In any health care setting, evidence-based practice plays an important role in making clinical decisions and providing the best and highest level of care to patients. What exactly does it mean though? Evidence-based practice (EBP) is the integration of research, clinical expertise, and patient preference, to develop and implement appropriate assessment and treatment.

As a nursing student, you learn about EBP a tremendous amount through coursework, and clinical experience, guided by your preceptors. It’s also helpful to understand why it’s valuable to the nursing profession as it is the basis for all of our nursing interventions. 

Here’s what every nursing student should know about evidence-based practice.

Evidence-Based Practice: A Brief History

The earliest rumblings of EBP date back to the 1800s, when Florence Nightingale began to take note of unsanitary hospital conditions and their negative effect on patient outcomes. She collected medical statistics using patient demographics to find the mortality rate associated with various diagnoses. She fought hard for hospitals in Britain to use statistical data collection methods, something we still use today.

In the 1960s, nursing education started to shift toward becoming an applied science. The field produced new medical knowledge and research, but it did not immediately translate into clinically useful information. At the time, medical care was largely based on assumptions rather than facts, and patients had little to no say in their treatment.

This began to change in 1972 when Archie Cochrane championed the implementation of randomized control trials (RCTs) and other research in nursing practice. He argued that since health care systems faced limited resources, they should only use treatment protocols that were proven to be effective. Cochrane’s push for RCTs laid out the groundwork for the movement toward evidence-based practice.

In 1996, David Sackett introduced the concept of evidence-based medicine. In addition to using research to inform treatment decisions, Sackett also sought to integrate patient values and the provider’s clinical experience. The early 2000s saw a major shift toward the use of evidence-based medicine to improve patient outcomes, especially as experts noted the chasm between known best practices and what was actually being carried out in health care settings.

As other health care fields began to adopt this model, evidence-based medicine was renamed “evidence-based practice,” a name that is still used today across medical and allied health professions.

What Role Does EBP Play in Nursing?

EBP empowers nurses to make informed decisions about patient care and keep up to date on best practices. In addition to improving individual patient outcomes, EBP is used across the board for various nursing procedures. For example, health care professionals help prevent hospital-acquired infection by adhering to evidence-based infection control protocols.

Health care organizations also benefit from implementing EBP. Fewer resources are wasted on ineffective or outdated protocols (as well as negative patient outcomes that can result). This reduces expenses, which allots more funds toward clinical resources, an increased number of patients, and generally improves patient care.

Finally, EBP results in improved patient satisfaction. Patients take an active role in their care plan, which not only increases their satisfaction but also increases the probability of follow-through with discharge orders.

Levels of Evidence

The levels of evidence, which is also known as the hierarchy of evidence, is based on the methodological quality of design, validity, and applicability to patient care. The seven levels of evidence for studies are as follows, with Level I indicating the highest strength of recommendation:

• Level I: evidence from a systematic review/meta-analysis of all relevant RCTs; practice guidelines based on systematic reviews of RCTs, or three or more high-quality RCTs with similar results
• Level II: evidence from at least one well-designed RCT
• Level III: evidence from well-designed, non-randomized controlled trials
• Level IV: evidence from well-designed cohort or case-control studies
• Level V: evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis)
• Level VI: evidence from one descriptive or qualitative study
• Level VII: evidence from the opinions of authorities or reports of expert committees

Steps of the Evidence-Based Process

The evidence-based process is a framework to help nurses think critically about nursing interventions and help formulate evidence to either support or reject aspects of nursing care. It is generally sparked by an incident that occurs with a patient that makes the nurse want to deep dive into why a therapy method is used, a lab test not ordered, or the etiology of the disease for example.

The five steps of the evidence-based process are:

1. Ask a clinical question: To find appropriate evidence, you need to develop a specific clinical question using the PICO(T) framework, outlined below:
   1. Patient/population: the patient population or disease
   2. Intervention: the experimental treatment of interest
   3. Comparison: what the intervention should be compared against, such as treatment vs. no treatment
   4. Outcome: what happens because of the intervention
   5. Time: the timeframe of the outcome measure, if applicable
2. Obtain the best research literature: Several literature search databases exist online to help you find the answer to your clinical question. Use the information from the PICO(T) framework to determine the best keywords to search for. Article titles, abstracts, and publish date can all help you determine the most relevant literature.
3. Critically appraise the evidence: Determine the strength of the presented evidence, as well as the relevance to your clinical question. Find additional research literature as needed until you have sufficient evidence to begin developing a plan.
4. Integrate the evidence with clinical expertise and patient preferences: Once you have your research evidence, integrate your clinical expertise as well as your patient’s values and preferences. If you don’t yet know your patient’s preferences, discuss this with them before implementing your treatment plan.
5. Evaluate the outcomes of the decision: Monitor and analyze the results of your decision. Did your treatment plan produce the desired patient outcome? If not, what factors could have impacted those results, and what additional research should be conducted? Be sure to communicate this information clearly with your patients as well as other health care providers.

Your nursing coursework will include further information on EBP, including how to find high-quality evidence as well as specific examples related to patient care protocols. Learning about EBP will help you to understand that there is a methodology and a science behind every nursing intervention. Nurses must continue to be empowered to critically evaluate research, integrate it seamlessly with patient values, and provide the highest quality of care.