Evidence-Based-Practice

An introductory tutorial

Evidence-Based Practice is an interprofessional tutorial from the Health Sciences Libraries at the University of Minnesota. This tutorial covers the foundational aspects of evidence-based practice.

If you are looking for a more comprehensive, in-depth lesson on evidence-based practice, please visit our advanced tutorial.

The content in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Creative Commons License
Images © 2016 Regents of the University of Minnesota. All rights reserved.

Evidence-Based Practice

Evidence-based practice (EBP) is the thoughtful integration of the best scientific research with clinical expertise and patient needs and values.

While we mainly talk about it with healthcare, the core concepts can be used in any profession.

After completing this tutorial, you will be able to:

Identify what EBP is and why it is important
Define the strategies that exist for EBP
Recognize the 5 steps of EBP
Demonstrate how to ask an answerable question
Categorize appropriate sources of information

Table of Contents

What is Evidence-Based Practice (EBP)?
Why is EBP Important?
Overview of The 5 Steps of EBP
Asking a Well-Built Question
Acquiring Resources
Test Your Knowledge

What is Evidence-Based Practice?

Evidence-based practice looks at:

Clinical expertise - the provider’s judgement about what works best in similar patients or in similar situations.

Research evidence - the results of scientific studies to find out which treatments, diagnostic methods, or ways of predicting a patient outcome work best.

Patients needs/values - what is important for the patient and what healthcare options best match those values.

So why is this important? Let's look at three reasons why.

Why is Evidence-Based Practice Important?

Practitioners surrounding patient on table

Clinical Expertise

Health is complex and there isn’t good research on every topic.

Through years of practice, healthcare providers develop clinical expertise that guides patient care decisions.

This clinical judgement is essential for applying evidence-based practice.

Why is Evidence-Based Practice Important?

Researcher looking at sample

Research Evidence

Scientists carefully design studies to give an unbiased measure of how well things such as treatment and diagnostic tests work.

Research evidence can provide a higher-level view than expert opinions or objective data to help inform healthcare decisions, and is one of the important pieces of evidence-based practice.

Why is Evidence-Based Practice Important?

Two nurses looking at child on mother's lap

Patient Needs & Values

There are many conditions where patient needs and preferences are important factors in choosing the right treatment or screening option.

Cost of care, quality of life, and personal beliefs are all important considerations.

Patients should be partners in their care and help decide what type of healthcare is best for them.

Evidence-based practice recognizes that patient values are essential in determining care.

Steps of Evidence-Based Practice

Now that we have identified why evidence-based practice is important, let’s address the steps of evidence-based practice.

There are five steps of evidence-based practice that provide a framework for approaching a question.

Step 1: Ask a well-built question
Step 2: Acquire evidence
Step 3: Appraise the evidence
Step 4: Apply the evidence along with clinical judgement and patient values
Step 5: Assess the results

Step 1: Ask

What is a well-built question and why is it important?

When you are presented with a patient case, there is usually a flood of details to digest.

To effectively search for the best evidence, you first need to decide what details are important.

For example:

  • Who is the patient?
  • Is their medical or social history important?
  • What characteristics of the patient matter?
  • Are certain signs and symptoms relevant?

Step 1: ASK

One strategy for creating a well-built clinical question is to use the PICO method.

PICO is a mnemonic device that helps us focus on the most important information in a case and formulate a question for searching.

The Parts of PICO

P: The patient’s disorder or disease or problem of interest
I: The intervention or finding under review
C: A comparison intervention (if applicable - not always present)
O: The outcome

Let's take a look at a few clinical scenarios and how we would break these into PICO.

Step 1: ASK

Clinical Scenario

A 65 year old man with high cholesterol wants to know if red yeast rice will work as well as the statin drug he is taking to lower his cholesterol.

PICO Breakdown

Problem: 65 year-old man with high cholesterol
Intervention: Red rice yeast
Comparison: Statin drug
Outcome: Lower cholesterol

Step 1: ASK

Clinical Scenario

A 50 year old man has a 2 year history of low back pain. He wants the pain to stop and is wondering if physical therapy or surgery is a better option. He is worried that physical therapy is less effective, but does not like the healing process and cost with surgery.

PICO Breakdown

Problem: 50 year old man with history of low back pain
Intervention: Physical therapy
Comparison: Surgery
Outcome: Pain relief

Step 1: ASK

Clinical Scenario

A 34 year old woman comes to the clinic with recurrent cold sores and wonders if taking zinc might help prevent them.

PICO Breakdown

Problem: 34 year-old woman with cold sores
Intervention: Zinc
Comparison: No treatment
Outcome: Prevention of cold sores

Using PICO to create a question

Now that you have identified the important elements of the scenario, some people find it helpful to pull together the elements into a question format.

For example:

In a 65 year old man with high cholesterol, is red yeast rice as effective at lowering cholesterol as a statin drug?

In a 50 year old man with low back pain, is physical therapy as effective at relieving pain as surgery?

In a 34 year old woman with cold sores, does taking zinc work help to prevent cold sores?

Step 2: Acquire

After you have formulated a question through using PICO, you need to acquire evidence to help inform your answer.

There are several different categories of information and different questions are often suited to different categories of information.

Background Resources: Provides an overview of a topic

Synthesized Resources: Appraises and summarizes studies (primary sources)

Primary Sources: A single research study that tries to answer a specific question

Step 2: Acquire

Background Resources

If you just need an overview of a topic, consider background resources, such as a textbook or a review article.

Strengths:
A summary on an entire topic, good for definitions and getting up to date quickly on history and best practices. Good for if you unfamiliar with a topic

Weaknesses:
May not include the most current evidence on a topic

Examples:
Review Articles or Textbooks like Harrison’s Principles of Internal Medicine or Williams’ Gynecology

Step 2: Acquire

Synthesized Resources

Evidence-based practice focuses on using synthesized resources as a first approach whenever possible. Synthesized resources gather and evaluate all the best evidence into an easily-readable summary.

Strengths:
More current than background sources, summarize other articles, built by experts following a systematic method

Weaknesses:
May not exist for every topic or question, may not include the latest information

Examples:
DynaMed Plus, Micromedex or Cochrane Library's systematic reviews

Step 2: Acquire

Primary Literature

When synthesized information is not available for a question, you should turn to the primary literature. These research study articles provide the most current and most detailed information.

Strengths:
Most current, most specific, level of detail allows methods to be examined

Weaknesses:
Time consuming to find and critique, more open to bias

Examples:
Journal articles in databases like PubMed, CINAHL, or Embase

Review

To review, can you identify:

What evidence-based practice is and why it is important?
What strategies exist for evidence-based practice?
The five steps of evidence-based practice?
How to ask an answerable question?
The three types of sources of information dentifying appropriate sources of information?

If you think you can, proceed to the assessment on the next slide. To get your results along with the correct answers, you will need to provide your email address at the end of the assessment.

Step 3-5

Once you find the information, you will need to appraise its quality and then apply it to your specific patient or situation.

Visit the module Step 3: Critical Appraisal to continue learning the steps of EBP.

Contact Information & Credits

The content in this tutorial, including the assessment was created by Jonathan Koffel, Franklin Sayre, and Elizabeth Weinfurter - Librarians at the University of Minnesota Bio-Medical Library.

Lindsay Matts-Benson and Andrew Palahniuk from the University of Minnesota Libraries Instructional Design Team provided Instructional Design support.

Contact the Biomedical Library staff if you have any additional questions about the content in this tutorial.

The content in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Creative Commons License
Images © 2016 Regents of the University of Minnesota. All rights reserved.