---
title: "Evidence-based nursing"
chunk: 1/5
source: "https://en.wikipedia.org/wiki/Evidence-based_nursing"
category: "reference"
tags: "science, encyclopedia"
date_saved: "2026-05-05T04:25:37.279571+00:00"
instance: "kb-cron"
---

Evidence-based nursing (EBN) is an approach to making quality decisions and providing nursing care based upon personal clinical expertise in combination with the most current, relevant research available on the topic. This approach is using evidence-based practice (EBP) as a foundation. EBN implements the most up to date methods of providing care, which have been proven through appraisal of high quality studies and statistically significant research findings. The goal of EBN is to improve the health and safety of patients while also providing care in a cost-effective manner to improve the outcomes for both the patient and the healthcare system. EBN is a process founded on the collection, interpretation, appraisal, and integration of valid, clinically significant, and applicable research. The evidence used to change practice or make a clinical decision can be separated into seven levels of evidence that differ in type of study and level of quality. To properly implement EBN, the knowledge of the nurse, the patient's preferences, and multiple studies of evidence must all be collaborated and utilized in order to produce an appropriate solution to the task at hand. These skills are taught in modern nursing education and also as a part of professional training.
Muriel Skeet, a British nurse, was an early advocate for the development of the evidence base for health care. She produced studies and surveys including Waiting in Outpatients (1965), which received widespread publicity and resulted in the introduction of appointment systems, and Marriage and Nursing (with Gertrude Ramsden, 1967), which resulted in staff creches for nurses.

== Cultivate spirit of inquiry ==
A spirit of inquiry refers to an attitude in which questions are encouraged to be asked about existing practices. Cultivating a spirit of inquiry allows healthcare providers to feel comfortable with questioning current methods of practice and challenging these practices to create improvements and change. A culture that fosters this should have a philosophy that incorporates EBP, access to tools that can  enhance EBP, and administrative support and leadership that values EBP.
    Key Elements to Foster EBP

Always question current practices as nursing professional.
Integrate EBP as higher standard/mission/philosophy and include competencies for EBP.
EBP mentors for skills and knowledge availability to others to provide and help.
Tools to enhance EBP (e.g. meetings, educational/classroom time, access to, etc.).
Higher level support and ability for leaders to model valued EBP skills.
Recognition of use of EBP often 

== Ask clinical question (PICOT) ==
PICOT formatted questions address the patient population (P), issue of interest or intervention (I), comparison group (C), outcome (O), and time frame (T). Asking questions in this format assists in generating a search that produces the most relevant, quality information related to a topic, while also decreasing the amount of time needed to produce these search results.

An example of an intervention focused PICOT question would be: In total knee arthroplasty patients (Population), what is the effect of nerve blocks (Intervention) compared to opioid pain medication (Comparison) in controlling post-operative pain (Outcome) within the first 24 hours after surgery (Time)?
An example of an issue of interest focused PICOT question would be: How do post-rehab chronic obstructive pulmonary disease (COPD) patients (Population) with stage 3 (Issue of Interest) perceive their ability to perform activities of daily living (Outcome) after first month (Time) of rehabilitation? [No comparison group].

== Search for and collect relevant evidence ==
To begin the search for evidence, use each keyword from the PICOT question that was formed. Once results have been found on the intervention or treatment, the research can be rated to determine which provides the strongest level of evidence. There are seven levels of evidence, with a level I being of the strongest quality and a level VII being of the weakest quality:

Level I: Evidence from systematic reviews or meta-analysis of randomized control trials
Level II: Evidence from well-designed randomized control trials
Level III: Evidence from well-designed control trials that are not randomized
Level IV: Evidence from case-control or cohort studies
Level V: Evidence from systematic reviews of descriptive or qualitative studies
Level VI: Evidence from a single descriptive or qualitative study
Level VII: Evidence from expert opinions
The strongest levels of evidence, systematic reviews and meta-analyses, summarize evidence related to a specific topic by finding and assessing studies that specifically relate to the question being asked. Meta-analyses are systematic reviews that also use quantitative measures such as statistics to summarize the results of the studies analyzed.
    Pyramid framework. Thinking of the information resources used to obtain evidence as a pyramid can help determine what the most valid and least biased evidence is. The top of the pyramid is just that. This is where decision support can be found, which is found within the medical record. The middle of the pyramid is the reviews of the evidence. This includes systematic reviews, practice guidelines, topic summaries, and article synopses. The bottom of the pyramid is the original studies. The bottom is also considered the foundation of the pyramid and where evidence begins. This includes research articles. Those who look for evidence here need special knowledge and skills to not only find the evidence itself but how to evaluate its worthiness.

== Critically appraise the evidence ==
To begin the critical appraisal process, three questions need to be asked to determine the relevance of evidence and if evidence applies to population being cared for. The three questions are: