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.

1. 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?
2. 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.
3. 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.
4. 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?
5. 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?

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).