What is Evidence-Based Medicine? What is Evidence-Based Nursing? What is Evidence-Based Practice?
Evidence-based medicine (EBM) was defined by David Sackett et al. in a BMJ editorial in 1996 as
"...the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
Nursing has taken this definition and refined it for its discipline in various publications. Here are a few examples.
"Evidence-based nursing is the incorporation of the best research evidence along with patient preferences, the clinical setting and circumstances, and healthcare resources into decisions about patient care." Ciliska, Donna. Evidence-based nursing: how far have we come? What's next? Evid Based Nurs 2006;9:38-40.
"Evidence-based nursing practice is the conscientious, explicit and judicious use of theory-derived, research based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences" Ingersoll, GL. Evidence-based nursing: what is it and what it isn't. Nurs Outlook. 2000 Jul-Aug; 48(4):151-2.
"The society defines EBN as an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served." From Sigma Theta Tau.
At its core, evidence-based practice is essentially the same across all disciplines. Each discipline has its own core principles that are important to it and may incorporate these somehow into the process.
Models of Evidence-Based Practice
Iowa Model: Used recently at Ohio State's Wexner Medical Center. This model guides a clinician through the process of asking a question, forming a team to investigate the question, and assessing whether there is sufficient evidence to move forward with an evidence-based decision, followed by implementation in small and large scales. Originally published in 2001 and implemented at the University of Iowa.
ARCC Model (Advancing Research and Clinical Practice Through Close Collaboration): A model integrating control and cognitive behavioral theories and works to build a cadre of EBP mentors to advance EBP in a system. Detailed in the popular EBP text by the model's authors, Evidence Based Practice in Nursing & Healthcare.
PARIHS (Promoting Action on Research Implementation in Health Services) Framework: A model that continues to develop, incorporating elements and sub-elements, including research, clinical experience, patient experience, local information, culture, and leadership. The latest phase of work is described in a 2008 article.
Johns Hopkins Nursing Evidence-Based Practice Model: Incorporates several directive steps and an evidence rating scale that incorporates a multitude of article types. Detailed in the latest edition of the book on topic.
Clinical Scholar Model: The work of Alyce Schultz, this is another mentorship-based model. More information can be found in Schultz' 2005 article.
Steps of Evidence-Based Practice
Some models of EBP have more than five steps, but in general, the following five steps are common to all.
1. Ask: construct a clinical question that forms the basis of a focused search strategy.
2. Acquire: Search databases and other relevant sources for appropriate evidence to address question.
3. Appraise: Critically appraise the evidence found through searching.
4. Apply: Make a decision about how to proceed with the initial clinical question.
5. Assess: Evaluate the impact of the decision on relevant outcomes.