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Evidence Based Practice in the Health Sciences: EBP Processes

This LibGuide is meant to provide an overview of Evidence Based Practice, including links, worksheets, and other relevant information related to each of the steps of the EBP process. 

Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, 5th Edition 2025

Melnyk's 7 Steps of Evidence-Based Practice: A systematic approach to improving healthcare outcomes

The 7 Steps of Evidence-Based Practice

(Adapted from Melnyk et al. 2010; Image from UC Davis, 2025)

Step 0: Cultivate a Spirit of Inquiry
  • What it means: Foster an environment where questioning current practices and seeking better ways to provide care is encouraged and supported. It's about asking, "Why do we do it this way?"
Step 1: Ask Clinical Questions in PICOT Format
  • What it means: Formulate clear, answerable questions that guide your search for evidence.
  • PICOT stands for:
    • Patient/Population
    • Intervention/Interest
    • Comparison Intervention/Group
    • Outcome
    • Time (optional)
Step 2: Search for the Best Evidence
  • What it means: Systematically look for relevant research and evidence from reliable sources (e.g., databases like PubMed, CINAHL, Medline, Cochrane Library). Using a well-formulated PICOT question helps narrow the search.
Step 3: Critically Appraise the Evidence
  • What it means: Evaluate the quality, validity, reliability, and applicability of the gathered evidence to your clinical question. This involves assessing the research methods and findings.
Step 4: Integrate the Evidence with Clinical Expertise and Patient Preferences/Values
  • What it means: Combine the best available research evidence with your own clinical experience and the individual patient's unique preferences, values, and circumstances to make a clinical decision.
Step 5: Evaluate Outcomes of the Practice Decision or Change Based on Evidence
  • What it means: After implementing a change based on EBP, measure and monitor its effects on patient outcomes, cost-effectiveness, and other relevant indicators. Is the change making a difference?
Step 6: Disseminate EBP Results
  • What it means: Share the findings and outcomes of your EBP initiative with others through presentations, publications, or internal reports. This helps to build the body of evidence and promotes further EBP implementation.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: step by step: The seven steps of evidence-based practice. AJN, American Journal of Nursing, 110(1), 51–53. https://doi.org/10.1097/01.NAJ.0000366056.06605.d2

Basic & Advanced Searching Competencies

(Melnyk & Fineout-Overholt, 2023, p. 64)

Hierarchy of evidence for intervention questions

 

 
 

 

EBP: evidence-based practice;
QI: quality improvement.
(Melnyk & Fineout-Overholt, 2023, p. 198)

BMJ Evidence Based Nursing Process

Step 1: reflecting on practice and identifying areas of uncertainty
Step 2: translating these areas of uncertainty into focused, searchable questions
Step 3: searching the literature for studies that use appropriate designs to help answer the question
Step 4: critically appraising the research
Step 5: changing practice if the research suggests this is necessary.
 
(Cullum, 2000)