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Evidence-based Nursing Practice



What is EBP?

Evidence-based Practice (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).

Citation: Dearholt, Sandra L., and Dang, Deborah. Johns Hopkins Nursing Evidence-Based Practice : Models and Guidelines (2nd Edition).

Additional Guides for EBP:

Asking a PICO Question


Describe the problem or population. 


Choose a main therapy, prognosis, or treatment.


Is there an alternative to compare with the intervention?


What will the intervention accomplish, measure, or improve?


PICO is an acronym used to describe the four elements of a compelling clinical research question. 

Fill in the blanks with information from your clinical scenario:


In_______________, what is the effect of ________________on _______________ compared with _________________?

Use: Randomized Controlled Trials (RCTs), meta-analyasis. Also: cohort studies, case-control studies, case series. 



For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?

Use: Randomized Controlled Trials (RCTs), meta-analyasis. Also: prospective studies, cohort studies, case-control studies, case series. 



Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?

Use: Randomized Controlled Trials (RCTs). Also: cohort studies. 



Does ____________ influence ______________ in patients who have _____________?

Use: Cohort studies. Also: case-control studies, case series. 



Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ with/without______________?

Use: Randomized Controlled Trials (RCTs), meta-analyasis, cohort studies. Also: case-control studies, case series. 



How do _______________ diagnosed with _______________ perceive __________________?

Use: Qualitative studies. 

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Request a copy through CSU+. 

Levels of Evidence

When it's time to critically appraise the evidence on your topic, consider these various levels of evidence. You can include all different types of evidence in your paper, but be aware of the strengths and weaknesses of each methodology. You should use the best available evidence for your topic. There may not always be systematic reviews or critically appraised evidence on your topic, so you may need to rely more on randomized controlled trials.

Pyramid image to visualize both the quality of evidence and the amount of evidence available. For example, systematic reviews are at the top of the pyramid, meaning they are both the highest level of evidence and the least common. As you go down the pyramid, the amount of evidence will increase as the quality of the evidence decreases.

Johns Hopkins Nursing EBP Toolkit