evidence based nursing practice essay

What is Evidence-Based Practice in Nursing? (With Examples, Benefits, & Challenges)

Are you a nurse looking for ways to increase patient satisfaction, improve patient outcomes, and impact the profession? Have you found yourself caught between traditional nursing approaches and new patient care practices? Although evidence-based practices have been used for years, this concept is the focus of patient care today more than ever. Perhaps you are wondering, “What is evidence-based practice in nursing?” In this article, I will share information to help you begin understanding evidence-based practice in nursing + 10 examples about how to implement EBP.

What is Evidence-Based Practice in Nursing?

When was evidence-based practice first introduced in nursing, who introduced evidence-based practice in nursing, what is the difference between evidence-based practice in nursing and research in nursing, what are the benefits of evidence-based practice in nursing, top 5 benefits to the patient, top 5 benefits to the nurse, top 5 benefits to the healthcare organization, 10 strategies nursing schools employ to teach evidence-based practices, 1. assigning case studies:, 2. journal clubs:, 3. clinical presentations:, 4. quizzes:, 5. on-campus laboratory intensives:, 6. creating small work groups:, 7. interactive lectures:, 8. teaching research methods:, 9. requiring collaboration with a clinical preceptor:, 10. research papers:, what are the 5 main skills required for evidence-based practice in nursing, 1. critical thinking:, 2. scientific mindset:, 3. effective written and verbal communication:, 4. ability to identify knowledge gaps:, 5. ability to integrate findings into practice relevant to the patient’s problem:, what are 5 main components of evidence-based practice in nursing, 1. clinical expertise:, 2. management of patient values, circumstances, and wants when deciding to utilize evidence for patient care:, 3. practice management:, 4. decision-making:, 5. integration of best available evidence:, what are some examples of evidence-based practice in nursing, 1. elevating the head of a patient’s bed between 30 and 45 degrees, 2. implementing measures to reduce impaired skin integrity, 3. implementing techniques to improve infection control practices, 4. administering oxygen to a client with chronic obstructive pulmonary disease (copd), 5. avoiding frequently scheduled ventilator circuit changes, 6. updating methods for bathing inpatient bedbound clients, 7. performing appropriate patient assessments before and after administering medication, 8. restricting the use of urinary catheterizations, when possible, 9. encouraging well-balanced diets as soon as possible for children with gastrointestinal symptoms, 10. implementing and educating patients about safety measures at home and in healthcare facilities, how to use evidence-based knowledge in nursing practice, step #1: assessing the patient and developing clinical questions:, step #2: finding relevant evidence to answer the clinical question:, step #3: acquire evidence and validate its relevance to the patient’s specific situation:, step #4: appraise the quality of evidence and decide whether to apply the evidence:, step #5: apply the evidence to patient care:, step #6: evaluating effectiveness of the plan:, 10 major challenges nurses face in the implementation of evidence-based practice, 1. not understanding the importance of the impact of evidence-based practice in nursing:, 2. fear of not being accepted:, 3. negative attitudes about research and evidence-based practice in nursing and its impact on patient outcomes:, 4. lack of knowledge on how to carry out research:, 5. resource constraints within a healthcare organization:, 6. work overload:, 7. inaccurate or incomplete research findings:, 8. patient demands do not align with evidence-based practices in nursing:, 9. lack of internet access while in the clinical setting:, 10. some nursing supervisors/managers may not support the concept of evidence-based nursing practices:, 12 ways nurse leaders can promote evidence-based practice in nursing, 1. be open-minded when nurses on your teams make suggestions., 2. mentor other nurses., 3. support and promote opportunities for educational growth., 4. ask for increased resources., 5. be research-oriented., 6. think of ways to make your work environment research-friendly., 7. promote ebp competency by offering strategy sessions with staff., 8. stay up-to-date about healthcare issues and research., 9. actively use information to demonstrate ebp within your team., 10. create opportunities to reinforce skills., 11. develop templates or other written tools that support evidence-based decision-making., 12. review evidence for its relevance to your organization., bonus 8 top suggestions from a nurse to improve your evidence-based practices in nursing, 1. subscribe to nursing journals., 2. offer to be involved with research studies., 3. be intentional about learning., 4. find a mentor., 5. ask questions, 6. attend nursing workshops and conferences., 7. join professional nursing organizations., 8. be honest with yourself about your ability to independently implement evidence-based practice in nursing., useful resources to stay up to date with evidence-based practices in nursing, professional organizations & associations, blogs/websites, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. what did nurses do before evidence-based practice, 2. how did florence nightingale use evidence-based practice, 3. what is the main limitation of evidence-based practice in nursing, 4. what are the common misconceptions about evidence-based practice in nursing, 5. are all types of nurses required to use evidence-based knowledge in their nursing practice, 6. will lack of evidence-based knowledge impact my nursing career, 7. i do not have access to research databases, how do i improve my evidence-based practice in nursing, 7. are there different levels of evidence-based practices in nursing.

• Level One: Meta-analysis of random clinical trials and experimental studies • Level Two: Quasi-experimental studies- These are focused studies used to evaluate interventions. • Level Three: Non-experimental or qualitative studies. • Level Four: Opinions of nationally recognized experts based on research. • Level Five: Opinions of individual experts based on non-research evidence such as literature reviews, case studies, organizational experiences, and personal experiences.

8. How Can I Assess My Evidence-Based Knowledge In Nursing Practice?

Key EBP Nursing Topics: Enhancing Patient Results through Evidence-Based Practice

This article was written in collaboration with Christine T. and ChatGPT, our little helper developed by OpenAI.

Evidence-based practice (EBP) is the use of the best available evidence to inform clinical decision-making in nursing. EBP has become increasingly popular in nursing practice because it ensures that patient care is based on the most current and relevant research. In this article, we will discuss the latest evidence-based practice nursing research topics, how to choose them, and where to find EBP project ideas.

What is Evidence-Based Practice Nursing?

EBP nursing involves a cyclical process of asking clinical questions, seeking the best available evidence, critically evaluating that evidence, and then integrating it with the patient’s clinical experience and values to make informed decisions. By following this process, nurses can provide the best care for their patients and ensure that their practice is informed by the latest research.

One of the key components of EBP nursing is the critical appraisal of research evidence. Nurses must be able to evaluate the quality of studies, including study design, sample size, and statistical analysis. This requires an understanding of research methodology and the ability to apply critical thinking skills to evaluate research evidence.

EBP nursing also involves the use of clinical practice guidelines and protocols, which are evidence-based guidelines for clinical practice. These guidelines have been developed by expert groups and are based on the best available evidence. By following these guidelines, nurses can ensure that their practice is in line with the latest research and can provide the best possible care for their patients.

Finally, EBP nursing involves continuous professional development and a commitment to lifelong learning. Nurses must keep abreast of the latest research and clinical practice guidelines to ensure that their practice is informed by the latest research. This requires a commitment to ongoing learning and professional development, including attending conferences, reading scholarly articles, and participating in continuing education programs.

You can also learn more about evidence-based practice in nursing to gain a deeper understanding of the definition, stages, benefits, and challenges of implementing it.

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How to Choose Evidence-Based Practice Nursing Research Topics

Choosing a science-based topic for nursing practice can be a daunting task, especially if you are new to the field. Here are some tips to help you choose a relevant and interesting EBP topic:

• Look for controversial or debated issues

Look for areas of nursing practice that are controversial or have conflicting evidence. These topics often have the potential to generate innovative and effective research.

• Consider ethical issues

Consider topics related to ethical issues in nursing practice. For example, bereavement care, informed consent , and patient privacy are all ethical issues that can be explored in an EBP project.

• Explore interdisciplinary topics

Nursing practice often involves collaboration with other health professionals such as physicians, social workers, and occupational therapists. Consider interdisciplinary topics that may be useful from a nursing perspective.

• Consider local or regional issues

Consider topics that are relevant to your local or regional healthcare facility. These topics may be relevant to your practice and have a greater impact on patient outcomes in your community.

• Check out the latest research

Review recent research in your area of interest to identify gaps in the literature or areas where further research is needed. This can help you develop a research question that is relevant and innovative.

With these tips in mind, you can expand your options for EBP nursing research topics and find a topic that fits your interests and goals. Remember that patient outcomes should be at the forefront of your research and choose a topic that has the potential to improve treatment and patient outcomes.

Where to Get EBP Project Ideas

There are several sources that nurses can use to get EBP project ideas. These sources are diverse and can provide valuable inspiration for research topics. By exploring these sources, nurses can find research questions that align with their interests and that address gaps in the literature. These include:

• Clinical Practice Guidelines

Look for clinical practice guidelines developed by professional organizations or healthcare institutions. These guidelines provide evidence-based guidelines for clinical practice and can help identify areas where further research is needed.

• Research databases

Explore research databases such as PubMed, CINAHL, and the Cochrane Library to find the latest studies and systematic reviews. These databases can help you identify gaps in the literature and areas where further research is needed.

