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Evidence-based Practice Tutorial

A Letter from Dr. Schirm

Welcome to this online tutorial for evidence-based practice.

Evidence-based practice (EBP) in nursing is using and carrying out nursing practices based on the best available knowledge. Evidence-based practice can be thought of as a triad that integrates the nurse’s clinical expertise with the best external research evidence, and takes into account patient preferences in order to deliver quality nursing care.

A nursing practice environment founded in EBP is an essential component of a Magnet institution. Evidence based practice assures that the best and current nursing care is given to patients and families.

Research findings have shown that patients who receive care based on the best research evidence experience better outcomes. Research findings suggest also that health care providers who use an evidence based approach to patient care have higher levels of satisfaction compared to health care practitioners who give care based solely on tradition.

Although clinical expertise and expert opinion are sources of knowledge and are ways that nurses have historically practiced; this traditional, authoritative decision making is not sufficient in today’s health care arena. The competent practice of nursing based on standards is required by accrediting bodies and professional organizations.

Nursing care that is based only on statements such as "“This is the way it has always been done," or "I have been working here for 15 years and I know that this way is the best" are not sufficient in today’s health care environment.

Evidence-based practice is a way for nurses to examine nursing practices, analyze alternative and contradictory data, and make sound nursing care decisions supported by the best available research evidence. This systematic approach to nursing practice enhances the likelihood that patients will receive the best nursing care possible.

Think about the care that you would personally want to receive or that you would want a family member to receive. Would you want to be cared for by someone who says "This is the best care, and I know it is good care because it has worked for patients like you for a number of years," or would you rather hear, "I know that you are frightened and confused about your mother's chemotherapy treatment. Your mother will receive treatment that has been tested in clinical trials with other similar cancer patients. And the nurses will give care using practice standards that have been tested and shown to help patients recover in less time and with fewer side effects."?

Evidence-based practice assures that the best and current nursing care is being given to patients and families. Regulatory agencies, such as Joint Commission (JAHCO) use standards that call for health care providers to implement best practices based on research evidence.

Third party payers are increasingly looking at paying for only health care interventions that have known effectiveness supported by scientific evidence. Even patients and families are using the Internet to seek information about the best treatments that have been tested in clinical trials.

As you review this tutorial keep the following points in mind.

  • Critical pathways are not EBP unless research, expert opinion, clinical expertise and consumer preferences were used to develop the pathway.
  • Product evaluation is not EBP. A critical examination of the research that supports the product is needed; and this information needs to be integrated with expert opinion, available resources (i.e., money to support purchase), and preferences and values of those who will use the product.
  • Performance Improvement and EBP share commonalities, but differ in that Performance Improvement focuses on systems and process, and not direct patient care. Performance Improvement and quality improvement are often a starting point to carry out a literature review to determine practices based on the best evidence available.
  • EBP is linked to research in that superior patient outcomes are achieved through research-based care.

This online tutorial is one method that we will use at Penn State Hershey Medical Center to promote consistent use of evidence based practices in the delivery of nursing care. The tutorial will show the steps in conducting EBP.

  • First, information will be presented about asking the clinical question in a way that will give the most relevant evidence.
  • Next, you will be guided through finding the most relevant evidence from the latest clinical practice guidelines or systematic reviews.
  • After gathering the evidence you will learn how to evaluate the validity, relevance, and applicability to the clinical situation.
  • Then you will use and apply critical thinking and appraisal skills to make a clinical decision that is based on integration of the gathered evidence with what you, the nurse, know about the situation at hand. This decision will also incorporate an understanding of available resources and the patient’s preferences and values.

Take as much time as you would like in this tutorial. And come back to it often.Bringing Research to the Bedside through Evidence Based Practice is a task for everyone who wants to give the best care possible to patients and families.

Victoria Schirm
Director of Nursing Research
Department of Nursing
Penn State Milton S. Hershey Medical Center
















nurse in clinical setting