 ]. In this study, there is a shortage of human resources, such as nursing researchers with doctoral degrees or higher, or educators with expertise in EBP, and nurses providing direct care have limited participation and authority in the decision-making in the organization, which requires active intervention and support at the organization level. It is necessary to form an independent EBP committee within the nursing organization for the facilitation of EBP and to establish and implement policies for the creation of EBP culture by leading this committee.
To create such an organizational culture, it is necessary to understand the characteristics of Korean nursing organizations. In general, south Korea has a higher nurse-to-patient ratio, a relatively high working time for nurses in three shifts, and a high workload compared with other countries such as the US, UK and Canada [ 42 , 43 ]. Additionally, South Korea’s nursing organizational culture has a tendency to be mainly hierarchical compared with other Western countries, and this vertical structure has been shown to reduce nurses’ work performance, professional autonomy, job satisfaction, and willingness to serve compared with other organizational cultures [ 16 , 22 , 42 – 44 ]. The ARCC © model emphasizes the creation of an EBP culture that facilitates clinical inquiry as part of the EBP facilitation strategy [ 24 ]. This culture emphasizes the flexibility of the nursing organization to respond to the rapidly changing environment and supports nurses questioning existing nursing practices with professional autonomy [ 7 , 24 ]. In this culture, nurses can perform a series of EBP steps to create various clinical questions, search for evidence, and critically evaluate and apply to practice [ 45 ]. Therefore, the willingness and leadership of nursing administrators with decision-making authority to facilitate EBP implementation are very important.
After analyzing the differences in major variables according to the characteristics of the nurses, higher educational status and experiences of conducting or participating in research had a significant impact on EBP implementation. The more research-related activities, the higher the level of EBP knowledge, beliefs, and organizational readiness, and the higher the level of EBP implementation [ 17 , 22 , 26 , 34 , 46 ]. It is necessary to provide both nursing managers and staff nurses with the opportunity to participate directly in the process of planning and carrying out EBP-related research projects at actual clinical settings [ 21 ]. Through this, it is necessary to reduce the unfamiliarity with EBP and to support frequent positive experiences through direct activities.
The results of this study will contribute to establishing systematic education/training programs and provide the basis for fostering EBP cultures for the successful implementation of the EBP, but there are some limitations. The level of EBP implementation can be affected by various factors, including the type of organizational culture, the characteristics of each hospital organization, regional characteristics, the type of leadership by units, and the composition of nursing staff. Therefore, in future studies, it is expected that the variance of the regression model will be improved by considering these variables. Moreover, as this survey was conducted at one particular hospital located in Korea, the results of this study cannot be generalized. Despite these limitations, we expect that active implementation of these strategies will contribute to providing a stepping stone for the next phase of EBP.
The results of this study suggest that the level of organizational readiness is the greatest factor in EBP implementation. Based on these results, the main focus of the study was the importance of individual nurses’ efforts in carrying out EBP, but above all efforts to create an organizational culture to prepare and support EBP at the nursing organization level. While the performance of EBP positively improves nursing-sensitive outcomes, the process of establishing such EBP also creates a work and psychological burden for clinical nurses and can also lead to resistance from unfamiliar concepts [ 10 ]. The hospital where this study was conducted has not yet activated EBP, but there has been a high demand for nursing managers and nurses to accept the new concept of EBP.
In the initial process of introducing and establishing EBP, nursing organizations will need to minimize expected barriers, enhance facilitators, and strive to build an infrastructure that includes vision, policy-making, budgeting, excellent personnel and facilities within the organization. In addition, it is necessary to participate in ongoing education training, as the improvement of individual EBP knowledge among nurses can enhance positive beliefs and values regarding EBP and actual performance. To this end, of course, the nursing administration will need to develop a curriculum that will foster and evaluate the EBP knowledge of each nurse.
Supporting information
S1 appendix. table 2 ..
