The first step in the Evidence Based Practice (EBP) process is identifying a clinical problem or question. Sounds easy enough, but this problem or questions must be something that is answerable. The PICOT method is very useful in providing guidance in the development of a research questions (DeNisco & Barker, 2016). The “P” refers to the target population, “I” is the intervention or variable that one is interested in studying, “C” is a comparison of with and without said intervention of variable, “O” is the outcome, and “T” refers to the time it takes to reach an outcome.
The next step in EBP is research. After forming a PICOT, you want to search for all existing and current evidence related to your topic. There are steps related to research as well. You must have inclusion and exclusion criteria; this is often related to age of study. You must select appropriate databases to search, and you must critically analyze the evidence types. Not all evidence is created equally, there is a major difference between evidence from a systemic review or meta-analysis with randomized trials versus observational descriptive or qualitative studies. According to DeNisco and Barker, the AACN has created a new evidence leveling system that essentially grades the evidence (2016, p. 476). Critically analyzing the newfound evidence is important to determine if the research is valid, of quality and applicable to your EBP. There are a number of models, checklist, and grading systems available to help with the critical analysis and organization of evidence (DeNisco & Barker, 2016). There are a number of databases that can be used to research, the GCU nursing library page lists several nursing databases that are great for the initial stages of EBP and research (GCU Library, n.d.). To name a few: CINAHL Complete is a good data based to start because it has quite a few specialties and is very nursing specific. PubMed is another one that has a gigantic database and is free to use. And COCHRAN library is a good one because it has seven different databases that related to providing medical providers with high-quality and independent evidence that can help with decision making in care.
After collecting new evidence, critically appraising it, one must then determine if the new evidence is strong enough to support an intervention or change in practice; or if more evidence is needed and more research must be conducted. If an intervention or implementation is made, they must be measurable, and one must be able to evaluate the effectiveness of said interventions. DeNisco & Barker said “Evaluating practice and changes in practice is essential to the successful implementation of any quality improvement or evidence-based practice initiative. Evaluation is an ongoing process that must start early in a project and be continual” (2016, p. 522). These outcomes can then be compared to national benchmarks; benchmarking is essentially like continuously comparing your outcomes to the industry’s “gold standard” or the best of the best. Benchmarking is a way to make sure that current practices are staying relevant with practices of other organizations or competitors.
References
DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Jones & Bartlett Learning.
GCU Library, (n.d.). Nursing & health sciences: Evidence-based practice. https://libguides.gcu.edu/Nursing/ebp
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