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Evidence Based Practice (EBP) Research

Introduction to the EBP process including resources and instruction.

Evidence Based Practice Research: Instruction & Resources

Healthcare providers face constant information overload making it difficult to quickly identify relevant, accurate and critically appraised patient care information. This guide provides point-of-care and evidence based tools, resources and information relevant to everyday patient care or research needs.

  • These resources help quickly and easily identify the most recent information on a clinical topic.
    • Avoid information overlook.
    • Evaluate the validity of information.
    • Stay up to date on new findings via search alerts.

Librarians are expert searchers who can assist with finding the right information, at the right time, for the right patient or purpose.

Clinical or Research Questions & Search Strategies

How do you decide on a topic when confronted with conducting research? You want a focused topic!

Need help getting started? Ask a Librarian. Consider the librarian tips below.

Tip 1: Make sure your topic meets the assignment requirements. Ask your professor for feedback if you are unsure.

Tip 2: Choose a topic that is interesting to you or your team. It may seem obvious, but this will make the research process more fun and engaging for you.

Tip 3: Consider the scope of your topic. If your topic is too broad it may be hard to find information that is focused and relevant; if your topic is too narrow it may be hard to find any information at all. 

Tip 4: Review all of the "Clinical or Research Questions & Search Strategies" tabs. Start with reviewing background information to get an understanding of what is already known about a topic, then move toward developing a PICO(TS) question which will lead to constructing a well-developed search strategy. Document the sources researched and your search strategies.

Tip 5: Check out the following sources to help identify ideas for a topic of interest.

It is helpful to begin by identifying the type of information you seek. For example, EBP questions are typically classified as background or foreground questions.  Ask a Librarian for assistance as you begin your research process. 

Background questions help you identify and understand what is known about an area of interest when it is unfamiliar. These questions address general knowledge of disease processes or clinical contexts and are often broad in scope. Example: Is Obesity a Disease? (Britannica ProCon.org).

I Need: Examples: Resources to Consider:

General overview of a particular disease or condition

What is already known about a clinical or research topic

Who, what, when, where, how, why? related to disorders, tests, treatments, etiology

Medical or nursing textbooks, peer-reviewed journal articles

How does the drug acetaminophen work to affect fever?

What is the difference between depression and bipolar disorder?

I have a new patient with sickle cell anemia; I need an overview of this condition.

What is the best treatment for GERD?

Should a patient with a recent MI take Ezetemib?

What causes migraines?

What is the best steroid dose for asthma exacerbation in children?

Access Medicine

ERIC

Harrison's Online

Joanna Briggs Institute (JBI)

Library Catalog

Merck Manuals

NatMed Pro

PubMed @SMU (Review articles)

StatPearls

UpToDate

Locating background information on a given topic can be critical for understanding the scope, context and foundation for a research area of interest. Background questions tend to be broader than specific clinical questions, and may include information such as:

  • overviews of a particular disease or condition
  • summaries of the key features of a given patient population
  • explanations of a type of intervention (e.g., drug information)
  • patient-facing educational materials related to a condition or an intervention
  • summary statistics regarding a given disease or condition

When selecting a background source, consider:

  • currency - how recently was the resource published? Is the topic an emerging technology or within a field of inquiry where information changes rapidly? (If so, consider searching for a very recent review article or evidence summary)
  • authorship - who is the author? (a person? an organization?) What are their qualifications or expertise within the field?

Foreground questions ask for specific knowledge to inform decisions or actions and generally compare one or more options (intervention/comparison to the gold standard of care).

Foreground questions are more granular and refer to a particular feature of the condition in question, such as how best to make the right diagnosis, how to treat it, or what to expect prognostically based on factors the patient possesses. Therefore, foreground questions require primary sources that synthesize a wide range of knowledge, requiring a comprehensive literature search. Ask a Librarian for assistance. 

In order to most appropriately choose an information resource and craft a search strategy, it is necessary to consider what kind of question you are asking: a specific, narrow "foreground" question, or a broader background question that will help give context to your research (e.g. prevention, etiology, diagnostic, therapy). 