• Clinical Experts

Consult with clinical experts in your practice area. These experts may have insights into areas where further research is needed or may provide guidance on areas of practice that may benefit from an EBP project.

• Quality Improvement Projects

Review quality improvement projects that have been implemented in your healthcare facility. These projects may identify areas where further research is needed or identify gaps in the literature that could be addressed in an EBP project.

• Patient and family feedback

Consider patient and family feedback to identify areas where further research is needed. Patients and families can provide valuable information about areas of nursing practice that can be improved or that could benefit from further research.

Remember, when searching for ideas for EBP nursing research projects, it is important to consider the potential impact on patient care and outcomes. Select a topic that has the potential to improve patient outcomes and consider the feasibility of the project in terms of time, resources, and access to data. By choosing a topic that matches your interests and goals and is feasible at your institution, you can conduct a meaningful and productive EBP research project in nursing.

Nursing EBP Topics You Can Use in Your Essay

Here are some of the latest evidence-based practice nursing research topics that you can use in your essay or explore further in your own research:

• The impact of telehealth on patient outcomes in primary care
• The use of music therapy to manage pain in post-operative patients
• The effectiveness of mindfulness-based stress reduction in reducing stress and anxiety in healthcare workers
• Combating health care-associated infections: a community-based approach
• The impact of nurse-led discharge education on readmission rates for heart failure patients
• The use of simulation in nursing education to improve patient safety
• The effectiveness of early mobilization in preventing post-operative complications
• The use of aromatherapy to manage agitation in patients with dementia
• The impact of nurse-patient communication on patient satisfaction and outcomes
• The effectiveness of peer support in improving diabetes self-management
• The impact of cultural competence training on patient outcomes in diverse healthcare settings
• The use of animal-assisted therapy in managing anxiety and depression in patients with chronic illnesses
• The effectiveness of nurse-led smoking cessation interventions in promoting smoking cessation among hospitalized patients
• Importance of literature review in evidence-based research
• The impact of nurse-led care transitions on hospital readmission rates for older adults
• The effectiveness of nurse-led weight management interventions in reducing obesity rates among children and adolescents
• The impact of medication reconciliation on medication errors and adverse drug events
• The use of mindfulness-based interventions to manage chronic pain in older adults
• The effectiveness of nurse-led interventions in reducing hospital-acquired infections
• The impact of patient-centered care on patient satisfaction and outcomes
• The use of art therapy to manage anxiety in pediatric patients undergoing medical procedures
• Pediatric oncology: working towards better treatment through evidence-based research
• The effectiveness of nurse-led interventions in improving medication adherence among patients with chronic illnesses
• The impact of team-based care on patient outcomes in primary care settings
• The use of music therapy to improve sleep quality in hospitalized patients
• The effectiveness of nurse-led interventions in reducing falls in older adults
• The impact of nurse-led care on maternal and infant outcomes in low-resource settings
• The use of acupressure to manage chemotherapy-induced nausea and vomiting
• The effectiveness of nurse-led interventions in promoting breastfeeding initiation and duration
• The impact of nurse-led palliative care interventions on end-of-life care in hospice settings
• The use of hypnotherapy to manage pain in labor and delivery
• The effectiveness of nurse-led interventions in reducing hospital length of stay for surgical patients
• The impact of nurse-led transitional care interventions on readmission rates for heart failure patients
• The use of massage therapy to manage pain in hospitalized patients
• The effectiveness of nurse-led interventions in promoting physical activity among adults with chronic illnesses
• The impact of technology-based interventions on patient outcomes in mental health settings
• The use of mind-body interventions to manage chronic pain in patients with fibromyalgia
• Optimizing the clarifying diagnosis of stomach cancer
• The effectiveness of nurse-led interventions in reducing medication errors in pediatric patients
• The impact of nurse-led interventions on patient outcomes in long-term care settings
• The use of aromatherapy to manage anxiety in patients undergoing cardiac catheterization
• The effectiveness of nurse-led interventions in improving glycemic control in patients with diabetes
• The impact of nurse-led interventions on patient outcomes in emergency department settings
• The use of relaxation techniques to manage anxiety in patients with cancer
• The effectiveness of nurse-led interventions in improving self-management skills among patients with heart failure
• The impact of nurse-led interventions on patient outcomes in critical care settings
• The use of yoga to manage symptoms in patients with multiple sclerosis
• The effectiveness of nurse-led interventions in promoting medication safety in community settings
• The impact of nurse-led interventions on patient outcomes in home healthcare settings
• The role of family involvement in the rehabilitation of stroke patients
• Assessing the effectiveness of virtual reality in pain management
• The impact of pet therapy on mental well-being in elderly patients
• Exploring the benefits of intermittent fasting on diabetic patients
• The efficacy of acupuncture in managing chronic pain in cancer patients
• Effect of laughter therapy on stress levels among healthcare professionals
• The influence of a plant-based diet on cardiovascular health
• Analyzing the outcomes of nurse-led cognitive behavioral therapy sessions for insomnia patients
• The role of yoga and meditation in managing hypertension
• Exploring the benefits of hydrotherapy in post-operative orthopedic patients
• The impact of digital health applications on patient adherence to medications
• Assessing the outcomes of art therapy in pediatric patients with chronic illnesses
• The role of nutrition education in managing obesity in pediatric patients
• Exploring the effects of nature walks on mental well-being in patients with depression
• The impact of continuous glucose monitoring systems on glycemic control in diabetic patients

The Importance of Incorporating EBP in Nursing Education

Evidence-based practice is not just a tool for seasoned nurses; it’s a foundational skill that should be integrated early into nursing education. By doing so, students learn the mechanics of nursing and the rationale behind various interventions grounded in scientific research.

• Bridging Theory and Practice:

Introducing EBP in the curriculum helps students bridge the gap between theoretical knowledge and clinical practice. They learn how to perform a task and why it’s done a particular way.

• Critical Thinking:

EBP promotes critical thinking. By regularly reviewing and appraising research, students develop the ability to discern the quality and applicability of studies. This skill is invaluable in a rapidly evolving field like healthcare.

• Lifelong Learning:

EBP instills a culture of continuous learning. It encourages nurses to regularly seek out the most recent research findings and adapt their practices accordingly.

• Improved Patient Outcomes:

At the heart of EBP is the goal of enhanced patient care. We ensure patients receive the most effective, up-to-date care by teaching students to base their practices on evidence.

• Professional Development:

Familiarity with EBP makes it easier for nurses to contribute to professional discussions, attend conferences, and conduct research. It elevates their professional stature and opens doors to new opportunities.

To truly prepare nursing students for the challenges of modern healthcare, it’s essential to make EBP a core part of their education.

In summary, evidence-based practice nursing is an essential component of providing quality patient care. As a nurse, it is important to stay up to date on the latest research in the field and incorporate evidence-based practices into your daily work. Choosing a research topic that aligns with your interests and addresses a gap in the literature can lead to valuable contributions to the field of nursing.

When it comes to finding EBP project ideas, there are many sources available, including professional organizations, academic journals, and healthcare conferences. By collaborating with colleagues and seeking feedback from mentors, you can refine your research question and design a study that is rigorous and relevant.

The nursing evidence-based practice topics listed above provide a starting point for further exploration and investigation. By studying the effectiveness of various nursing interventions and techniques, we can continue to improve patient outcomes and deliver better care. Ultimately, evidence-based practice nursing is about using the best available research to inform our decisions and provide the highest quality care possible to our patients.

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Strategies for teaching evidence-based practice in nursing education: a thematic literature review

May-elin t. horntvedt.

1 Faculty of Health and Social Sciences, the Department of Nursing and Health Sciences, University of South-Eastern Norway, P.O. Box 235, N-3603 Kongsberg, Norway

Anita Nordsteien

2 Department of Research and Internationalisation, University of South-Eastern Norway, P.O. Box 235, N-3603 Kongsberg, Norway

Torbjørg Fermann

Elisabeth severinsson.

3 Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, P.O. Box 235, N-3603 Kongsberg, Norway

Associated Data

Not applicable. All studies included in this review can be sourced online.

Evidence-based practice (EBP) is imperative for ensuring patient safety. Although teaching strategies to enhance EBP knowledge and skills are recommended, recent research indicates that nurses may not be well prepared to apply EBP. A three-level hierarchy for teaching and learning evidence-based medicine is suggested, including the requirement for interactive clinical activities in EBP teaching strategies. This literature review identifies the teaching strategies for EBP knowledge and skills currently used in undergraduate nursing education. We also describe students’ and educators’ experiences with learning outcomes and barriers.

We conducted literature searches using Medline, Embase, CINAHL, ERIC and Academic Search Premier. Six qualitative studies and one mixed-method study met the inclusion criteria and were critically evaluated based on the Critical Appraisal Skills Programme. Using Braun and Clarke’s six phases, the seven studies were deductively and thematically analysed to discover themes.

