Implementation of Evidence-based Practice

Implementation of Evidence-based Practice

The aim of baccalaureate education in nursing is to develop the competencies required for evidence-based practice (EBP) in the undergraduate nurses. Due to the ever increasing demand for safe, efficient and quality health care, the bodies charged with accreditation of undergraduate nursing schools have made EBP a core component of the nursing curricula. The Quality and Safety Education for Nurse’s primary objective are to ensure preparation of nurses with skills, knowledge, and attitude needed to continuously improve the safety and quality of healthcare systems within which they work (Gardner et al., 2016). This paper will provide a step by step analysis of the implementation process of the EBP. The analysis will have a particular focus.

Evidence-based practice is a complicated process that provides a framework for making decisions during clinical practice.  Studies have defined evidence-based practice as “a learned set of skills demanding clinical experience and include identification of clinically relevant questions, knowledge of information retrieval, integration of valid and clinically relevant research, clinical expertise and the patient’s unique values and circumstances (Brooke & Mallion, 2016). The model is dynamic and flexible as opposed to other linear models. It is a process that can be compartmentalized into a 5 step process that nursing students can follow.

Step 1: Problem Identification

The EBP process commences with the structuring of a question that is answerable using the PICO format. The clinical question formed is based on the problem that the nurse has identified in the care environment. The PICO format ensures the clinical problem identified is searchable, answerable and that is integral to the database searching process. The format allows for researchers to look for comparisons for the existing evidence. The initial point comes from the process of clinical inquiry that the nurses develop in the health care environment. Clinical synthesis, critical thinking, and clinical judgment are essential abilities that BSNs should have when identifying the problem (Gardner et al., 2016).

Studies have drawn similarities have drawn similarities between the capacity to think critically and EBP. Just like the critical thinker, the nurse in EBP tries to delineate the problem, comprehend its indication, and define its composition and elements. The nurse then develops a framework of reference related to the problem and finally selects the best direction to follow in trying to get a solution to the problem. Baccalaureate trained nurses even take other courses on critical thinking because it is a primary requisite for getting and evidence base to support any clinical activity.

Step 2: Search for Research

The next step in formulating a well-built question is finding the source of literature from which the nurses will get the best evidence to support the practice. The most vital step in the EBP is looking for evidence. To be successful in this move baccalaureate degree nurses are supposed to be familiar with the sources that are credible, actually, have access to online resources and have an essential skill in searching (Gardner et al., 2016). Selecting the right database and familiarity with the language used are necessary if the search for answers to the clinical problem is to be successful. Information literacy is a necessary prerequisite for baccalaureate degree nurses implementing evidence-based practice.

Information literate nurses can recognize the need for information, locate, evaluate and effectively utilize the information. Additionally, access to a database is vital in the search for literature. With access, nurses can obtain, and use information in a manner that will inform their practice and guide their actions as nurses. Access, utilization, evaluation after use and feedback into the database is now a core component of the nursing process representing the one part of the ever-changing clinical synthesis. Clinical synthesis is a vital aspect of evidence-based practice (Brooke & Mallion, 2016).

Step 3: Critical Appraisal of the Research

Identification and evaluation of the evidence for BSNs are necessary in EBP. Critical evaluation is the main feature or characteristic of EBP. For nurses to appraise the validity of the evidence, they have to assess the strength of the scientific evidence (Gardner et al., 2016). Nurses can conduct this assessment through grading systems such as the one developed by the Agency for Healthcare Research and Quality (AHRQ) that judges the quality, quantity, and consistency of evidence to determine its strength.EBP depends on the use of literature as the primary source of information. Additionally, EBP takes into account the other sources of knowledge as foundations for clinical decisions (Spruce, 2015). The stability and validity of the literature sources are therefore assessed before they are clinically recommended.

Nurses trained at degree level borrow from multiple fields of knowledge to get evidence for the decisions they make. To be able to make sound clinical decisions, the nurses need to draw from the best pools of literature; assessment is key (Spruce, 2015).

Step 4: Apply Research Evidence to Practice.

In this step, it is important that nurses be adept in clinical synthesis. Clinical synthesis involves the ability to integrate and link all the components, databases and sources in the most appropriate way to best inform the nursing decisions and guide their actions. Here, the BSNs have to factor in all the patient characteristics such as age, gender, socioeconomic class, and other individual patient factors before making the decisions. The BSNs have to possess good clinical judgment as EBP depends on the nurses’ clinical judgment (Spruce, 2015). Studies have revealed three clinical judgment aspects; they comprise a decision-making process that depends on the intuitive decision-making processes and making rational-technical decisions. Experience helps develop clinical judgment.

Step 5: Assessment of the Outcomes of EBP

The emphasis of this stage is to evaluate the outcome and use the information collected in the process to improve the quality of patient care and ultimately the patient outcomes. This step is the fifth important step in the process of EBP implementation. EBP is the last step in the clinical research process for the application of what is known about interventions and treatment modalities that can improve the quality to patient care that nurses give and the patient outcomes. Baccalaureate degree level nurses have an obligation to base their interventions on the best available empirical evidence (Brooke & Mallion, 2016).


In summary, this paper has described in detail the 5-step process of implementing the evidence based practice. There has been a focus on the BSN level nurses and their responsibilities at each step of the process. In line with IOM recommendations and with the Health people 2020 objectives (Spruce, 2015), EBP is a means to improve the quality and safety of healthcare thereby improving the patient outcomes. Nurses are obligated to guide their practice and actions with evidence from the valid and credible literature. They can achieve that by adopting the evidence based practice.


Brooke, J. & Mallion, J. (2016). Implementation of evidence-based practice by nurses working in community settings and their strategies to mentor student nurses to develop evidence-based practice: A qualitative study. International Journal Of Nursing Practice22(4), 339-347.

Gardner, K., Kanaskie, M., Knehans, A., Salisbury, S., Doheny, K., & Schirm, V. (2016). Implementing and Sustaining Evidence Based Practice Through a Nursing Journal Club. Applied Nursing Research31, 139-145.

Spruce, L. (2015). Back to Basics: Implementing Evidence-Based Practice. AORN Journal101(1), 106-114.e4.