Evidence-Based Practice

The fourth step in EBP is to apply your findings to clinical practice.

• Fineout-Overholt, E., Williamson, K. M., Gallagher-Ford, L., Melnyk, B. M., & Stillwell, S. B. (2011). Evidence-Based Practice, Step By Step: Following the Evidence: Planning for Sustainable Change. AJN: The American Journal of Nursing, 111(1), 54-60

Once you have determined that the study and its results are valid, you need to decide if it applies to your specific patient/population and situation.

Factors to consider include:

• Similarities between your patient/problem/population and those in the study;
• The needs and wishes of your patient or population;
• The clinical significance of the results;
• And the availability of said interventions in your practice or setting.

Remember that EBP balances three elements: 1) the latest, best evidence; 2) the patient or community’s values, needs, and preferences; and 3) your expertise.

From Evidence-Based Practice by Various Authors - licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Applying the best evidence is arguably the Evidenced-Based Practice (EBP) step that requires the most skill. It is at this step that you synthesize the best scientific knowledge with your clinical expertise and the patient's unique values and circumstances to reach a clinical decision.

Before applying evidence from research to your patient, ask yourself:

• Were the study patients similar to my population of interest - do the results apply to my patient?

• Were all clinically important outcomes considered and are the results clinically important?

• Are the likely treatment benefits worth the potential harm and costs?

• Can this practice be implemented in this healthcare setting?

• What are my patients’ values and preferences?

• How can I help my patient make a decision?

From Evidence-Based Practice in Health by Murray Turner at University of Canberra. Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

The final step of EBP is to assess the effectiveness of your practice and clinical decisions. 

The steps of evidence-based practice can be illustrated by a continuous evidence cycle. Once you have applied your evidence to your situation, you should evaluate how well it worked. This process often generates new clinical questions, prompting you to begin the cycle again.

Ask yourself the following questions:

• What questions do you still have, and what new questions have arisen?
• What assessments should you use to gather evidence?
• Was the diagnosis or treatment successful?
• Is there new evidence on this topic?
• What was the patient’s or community’s response or attitude?
• What new information would help you make a better decision next time?

From Evidence-Based Practice by Various Authors - licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Adapted from: Straus, S., Glasziou, P., Richardson, W., & Haynes, R. (2011). Evidence-based medicine: how to practice and teach it (4th ed.). Edinburgh: Churchill Livingstone Elsevier