Nursing (IUPUI)

About evidence-based practice

Evidence-Based Practice (EBP) is the judicious use of the best research evidence (found in health sciences literature), clinical expertise (what the health care provider knows) and patient values (what the patient wants and believes) to create a plan of action regarding patient care.  Evidence-based practice is an umbrella term that covers evidence-based medicine, evidence-based nursing, evidence-based dentistry, evidence-based public health, etc.

Publication types associated with higher levels of evidence

Typically, the higher up on the evidence pyramid, the better quality evidence and the fewer studies published.

Note: the evidence pyramid is general guidance-only. Consider your question type to identify publication type level of evidence (below)

Publication types by question type: Different study types are suited to different questions

• Most Clinical questions: Systems, summaries, synopses, syntheses, meta-analyses, systematic reviews
• Therapy questions: Randomized Controlled Trial
• Diagnosis questions: Prospective, blind controlled trial compared to gold standard
• Prognosis questions: Cohort study, case control, case series/case report

Evidence-based practice publication types

• Systems: An electronic medical record that is able to link updated, evidence-based information related to a patient's clinical information. Also known as an integrated computerized decision support system. Very few exist at this time.
• Summary: These include topic summaries and clinical practice guidelines that integrate evidence-based information about specific clinical problems with regular updating.
• Synopses of Syntheses: A synthesis would be a systematic review (defined below). A synopsis of that synthesis would be an expert/authoritative appraisal or critique of a high quality systematic review that provides sufficient information to support clinical action.
• Syntheses: A summary of the medical literature that uses explicit methods to perform a comprehensive literature search and critical appraisal of individual studies. There are two categories of synthesis.
• Systematic Reviews: A qualitative integration or description of individual studies.
• Meta-analysis: A quantitative integration of data from individual studies using statistical techniques.
• Synopses of Single Studies: An expert/authoritative appraisal or critique of an individual study that provides sufficient information to support clinical action.
• Randomized Controlled Trial: A study in which participants are randomly allocated into an experimental group or control group and followed over time for the variables/outcomes of interest.
• Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. A cohort study will have a control group that represents the unexposed population.
• Case Controlled Studies: A study which involves identifying patients who have the outcome of interest (cases) and patients without the same outcome (controls), and looking back to see if they had the exposure of interest.
• Case Series/Reports: A report on a series of patients or single patient with an outcome of interest. No control group is involved.

Source: Glossary of EBM Terms Centre for Evidence-Based Medicine (CEBM) Toronto, Accessing pre-appraised evidence: Fine tuning the 5S Model into a 6S Model