Level of EBP knowledge, beliefs, organizational readiness and EBP implementation.
https://doi.org/10.1371/journal.pone.0226742.s001
S2 Appendix. The original questionnaire (Korean version).
https://doi.org/10.1371/journal.pone.0226742.s002
S1 Dataset. Data of questionnaire.
https://doi.org/10.1371/journal.pone.0226742.s003
Acknowledgments
The contributions of all participants in this study are greatly appreciated. We would like to thank Editage ( www.editage.co.kr ) for English language editing.
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- 12. Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & healthcare: A guide to best practice: Philadephia, PA, Wolters Kluwer/Lippincott Williams & Wilkins; 2011.
- 13. Institute of Medicine, Committee on Assuring the Health of the Public in the 21th Century. The future of the public’s health in the 21st century. Washington, DC: National Academies Press; 2003. Available from: https://www.nap.edu/download/10548
- 14. American Association of Colleges of Nursing (AACN). The essentials of baccalaureate education for professional nursing practice. Washington, DC: American Association of College of Nursing; 2008 Available from: https://www.aacnnursing.org/Portals/42/Publications/BaccEssentials08.pdf .
- 27. Fineout-Overholt E, Melnyk B. Organizational culture and readiness scale for system-wide integration of evidence-based practice. Gilbert, AZ: ARCC, LLC; 2006.
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Evidence-Based Practice, Step by Step
- Creator: American Journal of Nursing
- Updated: 6/17/2021
- Contains: 17 items
The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles appeared every two months to allow time for staff to incorporate information as they worked toward implementing EBP at their institutions.
This series has received the Nursing Media Award for Print from Sigma Theta Tau International Awards for Nursing Excellence.
CE CREDIT AVAILABLE! Earn CE credit while learning about EBP with AJN's four-part CE series.
Evidence-Based Practice, Part 1: Developing and Searching the Clinical Question
Evidence-Based Practice, Part II: Critical Appraisal of the Evidence
Evidence-Based Practice, Part III: Implementation
Evidence-Based Practice, Part IV: Disseminating the Evidence and Sustaining the Change
EBP 2.0: Implementing and Sustaining Change: The Malnutrition Readmission Prevention Protocol
AJN, American Journal of Nursing. 119(12):60-64, December 2019.
- Abstract Abstract
- In Brief In Brief
- Permissions
EBP 2.0: Implementing and Sustaining Change: The STAND Skin Bundle
AJN, American Journal of Nursing. 119(10):45-48, October 2019.
Data-Driven Precision Implementation Approach
AJN, American Journal of Nursing. 119(8):60-63, August 2019.
EBP 2.0: Promoting Nurse Retention Through Career Development Planning
AJN, American Journal of Nursing. 119(6):62-66, June 2019.
Go to Full Text of this Article
EBP 2.0: From Strategy to Implementation
AJN, American Journal of Nursing. 119(4):50-52, April 2019.
Evidence-Based Practice, Step by Step: Sustaining Evidence-Based Practice Through Organizational Policies and an Innovative Model
AJN, American Journal of Nursing. 111(9):57-60, September 2011.
Evidence-Based Practice, Step by Step: Evaluating and Disseminating the Impact of an Evidence-Based Intervention: Show and Tell
AJN, American Journal of Nursing. 111(7):56-59, July 2011.
Evidence-Based Practice, Step by Step: Rolling Out the Rapid Response Team
AJN, American Journal of Nursing. 111(5):42-47, May 2011.
Evidence-Based Practice, Step by Step: Implementing an Evidence-Based Practice Change
AJN, American Journal of Nursing. 111(3):54-60, March 2011.
Evidence-Based Practice, Step By Step: Following the Evidence: Planning for Sustainable Change
AJN, American Journal of Nursing. 111(1):54-60, January 2011.
Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence Part III
AJN, American Journal of Nursing. 110(11):43-51, November 2010.
Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence: Part II: Digging deeper—examining the "keeper" studies.
AJN, American Journal of Nursing. 110(9):41-48, September 2010.
