Our Readers Respond

From our readers: ABC’s of evidence-based practice

Evidence-based practice (EBP) combines science, the nurse’s expertise in the art of nursing, and patient considerations to create a whole that is greater than the sum of the parts. Barriers inhibiting direct-care nurses’ use of EBP range from the culture within practice areas to unfamiliarity with how to apply this relatively complex process. I created a mnemonic —“ABCs of EBP”—to provide an easy-to-remember framework that all nurses could use as a guide for the process

The ABCs of EBP are:

A = Ask the question

B = Books and literature review

C = Consider the evidence

D = Develop and Apply

E = Evaluate

F = Facilitate

Here’s a closer look at each step.

A = Ask the question

Question development is so critical to EBP that the PICOT mnemonic was developed to help shape the essential elements into a workable format. In this mnemonic, P represents population of interest, I represents intervention, C represents comparison (comparing processes), O represents outcome (evaluating effectiveness of the process), and T represents time as an element to provide structure. PICOT works like a filter, targeting efforts and narrowing the search for information as it applies to a specific patient care issue.

B = Books and literature review

At this stage, the nurse collects both research-based and non-research based information to find what has been learned about the subject of the PICOT question. Sources of information include professional journals, books, expert opinions, clinical practice guidelines, organizational procedures, case studies, and literature reviews. A little practice with search engines coupled with a well-targeted PICOT question helps streamline the process of collecting information.

C = Consider the evidence

Now it’s time to consider the evidence, which includes the data that has been collected, as well as input from the patient and the expertise of the nurse. As the nurse gathers the information, consideration should be given to the strength of the research studies or expert opinions as they apply to the particular practice setting. Several formats exist for weighing the literature, such as examining the appropriateness of the study design. Quantitative research is considered the gold standard, but qualitative research is also helpful, particularly in cases when the question is related to attitudes or emotions.

Other considerations include cost and resources. A care intervention won’t work if it is cost prohibitive, the resources are not available, or the patient cannot perform the procedure. For example, a patient with debilitating arthritis or neuropathy may not be able to perform complex dressing changes. The key is to individualize the intervention for the patient.

Consideration, careful synthesis, and application of all available evidence provides an opportunity to produce the best outcome for a patient or a group of patients.

D = Develop and apply

This is the action step for a practice intervention or an EBP project. The direct care nurse uses the elements from the evidence, patient input, and the resources at hand to develop a nursing intervention that is acceptable to the patients within the immediate care area. If sufficient evidence is lacking, the nurse may start a practice or research study. In addition, evidence could also show that the current practice is the best practice and no changes are needed.

E = Evaluate
This is the most familiar step for nurses. It’s important to evaluate the response to an intervention so nurses can continue a plan or process that’s working or revise as needed. Some projects might be expanded into research studies.

F = Facilitate

Nurses can share what they learn with staff within an organization through poster presentations, journal clubs, or hospital newsletters. External avenues of dissemination include podium or poster presentations at nursing conventions and publishing review articles for nursing journals. Published, nurse-generated research and projects will increase the body of nursing knowledge.

A useful tool

Nurses can use the ABC mnemonic as a tool to improve patient care delivery, implement EBP projects, and develop the nursing research needed to promote professional growth. The ABC’s of EBP will support, stimulate, and further advance nursing professionalism.

Anne Burnett is co-chair of the Evidence-Based Practice Council and the Quality & Performance Specialist at Veteran’s Healthcare System of the Ozarks in Fayetteville, Arkansas.

From our readers gives nurses the opportunity to share experiences that would be helpful to their nurse colleagues. Because of this format, the stories have been minimally edited. If you would like to submit an article for From our readers, click here.

Selected references

DeLaune S, Ladner PK, eds. Research and evidence based practice. Fundamentals of Nursing. 4th ed. Albany, NY: Delmar Publishing; 2011.

Hockenberry M, Walaen M, Brown T, Barrera P. Creating an evidence-
based practice environment: one hospital’s journey. J Trauma Nurs. 2008;15(3):136-42.

Larrabee JH, Sions J, Fanning M, Withrow ML, Ferretti A. Evaluation of a program to increase evidence-based practice change. J Nurs Admin. 2007;37(6):302-10.

Melnyk BM, Fineout-Overholt E, eds. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2010.

Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Evidence-based practice, step by step: asking the clinical question: a key step in evidence-based practice. Am J Nurs. 2010;110(3):58-61.

Related Articles:

Leave a Reply

You have to agree to the comment policy.