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The University of Arizona

Master's Entry to the Profession of Nursing (MEPN)

A guide for MEPN Phoenix Campus students

The Steps in Evidence Based Practice process

Evidence-informed nursing practice analyzes the best evidence available to make a clinical decision, considering the availability of resources, taking into account the values and wishes of the patient, and evaluating outcomes. 


Analyzing the clinical situation

  • Do background research to make sure you have a solid foundation. 
  • Get to know your topic

Asking a focused clinical question

  • Create a research question to guide your search
  • Use the PICO method as a template for searching

Accessing the clinical research literature (i.e. the evidence) 

  • Where will you search?
  • What keywords or subject headings will you use to find information on your topic?
  • What types of studies or data will be most helpful in answering your question?

Appraising the best evidence you have found

  • Critically appraise the evidence/research you found: what methodologies were used?  How was the data analyzed and reported?  Are the conclusions supported by the data?

Applying the evidence to the care of the patient

  • Consider what the evidence means in your situation, related to your stakeholders and their needs, and how it may be best implemented.

Assessing the effectiveness of care based on this evidence

  • What are the outcomes?  Did you see results that created the outcomes you were trying to achieve?  Do you need to adjust the implementation?  Do you need a different solution?

PICO

PICO stands for:

P - patient, population, or problem.  What is the disease or condition you need to research?  What characteristics of the patient or population are important?  Do you need to consider age, gender, or any other characteristics?  Does the patient have any other conditions or medications that they take?

I - intervention.  What is the plan for the patient?  Usually this will be a form of treatment, but it may also involve monitoring the patient to check diagnosis.  It may also need consideration of the frequency or strength of treatment.

C - comparison.  Is there a comparative action to the intervention?  Sometimes there will be an alternative treatment, sometimes you will have no administered comparison and would use non-treatment as an alternative.

O - outcome.  What are the intended and potential outcomes?  There may be successful treatment, but there may also be potential side effects or problems to consider.  You may also need to look at cost effectiveness, or other organizational outcomes.  Outcomes should also be measurable where possible, in terms of speed and scale of improvements, or the number/severity of side effects, in order to assess whether the intervention was an improvement on the comparison.

Example PICO Questions

Example PICO Statements from CINAHL Evidence based practice care sheets:

 1.  In the elderly at risk of falling, is tai chi effective in reducing the risk and preventing falls as compared with those who do not practice tai chi?

2. Are alcohol based hand rubs more effective or less effective in reducing HRI's than soap and water techniques?

3.   Is peer-pressure more effective than educational interventions in improving hand hygiene practices?

4.   Are PPI's (proton pump inhibitors) effective medical therapy for esophagitis and GERD in children and adolescents?

5.   In older adults with wandering, is music therapy or exercise/activities more effective in decreasing wandering/pacing?