Nursing: Evidence Based Nursing Practice

Evidence based practice is answering clinical questions using a combination of information from existing research, your clinical expertise, your patient's values, and the local resources.

Evidence based practice can be broken down into the following steps:

1. You ask a question about patient care, prognosis, harm, or diagnosis. 
2. You clarify your question using PICO:    P=patient/problem   I=intervention   C=comparison  O=outcomes
3. You search for an existing answer in research studies or summaries .
4. You evaluate the answer that you find. Does it fit with your patient's values and with the resources at hand?
5. You carry out the answer.

A Literature Review is a scholarly analysis of a body of research about a specific issue or topic. (See Literature Reviews tab for more info.)

A Meta-Analysis is a statistical technique for combining the findings from independent studies to assess the clinical effectiveness of healthcare interventions.

A Randomized Controlled Trial (RCT) is an experiment that delivers an intervention or treatment; subjects are randomly assigned to control and experimental groups, so it is the strongest design to support cause and effect relationships.

A Systematic Review is a comprehensive, unbiased review of multiple research studies that tries to identify, appraise, select, and synthesize all high quality research evidence relevant to that research question.

PICO (alternately known as PICOT) is a mnemonic used to describe the four elements of a good clinical question. It stands for:

P - Patient/Problem (Describe as accurately as possible the patient or group of patients of interest)

I - Intervention (What is the main intervention or therapy you wish to consider?)

C - Comparison (Is there an alternative treatment to compare?)

O - Outcome (What is the clinical outcome?)

T - Time (Time it takes to demonstrate a clinical outcome. Optional.)

Many people find that it helps them clarify their question, which in turn makes it easier to find an answer. 

Use PICO to generate terms - these you'll use in your literature search for the current best evidence. Once you have your PICO terms, you can then use them to re-write your question.  (Note, you can do this in reverse order if that works for you.)

Example

Often we start with a vague question such as, "How effective is CPR, really?"  But, what do we mean by CPR?  And how do we define effective? PICO is a technique to help us (or force us) to answer these questions. Note that you may not end up with a description for each element of PICO. 

P -  our question above doesn't address a specific problem other than the assumption of a person who is not breathing. So, ask yourself questions such as, am I interested in a specific age cohort? (Adults, children, aged); a specific population (hospitalized, community dwelling); health cohort (healthy, diabetic, etc.)   

I - our question above doesn't have a stated intervention, but we might have one in mind such as 'hands-only'

C - Is there another method of CPR that we want to compare the hands-only to?  Many research studies do not go head to head with a comparison. In this example we might want to compare to the standard, hands plus breathing

O - Again, we need to ask, what do we mean by 'effective'?  Mortality is one option with the benefit that it's easily measured. 

Our PICO statement would be...

P - community dwelling adults
I - hands only CPR
C - hands plus breathing CPR
O - mortality

From our PICO, we can write up a clearer and more specific question, such as: In community dwelling adults, how effective is hands-only CPR versus hands plus breathing CPR at preventing mortality?