Four teaching strategy themes were identified, including subthemes within each theme: i.e., interactive teaching strategies; interactive and clinical integrated teaching strategies; learning outcomes; and barriers. Although four studies included a vague focus on teaching EBP principles, they all included research utilisation and interactive teaching strategies. Reported learning outcomes included enhanced analytical and critical skills and using research to ensure patient safety. Barriers included challenging collaborations, limited awareness of EBP principles and poor information literacy skills.

Four of the seven analysed studies included a vague focus on the use of EBP teaching strategies. Interactive teaching strategies are used, but primary strategies focus on searching for and critically appraising research for practice-based application. Although this review included a relatively small sample of literature, the findings indicate a need for more qualitative research investigating interactive and clinically integrated teaching strategies towards further enhancing EBP undergraduate nursing students’ knowledge and skills.

Evidence-based practice (EBP) in health care has become imperative for patient safety. EBP involves a conscious use and application of various knowledge sources, including the use of published research in conjunction with clinical expertise and patient values and preferences [ 1 ]. The process of EBP includes that health-care personnel formulate structured queries, and then conduct searches of databases from which they acquire trustworthy and reliable evidence. Further, they must then critically appraise the research for its reliability, validity and applicability to a clinical context [ 2 , 3 ].

Interactive methods including interactive lectures, small group work, journal clubs, reading quizzes, clinical nurse presentations, workshops and problem-based learning are needed in teaching EBP [ 2 , 3 ]. An interactive approach involves an interaction amongst the participants [ 3 ]. Effective learning reflects the quality of teaching. Learning though a constructivist approach refers to the creation of an environment in which the learner is an active participant who gains experience and engages in reflection, leading to problem-based, transformative learning [ 4 ].To engage the next generation of nurses and enhance their EBP knowledge and skills, a variety of teaching strategies have been recommended [ 5 – 7 ].

Khan and Coomarasamy [ 3 ] have described a three-level hierarchy of evidence-based medicine (EBM) teaching and learning methods. The first level is interactive clinical activities. The second level is classroom didactics using clinical and interactive activities. Finally, although less preferred for teaching EBP, the third level is classroom didactic or stand-alone teaching [ 3 ]. According to Fineout-Overholt et al. [ 2 ], it is important to keep teaching strategies simple and integration of EBP must be a natural part of the academic culture.

Research supports the first level in this hierarchy when teaching EBP; i.e., an interactive style is often preferred because this method facilitates student learning [ 8 – 10 ]. Johnson et al. [ 11 ] found that new learning methods and blended approaches to teaching EBP impact students’ attitudes towards research. In addition, Crookes et al. [ 12 ] identified different meaningful and engaging teaching strategies that have been adopted by nurse educators, such as online teaching, gaming and simulation techniques. However, these authors also concluded that nursing education needs to include more active lecture styles to strengthen the link between course content and clinical practice [ 12 ]. Ryan [ 10 ] introduced teaching strategies as extrinsic factors and found that teaching EBP and research methods may be more relevant if taught in a clinical context rather than using traditional didactic methods.

A mixed-methods meta-synthesis examining awareness and adoption of EBP stated that EBP skills for registered nurses and Bachelor of Science in Nursing (RN-to-BSN) students are influenced by exposure to partnerships and contextual teaching and learning, as well as clinical practice experience [ 13 ]. Teaching and learning strategies have included clinical practicum projects, lectures, small group work, post-clinical conferences, online modules and simulations [ 13 ]. EBP teachers who collaborate with their students, and nurses in clinical practice also influence students’ integration of EBP [ 2 ].

To ensure nursing students’ enhanced EBP knowledge, it is also essential to build partnerships with librarians who teach information literacy, which involves searching for relevant research in databases and evaluating and using that information in relation to course requirements and assignments [ 2 , 14 ]. Reported barriers to the adoption of EBP include difficulties with searching databases and evaluating research, feeling isolated from knowledgeable colleagues and the perception that there are minimal benefits from EBP. Countering these barriers, Phillips and Cullen [ 13 ] found that a variety of teaching and learning strategies may empower students’ implementation of EBP in clinical practice.

Emerson and Records’ [ 15 ] overview of scholarship and its role in nursing education includes a description of catalysts that enhance EBP in nursing and the knowledge necessary for EBP teaching. They state that scholarly teaching is an academic expectation; however, it does not appear to advance either the education or the discipline beyond the individual level. Indeed, nurses face challenges to EBP from their inability to locate and critically evaluate information [ 16 – 19 ].

The European Higher Education Area (EHEA) framework specifies expected learning outcomes for candidates with a Bachelor’s degree, including skills in finding, evaluating, referring and applying scientific information [ 20 ]. Likewise, the Code of Ethics of the International Council of Nurses stresses that nurses must be aware of and implement research results into their clinical practice [ 21 ]. Despite these guidelines, it appears that teaching EBP in nursing education varies among nurse educators and universities, and that clinical preceptors may have insufficient knowledge needed to support students [ 2 , 10 , 19 ]. Recent research indicates that nurses may not be well prepared to use EBP in their clinical practice [ 22 , 23 ].

There is a dearth of literature regarding the effect of teaching and learning strategies on implementing EBP in nursing education [ 10 , 13 , 23 , 24 ] and it is currently unclear whether implementation of EBP training leads to improved nursing practice [ 13 ].

In this literature review, we aimed to identify strategies for teaching EBP in undergraduate nursing education. The review questions were: “What teaching strategies are used to enhance knowledge and skills in EBP in undergraduate nursing education and what are the learning outcomes and barriers?”

Identification of studies

We conducted literature searches using Medline, Embase, CINAHL, Academic Search Premier and ERIC. The PICo framework for qualitative research was used to develop the review questions, plan the search and define the inclusion criteria. The population or participants assessed were nursing students, nursing education and nursing programmes. The phenomenon of interest was teaching and the specific context was EBP education. These concepts were transformed into the actual subject headings and text used in the search strategy in Medline (Table  1 ), which represents how the concepts were truncated and combined using Boolean and proximity operators in all database searches. The search criteria included qualitative studies published in English from 2006 through 2017. This range was chosen based on an initial search in PubMed PubReMiner indicating that most research on EBP training in nursing education was published since 2006, when EBP gained a foothold in nursing education. We examined the references cited in the retrieved studies, as well as studies in Google Scholar that cited the retrieved studies.

Example of the search strategy in Medline

The inclusion criteria were: 1) original, qualitative research focused on EBP teaching strategies in undergraduate nursing education, i.e., we focused on qualitative research to gain a deeper insight into teacher and student experiences with these strategies; 2) peer-reviewed, original research; 3) studies on educators, student participation, or both; and 4) studies evaluated as moderate or high quality according to the Critical Appraisal Skills Programme (CASP) [ 25 ]. The exclusion criteria were: reviews, quantitative studies, theoretical studies and contributions that were not original research articles. Articles related to teaching strategies directed at health-care personnel, master programmes or postgraduate nursing education were also excluded.

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) [ 26 ] flowchart in the retrieval and selection process (Fig.  1 ) to identify 972 records from an initial database search and an additional 35 by manually searching those studies’ bibliographies. After duplicates were eliminated, we screened the abstracts of 724 articles. Of these, 708 articles did not meet our inclusion criteria, thus we obtained 16 full-text articles for further analysis. Each of the four authors examined all 16 articles, of which nine were excluded because of their low quality, focus on clinical intervention, or lack of focus on undergraduate nursing education. The final seven articles were included in the review.

PRISMA flowchart of the screening and the assessment process

Critical appraisal

All four authors independently appraised the seven final articles for their methodological quality using CASP (Table  2 ), with moderate and high methodological quality defined as meeting 6–8 and 9–10 of the CASP checklist criteria, respectively. We discussed disagreements until consensus was reached.

Quality assessment based on the CASP Qualitative Research Checklist

CASP criteria for qualitative studies: 1. Was there a clear statement of the aims of the research?; 2. Was a qualitative methodology appropriate?; 3. Was the research design appropriate to address the aims of the research?; 4. Was the recruitment strategy appropriate to the aims of the research?; 5. Was the data collected in a way that addressed the research issue?; 6. Has the relationship between researcher and participants been adequately considered?; 7 Have ethical issues been considered?; 8. Was the data analysis sufficiently rigorous?; 9. Is there a clear statement of the findings?; 10. How valuable is the research? ( Y Yes, N No, U Unclear)

A thematic analysis was conducted to identify themes based on the six phases described by Braun and Clarke [ 27 ], whose deductive approach refers to themes identified top down; in other words, we coded themes based on our specific review question. Although Braun and Clarke [ 27 ] recommend using narrative text, the included qualitative studies and mixed-methods study provided text-based data. In the first phase, all four authors familiarised themselves with the research by reading and rereading the data from each study. In the second phase, the first author carried out a systematic, manual coding of features that led to initial codes, before searching for themes in the third phase. Phase four involved reviewing the themes for correlation with the codes and identification of subthemes. After defining the themes in phase five, the findings were evaluated for relevance to the research question. The authors met several times to discuss the analysis process and to reach consensus on the labelling.

