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6 Steps of the Evidence-based Practice Process

6 steps of the evidence-based practice process

1. Ask a clinical guiding question.
Organized in a format known as P I C O (T):
P – patient, population, or problem of interest
I – intervention or prognostic factor being considered
C – comparison or intervention
O – outcome measured
T – time period

2. Search for the best evidence.
Select the information databases or resources most likely to answer the type of question being asked; utilize keywords and concepts; combine multiple search terms and Boolean connectors.

3. Critically appraise the evidence.
Determine a study’s reliability, validity and applicability to the client in question. Assess and evaluate the strengths and weaknesses of the evidence.

4. Integrate the evidence with one’s clinical expertise…
…and client preferences to make the best clinical decision. Before integration, other considerations beyond applicability must be considered, such as biologic, socioeconomic and epidemiologic issues.

5. Evaluate the outcome or outcomes of the E B P practice decision or…
…change based on evidence of the E B P decision. Was the expected outcome achieved? If not, why not? Was it due to non-adherence to treatment plan, different client prognostic factors and or provider or providers not ready for the practice change? Was it because of N P skills, evidence interpretation, or in implementing the intervention?

6. Disseminate the outcome.
Disseminate evidence to colleagues within your organization, and beyond. Outcome dissemination can be done through intra- and inter-departmental in-services, journal clubs, online media, lectures, conferences, posters, and manuscripts.

Adapted from Facchiano, L. and Hoffman Snyder, C. (2012). Evidence-based practices for the busy nurse practitioner. Part one: Relevance to clinical practice and clinical inquiry process. (WWW document). URL http// (accessed on 25 June 2014).