Evidence Based Practice was first defined by Dr David Sackett in the 1990s, but a more recent definition has it as
“integrating the best available research evidence with clinical expertise and the patient’s unique values and circumstances” (Straus, Glasziou, Richardson, & Haynes, 2011).
And "it also requires the health professional to consider characteristics of the practice context in which they work. " (Hoffman, Bennett, & Del Mar, 2017).
Evidence-Based Practice has been expanded from Evidence-Based Medicine to apply to other health professions and other disciplines such as librarianship and education. This guide concentrates on (but is not exclusive to) EBP as it applies to the health professions.
Evidence-Based Practice vs Evidence-Informed Practice
A term that you might sometimes see used, especially in nursing research, is Evidence-Informed Practice. According to Woodbury and Kuhnke (2014), this term is used instead of, or as well as, evidence-based practice. They suggest that the term seems to give more flexibility regarding the nature of evidence and its use, “i.e., it implies that many different levels of evidence and types of evidence … are needed and used to support decisions in clinical practice.” (p. 29)
They also suggest that the terminology is less significant than the approach. “At the level of individual patients/ clients, it is important that clinicians know the unique values, preferences and circumstances of their clients in addition to the scientific evidence that supports and informs their practice”. (p. 29)
Hoffmann, T., Bennett, S., & Del Mar, C. (2017). Evidence-based practice across the health professions (3rd ed.). Elsevier Australia.
Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2011). Evidence-based medicine: How to practice and teach it (4th ed.). Churchill Livingstone Elsevier.
Woodbury, M. G., & Kuhnke, J. L. (2014). Evidence-based practice vs. Evidence-Informed Practice: What's the difference? Wound Care Canada, 12(1), 26-29.
The Evidence-Based Practice process is usually seen as having 5 steps:
| Step 1 | ASK | Express the problem as a clinical question (Ask the question) |
| Step 2 | ACQUIRE | Find evidence-based resources that answer the question (Acquire the evidence) |
| Step 3 | APPRAISE | Critically appraise the evidence to assess its validity (Appraise the evidence) |
| Step 4 | APPLY | Apply the evidence (Apply the evidence to the patient(s) or problem) |
| Step 5 | ASSESS/AUDIT | Evaluate your performance in carrying out Steps 1 - 4 (Assess and audit the process) |
Hoffman, Bennett, and Del Mar, in their book Evidence-Based Practice across the health professions, point out that Evidence-Based Practice is not the same as randomised controlled trials:
"... it is certainly true that randomised controlled trials are the cornerstone of research investigating whether interventions (treatments) work. However, questions about the effectiveness of interventions are not the only type of clinical question ." (Hoffman, Bennett, & Del Mar, 2017).
Health professionals also need information about questions of:
It's possible that each question will require a different type of research design, and randomised controlled trials are just one type of research design. Others include:
Hoffman, Bennett, & Del Mar also point out that EBP is not the same as "guidelines". Rather, practice guidelines are "just one route to getting the best available evidence into clinical practice." (Hoffman, Bennett, & Del Mar, 2017).
Hoffmann, T., Bennett, S., & Del Mar, C. (2017). Evidence-based practice across the health professions (3rd ed.). Elsevier Australia.
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