A summary of the studies and their findings are presented in Table  3 . The seven studies were conducted in Norway, the United Kingdom (UK), Sweden, Australia and Finland [ 28 – 33 ]. Qualitative data were also gathered from one mixed-methods study [ 34 ] conducted in the UK which, although using mixed methods, reported qualitative findings from students’ graffiti board comments and a focus group interview regarding lectures.

Studies included in this review

The four themes (and subthemes within each theme) were: 1) Interactive teaching strategies (Research utilisation, Information literacy and Assignments as learning activities); 2) Interactive and clinically integrated teaching strategies (Teaching EBP principles and Clinical integration and collaborations); 3) Learning outcomes (Enhancing analytical skills and Changing attitudes toward utilising research); and 4) Barriers (Information literacy skills and knowledge and Challenging collaboration).

Interactive teaching strategies

An improved understanding of the differences between quantitative and qualitative methods was highlighted as an important aspect of preparation for nursing practice [ 29 – 32 , 34 ]. Interactive strategies to teach the research process, critical appraisal and development of information literacy skills were also emphasised. Interactive learning activities such as problem-based learning, sharing information, flipped classroom and virtual simulation, workshops, group work and seminars with discussions were identified [ 30 , 33 , 34 ]. In some studies, oral presentations of students’ research findings in a clinical setting were highlighted as an important part of the teaching and learning strategy [ 28 , 32 , 34 ].

Research utilisation

Traditional teaching methods preparing students to use research were aimed at improving critical thinking skills, critically evaluating various literature sources and developing information literacy skills [ 30 – 32 , 34 ].

Group work was also identified as a teaching strategy for establishing research utilisation [ 28 , 30 , 34 ]. In the mixed-methods study [ 30 ], several workshops and monthly sessions were conducted to improve research competence among both lecturers and students.

Experiential learning was often supplemented by collaborative group learning, such as partnerships for learning course content [ 34 ]. The authors presented experiential teaching approaches as a motivational tool for improving research learning. The students used student-centred approaches and completed small group research studies. Assignments included carrying out a literature review, developing a proposal, facing a mock ethics committee, and collecting and analysing data. This student work was supported by pertinent lectures, including via ‘Blackboard’, a virtual learning platform. Finally, students presented their methodologic and analytic approaches on the virtual learning platform [ 34 ].

Information literacy

Teaching information literacy and interdisciplinary collaboration, especially with librarians, was emphasised as an important part of students’ learning how to find and use research [ 29 – 31 , 33 – 35 ]. In contrast, collaboration with librarians was not mentioned in Mattila and Eriksson’s [ 32 ] study.

Friberg and Lyckhage’s [ 30 ] study emphasised the significance of research utility and disseminating research results. Cader et al. [ 29 ] revealed differences in students’ knowledge of computer and information literacy skills. In one study, differences appear to have been influenced by the role of the library in supporting nursing students, curriculum content and emphasis, and interaction with lecturers and peers [ 33 ]. Nurse educators indicated a need for staff development and a progressive approach to the curriculum to ensure students’ understanding of IL and its links to learning [ 33 ].

An environment supportive of the learning process promoted change and development. Collaboration with and facilitation and guidance by academic and library staff was considered essential for a successful process and outcome [ 29 , 33 ]. It was also clear from these studies that nursing students need greater support to access, use and evaluate information fully [ 29 , 32 , 33 ].

Assignments as learning activities

Course assignments were included as a part of the learning process in all evaluated studies, which included activities preparing students to use research or enhance their EBP knowledge and skills. Assignments that were integrated into clinical practice were particularly emphasised in the studies that focused on teaching EBP principles [ 28 , 29 , 31 ].

An assignment focusing on analysis of health needs was undertaken to help student nurses gain an understanding of the relevance of EBP [ 29 ]. Nursing students were found to require further development of their critical appraisal skills and further improvement of the guidance from both academics and librarians was needed [ 29 ].

Friberg and Lyckhage [ 30 ] emphasised essay writing as a learning tool and used different literature-based research methods to meet this goal.

Interactive and clinically integrated teaching strategies

The thematic analysis identified interactive and clinically integrated teaching strategies. Interactive clinical strategies included assignments based on collaboration with health-care personnel in clinical practice. Learning activities with oral presentations of the findings from the students’ studies delivered in their clinical work settings were also mentioned [ 28 , 32 ].

Teaching EBP principles

A focus on teaching the six EBP steps was evident in the studies by André et al. [ 28 ], Cader et al. [ 29 ] and Malik et al. [ 31 ]. Research utilisation was emphasised in these reports. There was a vague focus on EBP principles in three of the studies [ 30 , 32 , 33 ] and integrated teaching activities to teach clinical strategies were described in four of the studies [ 28 , 29 , 31 , 32 ].

Clinical integration and collaboration

In the study by Malik et al. [ 31 ], students participated in clinical projects and analysed data with researchers. Clinical experts were also engaged in the lectures.

Cader et al. [ 29 ] emphasised the benefit of students carrying out analyses of health needs through collaboration within the clinical practice context. To this end, nursing students conducted ‘mini’ research projects including an analysis of the health needs of a particular patient group with a common problem or diagnosis. Although the nursing students found the assignment challenging and time consuming, they also considered it meaningful because accessing information about health needs made the evidence relevant.

Mattila and Eriksson [ 32 ] outlined a learning assignment conducted during a six-week clinical practice period in which students chose topics aimed at utilising research and enhancing their competence in the clinical practice context. The clinical instructor approved a selected research article that was applicable to clinical practice and the nursing students orally presented their findings to fellow students and staff at their clinical practice placement.

A Norwegian pilot study by André et al. [ 28 ] focused on participation and cooperation in clinical research projects, which nursing students specified was a motivation for learning EBP. These students strongly appreciated working with experienced nurses on their clinical projects.

Learning outcomes

Students expressed that writing assignments helped them understand the research process. Based on the nursing students’ reports, they were motivated by being able to choose topics that were of interest to them [ 29 , 32 , 34 ]. Learning outcomes from teaching strategies were presented in most of the studies we evaluated, and it was from these outcomes that the Enhancing analytical skills and Increased awareness of using research subthemes were identified.

Enhancing analytical skills

Nursing students reported learning enhanced analytical and critical thinking skills, and some of the findings were outcomes of specific assignments and teaching strategies [ 28 – 30 , 34 ]. Students experienced learning outcomes and thus acknowledged the importance of research utilisation to their future clinical practice. It was emphasised in the reports that these students considered their key roles to be research consumers rather than producers [ 28 – 30 , 32 , 34 ]. Students also developed a greater awareness of the core role of nursing and that use of research is imperative in the nursing profession.

Based on the assignments they were given, the students in these studies reported learning outcomes such as understanding how to apply relevant evidence to everyday clinical practice. In this way, they learned to link research to health needs [ 28 – 30 ]. Mattila and Eriksson [ 32 ] reported that nursing students gained greater insight into their future profession. That academic presentations and discussions inspired them to search for research was considered ‘meaningful’.

Although nursing students considered themselves prepared to use research, Friberg and Lyckhage [ 30 ] emphasised that students are insufficiently skilled to assess research critically. This perspective is consistent with the findings by Cader et al. [ 29 ] that there is a need for further support for developing students’ critical evaluation skills.

Some students emphasised the importance of bringing together clinical practice, their own practical experiences and the research context. They experienced EBP as a platform to facilitate the development of their curiosity and critical reflection within clinical practice [ 28 ].

Changing attitudes toward utilising research

Nursing students reported research awareness as a learning outcome associated with information gathering and improved information literacy skills [ 29 , 30 ]. Despite completing acourse, students in one study stated that they had neither a comprehensive understanding of the information literacy concept nor improved skills [ 33 ]. Computer and information literacy skills apparently vary among both lecturers and students [ 33 , 35 ]. However, in several of the studies, increased awareness and understanding of research appeared to be an important learning outcome of information literacy teaching strategies for nursing students [ 29 , 30 , 32 , 34 ].

Generating an awareness of how to critically evaluate research evidence rather than producing research is necessary for implementing EBP. To obtain this awareness, it is crucial to find creative ways of guiding undergraduate nursing students to find and critically appraise research reports [ 30 ]. These studies emphasised nursing students’ increased awareness that implementing nursing research in clinical practice is a prerequisite to providing safer patient care [ 28 – 30 , 32 ].

Barriers to acquiring EBP and research utilisation skills were divided into two subthemes: i.e., information literacy skills and knowledge, and Challenging collaborations.

Information literacy skills and knowledge

Discontinuity of information literacy content throughout the curriculum seems to constitute a barrier to searching for and finding research [ 33 ]. In addition, some academics reported their own limited awareness of EBP teaching strategies [ 31 ].

