Evidence-based practice
Evidence-based practice combines the best research, clinical expertise, and patient preferences. It ensures care reflects what actually works. For study only, not clinical guidance: always follow your programme, current local protocols, and supervising clinicians.
What evidence-based practice is
Evidence-based practice (EBP) integrates the best available research evidence with clinical expertise and patient values and preferences to guide care decisions. It replaces 'we've always done it this way' with care grounded in evidence, while respecting individual patients.
Asking clinical questions: PICO
Clinical questions are framed using PICO: Population or patient, Intervention, Comparison, and Outcome (sometimes PICOT, adding Time). For example: In adult surgical patients (P), does chlorhexidine bathing (I) compared with soap and water (C) reduce surgical site infections (O)?
Levels of evidence
Evidence is often ranked in a hierarchy. Systematic reviews and meta-analyses of randomised controlled trials (RCTs) are near the top; individual RCTs next; then cohort and case-control studies; then case series; and expert opinion at the bottom. The best design depends on the question: RCTs suit treatment questions; cohort studies suit questions about risks.
Randomised controlled trials
In an RCT, participants are randomly assigned to an intervention or control group, so groups are similar except for the intervention. Blinding, where participants or researchers do not know who receives what, reduces bias. RCTs are the strongest single study design for showing that a treatment causes an effect.
Qualitative research
Qualitative research explores experiences and meanings through interviews, focus groups, and observation, rather than numbers. It answers questions such as what it is like to live with chronic pain, or why patients miss appointments. It is valuable for understanding patient perspectives and designing acceptable care.
Appraising research
Critical appraisal asks: Was the study design appropriate? Was the sample large and representative? Were groups comparable? Were outcomes measured reliably? Are results statistically and clinically significant? Who funded it? Could findings apply to my patients? Tools such as CASP checklists help structure appraisal.
Implementing evidence
Moving evidence into practice is challenging: research shows it can take many years for findings to be adopted widely. Implementation involves clinical guidelines, education, champions, audits and feedback, and changing systems (such as electronic reminders). Models like the Iowa Model guide EBP projects in hospitals.
Worked example
Nurses notice frequent pressure injuries on a ward. They ask: In immobile adult inpatients (P), does a two-hourly repositioning schedule with pressure-redistributing mattresses (I) compared with usual care (C) reduce pressure injury rates (O)? They find a systematic review supporting the intervention, adapt a protocol with the team, educate staff, and audit rates before and after.
Key takeaways
EBP integrates research, clinical expertise, and patient preferences. PICO frames clinical questions. Systematic reviews and RCTs rank high in the evidence hierarchy; the best design depends on the question. RCTs use randomisation and blinding to reduce bias. Qualitative research explores experiences. Critical appraisal assesses design, sample, and applicability. Implementation requires guidelines, education, and system changes.
Flashcard
Research + clinical expertise + patient preferences
Check your understanding
In the PICO question 'In older adults, does a daily exercise programme compared with usual activity reduce falls?', what is the 'O'?