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Evidence-Based Practice: Step 2

A tutorial on evidence-based practice.

Steps in the Process

  • Step 1: FORMULATE an answerable question

    The first step in this tutorial helps you to refine your question by defining your clinical problem using a process called PICO. Through this process you will create an “answerable question”. This process will facilitate your search by helping you to identify keywords specific to the patient population, intervention, comparison group and outcomes that are appropriate to your patient care inquiry.

     

  • Step 2: SEARCH FOR the best evidence using the keywords from your PICO question

    The second step in this tutorial helps you to search for an evidence-based answer to your question using the keywords from your PICO question. Through the process you will become aware of four different types of information resources you can use in your search.

     

  • Step 3: ASSESS the validity and usefulness of the search results

    The third step in this tutorial helps you to evaluate your search results. Through this process you will identify the studies which are valid and useful to your question, and then identify and compare the study conclusions. If there are conflicting results, you must look at the evidence to find explanations for the differences and resolve them.

     

  • Step 4: APPLY the evidence

    The fourth step in this tutorial helps you to apply the evidence to your clinical scenario. Through this process you will determine if the evidence can be extrapolated to your patient and then communicate with your patient to make an informed decision.

    • Step 2: SEARCH FOR the best evidence using the keywords from your PICO question

    Evidence-Based Practice Tutorial

     

    The Evidence-Based literature is ranked according to the hierarchy of usefulness to clinical decision making. This pyramid from the Penn State Libraries Evidence-Based Practice Tutorial for Nurses is a visual representation of that hierarchy. The higher up on the pyramid is considered the “best evidence.” You will not always find your topic in the highest ranked resource and will have to move further down the pyramid.

    If you find evidence to support your inquiry in the top two resources then you can skip STEP 3 (ASSESS the validity and usefulness of the search results) and move on to STEP 4 (APPLY the evidence) because literature from the top two resources have already been assessed for you.

     

    Graphic Source: Penn State University Libraries

     

     

    • Summaries of the Evidence

      Summaries of the Evidence include Systematic Reviews, Meta-Analyses, and Evidence-Based Clinical Practice Guidelines. The strongest evidence comes from Systematic Reviews and Meta-Analyses. Summaries of the Evidence have been produced through rigorous methods to identify, critically appraise, and synthesize all the relevant studies from the published medical literature on that particular topic.
      Example: A systematic review from the Cochrane Library Database.

    • Critically Appraised Research Studies

      Critically Appraised Research Studies (CARS) include Evidence Summaries and Reviews, Critical Research Critiques, Randomized Controlled Clinical Trials, and Cohort and Case Control Studies. CARS have been published in a peer-reviewed evidence-based journal and have already been apparaised for validity.
      Example: A research article in the journal Evidence-Based Nursing.

    • Individual Research Studies

      Individual Research Studies (IRS) include Randomized Controlled Clinical Trials, Cohort and Case Control Studies, Case Reports, Case Studies. IRS published in the journal literature are the information from which CARS are created. This information has not been synthesized or validated.
      Example: A research article from MEDLINE.


    • Textbooks

      Textbooks are useful for obtaining synthesized background information on specific medical topics but not questions related to the care of specific patients. Online textbooks can be more useful than print textbooks because they are often more current.
      Example: Topic Reviews in UpToDate.