The Seven Steps of Evidence-Based Practice

1 Rese arc h stu dies sho w thatevi de nc e-base d prac tic e(EB P) lead s to highe r qu al -ity ca re, improve d patie nt out-comes,red uced co st s, an d grea ternursesatisfaction tha n tra di ti on alapproaches to car 5De spit ethese fa vor able findi ngs, manynursesrem ai n inconsisten t in theirimplementa ti on of evide nc e- re ove r, some nurses,wh os e edu cat ion pr ed ates the in -cl us ion of EBP in the nursingcur-ri cu lu m, st ill lac k the co mp ute ran d In tern et se arch skillsnec es -sa ry to im pl emen t thes e prac tic a resu lt, mis co ncept ions aboutEB P that it s too diffi cul t or to otime-consuming con ti nue toflo ur is the first articlein thi s ser ies( Ign iting a Sp irit of Inq ui ry: AnEss ent ial Fou nd atio n for Evi de nc e-BasedPra ctice, Novembe r 2009),we described EBP as a pro blem -so lv in g approach to the deliveryof healthca re th at int egratesthebest evi den ce fro m wel l- des ignedst udie s an d pati en t car e data ,and com bi nes it with pati entpref er encesand values an d nu rseexpertis e.

2 We als o addres sed thecon tri buti on of EBP to improvedcare and pat ie nt ou tcom es , de -scri bed bar rier s to EB P as well asfac tors fac ilit at ing it s im ple menta -tion, and dis cus sed str ateg ies forign it ing a spi rit of inq uir y in cl in-ic al pra ct ic e, whic h is the founda-tion of EBP , refer red to as StepZe ro. (Edit or s note: al thoughEBP has se ve n ste ps , they ar enum bered zero to six. ) In thi sarti cle, we of fer a br ief over vi ewof th e mu lt istep EBP pr oc es re arti cle s will elab orateoneac h of th e EBP Steps , us ingthe con text provided by theCaseScenario Zero : Cul tivat e a spiri t ofin qui ry.

3 If yo u v e be en fo llo wi ngthis ser ies , yo u may have alre ad ysta rted ask in g th e kin ds of que s-tion s th at lay the grou ndw orkfor EB P, fo r exa mpl e: in patie ntswi th he ad inj ur ies, how doe ssupi ne pos iti oni ng comparedwi th eleva ting the he ad of thebed 30 deg re es af fect intr acr an ia lpr es sure? Or , in pat ien ts withsu prav en tri cula r ta chy ca rdi a,how does ad mi ni ster ing the -blo cke r meto pro lol (Lop ress or,Topr ol- XL) compare d wi th ad -mi ni st ering no medi cine af fectByBe rn adette MazurekMelnyk , PhD,RN,CPNP/PMHNP , FNAP, FAAN,Ellen Fineou t-Overho lt,PhD, RN,FNAP, FAAN, Su illwell,DNP,RN,CNE,andKathleen ,PhD, RNTheSevenStepsofEvidence-BasedPracticeF ollowingthisprogressive, is the secondarticlein a new seriesfromthe ArizonaStateUniversityCollegeof Nursingand HealthInnova-tion sCenterfor the Advancementof Evidence- basedpractice(EBP)

4 Is a problem-solvingapproachto the deliveryof healthcarethat integratesthe best evidencefromstudiesand patientcaredatawith clini -cian expertiseand patientpreferencesand a contextof caringand in a supportiveorgani-zationalculture,the highestqualityof careand best patientoutcomescan be purposeof this seriesis to give nursesthe knowledgeand skillsthey needto implementEBP consistently,onestep at a appeareverytwo monthsto allowyou time to incorporateinformationas you worktowardimplementingEBP at ,we vescheduled Askthe Authors callseveryfew monthsto pro -vide a directline to the expertsto help you January2010 , k the Aut ho rs on Ja nu ar y 22!

5 On Jan uary22 at 3: 30 PMEST, join the A sk the Aut ho rs ca ll . It s your ch anc e to ge t personalconsultationfromtheexp er ts! Andit's limi ted to the fir st 50 callers,so dial-inearly!U. S. an d Ca nad a, dial 1-800-947-5134(Internati onal , dial001-574-94 1- 696 4). When prompted, ente r code121 028 #.Go cli ck on Podcasts and thenon Co nver sati ons to listento ou r interviewwiththe fr equency of tac hycardicepis ode s? Wit houtthis spiri t ofin qui ry, the nex t st ep s in the EBPpr oc es s are no t lik ely to happ en .Ste p 1: Ask cli nical questi on sin PIC OT form at .In qu irie s in thisfo rm at take in to ac co un t pat ie ntpopu lat ion of in te re st (P ), int er-ve nt ion or area of int erest (I),co mpar ison int erv ent ion or gro up(C) , out com e (O) , an d time (T).