Nursing students reported finding it challenging to find and interpret research. They were dependent on assistance from librarians and lecturers [ 32 , 33 ]. The need for more interdisciplinary support to teach information literacy skills was also emphasised in several studies [ 29 , 32 , 33 , 35 ]. When integrating EBP, it was challenging for academic nurses to implement innovative teaching strategies because they lacked knowledge, had a large workload or had insufficient time and resources to study new strategies [ 31 ].

Challenging collaboration

In one study, group work was interpreted as a barrier to learning EBP [ 34 ], which demonstrated that dysfunctional group dynamics can negatively affect the learning process. In contrast, in the same study, some students reported positive teamwork experiences that were motivating and enhanced their learning process [ 34 ]. In the study by Malik et al. [ 31 ], the academic educators reported that their students loved workshops on searching databases. Some nursing students reported that their clinical practice status made it difficult to gather the information required for their assignments [ 29 ].

The findings from this initial review demonstrate that various interactive teaching strategies have been emphasised to enhance knowledge and utilise research. However, despite being recommended strategies [ 3 , 14 , 36 ], factors such as teaching strategies that include clinical activities to develop EBP knowledge and skills seem to be given a lower priority. This review identified that self-reports and evaluations show that nursing students report development of critical thinking skills as a learning outcome of various teaching strategies [ 28 – 30 , 34 ], which is consistent with earlier studies [ 16 – 18 ]. In contrast, barriers to enhancing students’ EBP knowledge and skills included a weak understanding of information literacy and difficulties finding and interpreting research.

All analysed studies herein reported at least some use of interactive teaching strategies. Patient safety and quality of care in Western society require that future nurses have EBP knowledge, which means that they must use available research as well as patients’ preferences and their own clinical expertise in decision-making processes [ 14 , 36 ]. We identified studies that emphasised teaching strategies specifically aimed at finding research, critical appraisal and research utilisation through interactive methods [ 30 , 32 , 33 ]. However, it may be challenging for future nurses to obtain sound EBP knowledge if teaching strategies are mainly focused on research utilisation. A commission of health-care professionals and academic leaders presented their vision and common strategy toward strengthening global health-care systems, which argued that cross-professional collaboration in education is a powerful instrument for improving health-care outcomes [ 37 ]. Guiding principles, such as the code of ethics, the EHEA framework for expected learning outcomes [ 20 , 21 ] and health legislation emphasise wider use of the best research evidence in nursing practice, which may explain why teaching strategies are primarily directed at research utilisation. Information literacy skills are important to EBP; however, studies show that nurses and nursing students lack these skills [ 17 , 18 , 38 – 40 ].

Clinically integrated teaching strategies

In the present review, three studies [ 28 , 29 , 32 ] focused on clinically integrated teaching strategies in particular. The relationships between the clinical practice context and health needs analysis [ 29 ] were emphasised in a six-week clinical practice assignment, using oral presentation as a learning activity [ 32 ] and participation in clinical research projects [ 28 ].

Ryan [ 10 ] identified that learning EBP would have greater relevance for students if teaching strategies took place in a clinical setting. According to Llasus et al. [ 38 ], knowledge translation from education to clinical practice is challenging. These authors argue that if nursing students are expected to be able to implement EBP in clinical practice, they must have both EBP knowledge and EBP ‘readiness’, which requires strengthening their confidence in EBP.

Phillips and Cullen [ 13 ] observed that development of EBP skills for RN-to-BSN students was influenced by exposure to educational partnerships, contextual teaching and learning, and clinical practice experience. However, the findings from a Norwegian study in physiotherapy students reported a lack of both EBP culture and role models in their clinical practice [ 41 ].

A systematic review showed that EBP knowledge in medicine is increasing, irrespective of whether or not it is provided at undergraduate or postgraduate levels. Indeed, learning outcomes appear more effective if the teaching strategies are connected to clinical practice [ 42 ]. This notion was emphasised in the core clinical evaluation criteria developed in the Delphi Study by Bostwick and Linden [ 43 ]. In contrast, Ilic and Maloney [ 44 ] found no difference in learning outcomes. Despite the variety of teaching strategies across the studies we reviewed, they cumulatively show good evidence that any form of teaching EBM increases knowledge.

The findings from this review demonstrate that collaboration through clinical practice and patient care appears to be a relatively low priority. Patients’ preferences are not explicitly considered, despite an increased focus on seeing the patient as a collaborative partner in the EBP paradigm, ethical guidelines and legislation on education and health [ 2 , 3 , 20 , 21 ]. This is also contrary to recommendations about the factors that influence EBP skills, such as contextual teaching and learning and practical experience opportunities [ 13 ].

Becoming more analytical

It is worth mentioning that the nursing students in some of the studies included in this review increased their analytical skills because of EBP teaching strategies [ 28 – 30 , 34 ], regardless of whether the teaching focused exclusively on interactive or targeted both interactive and clinical strategies. However, research has shown that nursing students have inadequate knowledge to make them capable of judging, reflecting on and critically assessing research [ 10 ]. Becoming more analytical and changing attitudes towards utilising research in clinical situations may be essential for nurses in their future careers and could contribute to increased patient safety. These skills may lead to nurses with a higher level of analytical skills and clinical judgment, who have a greater ability to reflect and reason.

Course assignments as a teaching and learning strategy

According to the review findings, a variety of course assignments promote EBP knowledge and skills. Choosing topics of interest to students motivates them to develop EBP knowledge [ 29 , 32 , 34 ]. Several studies argue that assignments are essential for self-directed, continuous learning [ 18 , 38 – 40 ].

Methodological limitations

There are some limitations to this review. We used a relatively small sample of articles and excluded non-English language studies, which may have caused us to overlook some studies on enhancing EBP skills and knowledge in nursing education. However, to ensure a systematic search process, the literature search was performed by AN, an academic librarian. In addition, our use of several databases likely decreased the possibility of selection bias. The six qualitative studies included in this study were homogeneous in terms of their qualitative research design and meeting our inclusion criteria. Qualitative data from the mixed-methods study that addressed our research question was also included. Variations such as cultural diversity and differences in participant perspectives may also have affected the analyses in these studies. Despite these limitations, we met our goal of examining teaching strategies, learning outcomes and barriers in undergraduate nursing education, from the perspectives of both educators and students.

Conclusions

Insufficient attention has been paid to the use of EBP principles in nursing education. The teaching strategies identified in the represented studies show that interactive teaching strategies are used alongside traditional lectures to enhance research utilisation skills in nursing education. However, collaboration with clinical practice to enhance EBP knowledge was only vaguely addressed in most of these studies. In conclusion, there is a need to improve educators’ consciousness of and competences in teaching EBP principles, which involves using interactive and clinical integrated teaching strategies. Only seven studies met criteria for inclusion in this review, indicating that further targeted qualitative research is needed.

Acknowledgements

The authors acknowledge The University of South-Eastern Norway, Faculty of Health and Social Sciences for supporting this research.

The University of South-Eastern Norway, Faculty of Health and Social Sciences supported this research.

Availability of data and materials

Abbreviations.

Authors’ contributions

METH was the lead author who planned and implemented the study in close collaboration with AN, TF and ES. AN predominantly carried out the literature research. All authors collaborated on analyses. ES provided substantial support for the study as an expert in qualitative research. METH drafted the manuscript. All authors provided critical comments on the manuscript and have approved the final version.

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The authors declare that they have no competing interests.

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What is Evidence-Based Practice in Nursing?

5 min read • June, 01 2023

Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs. 

Nurses can expand their knowledge and improve their clinical practice experience by collecting, processing, and implementing research findings. Evidence-based practice focuses on what's at the heart of nursing — your patient. Learn what evidence-based practice in nursing is, why it's essential, and how to incorporate it into your daily patient care.

How to Use Evidence-Based Practice in Nursing

Evidence-based practice requires you to review and assess the latest research. The knowledge gained from evidence-based research in nursing may indicate changing a standard nursing care policy in your practice Discuss your findings with your nurse manager and team before implementation. Once you've gained their support and ensured compliance with your facility's policies and procedures, merge nursing implementations based on this information with your patient's values to provide the most effective care. 

You may already be using evidence-based nursing practices without knowing it. Research findings support a significant percentage of nursing practices, and ongoing studies anticipate this will continue to increase.

Evidence-Based Practice in Nursing Examples

There are various examples of evidence-based practice in nursing, such as:

• Use of oxygen to help with hypoxia and organ failure in patients with COPD 
• Management of angina
• Protocols regarding alarm fatigue
• Recognition of a family member's influence on a patient's presentation of symptoms
• Noninvasive measurement of blood pressure in children 

Improving patient care begins by asking how you can make it a safer, more compassionate, and personal experience. 

Learn about pertinent evidence-based practice information on our  Clinical Practice Material page .

