1.
Evidence-Based
Practice
Updated by Kristy Padron
Original Content by Jennifer Boxen, Kristy Padron, and Tiffany
Moxham for an FAU Libraries Lunch and Learn Session, March
2011.

2.
• Define Evidence-Based Practice (EBP) and its
characteristics.
• Summarize the history of EBP.
• Apply EBP to other disciplines.
• Identify sources of evidence for various subject
areas.
Objectives

3.
Definition of Evidence-
Based Practice (EBP)
Evidence-Based Practice (EBP) is defined as
the conscientious, explicit, and judicious
use of current best evidence in making
decisions (Sackett, Rosenberg, Gray,
Haynes, & Richardson, 1996).
A process that combines well-researched
interventions with the following (National
Association of Social Workers, 2018):
• Clinical experience
• Ethics
• Patient/ client preferences
• Culture

4.
EBP is synonymous or similar
to other terms in use:
• Evidence-Based Practices
• Evidence-Based Treatments
• Evidence-Based Interventions
• Evidence-Based Care
• Evidence-Informed
Interventions

5.
History of EBP
• EBP has its roots in Evidence Based Medicine (also
referred to as Evidence–Based Health Care).
• Created in the 1980s and popularized in the early
1990s: medical textbooks were unable to keep up
with rapid changes in medicine, and were frequently
based on the interpretations of a few people in a
respective field.
• At the same time, the medical literature in journals
was being produced in record numbers, but was
poorly organized.

6.
History of EBP: Factors Influencing
Its Use in Other Disciplines
• “But it’s always been done this way”: health sciences (and others)
realized many tasks and treatments were based on experience or
routine rather than empirical proof.
• Accountability: numerous accrediting agencies, organizations,
government, and the public want to see that resources are going
towards “what’s shown to work.”
• Cost effectiveness: England’s NHS and presently, health insurance.
• Multidisciplinary Teams:
• Many problems or scenarios can improve their outcomes by having
multidisciplinary teams work together.
• Some problems are too complex for a single discipline to address.

7.
Differences Between EBP and
EBM
• EBM/EBHC is primarily limited to the health care field and
focuses on a specific patient or population.
• EBP can be applied to many fields and is constantly being
modified to best suit the subject where it is being applied.

8.
The EBP Process: 5 Steps
1. Defining a question that needs to be answered.
2. Acquiring the literature that will be analyzed.
(building and executing the search).
3. Critical appraisal: conducting a formal evaluation
of the results (evidence, patient preferences).
4. Integrating the evaluated evidence into practice.
5. Re-evaluating the process to assess its efficacy and
improve it in the future.

9.
Defining the Question
In EBM, a question is structured and defined in a specific way,
referred to as a PICO question:
This can be modified for EBP.
P Patient/ Population/ Problem
I Intervention (drug, diagnostic test, etc.)
C Comparative Intervention
O Outcomes (desired result)

10.
Traditional EBM
Question: In a 52-year old African American male with Type II
diabetes, is metformin better than insulin at regulating blood
sugar?
(P) Patient/
Population/
Problem
52-year old African American Male
Diabetes
(I) Intervention
(drug, diagnostic
test, etc.)
Metformin
(C) Comparative
Intervention
Insulin
(O) Outcome
(desired result)
Blood Sugar Levels

11.
EBP Applied to Criminal
Justice
Is re-entry programming more effective than participation in
corrections education programs in reducing recidivism among people
released from prison?
(P) Population/
Problem
Prisoners or Inmates
Recidivism
(I) Intervention
(drug, diagnostic
test, etc.)
Re-entry Programming
(C) Comparative
Intervention
Corrections Education Programs
(O) Outcome
(desired result)
Decreased Recidivism

12.
EBP Applied to Library
Settings
In a library with a decreased budget, which is more effective: a
self-checkout machine or a check-out desk for borrowing books?
(P) Population/
Problem
Library
Decreased Budget
(I) Intervention
(drug, diagnostic
test, etc.)
Self Check-out Machine
(C) Comparative
Intervention
Check-out Desk
(O) Outcome
(desired result)
Cost Effectiveness

