This presentation is used with the video on the VCU Nursing Research Guide to explain what evidence based practice is and how the process works.

1. WHAT IS EVIDENCE
BASED PRACTICE?

2. Patient Values/
Preferences
Or
Expectations
Clinical
Data/
Knowledge
Research
Evidence
Optimal
Decision
What does the patient
want?
What are they willing to
do?
What does your experience tell
you?
What has been the experience of
your colleagues?
What does the research
say?

3. Evidence Based Practice Inquiry Process
Focus
the
question
Adequate
evidence?
Assign /
Find
mentor
IRB
Proposal
&
Approval
Data
collection
Data
analysis
Disseminate
Impact
and/or
outcome
Initial
question
Unit
or
department
resource
Assess
translation
of evidence
into
practice
setting
Create
action
plan
and
implement
change
Evaluate
outcome
and/or
impact
Finalize team
membership
and schedule
conferences
Report
results
to
decision-
makers
Adopt
change
and
identify
next steps
Contact Research
Advisory Council
or
Group (If Applicable)
Appraisal
of
literature
Assemble
initial
project
team
If answer is yes,
proceed to EBP
Project.
If answer is no,
proceed to research
project
Consult
Librarian &
Do Lit. Search
Adapted from VCUHS Nursing Inquiry Process Diagram

4. Levels of Evidence
Evidence
Based
Practice
Guidelines
Meta- Analysis /
Systematic
Review
Critically Appraised
Topics
[Evidence Syntheses]
Critically Appraised Individual
Articles
[Article Synopses]
Randomized Control Trials (RCT’s)
Cohort Studies / Cross-Sectional Study
Case Controlled Studies/
Case Reports
Reviews
Background Information / Expert Opinion
Filtered Information
Unfiltered
Information
EBP Objective:
Clinical Knowledge Bedside

5. Practice Guideline
Advantages
Created by panels of experts
Based on professional published
literature
http://www.gwumc.edu/library/tutorials/studydesign101/practiceguidelines.html
Statement produced by a panel of experts that outlines current best
practice to inform health care professionals and patients in making
clinical decisions.
 Where Can They Be Found?
o PubMed
o CINAHL
o National Guidelines Clearinghouse
Disadvantages
 Slow to change or be updated
 Not always available, espeically
on controversial topics
 Recommendations might be
affected by the type of
organization creating the
guideline

6. Review Articles
Review Articles
• Provide Overview of a field or subject
• Synthesize Previous Research
• Useful when you need background information and additional references
Systematic Review
• Evidence based search and review of the literature on a topic by an
established method.
Meta-Analysis
• A systematic method that takes data from a number of independent studies
and integrates them using statistical analysis (Dorland’s Medical Dictionary for Health
Consumers)

7. Primary Research Articles
• Present new and original scientific findings
• Explain research methodology and provide data
Randomized Controlled Trials (RCT’s)
Cohort Studies
Case-Controlled Studies
Studies that randomly assign individuals to
an intervention group or to a control
group, in order to measure the effects of the
intervention.
Study in which a particular outcome, such as
death from a heart attack, is compared in groups
of people who are alike in most ways but differ
by a certain characteristic
Study that compares patients who have a disease
or outcome of interest (cases) with patients who
do not have the disease or outcome
(controls), and looks back retrospectively to
compare how frequently the exposure to a risk
factor is present in each group to determine the
relationship between the risk factor and the
disease.
Types of Research Articles
Cause & Effect

8. Type of Question/ Best Type of Study
Type of Question Best Type of Study
Therapy
How to select treatments to offer patients that do more
good than harm and that are worth the efforts and costs of
using them
Randomized Control Trial (RCT)
Prevention
How to prevent a disease or condition
RCT/ Cohort Study / Case Control
Prognosis
How to estimate the patient's likely clinical course over
time and anticipate likely
complications of disease
Cohort Study/ Case Control/ Case Series or Case Report
Diagnosis
How to select and interpret diagnostic tests
Blind RCT Compared to the Gold Standard
(best treatment/test for diagnosis)
Etiology/Harm
How to identify causes for disease
RCT/ Cohort Study /Case Control
Cost analysis
Economic costs of all facets of a intervention or disease
treatment
Economic Analysis
Search Process Checklist

9. Selecting the Right Resource
• Research Guides
• Nursing Research Guide
• Important Databases
• PubMed/Medline (Free)
• CINAHL
• APA PsycNet/PsychInfo
• Cochrane Library
• TRIP Database (Free)
• National Guidelines
Clearinghouse (Free)
• PubMed Health (Free)
• Medline Plus (Free)
http://guides.library.vcu.edu/nursing
Evidence
Based
Practice
Guidelines
Meta- Analysis /
Systematic
Review
Critically Appraised
Topics
[Evidence Syntheses]
Critically Appraised Individual
Articles
[Article Synopses]
Randomized Control Trials (RCT’s)
Cohort Studies / Cross-Sectional Study
Case Controlled Studies/
Case Reports
Reviews
Background Information / Expert Opinion
Filtered Information
Unfiltered
Information

11. Evidence
Based
Practice
Guidelines
Meta- Analysis /
Systematic
Review
Critically Appraised
Topics
[Evidence Syntheses]
Critically Appraised Individual
Articles
[Article Synopses]
Randomized Control Trials (RCT’s)
Cohort Studies / Cross-Sectional Study
Case Controlled Studies/
Case Reports
Reviews
Background Information / Expert Opinion
Filtered Information
Unfiltered Information

12. Objectives:
By the end of this presentation you will :
• Have an understanding of how evidence based practice is
defined.
• Understand the quality of the different types of literature that
are assessed when making decisions based on evidence.
• Be aware of the different types of EBP questions and what studies
best answer each type.