1. What is Evidence Based Practice
Barbara Ann M. Messina, PhD, RN, ANP Clinical Associate Professor School of Nursing – Department of Adult Health Adjunct Clinical Associate Professor School of Medicine – Department Pharmacology

2. Objectives Define what is evidence based practice (EBP).
Discuss the history of EBP.
Implementing Evidence-Based Practice: The Iowa Model.
Discuss the Determination of Clinical Relevance in EPB.
Discuss how to Framing a Clinical Question using the PICO model.
Discuss the Literature Review and Search Techniques.
Define the AHRQ.

3. What is EBP?
The use of evidence-based practice (EBP) and national guidelines
to improve the quality of patient care. EBP closes the gap
between research outcomes and practice (Newhouse, Dearbolt,
Poe, Pugh, & White, 2005)

4. What is EBP?
EBP uses current research evidence combined with clinical expertise
and patient values to formulate sound interventions (DiCenso, Guyatt,
& Clinska, 2005).

5. History of EBP
FFCM ( ) in Dr. Cochran, a British epidemiologist,
identified a gap between current practices and evidence-based
guidelines.

6. Implementing EBP: The Iowa Model
The Iowa Model of EBP was developed by Marita G. Titler, PhD, RN,
FAAN, Director Nursing Research, Quality and Outcomes
Management, Department of Nursing Services and Patient Care,
University of Iowa Hospitals and Clinics, Iowa City, Iowa
Iowa Model:
Considers the entire health care system:
Provider
Patient
Infrastructure

7. Iowa Model Identify a trigger – problem focused or knowledge focused
Determine clinical relevance – is it important to the organization or culture

8. Framing the Clinical Question
What to include what to exclude?

9. PICO Model P = Who is the Patient Population?
I = What is the potential Intervention or area of Interest?
C = Is there a Comparison intervention or Control group?
O= What is the desired Outcome?
Your question drives your research!

10. The Literature Review Cochrane Library Clinical Practice Guidelines
Cumulative Index to Nursing and Allied Health Literature (CINAHL); and
PubMed.

11. Types of Literature Reviews
Systematic Review: Looks for similar Studies (Critiquing an Article)
Meta Analysis: Statistical technique for
averaging an effect of treatment across
studies (Cochrane Data Base)

12. Levels of Evidence

13. Hierarchy of Evidence

14. Hierarchy of Evidence Levels of Evidence
Category I:  Evidence from at least one properly randomized controlled
trial.
Category II-1: Evidence from well-designed controlled trials without
randomization.
Category II-2: Evidence from well-designed cohort or case-control
analytic studies, preferably from more than one center or
research group.
Category II-3: Evidence from multiple times series with or without
intervention or dramatic results in uncontrolled
experiments such as the results of the introduction of
penicillin treatment in the 1940s.
Category III: Opinions of respected authorities, based on clinical
experience, descriptive studies and case reports

15. Hierarchy of Evidence

16. Hierarchy of Evidence

17. Evaluating Evidence

18. EBP (Medicine) United States:
Agency for Health Care Policy and Research (AHCPR)
Department of Health & Human Services
Developed many clinical guidelines to direct the EBM movement.

19. GUIDELINE TITLE Evidence-based practice guideline
GUIDELINE TITLE Evidence-based practice guideline. Exercise promotion: walking in elders.
BIBLIOGRAPHIC SOURCE(S)
Jitramontree N. Evidence-based practice
guideline. Exercise promotion: walking in elders.
Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; 2007 Jun. 57 p. [95 references]
GUIDELINE STATUS
This is the current release of the guideline.
This guideline updates a previous version: Jitramontree N. Evidence-based protocol. Exercise promotion: walking in elders. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; 2001 Feb. 53 p.

20. References
Ackermann, R.T. & Williams, J.W. (2002). Rational treatment choices for non-major depressions in primary care: an evidence-based review. Journal of General Internal Medicine, 17,
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (Rev. ed.) (4th ed.). (DSM-IVTR). Washington, DC: American Psychiatric Association.
Balas, E. & Boren, S. (2000). Managing clinical knowledge for health care improvement. In J. Bemmel & A.T. McCray (ed.). In Yearbook of Medical Informatics: Patient Centered Systems (pp ). Stuttgart, Germany: Schattauer Verlagsgesellschaft.
Cliliska, D., Ciliska, D. , Pinelli, J., DiCenso, A., Cullum, N. (2001). Resources to enhance evidence-based nursing practice. American Association of Critical Care Nurses: Advanced Practice in Acute and Critical Care, 12(4),

21. References
Collins, S., Vothe, T., DiCenso, A., Guyatt, G. (2005). Finding the evidence. In DiCenso, A., Guyatt, G., Clinska, D. (Eds). Evidence-Based Nursing: A Guide to Clinical Practice. PA: Elsevier; 2005
DiCenso, A., Guyatt,G., & Clinska, D. (Eds.). (2005). Evidence-Based Nursing: A Guide to Clinical Practice. PA: Elsevier.
Fineout-Overholt E., Melynk, B. , Schultz, A. (2005). Transforming health care from the inside out: Advancing evidence-based practice in the 21st century. Journal of Professional Nursing, 21,
Glass, G.V. (Ed.) (1976). Evaluation Studies Review Annual, Vol. 1. Beverly Hills:
SAGE Publications.

22. References
Gordis L. (2008). Epidemiology (4th ed.). PA: Elsevier-Saunders.
Lang, N.M., Hook, M.L., Akre, M.E., et al., (2006). Translating knowledge-based nursing into referential and executable application in an intelligent clinical information system. In Weaver, C., Delaney, C., Webber, P., Carr, R. (Eds.). Nursing and Informatics for the 21st Century: An International Look at the Trends, Cases, and the Future (pp ). Chicago: Healthcare Information and Management Systems Society.
Malloch, K., Porter-O'Grady T. (2006). Introduction to Evidence-Based Practice in Nursing and Health Care. Boston: Jones and Bartlett.
Melnyk, B. & Fineout-Overhold, E. (2005). Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. PA: Lippincott, Williams, & Wilkins.

23. References
Newhouse, R., Dearbolt, S., Poe, S., Pugh, L., & White , K. (2005). Evidence-based practice: A practical approach to implementation. Journal of Nursing Administration. 35,
Pignone, M.P., Gaynes, B.N., Rushton, J.L., et al., (2002). Screening for depression in adults: a summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine,136,
Simon, G.E. (2000). Long-term prognosis of depression in primary care. Bull World Health Organization, 78:
Titler, M.G., Kleiber, C., Steelman, V.J., et al. (2001). The Iowa model of evidence-based practice to promote quality care. Critical Care Nurse Clinical North America. 13,

24. References
Theroux, R. (2006). How to bring evidence into your practice. Association of Women's Health, Obstetric and Neonatal Nurses Lifelines. 10,
US Preventive Services Task Force (May, 2002). Screening for Depression: Recommendations and Rationale. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved August 13, 2008, from