Five Steps to Implement Evidence-Based Practice in Nursing

Evidence-based nursing draws upon critical reasoning and judgment skills developed through experience and training. You can practice evidence-based nursing interventions by  following five crucial steps  that serve as guidelines for making patient care decisions. This process includes incorporating the best external evidence, your clinical expertise, and the patient's values and expectations.

• Ask a clear question about the patient's issue and determine an ultimate goal, such as improving a procedure to help their specific condition. 
• Acquire the best evidence by searching relevant clinical articles from legitimate sources.
• Appraise the resources gathered to determine if the information is valid, of optimal quality compared to the evidence levels, and relevant for the patient.
• Apply the evidence to clinical practice by making decisions based on your nursing expertise and the new information.
• Assess outcomes to determine if the treatment was effective and should be considered for other patients.

Analyzing Evidence-Based Research Levels

You can compare current professional and clinical practices with new research outcomes when evaluating evidence-based research. But how do you know what's considered the best information?

Use critical thinking skills and consider  levels of evidence  to establish the reliability of the information when you analyze evidence-based research. These levels can help you determine how much emphasis to place on a study, report, or clinical practice guideline when making decisions about patient care.

The Levels of Evidence-Based Practice

Four primary levels of evidence come into play when you're making clinical decisions.

• Level A acquires evidence from randomized, controlled trials and is considered the most reliable.
• Level B evidence is obtained from quality-designed control trials without randomization.
• Level C typically gets implemented when there is limited information about a condition and acquires evidence from a consensus viewpoint or expert opinion.
• Level ML (multi-level) is usually applied to complex cases and gets its evidence from more than one of the other levels.

Why Is Evidence-Based Practice in Nursing Essential?

Implementing evidence-based practice in nursing bridges the theory-to-practice gap and delivers innovative patient care using the most current health care findings. The topic of evidence-based practice will likely come up throughout your nursing career. Its origins trace back to Florence Nightingale. This iconic founder of modern nursing gathered data and conclusions regarding the relationship between unsanitary conditions and failing health. Its application remains essential today.

Other Benefits of Evidence-Based Practice in Nursing

Besides keeping health care practices relevant and current, evidence-based practice in nursing offers a range of other benefits to you and your patients:

• Promotes positive patient outcomes
• Reduces health care costs by preventing complications 
• Contributes to the growth of the science of nursing
• Allows for incorporation of new technologies into health care practice
• Increases nurse autonomy and confidence in decision-making
• Ensures relevancy of nursing practice with new interventions and care protocols 
• Provides scientifically supported research to help make well-informed decisions
• Fosters shared decision-making with patients in care planning
• Enhances critical thinking 
• Encourages lifelong learning

When you use the principles of evidence-based practice in nursing to make decisions about your patient's care, it results in better outcomes, higher satisfaction, and reduced costs. Implementing this method promotes lifelong learning and lets you strive for continuous quality improvement in your clinical care and nursing practice to achieve  nursing excellence .

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Why has research-based practice become so important and why is everyone talking about evidence-based health care? But most importantly, how is nursing best placed to maximise the benefits which evidence-based care can bring?

Part of the difficulty is that although nurses perceive research positively, 2 they either cannot access the information, or cannot judge the value of the studies which they find. 3 This journal has evolved as a direct response to the dilemma of practitioners who want to use research, but are thwarted by overwhelming clinical demands, an ever burgeoning research literature, and for many, a lack of skills in critical appraisal. Evidence-Based Nursing should therefore be exceptionally useful, and its target audience of practitioners is a refreshing move in the right direction. The worlds of researchers and practitioners have been separated by seemingly impenetrable barriers for too long. 4

Tiptoeing in the wake of the movement for evidence-based medicine, however, we must ensure that evidence-based nursing attends to what is important for nursing. Part of the difficulty that practitioners face relates to the ambiguity which research, and particularly “scientific” research, has within nursing. Ambiguous, because we need to be clear as to what nursing is, and what nurses do before we can identify the types of evidence needed to improve the effectiveness of patient care. Then we can explore the type of questions which practitioners need answers to and what sort of research …

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Addressing the current challenges of adopting evidence-based practice in nursing

Senior Lecturer, School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast

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Deborah Rainey

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This aim of this article is to explore the current position of evidence-based practice (EBP) in nursing. The article provides an overview of the historical context and emergence of EBP with an outline of the EBP process. There is an exploration of the current challenges facing the nursing profession as it endeavours to adopt EBP into care delivery, along with actions to address these challenges. There will also be a discussion on how to integrate EBP into undergraduate nursing curricula as academic institutions implement the Future nurse standards of proficiency from the Nursing and Midwifery Council.

It has been suggested that the idea of delivering care based on evidence had its early foundations in the 1800s with Florence Nightingale, who aimed to provide better outcomes for patients who experienced unsanitary conditions ( Mackey and Bassendowski, 2017 ). However, it is generally agreed that Professor Archie Cochrane, whose work inspired the Cochrane Collaboration ( Smith and Rennie, 2014 ; Barker and Linsley, 2016 ), is credited for being at the forefront of the modern evidence-based practice (EBP) approach. The concept of evidence-based medicine (EBM) emerged from researchers at McMaster University, Canada, who redefined the practice of medicine to move from a culture based solely on clinical experience, to one which is more inclusive of medical evidence ( International Council of Nurses, 2012 ). Smith and Rennie (2014) noted that the phrase EBM was coined by Gordon Guyatt in 1991, so has had a relatively short life span. Although a number of individuals contributed to the development of EBM, David Sackett is regarded as the father of EBM as in 1996 he distinguished EBM as one that combines research evidence with clinical skills, and patient values and preferences ( Smith and Rennie, 2014 ).

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Thoughts about evidence-based nursing practice

Affiliation.

• 1 Department of Nursing, University of Massachusetts Boston, USA.
• PMID: 22451643
• DOI: 10.1177/0894318412437967

This paper is an essay about evidence-based nursing practice, with an emphasis on evidence in the form of various types of theories developed by various modes of inquiry. The essay is the second in a series written to acknowledge the 25th anniversary of the founding of Nursing Science Quarterly.

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• The effects of the flipped classroom in teaching evidence based nursing: A quasi-experimental study. Chu TL, Wang J, Monrouxe L, Sung YC, Kuo CL, Ho LH, Lin YE. Chu TL, et al. PLoS One. 2019 Jan 15;14(1):e0210606. doi: 10.1371/journal.pone.0210606. eCollection 2019. PLoS One. 2019. PMID: 30645609 Free PMC article.
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Evidence Based Practice’ Impact on Nursing Essay (Article)

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Brief discussion, ebp discussions.

Reid, J., Briggs, J., Carlisle, S., Scott, D., & Lewis, C. (2017). Enhancing utility and understanding of the evidence-based practice through undergraduate nurse education. BMC Nursing, 16 (58), 1-8. Web.

The selected article offers meaningful insights that can empower nursing educationists and practitioners to embrace the power of evidence-based practice (EBP). The authors describe a new course (Evidence-Based Nursing 1) that was implemented as part of an undergraduate nursing program. The researchers observed that the targeted learners were willing to make evidence-based practices part of their nursing philosophies after completing the course. The practice can encourage practitioners to integrate EBP into their respective care delivery models (Reid, Briggs, Carlisle, Scott, & Lewis, 2017). The judicious use of emerging or current evidence in care delivery and health decision-making processes can result in improved patient outcomes and support advanced practice nursing. This article describes the meaning of EBP and how it can be implemented in nursing institutions to ensure that advanced practice nurses (APNs) are prepared to meet their patients’ health needs. The use of emerging evidence and concepts from research studies can guide nurses to offer advanced care. When APNs embrace the power of EBP, they will achieve their potential and offer quality and equitable health services.

The concept of EBP revolves around the use of best evidence to improve patient outcomes. Mackey and Bassendowski (2016) indicate that external clinical findings, results from systematic studies, and personal nursing expertise constitutes “best evidence” for EBP. Nurses should combine such concepts to develop appropriate care delivery models and make desirable decisions to support their patients. EBP is a powerful approach that can be used at the point of care. Proficient nurses can diagnose and educate patients depending on their conditions. Such practitioners will identify signs and symptoms, offer timely patient education, and empower individuals to engage in disease management practices. These tasks at the point of care will be informed by every nurse’s current evidence and information backed by the latest research findings.

Informatics can bring the best available evidence to support AGPC practice. Modern technologies empower nurses to use standardized terminologies that can result in desirable health outcomes. Digital sources of timely or latest evidence can also be used to meet patients’ needs. Practitioners can use informatics processes to acquire and apply evidence to different clinical situations (Reid et al., 2017). Informatics competencies empower nurses to minimize sentinel events and meet patients’ needs.

