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Nurse Residency Program Resources: Evidence-Based Nursing Process

This guide has been created to support the Nurse Residency Program at Bryan Medical Center.

Evidence-Based Process

The EBP process is a stepwise process:

0. Cultivate a spirit of inquiry. (Be curious!)

1. Develop a question using the PICOT format.

2. Search for and collect the most relevant best evidence.

3. Critically appraise the evidence.

4. Integrate the evidence into practice using clinical expertise with attention to patient's values and perspectives.

5. Evaluate outcomes of the practice decision or change based on evidence.

6. Disseminate the outcomes of the EBP decision or change.

‚ÄčMelnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: a guide to best practice. Philadelphia : Wolters Kluwer/Lippincott Williams & Wilkins Health,  p. 11.

Evidence Quality & Strength

The strength and quality of evidence becomes stronger as you approach the top of the evidence pyramid. Try to find this type of evidence first. Are there clinical guidelines or systematic reviews related to your topic?

Click on the following links for definitions of the following:

Appraising the Evidence

You can ask three key questions for many of your articles in a rapid critical appraisal process!

 1.  Are the results of the study valid? This refers to validity, and if the results reflect the researchers using the best research methods possible.  In experimental trials, for example, did the researchers randomly assign treatments or groups, or was a control group used? Were the groups similar in their characteristics prior to beginning the treatment?

  2. What are the results? Did the research approach fit the purpose of the study, and in an experimental/intervention trial, did the intervention work? Could clinicians expect the intervention to produce the same results in their own clinical setting? This refers to reliability of the results.

  3. Will the results help me in caring for my patients? Compare the subjects in the study with the patients you are caring for—is it applicable? How do the benefits of the change or treatment weigh against the risks? Is the treatment something feasible and something the patients will accept? 

Source: Melnyk, B.M., & Fineout-Overholt, E. (2015).  Evidence-based practice in nursing & healthcare: A guide to best practice. (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins. 

For more information about critical appraisal, the following articles provide an excellent overview of the process:

Evidence Pyramid

Adapted from University of Pennsylvania "Evidence-Based Medicine Resources" guide,