13.
When To Apply EBP
Background Questions: the need is to define some concepts, and not to
compare interventions.
• What are some good strategies of increasing parental involvement in an
elementary school?
Factual Questions: the need is to identify some facts that do not necessarily
come from higher levels of research.
• What was the population of Palm Beach County in 20?
Too Few Studies: utilizing EBP is difficult if little has been published on a
research question.
• Is the use of herbal remedies for pain management during childbirth more
effective than conventional medicine in Haitian communities?

14.
Critical Appraisal
Definition: the process of carefully and systematically examining
research to judge its validity, reliability, and relevance to a
particular context.
Considerations in Critical Appraisal:
1. Hierarchy (or levels) of evidence
2. Hierarchies consist of varying levels of research ranked by:
a. Subject area or discipline
b. Type of research done within a discipline
c. Committees or organizations who create EB guidelines.
3. EBP does not assume the innate superiority of any particular
research design.

15.
For the convenience of readers, scholarly articles in
many disciplines evolved to follow an IMRAD format (or
something like it).
Critical Appraisal: IMRAD
I Introduction: Background, rationale, and purpose of study.
M Methods: Study design, measurement instruments, and rationale for
their use.
R Results: Describes the results without repeating methodology
A Analysis (some articles include this): statistical analysis.
D Discussion: principles, relationships, and generalizations drawn from
study; how results support or refute previous work; theoretical
implications; conclusions.

16.
• Experimental or Observational
• Quantitative or Qualitative
• Take a look at the research methods of a given field
to determine their study designs, and how (or if)
evidence-based practice can be utilized.
• An appropriate study design will be determined by
the nature of the question being answered.
Types of Study Designs

17.
Part of critical appraisal is to identify potential sources of bias
in order to evaluate the validity of a study.
Common Types of Bias (Among Many):
• Conflict of Interest Bias
• Wrong Sample Size Bias
• Positive Results Bias
• Correlation Bias
• Missing Clinical Data Bias
• Publication Date Bias
Identifying Bias

18.
Pyramid of Evidence,
Medicine
Meta-
Analysis
Systematic
Review
Randomized
Control Trial
Cohort
Studies
Case Control
Studies
Case Series
Case Reports
Editorials, Opinions,
and Ideas
Animal Research
In Vitro Research
Examples of
Hierarchies

19.
Hierarchy of Evidence
for Intervention/
Treatment Questions
in Nursing,
Melnyk Model
(Melnyk & Fineout-
Overholt, 2018)
Examples of
Hierarchies

20.
Hierarchy of Research
Methods, Social Work
Examples of
Hierarchies
Meta-
Analysis
Systematic
Review
Randomized
Control Trial
Quasi-
Experimental
Studies
Case Control
Studies
Cohort Studies
Pre-Experimental
Group Studies
Surveys
Qualitative Studies

21.
• Cookbook approach: simplifies practice and stifles
creativity.
• Time between doing research and getting
published: empirical research is time consuming
and can take up to 2 years before it is published.
• Lack of evidence: Cannot address concepts that
are not widely studied or published.
• Overlooks the human experience: its outcome-
based focus may simplify the complexity of people
(Baumann, 2010).
Shortcomings or Arguments
Against EBP

22.
• Indexes & Databases (Discipline-Specific)
• Well-Designed Empirical Articles
• Systematic Reviews
• Meta-Analyses
• Journals
• Evidence-Based Focus
• Gray Literature
• Professional Associations
• Government Agencies
• Use based on professor/assignment preferences.
Sources of Evidence

