Melnyk and Fineout-Overholt define Evidence-based practice (EBP) as ‘a problem solving approach in clinical practice that involve conscientious use of current best evidence, along with clinical expertise and client preferences in making decision about client care’ (2005). As new information and technologies emerge from updated research studies, practical guidelines and technological development, nursing practices also continue to evolve. Thus, nurses should keep up with new developments in order to provide the highest quality of client care, and this step-by-step approach will ensure that you obtain the most current and updated evidence to apply to client care:

1. Ask a clinical question

Integrating EBP in a clinical setting begins with creating clinical questions, which will guide you to find the best evidence and make clarification for the answer. Nurses often encounter all sorts of client conditions and clinical situations, thus it is crucial for you to identify what needs further clarification and question what does not make sense to you. For instance, while you are providing nursing care, you notice that there is an elderly client with visual impairment and high risk for falls, so this leads to you to ask, ‘How can I reduce the risk of fall for this client?’ Or perhaps in your nursing unit, you may ask ‘what is the best solution to promote hand washing among staffs and clients?’

2. Collect the most relevant and best evidence

When you are clear on the question, proceed with searching for the evidences. Integrating EBP in clinical practice requires you to assemble the most relevant evidences from the valid sources. Those sources may come from clinical practice guidelines, research databases, or existing policies and procedure manuals. Collecting the evidence may take time, so you have to refine the available sources that are closely related to your clinical questions and avoid unnecessary ones. If you are being assigned to look for evidence in healthcare settings, liaising with experts such as nurse educators, nurse managers, advanced practice nurses and infection control nurses is recommended. Also, when you are looking for scientific literature, you can seek assistance from the librarian as they are expert in looking for various databases available for you (Titler et al., 2001).

3. Critically evaluate the evidence

The next stage is to evaluate the evidence by considering their scientific value and how effective it can be applied in clinical practice. Get opinions from the experts to determine which evidence or findings are most pertinent to be reliably used in a clinical setting. Note that when you are looking for articles, you need to read the articles thoroughly to find the main points. The biggest mistake that most people make when evaluating the articles is only reading the abstract and then concluding that the points they were looking for are not available in the article. It will be difficult in the beginning to evaluate the evidence in a short period, but it is nonetheless necessary, so be sure to spend some time polishing skills in this area (Melnyk & Fineout-Overholt, 2005).

Integrate the evidence

When you have chosen the relevant evidence, you can integrate these into practice (Oncology Nursing Society, 2005). This may start with using the evidence directly in nursing care. Referring to the example above, let’s say you are looking for solutions to prevent falls for an elderly patient with visual impairment. You come across evidence saying that it is practical to provide the visual devices, ensure the bed is occupied with functioning rails, adequate lighting, and encourage the family members to assist the patient in ambulating. You can then integrate what you have learnt when caring for this patient.

Evaluate the practice decision

The final stage of integrating EBP into practice is to evaluate your new nursing process after integrating the evidence. Were these changes effective for your patients? Did you manage to resolve the risk of falls for him/her? This evaluation will be easier for you if the expected outcomes for the patient have been met.

Applying EBP into clinical practice has helped nurses and health care providers resolve problems related to clinical settings, guided their decision making processes and most importantly, improved the quality of patient care. EBP is an important element in clinical practice, and all nurses are encouraged to incorporate EBP in their nursing interventions by following the steps. MIMS

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Sources:
Melnyk, B.M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing and health care: a guide to best practice. Lippincott Williams & Wilkins.
Oncology Nursing Society. (2005). Evidence-based practice resource area.
Titler, M.G. et al. (2001). The lowa model of evidence-based practice to promote quality care. Crit Care Clin North Am. 13(4):497