6 The PI COTformatpro vide s aneff icien t fr ame wor k fo r sear chi ngelec tro nic data base s, one des igne dto ret rieve only tho se articles rel -ev ant to the clinic al ques ing th e case sce narioon rapidre spon se teamsas an example,the wa y to fram e a ques tion aboutwhether use of such team s wou ldres ul t in posi tiv e outc om es wouldbe : Inacutecareho spitals(p atie nt populat ion) , how doeshav ing arapid res po nseteam(i nte rv ent ion) compared wi thnothaving a respons e team(compar-ison)affe ct thenumbe r ofcar-diac arr es ts(o ut come)duringathree -monthpe riod(tim e) ? Ste p 2: Sea rc h for th e be se arch for evide nceto inf or m clinicalprac tice is tre -mendously st re am line d whe nques ti ons are aske d in PIC OTfor mat.

7 If the nurs e in the rapidre spon se scenario had simp lyty ped Wha t is th e impact ofha vi ng a rap id re sponsete am ? int o the sea rch fie ld of the dat a-ba se, the res ult wouldhave bee nhund red s of ab st rac ts, mostofth em irr ele vant . Usingthe PIC OTfor ma t hel ps to iden tify ke y wordsor ph ra ses th at , wh en ent eredsu ccess ively an d then co mbined,valid ity cen ters on whe ther there searchmethods are ri go ro useno ugh to re nde r fin din gs asclo se to the tr uth as poss ibl exa mple , di d the re-sea rch ers random ly ass ignsu bject s to treatmentor con -trol groupsan d ens ure thatthey sha re d key cha ra cter ist icspr ior to trea tmen t?

8 We re vali dand rel ia ble inst rume nts usedto mea su re ke y ou tcome s? Whatareth e re su lt s an d arethe y important?Fo r in ter ven -tio n stu di es, th is questio n ofst udy reli abi lity addre sse swhe ther the inter ven tio nwor ke d, its im pa ct on out -com es, an d th e lik el ihoo d ofobt ain in g simila r res ul ts in thecl inic ians own pra ctic e se t-ting s. For qua li ta ti ve stud ies,this in cludesassessi ng whetherthe researchap proachfits thepur pos e of th e stu dy , alongwit h evalu at in g oth er asp ectsof th e res ear ch su ch as whet h-er the re su lts can be co nfir me d. Willth e re su ltshelpmecareformypa tients?

9 This quest ionof st udy ap pli cab ility cov erscli nica l co ns ider at ion s su ch aswhe ther sub ject s in the st udyare simi la r to one s own pa-tien ts, whet her bene fits out -wei gh risk s, feas ibi lit y andcos t-eff ecti ven ess , and pa tie ntva lue s an d pr efer ence te r appr ai si ng ea ch stu dy, th enex t st ep is to syn thesizethe st ud -ies to de termi ne if they cometosimilarconc lu sio ns, thus support-ing an EBP dec isi on or ch ang ep 4: Int eg rat e the evid en cewi th cli nical exp erti se and pa-tient pre fere nces an d val sea rch evid enc e al one is notsu ffici ent to ju sti fy a cha ng e inpractice.

10 Clini cal expertise, ba sedon pati ent ass ess ments, la bo ra to -ry dat a, and data fro m out come sma nagemen t pr ograms , as wellas pat ien ts prefe ren ces and val -ues are imp ortantcomponents ofex ped ite th e lo catio n of rele -van t ar ti cl es in massive resea rchda tabas es suc h as MED LINEorCIN th e PICOTque s-tion on ra pid re sponse teams,th e fi rst ke y phras e to be ente redint o th e datab ase wo uld beacuteca re hosp ital s, a com mon subj ecttha t wi ll mos t like ly re su lt in tho u-sands of ci tat ion s an d ab str act sec on d ter m to be sea rc hedwou ld berap id respo nseteam,fo llow ed bycardiacarr estsan dth e remai ning termsin th ePI COTqu es ti on.