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Nursing

A guide for finding information about nursing practice, research, and education.

"[Evidence Based Practice] (EBP) is a process used to review, analyze, and translate the latest scientific evidence. The goal is to quickly incorporate the best available research, along with clinical experience and patient preference, into clinical practice, so nurses can make informed patient-care decisions. EBP is the cornerstone of clinical practice. Integrating EBP into your nursing practice improves quality of care and patient outcomes" (Dang et al., 2022 as cited in Johns Hopkins Nursing, 2024).

ebp diagram

Source: Marcie Hopkins, U of U Health

Developing an Answerable Question Using PICO

The first step in evidence-based practice is to develop a clinical question that is answerable with published literature.  Your question should be focused, i.e., not overly broad. To focus your question, use an approach called PICO.

What is PICO? 

PICO is an acronym for:

P = Patient, Population, and/or Problem

I = Intervention

C = Comparison (not always applicable)

O = Outcome

Some researchers also add a "T" to the framework to define the type of study that is best to answer the question that they are creating. Or, alternatively, "T" can refer to time, which might look at variable lengths of time for the intervention outcome. 

Other Frameworks: SPIDER & SPICE

SPIDER...

S = Sample. The group of people being studied, because qualitative research is not easy to generalize, sample is preferred over patient.

P = Phenomenon of Interest - reasons for behavior and decisions, rather than an intervention.

D = The Design of research used, such as interview or survey.

E = Evaluation or outcome measures.

R = Research type, i.e., Qualitative, quantitative and/or mixed methods.

More information on the SPIDER method can be found at the link below.

Beyond PICO: The SPIDER tool for qualitative evidence synthesis Qual Health Res October 2012 vol. 22 no. 10 1435-1443

SPICE is used mostly in social science and healthcare research.   

S = Setting: the location or environment relevant to your research (e.g. accident and emergency unit) 
​P = Population (or perspective): the type of group that you are studying (e.g. older people)
I = Intervention: the intervention/practice/treatment that you are evaluating (e.g. initial examination of patients by allied health staff)
C = Comparator: an intervention with which you compare the above comparator (e.g. initial examination by medical staff) 
E = Evaluation: the hypothetical result you intend to evaluate e.g. lower mortality rates)

Clear and Present Questions: Booth 2004

Scholarship and research in health sciences can vary widely in quality and purpose. The following Hierarchy of Evidence Pyramid illustrates how evidence published via literature is ranked based on its quality (i.e. minimizing bias). The higher up on the pyramid, the higher quality and less biased the information should be.

Primary research studies are considered "unfiltered" information because they are individual, original research studies, usually adding relatively small bits of truth about a topic. Secondary literature is considered "filtered" information, because multiple studies are synthesized and analyzed to conclude broader claims.

heirarchy pyramid

Image: Desai, V.S., Camp, C.L., Krych, A.J. (2019). What Is the Hierarchy of Clinical Evidence?. In: Musahl, V., et al. Basic Methods Handbook for Clinical Orthopaedic Research. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58254-1_2

After identifying relevant evidence for your clinical question, it's necessary to critically appraise the information you find. Refer to the following resources to evaluate the quality of the articles' findings and make informed decisions.