UC Library Guides: Evidence-Based Practice in Health: Introduction (2024)
What is Evidence-Based Practice?
The classic definition of Evidence-Based Practice (EBP) is from Dr David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research”.2
EBP has developed over time to now integrate the best research evidence, clinical expertise, the patient's individual values and circ*mstances, and the characteristics of the practice in which the health professional works.3
So, EBP is not only about applying the best research evidence to your decision-making, but also using the experience, skills and training that you have as a health professional and taking into account the patient's situation and values (e.g. social support, financial situation), as well as the practice context (e.g. limited funding) in which you are working. The process of integrating all of this information is known as clinical reasoning. When you consider all of these four elements in a way that allows you to make decisions about the care of a patient, you are engaging in EBP.4
Why is Evidence-Based Practice Important?
EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence. EBP promotes an attitude of inquiry in health professionals and starts us thinking about: Why am I doing this in this way? Is there evidence that can guide me to do this in a more effective way? As health professionals, part of providing a professional service is ensuring that our practice is informed by the best available evidence. EBP also plays a role in ensuring that finite health resources are used wisely and that relevant evidence is considered when decisions are made about funding health services.4
What happened before Evidence-Based Practice?
Before EBP health professionals relied on the advice of more experienced colleagues, often taken at face value, their intuition, and on what they were taught as students. Experience is subject to flaws of bias and what we learn as students can quickly become outdated. Relying on older, more knowledgeable colleagues as a sole information source can provide dated, biased and incorrect information. This is not to say that clinical experience is not important - it is in fact part of the definition of EBP. However, rather than relying on clinical experience alone for decision making, health professionals need to use clinical experience together with other types of evidence-based information.5
Is not all Published Research of Good Quality?
Not all research is of sufficient quality to inform clinical decision making. Therefore you need to critically appraise evidence before using it to inform your clinical decision making. The three major aspects of evidence that you need to critically appraise are:
Rationale, aims and objectives: Four pillars of evidence underpin evidence-based behavioural practice: research evidence, practice evidence, patient evidence and contextual evidence.
The first step in the evidence-based practice (EBP) process is to identify the clinical problem or question for which you are seeking evidence. Asking a focused and relevant question about your client's situation will inform your search.
The Three Pillars: The mantle or roof of the house balances on three pillars (best available research, clinical expertise, and patient characteristics, culture, and preferences). Each pillar must be just as long and sturdy as the other pillars in order for the house to stand.
The first step in the evidence-based practice process is to formulate a clinical question. The clinical question should be relevant to the patient or the problem and constructed so as to help you search for an answer. There are tools that help make this process easier.
to add that evidence-based practice must consider patient values. With this new consideration, evidence- based practice in any discipline in- cludes the interplay of three essential elements: (1) individual expertise; (2) best available evidence; and (3) the customer's values.
For example, systematic reviews are at the top of the pyramid, meaning they are both the highest level of evidence and the least common. As you go down the pyramid, the amount of evidence will increase as the quality of the evidence decreases.
Pressure ulcer prevention: Evidence-based guidelines help nurses understand the risk factors and implement interventions to prevent pressure ulcers. Examples include turning patients regularly, using pressure-relieving devices, and maintaining skin integrity through proper care.
The first stage of any evidence-based practice process is formulating an answerable question. This forms the foundation for quality searching. A well-formulated question will facilitate the search for evidence and will assist you in determining whether the evidence is relevant to your question.
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