Search Techniques

SECTION 6:  EVIDENCE-BASED PRACTICE

Evidence-based practice has also been described in terms of a five-step process that begins and ends with the patient. The five steps are as follows:

1. Construct a relevant, answerable question derived from a clinical case--that is, from a patient.
2. Select the appropriate resource(s) and conduct a search of the literature for external evidence to incorporate with your existing knowledge.
3. Appraise that evidence for both its applicability to your clinical case and for validity.
4. Taking patient wishes and preferences into account, integrate that evidence with your clinical expertise and apply it to the care of the patient.
5. Evaluate your performance with this patient.

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The Five-Step Process: Step 1

1. Construct a relevant, answerable question derived from a clinical case--that is, from a patient.

An effective EBP search begins with a clear idea as to the type of information you are looking for. You can start this thought process by applying a set of questions to the clinical problem. One method of asking yourself these questions is called PICO, an acronym for:

P--Patient or population. How would you describe the patient in terms of age, sex, race, past medical history, or other personal characteristics?

I--Intervention. What sort of action do you wish to explore--a treatment or therapy, a diagnostic test, a screening procedure, etc.?

C--Comparison. To what do you want to compare your proposed course of action--doing nothing, placebo, the current "gold standard" diagnostic tool or treatment, or some other intervention?

O--Outcomes. What is the effect of the intervention--higher or lower rate of cure, decreased or increased likelihood of a particular side effect, mortality after a particular time period, more or fewer subsequent hospitalizations?

There are many books and websites with information about constructing good clinical questions. Among the many books owned by Perry Library that you might find helpful is:

Melnyk, Bernadette Mazurek and Ellen Fineout-Overholt (2005). Evidence-Based Practice in Nursing & Healthcare : a Guide to Best Practice. Philadelphia : Lippincott Williams & Wilkins. This book has a chapter devoted to "Asking Compelling Clinical Questions."

The Duke University Medical Center Library and the Health Sciences Library at UNC-Chapel Hill have produced an excellent tutorial on EBP that you may wish to go through in its entirety. The section on "The Well-Built Clinical Question" is particularly worthwhile.

Next: The Five-Step Process: Step 2