I Need: Examples:  Resources to Consider:

Qualitative “synthesis” of primary evidence, in some cases accompanied by meta-analysis

Critically appraised topics, systematic reviews +/- meta-analysis

Primary research studies (e.g, Randomized Controlled Trials)

Studies that prove clinical effectiveness with empirical data

Is cognitive behavioral therapy a useful adjunct to standard care for people with schizophrenia?

Does a diet high in omega-3 fatty acids lessen asthma severity in children?

In veterans with PTSD, does eye movement desensitization and reprocessing versus cognitive-behavioral therapy decrease PTSD symptoms?

In a 65-year-old obese male with Type 2 Diabetes, does gastric bypass surgery compared to Semaglutide medication administration result in weight loss and remission of diabetes?

Are proton pump inhibitors more effective than H2 blockers for the alleviation of GERD symptoms in adults who do not have peptic ulcer disease?

ACP Journal Club

CINAHL Plus w/Full Text

Cochrane Database of Systematic Reviews

Health Services Research PubMed Queries

MEDLINE (Ovid)

Nursing & Allied Health Premium (ProQuest)

PsycINFO

PubMed Clinical Queries

PubMed @ SMU (Systematic Reviews or Meta-Analysis)

Trip Database Pro

ToolsCochrane Reviews (PICOs) PICO Resource Center (Ovid)


Developing an effective and well-structured EBP question is very important because it directs the strategies you and your team will use to search for evidence. The PICO(TS) format is used to create questions that are as specific as possible, making your search more productive and efficient. Ask a Librarian for assistance. 

PICO(TS) defines and describes the elements of an answerable EBP question:

P = Patient/Population/Problem: Describes the patient, population, or problem succinctly. Includes the type of patient or population and the setting, considering attributes such as age, gender, symptoms, and diagnosis.

I = Intervention or Issue of Interest: The intervention can be a clinical treatment, an educational or administrative intervention, or a structure or process.

C = Comparison:  Foreground questions compare one intervention to another. Background questions do not include a comparison.

O = Outcome: This component describes the desired change or improvement.

T = Timing: Define the duration of treatment and the follow-up schedule that matter to patients. Consider both long- and short-term outcomes.

S = Setting: Define the setting (primary, specialty, inpatient, nursing homes, or other long-term care setting) where the study is implemented and the relevance of the study setting to real world use.

Source: Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. 


PICO is a widely used acronym to assist in remembering the key components of a clinical question. There are additional letters and frameworks to help you formulate a question fitting your research. Not all parts of PICO are required! PICO is a framework to help you narrow your topic, not a rule. PICO is the most common framework for developing a clinical research question, but multiple question frameworks exist.

When should you use PICO?

  • In academia, when you are looking for evidence to support best practice
  • In practice, when you have a question about patient care

Why should you use PICO?

  • Helps you form a focused question that will return relevant results
  • Helps you retrieve a manageable amount of results
  • Assists you in brainstorming keywords for your research
  • Saves time!

When should you use PPCO (Problem, Population, Change, Outcome)?

  • Evidence based practice quality initiatives.
  • Example: “Because the county’s one OB-GYN clinic no longer offers perinatal care services (P) to childbearing people (P), what clinic alternatives exist (C) for the delivery of safe perinatal care (O)?"

 Across most frameworks, you will often be considering:

  • who (who was studied - a population or sample)
  • what (what was done or examined - an intervention, an exposure, a policy, a program, a phenomenon)
  • how ([how] did the [what] affect the [who] - an outcome, an effect)

Branum, Candise MLS; Schiavenato, Martin PhD, RN. Can ChatGPT Accurately Answer a PICOT Question?: Assessing AI Response to a Clinical Question. Nurse Educator: 10.1097/NNE.NNE.0000000000001436, April 28, 2023. DOI: 10.1097/NNE.0000000000001436.

