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Nursing Scholarly Sources Guide

EBP Process and Frameworks

Evidence-based practice (EBP) is the process of applying current, best evidence, patient perspective, and clinical expertise to make decisions about management of care.

There are a variety of methods and models for approaching the EBP process. Each is slightly different yet have the same end result. Best practice is to select one model to use throughout the entire process. 

Below is a 4-Step EBP Process.

The Four-Step EBP Process 1. Develop a Clinical Question 2. Gather Evidence 3. Critically Appraise/Assess the Evidence 4. Apply the Evidence

Here are some additional EBP frameworks:

PICO(T) Questions

Use the PICO(T) mnemonic to develop a clinical question for your search. The PICO(T) will help you identify keywords that can be used as search terms.

Example question: "What effect does palliative care (I) have on quality of life (O) for women with breast cancer (P) in the last year of life (T) as compared to curative care (C)?" 

  Explanation  Example
P= Population

Describe your population (e.g. age, sex, medical condition, care setting, problem).

 women with breast cancer 
I= Intervention or Issue 

Describe the therapy, treatment, or other intervention being considered, or describe the issue to investigate.

 palliative care
C= Comparison (optional) 

If there is one, identify the comparison to the Intervention. The comparison may be the current standard of care. 

 curative care (ie. chemotherapy, radiation)
O= Outcome 

Describe the desired outcome of the intervention.

 better quality of life
T= Timeframe (optional)

If a specific time period is relevant for your question, note the period over which population is observed or outcome is measured. 

 last year of life

All elements of the PICO(T) are not always needed to develop a clinical question. The PIO are the required elements, as in the example below.

Simplified example: What effect does palliative care (I) have on quality of life (O) for women with breast cancer (P)?

Once you have identified the keywords in your question, brainstorm additional terms that may be helpful for your search. 

Keywords Synonyms 
palliative care hospice, terminal care, end of life care
breast cancer breast neoplasm, breast carcinoma
quality of life QOL, life quality, well being

Critical Appraisal Checklist

Critical Appraisal Checklists are used to determine the quality of evidence. For example, a Critical Appraisal Checklist might ask you to consider whether the design of a study was appropriate or whether the results of a study were communicated clearly.

Use the checklist linked in the Blackboard page for your specific course. An example Critical Appraisal Checklist is included below.