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Evidence Based Practice


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Ying Li
Subjects: Health and Nursing

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The first step of the EBP process is to ask an answerable question. How do you come up with a question? Let's see, you may be frustrated with ineffective procedures and you ask yourself, is there a better way? Or you want to help a stroke patient with her balance and gait recovery, and you wonder if newer therapies, such as the use of VR (virtual reality), have shown improvements with stroke patients? A well-formulated question will facilitate the search for evidence and will assist you in determining whether the evidence is relevant to your question.

An answerable question has a format that follows the PICO concept. The acronym translates to:
I =Intervention
Initially only four components were included. Later, Melnyk and Fineout-Overholt (2010) added a fifth, representing time (i.e., the time it takes for the intervention to achieve an outcome, or how long participants are observed). 

PICO Example 1
Does feeding via the transpyloric route vs. the gastric route improve feeding tolerance, and growth and development without increasing adverse consequences? 
adapted from Fast Facts for Evidence-Based Practice in Nursing. 

PICO Example 2
Will the emphasis of nursing assessment regarding need for and the early removal of indwelling catheters decrease the number of catheter device days and the incidence of CAUTIs? 
adapted from Maryland Hospital Association.

  Patient/population Intervention Comparison Outcome
Example 1 Pediatric patients admitted to the PICU who are mechanically ventilated Placement of postpyloric feeding tubes for all mechanically ventilated patients Postpyloric feeding tubes versus gastric feeding tubes Decreased incidence of aspiration pneumonia in the PICU patients receiving long-term mechanical ventilation
Example 2 Patients with indwelling catheters and increased number of CAUTIs Nursing assessment regarding need for and the early removal of indwelling catheters Without the emphasis of nursing assessment Decreased incidence of CAUTIs and decreased length of hospital stay

Godshall, M. (2016). Fast Facts for Evidence-Based Practice in Nursing (2nd ed.). New York: Springer Publishing Company.
​Melnyk B. M. & Fineout-Overholt E. (2019). Evidence-based practice in nursing & healthcare (4th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.