Waldrop, J., & Jennings-Dunlap, J. (2024). CE: Beyond PICO-A New Question Simplifies the Search for EvidenceThe American journal of nursing124(3), 34–37. https://doi.org/10.1097/01.NAJ.0001007676.91191.dd  

Waldrop, Julee DNP, PNP-BC, EBP-C, FAANP, FAAN; Jennings-Dunlap, Jayne DNP, FNP, CNE, EBP-C. CE: The Mountain Model for Evidence-Based Practice Quality Improvement Initiatives. AJN, American Journal of Nursing ():10.1097/01.NAJ.0001014540.57079.72, April 10, 2024. | DOI: 10.1097/01.NAJ.0001014540.57079.72 

Searching databases in a consistent, structured manner will save you time. As your searching progresses and your searches are refined, your search history can be extremely useful. It can also improve the relevancy of results obtained, as you reflect on your keywords and synonyms and how these influence your search results.

To develop a search strategy you will need to:

  • define and write down your research question - what is it that you are going to research?
  • identify, and keep a record of PICO question key words, MeSH terms and phrases
    • brainstorming your main discussion points to create concept/mind maps can help tease out themes and keywords
    • identify keyword synonyms, use a database Thesauri or Subject Headings;
  • determine a time frame for your research, if needed
  • consider what type of material you will include and why
  • identify where you will search for the information
  • look for pros and cons in your research - Example: Do Video Games Contribute to Youth Violence?
  • DO NOT only look for studies that support your hypothesis, rather follow where the evidence leads you
  • Ask a Librarian for assistance! or Schedule a Synchronous 1:1 appointment or 5-Minute Consult.

Searching is an iterative process and often requires re-evaluation and testing by adding or changing keywords and the ways they relate to each other. To guide your search development, follow the search steps below.


PICOT Example:

  • P: Hospitalized adult patients
  • I: Implementation of a nurse-led patient education program
  • C: Standard care without a specific education program
  • O: Reduction in hospital readmission rates
  • T: Within 30 days post-discharge

Example PICOT Question: In hospitalized adult patients (P), how does the implementation of a nurse-led patient education program (I) compared to standard care affect hospital readmission rates (O) within 30 days post-discharge (T)?

Example Search Strategy:

  1. Keywords and Phrases:
    • Hospitalized adult patients
    • Nurse-led patient education program
    • Standard care
    • Hospital readmission rates
    • 30 days post-discharge
  2. Databases to Search:
    • Agency for Healthcare Research & Quality
    • ERIC
    • PubMed @ SMU
    • CINAHL (Cumulative Index to Nursing and Allied Health Literature)
    • Cochrane Library
    • Ovid | MEDLINE
    • Nursing & Allied Health Premium
    • Google Scholar
    • Trip Database Pro

Hand Search Journals: Health Affairs, Nursing, American Journal of Nursing

  1. Medical Subject Headings [MeSH] Search Terms and Keyword Search Strategy:
    • ("Patient Readmission"[Mesh]) AND "Patient Education as Topic"[Mesh]
    • Combine keywords using Boolean operators (AND, OR, NOT)
    • Example: (“hospitalized adult patients” AND “nurse-led patient education program” AND “hospital readmission rates” AND “30 days post-discharge”)
  2. Filters and Limits:
    • Limit to peer-reviewed articles, Adult: 19+ years), English
    • Set publication date range (e.g., last 5 years)
    • Filter by study type (e.g., randomized controlled trials, systematic reviews)
  3. Review and Refine:
    • Review abstracts and titles for relevance
    • Refine search terms based on initial results
    • Use citation tracking to find additional relevant studies

Good search practice could involve keeping a search "research" log or document detailing your search activities so that you can keep track of effective search terms, or to help others to reproduce your steps and get the same results. 

This record could be a document, table, or spreadsheet with:

  • The names of the sources you search and which provider you accessed them through - eg Medline (Ovid). You should also include any other literature sources you used.
  • The search strategies that you applied when searching different sources (eg Medline) can be added as an appendix to your document. This provides additional detail on:
    • how you searched (keyword and/or subject headings)
    • which search terms you used (which words and phrases)
    • any search techniques you employed (truncation, adjacency, etc)
    • how you combined your search terms (AND/OR). 
  • The number of search results from each source and each strategy used. This can be the evidence you need to prove a gap in the literature and confirms the importance of your research question.
  • Gather your sources and organize with our writing and citing resource guides

A search planner may help you to organize your thoughts prior to conducting your search. If you have any problems with organizing your thoughts prior, during, and after searching please Ask a Librarian for individual help.