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Nursing Literature Search

Evidence-Based Practice (EBP)

Evidence-Based Practice or EBP is integrating the best available evidence with clinical expertise and patient preferences to inform decision-making in health care settings. 

It ensures the delivery of high-quality care, improves patient outcomes, and fosters critical thinking among nursing professionals. EBP fosters a culture of continuous learning, encouraging nursing students and practitioners to stay informed about the latest advancements in nursing research. 

It is a fundamental component of nursing education, equipping students with the skills to integrate research into practice, deliver patient-centered care, and contribute to the ongoing improvement of healthcare outcomes. 

 

Venn diagram-style illustration with three circles, each representing the contributing factors of EBP. The center is highlighted with a star to show it is where evidence-based practice lives.

The Five Steps of EBP

1. Ask a searchable clinical question;

2. Find evidence to answer the question;

3. Appraise the evidence; 

4. Apply the evidence, using clinical expertise and patient's wants and needs;

5. Evaluate the process on its effectiveness and efficiency. 

Adapted from: "The five steps of EBP," Winona State University. 

EBP Suggested Reading

Levels of Evidence

The levels, or hierarchy, of evidence in Evidence-Based Practice are important to take into consideration when collecting and evaluating literature to answer or support your PIO/PICO question.

There are 7 levels, with level 1 being the strongest form of evidence, and level 7 being the weakest. These levels are attributed to studies based on the research design, quality of the study, how generalizable and applicable it is to patient care, and potential risk of bias.

Table of Levels of Evidence and Type of Source
Level Research Design & Evidence Description
1 Systematic Review or meta-analysis of randomized control trials (RCTs)
2 Evidence meta-synthesis of critically-appraised topics. 
3 Quasi-experimental studies, such as well-designed controlled trials, or a mixed methods intervention study; Critically-appraised article synopses.
4 Non-experimental studies, such as well-designed cohort studies; Randomized control trials (RCTs) such as a well-designed multi-site RCT.
5 Meta-synthesis
6 Qualitative studies, which measure experiences vs. numerical data; or Case studies and limited cohort studies. 
7 Expert opinions, such as reports from expert panels and organizations, literature reviews, other background information sources.

Adapted from: Melnyk, & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (Fifth edition.). Wolters Kluwer.

A key component of the level of evidence is if the information has been filtered or unfiltered through the lens of another analysis. The more eyes that have seen, processed, and critiqued a research study, the higher its level of evidence 

It helps to view the levels of evidence as a pyramid, with the highest level (1) at the top, and the lowest (7) at the bottom. The shape of the pyramid denotes the availability of information. Thus, it is easier to find lower-level evidence (7), than higher-level evidence (1) on many topics. 

Below is an interactive EBP pyramid to further illustrate this concept. 

Interactive EBP Pyramid