I am planning to embrace the future by using EBP in my practice. I will incorporate the concept using a powerful strategy. The approach will be implemented using the notion of lifelong learning. I will also undertake numerous researches and use modern informatics to improve my nursing philosophy. Unfortunately, some barriers can affect the implementation and development of an EBP culture. The first one is the existing gap in education and practice. This limitation affects nurses’ ability to use evidence accurately and efficiently. The lack of appropriate policies to support the use of EBP is the second challenge (Mackey & Bassendowski, 2016). The third obstacle is that many institutions and practitioners have failed to embrace the power of informatics. These gaps affect patients’ health outcomes negatively.

EBP is expected to impact advanced nursing practice positively. The concept can sanction practitioners to make informed decisions and offer desirable care depending on their patients’ expectations. The approach results in improved care delivery systems. It also encourages practitioners to improve their nursing philosophies using emerging ideas (or concepts) and their competencies (Reid et al., 2017). EBP empowers nurses to make informed decisions, develop superior care delivery models, and update their skills. APNs using the concept will, therefore, offer safe, affordable, and sustainable care to their patients.

Mackey, A., & Bassendowski, S. (2016). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33 (1), 51-55. Web.

Reid, J., Briggs, J., Carlisle, S., Scott, D., & Lewis, C. (2017). Enhancing utility and understanding of evidence based practice through undergraduate nurse education. BMC Nursing, 16 (58), 1-8. Web.

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Evidence Based Practice

What it is and how to implement it into your professional work?

This guide is designed to help you understand and implement Evidence Based Practice in your professional work. It provides resources, tools, and information to support your research and application of EBP principles.

• 1.) Introduction to Evidence Based Practice
• 2.) Formulating a Clinical Question
• 3.) Finding Evidence
• 4.) Appraising the Evidence
• 5.) Applying the Evidence
• 6.) Assessing the Outcome
• 7.) Additional Resources

Introduction to Evidence Based Practice

What is Evidence Based Practice?

Evidence Based Practice (EBP) is an approach to clinical decision-making that integrates the best available research evidence with clinical expertise and patient values. It aims to improve patient outcomes by applying the most current and relevant information to healthcare decisions.

The EBP Process

The EBP process involves five key steps:

• Ask : Formulate a clear, answerable clinical question.
• Acquire : Search for the best available evidence.
• Appraise : Critically appraise the evidence for its validity and relevance.
• Apply : Apply the evidence to clinical practice.
• Assess : Evaluate the effectiveness and efficiency of the practice.

Formulating a Clinical Question

PICO Framework

The PICO framework is a tool used to formulate clinical questions in a structured and focused way. It stands for:

• P atient/Problem
• I ntervention
• C omparison

Example : In patients with chronic low back pain (P), does yoga (I) compared to standard physical therapy (C) improve pain management (O)?

Finding Evidence

Databases and Journals

Key databases for EBP include:

• PubMed (link)
• CINAHL (link)
• Cochrane Library (link)
• PsycINFO (link)

Search Strategies

Effective search strategies include:

• Using specific keywords related to your PICO question
• Applying Boolean operators (AND, OR, NOT) to refine your search

Grey Literature

Grey literature refers to research that is not published in traditional journals. It includes reports, theses, conference papers, and more. Important sources of grey literature are:

• OpenGrey ( link )
• National Institutes of Health (NIH) ( link )
• World Health Organization (WHO) ( link )

Appraising the Evidence

Critical Appraisal Tools

Use tools like:

• CASP (Critical Appraisal Skills Programme) checklists (link)
• PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) (link)

Levels of Evidence

Understanding the hierarchy of evidence helps in determining the strength of recommendations:

• Systematic reviews and meta-analyses
• Randomized controlled trials (RCTs)
• Cohort studies
• Case-control studies
• Case series and case reports
• Expert opinion

Applying the Evidence

Integrating Evidence into Practice

Strategies for implementation include:

• Developing clinical guidelines and protocols
• Collaborating with interdisciplinary teams
• Engaging in continuous education and training

Case Studies and Examples

Explore real-world applications of EBP through case studies and examples from various healthcare settings.

Assessing the Outcome

Evaluating the Impact

Methods for assessing outcomes:

• Patient feedback and satisfaction surveys
• Clinical outcome measures
• Quality improvement metrics

Continuous improvement is vital to ensure that EBP is effectively enhancing patient care and outcomes.

Additional Resources

Websites and Online Resources

• Cochrane Collaboration ( link )
• Centre for Evidence-Based Medicine (CEBM) ( link )
• National Institute for Health and Care Excellence (NICE) ( link )

• A Framework for Enhancing the Value of Research for Dissemination and Implementation
• Learning how to undertake a systematic review: part 1
• Learning how to undertake a systematic review: part 2
• Systematic reviews of complex interventions: framing the review question

Video: What is Evidence Based Practice

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Content relating to: "evidence-based practice"

Evidence based practice refers to all the clinical judgments that are prepared on the basis of investigation and scientific studies which facilitates in the distribution of the high quality care to the patient to make better results. Evidence-based health care practices are accessible for a number of circumstances such as diabetes, heart failure, kidney failure, and asthma.

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Evidence-Based Nursing Practice

Research question in picot format, evaluation of research, research topic, literature review, the impact of the evidence on future nursing practice and health outcomes of patients, recommendations.

• Population: diabetic patients
• Intervention:  exercise and dietary glycemic control
• Comparison:  anti-hyperglycemic therapy
• Outcome: prevention of diabetes-associated complications
• Time: The lifetime of diabetic patients

According to the Australian Institute of Health Welfare (2018), diabetes is among the primary chronic diseases that have shown a high prevalence rate and adverse complications to the patients. It is due to this concern that the National Strategic Framework for Chronic Conditions presents approaches to ensure that evidence-based practice is implemented into the clinical practice so that patients can receive appropriate and patient-centered care. Thus achieving quality lives with fewer complications (National Strategic Framework for Chronic Conditions, 2017).

Based on the National Strategic Frameworks for Chronic diseases, chronic diseases have increasingly become a common cause of death in the Australian nation. This is because of a change in lifestyle. This increasing occurrence of chronic diseases with the associated effects as are affecting individuals, families, public health and the nation at large. As such, the National Strategic Frameworks for Chronic diseases provides approaches that outline the management and care principles for the prevention and control of many conditions such as cancer and diabetes. These approaches are evidence-based practices that need to be implemented in the nursing practice to improve the patients’ outcome and the general service delivery of the healthcare sector. That will entail enhanced healthcare management under which chronic patients receive supervised, patient-centered and appropriate services (National Strategic Framework for Chronic Conditions, 2017). The National Strategic Frameworks for chronic disease ensure that the evidence-based practice will result in reduced complications and multi-morbidities.

The National Strategic Frameworks for Chronic conditions provides that evidence-based practices which are appropriate in the nursing practice will ensure patient safety and enhanced outcomes. In this case, improved outcomes for chronic conditions will include slowing the condition’s progression, practices that help to control and delay any other additional chronic disease (National Strategic Framework for Chronic Conditions, 2017). It further provides that an appropriate practice will prevent the complications and disabilities associated with the disease thus enhancing the general wellbeing and the quality of life as it has been provided in the various literature reviews regarding the use of physical exercises to control and prevent diabetes-associated complications rather than using anti-hyperglycemic therapy.

1. Alhadramy, M. (2016). Diabetes and oral therapies: A review of oral therapies for diabetes mellitus. Journal of Taibah University Medical Sciences, 11(4), 317–329. https://doi.org/10.1016/j.jtumed.2016.02.001

2. Balk, E. M., Earley, A., Raman, G., Avendano, E. A., Pittas, A. G., & Remington, P. L. (2015). Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force. Annals of Internal Medicine, 163(6), 437–451.

3. CardioSmart. (2012). Exercise and Diet Remain Important for Diabetes Prevention and Control. Retrieved August 24, 2018, from https://www.cardiosmart.org/News-and-Events/2012/10/Exercise-and-Diet-Remain-Important-for-Diabetes-Prevention-and-Control

4. Carpio, G. R. A., & Fonseca, V. A. (2014). Update on Safety Issues Related to Antihyperglycemic Therapy. Diabetes Spectrum : A Publication of the American Diabetes Association, 27(2), 92–100. https://doi.org/10.2337/diaspect.27.2.92

5. Laaksonen, D. E., Lindström, J., Lakka, T. A., Eriksson, J. G., Niskanen, L., Wikström, K., … Uusitupa, M. (2005). Physical Activity in the Prevention of Type 2 Diabetes: The Finnish Diabetes Prevention Study. Diabetes, 54(1), 158–165. https://doi.org/10.2337/diabetes.54.1.158

6. Mendham, A. E., Duffield, R., Marino, F., & Coutts, A. J. (2015). A 12-week sports-based exercise programme for inactive Indigenous Australian men improved clinical risk factors associated with type 2 diabetes mellitus. Journal of Science and Medicine in Sport, 18(4), 438–443.

