Originally coined as Evidence-Based Medicine, the concept has been expanded over the years to include a variety of disciplines and fields. As such, you may see references to Evidence-Based Medicine, Evidence-Based Dentistry, Evidence-Based Nursing, and others. However, for the most part these all refer to the same basic concept of Evidence-Based Practice (EBP), or using the best evidence available, combined with the practitioner's clinical expertise and the patient's preferences, to inform the care of patients. EBP is typically broken down into 5 main steps:
We will discuss the first 3 steps of this process in this guide. |
EBP Definitions
Below are some definitions of discipline-specific versions of EBP:
Evidence-Based Medicine: "Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research." Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn’t. BMJ : British Medical Journal, 312(7023), 71–72. |
Evidence-Based Dentistry: “an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences.” American Dental Association. (2017). About EBD. Retrieved from //ebd.ada.org/en/about |
Evidence-Based Nursing: "an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served." Sigma Theta Tau International. (2005). Evidence-Based Nursing Position Statement. Retrieved from //www.sigmanursing.org/why-sigma/about-sigma/position-statements-and-resource-papers/evidence-based-nursing-position-statement |
Understanding Evidence Based Practice
Video created by Steely Library at Northern Kentucky University (NKU). This video is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a
clinician's expertise in making decisions about a patient's care. Unfortunately, no standard formula exists for how much these factors should be weighed in the clinical decision-making process. However, there are a variety of rating systems and hierarchies of evidence that grade the strength or quality of evidence generated from a research study or report. Being knowledgeable about evidence-based practice and levels of evidence is important to every clinician as clinicians need to be confident
about how much emphasis they should place on a study, report, practice alert or clinical practice guideline when making decisions about a patient's care. The levels of evidence listed here have been developed with the help of nurse experts and other industry resources. We thank those who have contributed to making our system relevant and applicable to determining the levels of evidence that support our CE publications. Evidence-based information ranges from
Level A (the strongest) to Level C (the weakest). In 2013, Level ML, multilevel, was added to identify clinical practice guidelines that contain recommendations based on more than one level of evidence:Levels of Evidence
Rating System:
LEVEL A: Evidence obtained from:
LEVEL B: Evidence obtained from:
LEVEL C: Evidence obtained from:
LEVEL ML (multilevel): clinical practice guidelines, recommendations based on evidence obtained from:
Evidence-based Practice Resources:
- Agency for Healthcare Research and Quality Evidence-based Practice Centers (//www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html)
- The Cochrane Collaboration:
- Cochrane Reviews (//www.cochrane.org/what-is-cochrane-evidence)
- Evidence-based healthcare (//www.cochrane.org/what-is-cochrane-evidence)
- National Guideline Clearinghouse: (//www.guideline.gov/)
References for EBP:
Alfaro-LeFevre R. Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach. 5th ed. St. Louis, MO: Elsevier-Saunders; 2013.
Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69(3):548-556. //www.aafp.org/afp/2004/0201/p548.html. Published February 1, 2004. Accessed November 11, 2015.
Evidence-based medicine toolkit. American Academy of Family Physician Web site. //www.aafp.org/journals/afp/authors/ebm-toolkit.html. Accessed November 11, 2015.
What is evidence based medicine? University of Illinois at Chicago University Library Web site. //researchguides.uic.edu/ebm. Updated March 7, 2008. Accessed November 11, 2015.
Levels of evidence. Oxford Centre for Evidence-Based Medicine Web site. //www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Published March 2009. Updated April 15, 2011. Accessed November 11, 2015.
Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare. A Guide to Best Practice. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
Newhouse RP, Dearholt SL, Poe SS, Pugh LC, White KM. Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Indianapolis, IN: Sigma Theta Tau International; 2007.
Strength of recommendation taxonomy (SORT). American Academy of Family Physicians Web site. //www.aafp.org/dam/AAFP/documents/journals/afp/sortdef07.pdf. Accessed November 11, 2015.
Understanding research study designs. University of Minnesota Bio-Medical Library Web site. //www.biomed.lib.umn.edu/guides/understanding-research-study-designs. Accessed November 11, 2015.