Evidence-Based Practice Step by Step: Critical Appraisal of the Evidence: Part I
AJN, American Journal of Nursing. 110(7):47-52, July 2010.
Evidence-Based Practice, Step by Step: Searching for the Evidence
AJN, American Journal of Nursing. 110(5):41-47, May 2010.
Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice
AJN, American Journal of Nursing. 110(3):58-61, March 2010.
Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice
AJN, American Journal of Nursing. 110(1):51-53, January 2010.
Evidence-Based Practice: Step by Step: Igniting a Spirit of Inquiry
AJN, American Journal of Nursing. 109(11):49-52, November 2009.
Explore People Profession
- Profession Map
Core knowledge
- Evidence-based practice
Using evidence and data to create insight, problem solve and develop ideas and measure impact
More, now than ever, people professionals are taking an evidence-based approach to their work, using organisation data, research, stakeholder insights and perspectives as well as professional expertise to deliver work that’s impactful.
Evidence-based practice is, quite simply, taking an evidence-based approach to your work: using the right data and the right information in a structured way, to inform the decisions you take and the work that you do, because it leads to better outcomes.
This area of the Profession Map focuses on the knowledge required to take this evidence-based approach. It covers an understanding of evidence-based practice itself, as well as how to analyse and solve problems in order to understand the business problem that needs resolving. It also includes knowledge of how to use evidence in your work, such as using and commissioning research, using data and analytics, and exploring stakeholder needs and concerns.
This Core knowledge area is strongly supported by two of the core behaviours: Insights focused, and Situational decision-making. Together, they are the knowledge and behaviours required for people professionals to be truly evidence-based in their approach at work, and to live the CIPD’s values.
'The essence of the value created by organisations is delivering the promise made to a customer and that applies equally whether you are operating in the for-profit, public or not-for-profit sectors. In terms of how analytics contributes to the creation of value, this quote from the late author Terry Pratchett comes to mind: "If you do not know where you come from, then you don't know where you are, and if you don't know where you are, then you don't know where you're going. And if you don't know where you're going, you're probably going wrong".'
Eugene Burke, Psychologist, Data Analyst, Board Advisor and Analytics Advisor to the CIPD
Profession Map menu
Profession map overview, purpose and values.
- Our purpose: overview
- Principles-led
- Evidence-based
- Outcomes-driven
- Core knowledge: overview
- People practice
- Culture and behaviour
- Business acumen
- Technology and people
Core behaviours
- Core behaviours: overview
- Ethical practice
- Professional courage and influence
- Valuing people
- Working inclusively
- Commercial drive
- Passion for learning
- Insights focused
- Situational decision-making
Specialist knowledge
- Specialist knowledge: overview
- Employee experience
- Employee relations
- Equality, diversity and inclusion
- Learning and development
- Organisational development and design
- People analytics
- Talent management
Evidence-based practice standards
Each standard progresses through four levels of impact. Which level do you most embody in your day-to-day work?
Foundation level
At this level you'll understand:
- What evidence-based practice is, and the different steps and types of evidence used
- Analysis and problem solving tools (e.g. SWOT, PESTLE, 5 Whys)
- What data is and why it's important
- How to access research via websites (such as the CIPD website)
- The range of stakeholders that people professionals work with
- The different measures used in your organisation and how they apply to your work
Associate level
- The four types of evidence used in decision-making, and how to identify and acquire sources of evidence
- How to select analysis and problem solving tools for a specific situation
- How data and analytics can be used and communicated to resolve people issues
- How to access published research relating to your area of work
- Stakeholder analysis and mapping and ways to gather stakeholder feedback (e.g. pulse checks and surveys)
- Measures and metrics that can be used to track the achievement of outcomes and the impact of your work
Chartered Member level
- How to assess the quality and relevance of evidence available, by identifying sources of bias and using evidence-based questioning models
- How to use analysis and problem solving techniques to translate issues into answerable questions
- How to use data and analytics (e.g. people, financial, business) to provide insight, answer questions and make decisions
- How to use relevant research (published or commissioned) to inform your approach
- How to explore stakeholder needs and concerns using a range of methods (e.g. focus groups)
- How to define outcomes for people practices and measure their impact and value
Chartered Fellow level
- How to build organisation capability and systems to enable evidence-based practice
- How to develop analysis and problem solving capability
- How to use business and people analytics and insights to influence and shape strategy
- Emerging research and findings that have the potential to add value to the organisation
- How to reflect and balance different stakeholders' perspectives and values when developing strategy
- How to define outcomes for people strategies and measure their short and long-term impact and value
Resources to guide your work, career planning and development, available on the CIPD's main site.