23.
Cochrane: The Cochrane Library: www.cochrane.org/
The Cochrane Library is comprised of 6 different databases that
provide information supporting the top three levels of the hierarchy
of evidence:
 Systematic Reviews/Meta Analysis:
CDSR: Cochrane Database of Systematic Reviews
 Randomized Controlled Trials
CENTRAL: The Cochrane Central Register of Controlled Trials
 Cochrane Clinical Answers (CCAs)
Sources of Evidence: Health
Sciences

24.
Use limiters and other features available to filter results.
CINAHL
• Limiters
• Clinical Queries: therapy, prognosis, review, qualitative, etiology
• Randomized Controlled Trials
PubMed
• Clinical Queries: therapy, diagnosis, etiology, prognosis,
systematic reviews, and clinical prediction guides
Sources of Evidence: Health
Sciences

25.
The Campbell Collaboration Online Library:
www.campbellcollaboration.org/library.html
• Systematic reviews in the fields of education, criminal justice and social
welfare are freely available online.
• Includes plain language summaries.
Social Work Policy Institute:
www.socialworkpolicy.org/research/evidence-based-practice-2.html
SAMSHA Guide to Evidence-Based Practices:
www.samhsa.gov/ebp-web-guide
• EBP for substance abuse and treatment, mental health disorders
prevention and treatments, and adult EBPs.
Journal of Evidence-Based Social Work
Sources of Evidence: Social
Work

26.
National Institute of Corrections
• Evidence-Based Decision Making:
info.nicic.gov/ebdm/
• Evidence-Based Practices:
nicic.gov/evidence-based-practices-ebp
Crime Solutions.Gov: www.crimesolutions.gov/default.aspx
National Criminal Justice Reference Service: www.ncjrs.gov
Criminal Justice Policy Review
Sources of Evidence: Criminal
Justice

27.
• Best Evidence Encyclopedia (John Hopkins University):
www.bestevidence.org/
• What Works Clearinghouse (Institute of Education
Sciences): ies.ed.gov/ncee/wwc/
• Evidence-Based Practices in Instruction (U.S. Dept. of
Education): ccrs.osepideasthatwork.org/teachers-
academic/evidence-based-practices-instruction
• Culturally Responsive Teaching (Education Northwest):
educationnorthwest.org/resources/culturally-
responsive-teaching-guide-evidence-based-practices-
teaching-all-students
• Journal of Evidence-Based Practices for Schools
Sources of Evidence:
Education

28.
FAU Libraries Evidence-Based Practice LibGuide:
libguides.fau.edu/evidence-based-practice-boca
Buskist, W., & Grocca, J.E. (Eds.) (2011). Evidence-based teaching. San
Francisco, CA: Jossey-Bass.
Holland, K., & Rees, C. (2010). Nursing: Evidence-based practice skills.
New York: Oxford University Press.
Patterson, G.T., & Graham, W.K. (2018). Clinical interventions in criminal
justice settings: Evidence-based practice. Cambridge, MA: Academic
Press.
Roberts, A.R., & Yeager, K.R. (2006). Foundations of evidence-based social
work. New York: Oxford University Press.
Straus, S.E., Richardson, W.S., Glaszious, P., & Haynes, R.B. (2010).
Evidence-based medicine: How to practice and teach it (4th Ed.). New
York: Churchill Livingstone.
More Information

29.
References
Baumann, S.L. (2010). The limitations of evidence-based
practice. Nursing Science Quarterly, 23(3): 226-230.
doi:10.1177/0894318410371833
Melnyk, B., & Finout-Overholt, E. (2018). Evidence-based practice
in nursing and healthcare: A guide to best practice (4th Ed.).
Philadelphia, PA: Lippincott, Williams & Wilkins.
National Council of Social Workers (2018). Evidence-based
practice: NASW practice snapshot. Retrieved from
https://www.socialworkers.org/News/Research-Data/Social-
Work-Policy-Research/Evidence-Based-Practice
Sackett, D.L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., &
Richardson, W.S. (1996). Evidence based medicine: What it is
and what it isn't. BMJ, 312(7023): 71-72.