In Lesson 1 we mentioned that information literacy is important to evidence based practice. So what is evidence based practice (EBP)? In their seminal article published in the British Medical Journal in 1996, Sackett, Rosenberg, Gray, Haynes, and Richardson define evidence based medicine (EBM) as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (1996, ¶ 2). While first introduced in the field of medicine, the concept of EBM has evolved to include other health care fields (Perry and Kronenfeld, 2005). Evidence based practice often refers to using the concepts first defined in EBM in health care. While EBM and EBP are often used interchangably, they are not necessarily exactly the same. For our purposes, we can think of evidence based practice as using evidence in clinical decision making (Gebb, Young, and Anderson, 2013).
Evidence based practice relies on following a series of steps to improve health care delivery and outcomes:
As you can see, the concepts of information literacy are very important to steps three and four. The strategies we have discussed for locating and evaluating information will be put to use as you search for evidence.
After identifying a clinical problem, the next step is to form a focused, answerable question. So instead of asking,
"What are therapies for depression?"
you should ask,
"Does exercise reduce depressive symptoms in women?"
The PICO method was designed to help with this process. PICO stands for:
P = patient (or problem)
I = intervention
C = comparison
O = outcome
You can build your question by identifying each of the elements in your PICO statement. In the above example, our PICO statement may have looked like this:
|P||patient or problem||30 yr old female|
|C||comparison (if necessary)||antidepressants|
|O||outcome||symptom reduction, increased quality of life|
In order to search for evidence, you need to understand what is meant by that term. Evidence essenitally means knowledge which leads us to believe something is true. For example, evidence has to be shown to convict someone of a crime. In health care, we want to see evidence that a particular intervention or treatment will work. Importantly, we don't want to see just any evidence, we want to see the best evidence. For this reason, evidence is usually organized into a hierarchy, with the best evidence at the top and the least reliable evidence at the bottom.
Hover over each term below to see its definition.
Now that you know what the best evidence is, you can use advanced search strategies to help you find it. For example, limiters can be a great help when searching for evidence. Using the Publication Type limiter in EBSCOhost, you can limit your search to ONLY meta-analyses, for example.
The Publication Type limiter is found in the search options on the EBSCOhost search screen:
In an article record, there is a field to show the publication type. Using the limiter searches for your choice within that field.
Gebb, B.A., Young, Z., & Anderson, B.A. (2013). Evaluating and using the evidence. In B.A. Anderson & S. Stone (Eds.), Best practices in midwifery: Using the evidence to implement change. Springer Publishing.
Perry, G.J., & Kronenfeld, M.R. (2005). Evidence-based practice: A new paradigm brings new opportunities for health sciences librarians. Medical Reference Services Quarterly, 24(4), 1-16. https://doi.org/10.1300/j115v24n04_01
Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996 Jan 13). Evidence-based medicine: what it is and what it isn't. BMJ: British Medical Journal, 312(7023), 71-72. https://doi.org/10.1136/bmj.312.7023.71