- Evidence-based practice for effective decision-making – Factsheet
- Evidence-based practice for HR: beyond fads and fiction – Podcast
- People analytics - Factsheet
- People analytics – Viewpoint
- Getting started with people analytics: a practitioner's guide - Guide
- Workforce reporting – Factsheet
- PESTLE analysis - Factsheet
- SWOT analysis - Factsheet
Next: Technology and people
Understanding the impact of technology on people at work
Join the conversation
How Does Evidence-based Practice Differ from Evidence-informed Practice?
View all blog posts under Articles | View all blog posts under Nursing Resources
In nearly every industry, but particularly in health care, it’s common to make decisions based on data and other statistical evidence. Clinical studies and other resources can help health care practitioners, including family nurse practitioners, make the best choices regarding their patients’ needs.
Within the health care sector, there are two main terms used in conjunction with this concept: evidence-based practice and evidence-informed practice. And while they are sometimes used interchangeably by health care providers, there is a slight but important distinction.
Defining evidence-based practice
Nurse practitioners and those working in the health care industry will likely come across evidence-based practice as a concept more often than evidence-informed practice, which we’ll explore more in-depth later.
As defined by the Academy of Medical-Surgical Nurses (AMSN) in 2019, evidence-based practice refers to the process of using the latest and most relevant evidence to guide decisions related to nursing care, with the overarching goal of improving patient outcomes. Evidence-based practice is an evaluative, qualitative, problem-solving approach that leverages the best available information to support nurse practitioners’ decisions.
Evidenced-based practice (EBP) enables nurse practitioners and health care professionals to use relevant evidence in the form of clinical studies and other sources to answer important questions about patient care. As AMSN noted, the process involves:
- Searching for and validating relevant evidence
- Leveraging one’s own clinical experience in the field
- Incorporating details related to the patient’s individual preferences, needs and values
“The EBP process is a method that allows the practitioner to assess research, clinical guidelines and other information resources based on high-quality findings and apply the results to practice,” AMSN stated in 2019.
It can be helpful to think of evidence-based practice as a health care concept that’s similar to the scientific method. An April 2014 research paper from M. Gail Woodbury and Janet L. Kuhnke pointed out that the process starts with a well-developed, answerable question, akin to a hypothesis statement in a scientific experiment. From here, the process follows that explained above, with the search and evaluation of evidence. As Woodbury and Kuhnke noted, though, the process doesn’t end once the initial question has been answered through research validation. Afterward, it’s important for NPs to examine and evaluate the success and effectiveness of their care decisions, and apply these insights to their future practice.
What types of questions can be answered with evidence-based practice?
Nurse practitioners can leverage the evidence-based practice process to find solutions for an array of different health care and treatment-focused questions. Woodbury and Kuhnke provided a few key examples, including questions like:
- How widespread or common is a certain condition or medical complication?
- What is the best approach for assessing the condition or the risks involved?
- Which treatment will be the most clinically or cost effective?
- Which preventive strategies will the patient most likely follow?
- How should the outcome be accurately measured?
Formulating the right questions can help nurse practitioners find the right research sources to guide their decisions. For instance, a question regarding treatment types, therapy or intervention is typically best answered with a systematic review or randomized controlled trial. On the other hand, practitioners seeking to answer questions about patient experiences or concerns should look to the best available qualitative studies.
