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0 REUSABLE CONTENT (common elements): Evidence based practice

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Finding evidence for evidence based practice

Use these resources to locate evidence to support your clinical decision-making

Selected databases for systematic reviews, randomised controlled trials, case studies and other evidence.

Web resources

Searching for evidence

Evidence Based Practice (EBP) is the process of making clinical decisions based upon evidence, combined with clinical experience and patient expectations.

EBP is used in a variety of fields, including medicine, nursing, psychology and allied health.

The process involves an assessment of evidence using a hierarchy of evidence types, with Cochrane systematic reviews commonly considered the 'gold standard' for evidence. For example, see the EBP evidence pyramid,  or the Joanna Briggs Levels of Evidence.

To find evidence to base your decision upon, start by phrasing your scenario as a specific, answerable question. You can use 'PICO' for this.

  • [P] Who or what is your patient or population group?
  • [I] What is your intervention or indicator?
  • [C] What is your comparison or control?
  • [O] What outcome are you looking for?

For example:
A 47 year old woman comes to see you. She is overweight, concerned about her overall health, and would like to lose weight quickly. She has heard a report on the radio suggesting that resistant corn or potato starch can reduce obesity. You begin to investigate any evidence to support this.

Rephrased as a specific, answerable question, using PICO:

In [P] overweight, how does [I] resistant starch compared with [C] ordinary starch effect the [O] weight loss?

Next, translate PICO into a search strategy which you can apply to a database to find evidence.

  • treat each component as a separate concept.
  • brainstorm for synonyms and alternative spellings and terminology for each concept, linking these with OR - this will broaden your search.
  • combine your concepts with AND - this will focus your search.

[P] overweight OR obese
AND

[I] resistant starch OR R.S.
AND

[C] ordinary starch
AND

[O] weight loss

Choose the most relevant components to combine - you don't need to combine all four in a single search. For example, you could conduct a search on ([P] AND [I] AND [C]), or on ([I] AND [C]), or ([P] and [I]).

Choose an appropriate EBP resource to search, select from the databases listed on the left, and conduct your search.

Evaluating the evidence - Trust v. Skepticism

Evaluating the evidence for quality is a critical component of evidence based practice. Consider where the evidence sits in the evidence hierarchy. Use the highest evidence possible, such as Cochrane Systematic Reviews. If there is not any evidence available at the top levels, you may need to drop lower in the hierarchy. Be critical

Consider:

  • Credibility - author qualifications, reputability (peer-review)
  • Accuracy - currency of the evidence
  • Reasonability - objective, unbiased (research question, study design, funding, publishing), transparency of methodologies
  • Support - use of references

Applying the evidence

The final stage in Evidence Based Practice is to apply the evidence to your practice. This means that you need to evaluate the evidence, once you have found it, and use it to support the clinical decisions that you make. Do this in conjunction with your experience and your patient's values.

Selected resources: