Skip to main content

Nursing: Evidence Based Research

What is Evidence Based Medicine

Evidence-Based Medicine is 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.
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13; 312 (7023): 71-2.

Evidence-Based Nursing - A way of providing nursing care that is guided by the integration of the best available scientific knowledge with nursing expertise. This approach requires nurses to critically assess relevant scientific data or research evidence, and to implement high-quality interventions for their nursing practice. (NLM PubMed MeSH)

Types of Evidence Based Medicine Resources

This pyrimid depicts the level of evidence. The higher up the pyrimid the strength of the evidence in the content generally increases.

 

PICO (T) Format for Building Research Questions

To formulate questions in Evidence Based Practice, use the PICOT format.

PICOT stands for:

  • Population/ Patient Problem: Who is your patient? (Disease or Health status, age, race, sex)
  • Intervention: What do you plan to do for the patient? (Specific tests, therapies, medications)
  • Comparison: What is the alternative to your plan? (ie. No treatment, different type of treatment, etc.)
  • Outcome: What outcome do you seek? (Less symptoms, no symptoms, full health, etc.)
  • Time: What is the time frame? (This element is not always included.)

PICOT questions will typically fall under one of these types:

  • Therapy/Prevention: Is this intervention more effective than another
  • Diagnosis/Diagnostic test: How accurate is this diagnostic test
  • Etiology/Harm: What are the causes of this condition or state of affairs
  • Prognosis: What is a patients likely course over time

Type of Study for Question ***

Therapy: RCT (randomized controlled trial)

Diagnostic Test: independent, blind comparison to a gold standard

Harm/Etiology: RCT>cohort study.case control

Quality of Life: Qualitative Study

Cost-Effectiveness: Economic analysis

*****In each case, a systematic review  of all the available studies is better than an individual study. A systematic review will compare several RCt"s that have studied the same treatment and aggregate results.

PICO Resources

Finding Systematic Reviews and Meta Analysis

  • A Systematic Reviewis a literature review focused on a single question which tries to identify, appraise, select and synthesis all high quality research evidence relevant to that question. Systematic reviews use explicit methods to identify, select, and critically evaluate relevant research.
  • Meta-analyses are systematic reviews that combine the results of several studies using quantitative statistics.
  • Systematic reviews minimize the possibility of bias by using explicit criteria, and expand the relevance of individual studies with limited scope, but ...
  • Only a small number of clinical topics are covered by systematic reviews, because they require years of effort to develop.
  • Locate systematic reviews using:
    •  

SPIDER Tool : Building a Qualitative Research Question

Sample is similar to Patient/Population of PICO. This is the group of people you are interesting in studying qualitatively.

For example, in the qualitative research question, "What are the barriers felt by nurses that lead to the reluctance to use EBP in practice?"

S = Nurses


SPIDER Table from the Gonzaga University Evidence-Based Practice LibGuide

The Phenomenon of Interest can be similar to Intervention of PICO. This can be viewed as the topic of the research,

For example, in the qualitative research question, "What are the barriers felt by nurses that lead to the reluctance to use EBP in practice?"

PI = Use of EBP


SPIDER Table from the Gonzaga University Evidence-Based Practice LibGuide

Design can be viewed as the techniques used by the qualitative researchers to gather their data. Typically these are:

  • Focus Groups
  • Interviews
  • Observations

The design choice depends on what your qualitative research design plan will be. For example, in the qualitative research question, "What are the barriers felt by nurses that lead to the reluctance to use EBP in practice?"

D = Interviews or Focus Groups


SPIDER Table from the Gonzaga University Evidence-Based Practice LibGuide

Evaluation is similar to Outcomes of PICO. 

For example, in the qualitative research question, "What are the barriers felt by nurses that lead to the reluctance to use EBP in practice?"

E = Barriers to use of EBP


SPIDER Table from the Gonzaga University Evidence-Based Practice LibGuide

Research type can be viewed as the type of qualitative research that could have been used. The types are:

  • Phenomenology
  • Ethnography
  • Grounded theory
  • Case study

Review this Qualitative Research for more information on the types.

For example, in the qualitative research question, "What are the barriers felt by nurses that lead to the reluctance to use EBP in practice?"

R = Phenomenology


SPIDER Table from the Gonzaga University Evidence-Based Practice LibGuide

Now that you have your qualitative research questions broken into SPiDER, you can now think about your search strategy.

For example, in the qualitative research question, "What are the barriers felt by nurses that lead to the reluctance to use EBP in practice?"

S = Nurses (and other possible terms)

Pi = EBP (and other possible terms)

D = Interviews or Focus Groups

E = Barriers (and other possible terms)

R = Phenomenology

Search Strategy:

Nurse AND EBP AND (Focus Groups OR Interviews) AND Barriers AND Phenomenology

Also consider possible controlled vocabulary with the understanding that literature research databases will vary with that they may have for qualitative research terms.


SPIDER Table from the Gonzaga University Evidence-Based Practice LibGuide

Loading

Library Contact Info and Hours