Defining evidence-informed practice
Evidence-informed practice (EIP), while sometimes used to describe the evidence-based practice process, is actually a bit different.
While evidence-informed practice still relies on the use of the best available research, it typically involves the implementation of a facility-wide program, as opposed to guiding decisions regarding an individual patient case, noted the Child Welfare Information Gateway. EIP is used to support health care policymaking — for instance, the World Health Organization and the Canadian Institutes of Health Research both utilize EIP for their policy decisions, according to Woodbury and Kuhnke’s 2014 research paper.
Overall, evidence-informed practice includes a wider scope than evidence-based practice, and, as Woodbury and Kuhnke noted in their 2014 research paper. EIP also addresses a wider set of goals. In addition, evidence-informed practice in the health care industry can provide more flexibility in terms of evidence sources, encompassing information besides clinical studies like clinical best practice guidelines.
“Critics of EBP have suggested that information used to make clinical decisions should include more than evidence collected with the singular goal of reducing bias in intervention research and should include a variety of sources of research information that address a wider range of goals,” Woodbury and Kuhnke wrote in 2014. “… [EIP] implies that many different levels of evidence and types of evidence are needed and used to support decisions in clinical practice. Many people believe that ‘evidence-informed practice extends beyond the early definitions of evidenced-based practice.'”
What MSN-FNP students can learn through Bradley University’s online program
Nurses studying in Bradley University’s online Master of Science in Nursing – Family Nurse Practitioner program will take part in course NUR 526: Evidence-Based Practice . This three-credit course will educate nurses about current study theories as part of gathering health care evidence, as well as the best ways to use this research in their health care practices. During the course, nurses will learn to pinpoint emerging problems across several different practice areas and leverage these scenarios to create a researchable project.
This course provides hands-on experience with the evidence-based practice process and is beneficial training for nurse practitioners.
To find out more, check out our curriculum information , and connect with one of our enrollment advisors today.
Recommended Reading
Inpatient vs. Outpatient Challenges Faced by FNPs
What Are The Benefits of an Online-only FNP Program?
Bradley University Online MSN-FNP Program
AMSN – Evidence-Based Practice
ResearchGate – Woodbury and Kuhnke Research Paper
Child Welfare Information Gateway – Evidence-Based Practice Definitions and Glossaries
- #5 Among Regional Universities (Midwest) – U.S. News & World Report: Best Colleges (2021)
- #5 Best Value Schools, Regional Universities (Midwest) – U.S. News & World Report (2019)
- Bradley Ranked Among Nation’s Best Universities – The Princeton Review: The Best 384 Colleges (2019). Only 15% of all four-year colleges receive this distinction each year, and Bradley has regularly been included on the list.
- Bradley University has been named a Military Friendly School – a designation honoring the top 20% of colleges, universities and trade schools nationwide that are doing the most to embrace U.S. military service members, veterans and spouses to ensure their success as students.
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What is problem solving.
The definition of problem-solving is the process and ability to find solutions within complex problems and issues. Solving problems and finding potential solutions to fix a current issue is part of the problem-solving process. Practical problem solving can deal with creative thinking to see common sense to the original problem and figure out what the next steps should be. The beauty of problem-solving is that new issues come up all the time, so learning the steps needed to identify a solution will be an essential skill to have. There is no one way via problem-solving techniques, so it's important to learn skills to figure out solutions to issues.
Problem Solving Skills Examples
Many scenarios revolve around problem-solving and decision making. Being able to be a problem solver for a wide range of issues will make you more confident in any matter. Some typical examples in which problem-solving is necessary include math problems, project management, social problem solving, and more.
Who were Great and Famous Problem Solvers?
There are many famous problem solvers over the years to learn great tips from. Each of these people had different approaches to creative problem solving, but they were all masters in problem finding and solutions. Some of the greats include Albert Einstein, Bill Gates, Edward Jenner, Marie Curie, Thomas Edison, and more.
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Evidence-based practice is held as the gold standard in patient care, yet research suggests it takes hospitals and clinics about 17 years to adopt a practice or treatment after the first...
Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values.
Johns Hopkins Evidence-Based Practice Model The Johns Hopkins Evidence-Based Practice model for Nurses and Healthcare Professionals is a powerful problem-solving approach to clinical decision-making and is accompanied by user-friendly tools to guide individuals or groups through the EBP process.
Evidenced-based practice is often described as an approach to patient care that involves considering the best available research and practice guidelines associated with a specific clinical situation. Key elements in the successful implementation of evidence-based practice in nursing include:
Models and Frameworks for Implementing Evidence- Based Practice: Linking Evidence to Action. Johns Hopkins Model. a powerful problem-solving approach to clinical decision-making, and is accompanied by user-friendly tools to guide individual or group use. It is designed specifically to meet the needs of the practicing nurse and uses a three-step ...
Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values.
The AORN Journal Quality Improvement Showcase follows the five steps of EBP, namely: 1) identifying the problem, 2) accessing the best evidence, 3) critically appraising the evidence, 4) applying the change to practice, and 5) evaluating the change in practice. 1 As described elsewhere, the five steps of EBP also align with the steps of the …
Evidence-based practice (EBP) is defined by Duke University Medical Center as "the integration of clinical expertise, patient values and the best research evidence into the decision-making process for patient care." EBP strategies allow nurse practitioners (NPs) and other health care providers to translate research findings into clinical practice.
Evidence-Based Practice Levels of Evidence Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a clinician's expertise in making decisions about a patient's care.
The International Council of Nurses defines evidence-based practice as "A problem solving approach to clinical decision making that incorporates a search for the best and latest evidence, clinical expertise and assessment, and patient preference values within a context of caring."
EBP is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. ... The JH Evidence-based Practice Model occurs in three phases: Practice Question, Evidence, and Translation.
The ultimate goal of the evidence-based nursing problem-solving approach is to help nurses provide the highest-quality, most cost-efficient care possible. Today, evidence-based nursing practice is part of the curriculum for most nursing degrees, including RN-to-BSN programs. Why is evidence based practice important?
Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from … This is the third article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice.
This paper reviews the empirical evidence in support of the three concepts in the title. To the extent that a skill should be a general strategy, applicable in a variety of situations, and independent of the specific knowledge of the situation, there is little evidence that problem-solving skills, as described and measured in medical education, possess these characteristics.
An evidence-based approach to decision-making is based on a combination of using critical thinking and the best available evidence. It makes decision makers less reliant on anecdotes, received wisdom and personal experience - sources that are not trustworthy on their own.
Evidence-based practice (EBP) is a problem-solving approach to clinical care that incorporates the conscious use of the best available ... Gallagher-Ford L, Stillwell SB. Evidence-based practice, step by step: sustaining evidence-based practice through organizational policies and an innovative model. Am J Nurs. 2011;111(9):57-60. pmid ...
Evidence is summarized of the use and effectiveness of the proposed evidence-based strategy. Most successful problem solvers use a "strategy.". In this paper, we survey published strategies ...
Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best ...
Evidence-based practice is, quite simply, taking an evidence-based approach to your work: using the right data and the right information in a structured way, to inform the decisions you take and the work that you do, because it leads to better outcomes.
Evidenced-based practice (EBP) enables nurse practitioners and health care professionals to use relevant evidence in the form of clinical studies and other sources to answer important questions about patient care. As AMSN noted, the process involves: Searching for and validating relevant evidence
The evidence supporting the three mathematical problem solving instructional tips is drawn from research that meets What Works Clearinghouse (WWC) design standards and is summarized here. [For the full practice guide, see ED532215. For "Improving Mathematical Problem Solving in Grades 4 through 8: Instructional Tips Based
Practical problem solving can deal with creative thinking to see common sense to the original problem and figure out what the next steps should be. The beauty of problem-solving is that new issues come up all the time, so learning the steps needed to identify a solution will be an essential skill to have. There is no one way via problem-solving ...