7. National Strategic Framework for Chronic Conditions. (2018). National Strategic Framework for Chronic Conditions. Australian Government Department of Health. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/nsfcc

8. Thent, Z. C., Das, S., & Henry, L. J. (2013). Role of Exercise in the Management of Diabetes Mellitus: the Global Scenario. PLoS ONE, 8(11). https://doi.org/10.1371/journal.pone.0080436

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Evidence-Based Nursing Practice

Impact of the problem on the patient.

People with T2DM have a higher risk of health problems such as stroke, kidney failure, and heart attack. Patients may also perceive a loss of independence and self-control. Treatment of T2D is very costly. Individuals diagnosed with T2D incur approximately $16,750 yearly in medicinal costs. Diabetes can even cause the death of a patient.

Impact of the Problem on the Organization

Increased hospital expenditure. About $1 in every $4 in health care is spent on patients diagnosed with T2D. Most expenses are associated with hospitalizations and medicines used to cure diabetes complications.

Identify the PICO components.

P –  Novel DSME patient group with type 2 diabetes mellitus (T2DM)

I –  Diabetes self-management education (DSME) programme

C –  The traditional DSME group

O –  Improved self-management behavior, social resources utilization, and hemoglobin

Evidence-Based Practice Question

In the novel DSME patient group with type 2 diabetes mellitus (T2DM), what is the effectiveness of a diabetes self-management education (DSME) programme based on multi-social utilization compared to a traditional DSME group in improving self-management behavior, social resources utilization, and HbA1c levels?

Research Article Title

The effectiveness of the self-management programme based on multilevel social resources utilization in diabetes mellitus patients

Background Introduction

Diabetes mellitus (DM) is among the most common chronic illnesses, whereby 90% of the affected individuals experience type 2 diabetes mellitus (T2DM) (Zhang et al., 2023). Most healthcare organizations have considered T2D diabetes self-management education effective in helping them live optimally in terms of health. Studies report that DSME is designed to reduce the inception and advancement of complications resulting from DM, to enhance lifestyle behaviors (like healthy eating and conducting more regular physical activities, to improve associated diabetes self-effectiveness), to facilitate healthy coping, to reduce undesirable emotions like depression and anxiety, and to mend the quality of life. Such benefits are particularly the outcome of diabetes self-management behavior gained through DSME. While researchers formally recognize the significance of DSME, it fails to assure long-standing effective DM self-management. At the same time, the management behavior level has proved to diminish after six months of the intervention.

Methodology

The study employed a randomized control trial. The authors recruited 118 participants suffering from T2DM from two different communities through a randomized sampling randomly assigned to the novel and the traditional DSME groups. The study implemented DSME focused on multilevel social resource use in the novel DSME group. The authors collected data at the baseline (T 0 ), at the intervention’s end (T 1 ), and three months after the intervention ended (T 2 ).

Level of Evidence

The level of evidence for the research-based article is Level I (higher quality of evidence). It is a high-quality randomized trial, testing previously developed diagnostic criteria on sensible costs, consecutive patients, and values acquired in various studies with a multi-sensitivity analysis.

Data Analysis

The study performed data analysis using the IBM SPSS version. The authors conducted descriptive statistics to obtain a summary of the demographic and medical variables. The baseline characteristics of the participants were compared by employing an unpaired t-test. For ranked or categorical variables, the study used Person’s X2. The overall linear model with repetitive ANOVA measures investigated the impact of groups, variations with time, diabetes self-management tendency, DM self-management SRU, and hemoglobin levels.

Ethical Considerations

The ethical considerations in the research-based article involved guaranteeing the participant’s safety, accurately and honestly reporting the results, and adhering to the accepted protocols. In addition, the study sought approval from the Institutional Review Board (IRB) at West China Hospital of Sichuan University. Every participant gave informed written consent.

Quality Rating

The quality rating for this research-based article was Grade A. The certainty of evidence for the effectiveness of treatment is very high. The study’s high level of proof reflects the degree to which confidence in estimating the effect is satisfactory in supporting the recommendations.

Analysis of the Results / Conclusions

The novel DSME program focusing on multilevel social resource use can efficiently enhance self-management behaviors, social resource use, and lower levels of HbA1c T2DM among patients. More significantly, the effect can last longer.

Alignment to the EBP question

The results or conclusions of the study demonstrated that in the novel DSME patient group with type 2 diabetes mellitus (T2DM), the diabetes self-management education (DSME) programme based on multi-social utilization is effective compared to traditional DSME group in improving self-management behavior, social resources utilization and HbA1c levels.

Non-Research Article Title

Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program

Diabetes mellitus is among the most chronic infections globally and is the fifth leading cause of death in many developed nations and, hurriedly, becoming the most significant health issue. Type 2 diabetes accounts for about 95% of cases of diabetes (Kumah et al., 2021). The increasing T2DM prevalence has emphasized the need for evidence-based procedures for effective management, prevention, and treatment. Diabetes self-management education (DSME) can generate positive outcomes on a patient’s behavior in the status of their health.

Type of Evidence

The type of evidence used in the non-research-based article was a systematic review.

Due to its risk of bias because of increased heterogeneity, the evidence level in the non-research article was moderate.

The quantity of rating in the non-research-based article was Grade B.

Author’s Recommendations

The author’s recommendation in the non-research-based article was to consider patient’s routine medical care providers throughout the design and application of DSME interventions. Researchers should also evaluate the effectiveness of DSME intervention to consider care providers’ potential influence on the policy effects.

Recommended Practice Change

Based on the research and the non-research-based articles, a practice change recommendation to improve self-management behavior, social resource use, and hemoglobin Alc (HbA1c) levels in patients with T2DM is that professionals must pay attention to the social resources use education to improve and solidify the self-management behavior of diabetic patients additionally. Particularly in regions with a large number of people and minimal medical help, encouraging patients to proactively tap and use potential and available resources to self-manage themselves would be effective and economical.

Key Stakeholders

As suggested by the research and the non-research article, the key stakeholders in improving self-management behavior, social resource use, and reducing hemoglobin Alc (HbA1c) levels in patients with T2DM include patients, clinicians, policymakers, doctors, healthcare managers, and the community.

Barrier to Implementation

A potential barrier to implementing the practice change recommendations is that there needs to be uniform and accepted common patient education perceived as effective for all individuals. There may also be a limited collaboration level between caregivers and patients and self-management educators, which might not allow for a comprehensive analysis of the effect of care providers’ engagement in SME interventions on the program outcome.

Strategy to Overcome the Implementation Barrier

The articles suggest various strategies to overcome implementation barriers, such as health education programs, capacity building, and advocacy, which are key to overcoming the barrier to implementing the DSME program.

Indicator to Measure the Outcome

Various indicators will show positive outcomes of implementing the DSME policy on T2DM patients. Some of them would be improved self-management behavior, utilization of social resources, and optimum glucose control.

Kumah, E., Afriyie, E. K., Abuosi, A. A., Ankomah, S. E., Fusheini, A., & Otchere, G. (2021). Influence of the model of care on the outcomes of diabetes self-management education program: a scoping review.  Journal of Diabetes Research ,  2021 , 1-12.

Zhang, F., Fu, L., Wang, L., Xing, L., Liu, K., & Jiang, X. (2023). The effectiveness of the self-management programme based on multilevel social resources utilization in diabetes mellitus patients: A randomized controlled study.  International Journal of Nursing Practice , e13138.

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2. device specification, 3. periprocedural outcomes, 4. drt and pdls, 5. long-term outcomes, 6. anti-thrombotic therapy, 7. ongoing trials and future directions, 8. conclusions, author contributions, conflicts of interest.

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Frazzetto, M.; Sanfilippo, C.; Costa, G.; Contrafatto, C.; Giacalone, C.; Scandura, S.; Castania, G.; De Santis, J.; Sanfilippo, M.; Di Salvo, M.E.; et al. Watchman vs. Amulet for Left Atrial Appendage Closure: Current Evidence and Future Perspectives. J. Clin. Med. 2024 , 13 , 4651. https://doi.org/10.3390/jcm13164651

Frazzetto M, Sanfilippo C, Costa G, Contrafatto C, Giacalone C, Scandura S, Castania G, De Santis J, Sanfilippo M, Di Salvo ME, et al. Watchman vs. Amulet for Left Atrial Appendage Closure: Current Evidence and Future Perspectives. Journal of Clinical Medicine . 2024; 13(16):4651. https://doi.org/10.3390/jcm13164651

Frazzetto, Marco, Claudio Sanfilippo, Giuliano Costa, Claudia Contrafatto, Chiara Giacalone, Salvatore Scandura, Giuseppe Castania, Jessica De Santis, Maria Sanfilippo, Maria Elena Di Salvo, and et al. 2024. "Watchman vs. Amulet for Left Atrial Appendage Closure: Current Evidence and Future Perspectives" Journal of Clinical Medicine 13, no. 16: 4651. https://doi.org/10.3390/jcm13164651

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