“We’ve always done it this way” is one of the most dangerous phrases in healthcare. Evidence-based practice (EBP) means making care decisions based on the best available research evidence, combined with clinical expertise and the patient’s values and preferences. Nurses at every level can use EBP, not only researchers and academics. It’s also central to exams, revalidation and promotion in many countries.
The steps of EBP
- Ask a focused clinical question.
- Acquire the best evidence.
- Appraise it critically.
- Apply it to practice, with patient preferences and clinical judgement.
- Assess the outcome.
Ask: the PICO question
- P – Population/Patient: who?
- I – Intervention: what are you considering?
- C – Comparison: compared with what?
- O – Outcome: what result matters?
Example: In adult surgical patients (P), does chlorhexidine-alcohol skin preparation (I), compared with povidone-iodine (C), reduce surgical site infections (O)?
Acquire: where to find evidence
- Guidelines: WHO, NICE, national ministries of health, professional bodies. A good starting point because experts have already reviewed the evidence.
- Cochrane Library: systematic reviews (abstracts free; full access free in many low-income countries).
- PubMed: free database of biomedical literature.
- Research4Life/HINARI: free or low-cost access to journals for institutions in eligible low- and middle-income countries.
- Google Scholar, with care.
- Your institution’s library and librarians.
The hierarchy of evidence
Roughly from strongest to weakest for questions about treatment effectiveness: systematic reviews and meta-analyses; randomised controlled trials; cohort studies; case-control studies; case series and reports; expert opinion. Qualitative research is the best evidence for questions about experiences and meaning.
Appraise: key questions
- Is the study relevant to my patients and setting?
- Was the method appropriate and rigorous (sample size, randomisation, blinding)?
- Are the results significant and meaningful in practice?
- Who funded it? Any conflicts of interest?
- Tools such as CASP checklists help structure appraisal.
Apply: changing practice
- Discuss with your team and manager.
- Propose a policy update or audit.
- Start small (a pilot) and measure outcomes.
- Share findings through teaching sessions, posters or publications.
Beware of misinformation
Social media health claims, unverified “nursing hacks” and commercial promotions are not evidence. Nurses have a professional duty to share accurate information. See misinformation is a threat to nurses.
Related: Reflective practice · The nursing process
Based on Sackett’s model of evidence-based medicine, Melnyk and Fineout-Overholt’s EBP framework and CASP appraisal tools. Educational content.