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Evidence-Based Practice: EBP Five Steps

EBP Five Steps

Evidence-based practice consists of five steps:

1. Ask  a searchable clinical question;
2. Find the best evidence to answer the question;
3. Appraise the evidence;
4. Apply the evidence with clinical expertise, taking the patient's wants/needs into consideration;

5. Evaluate the effectiveness and efficiency of the process.

Use the tabs of this LibGuide to learn:

  • how to ask a searchable clinical question;
  • what to look for;
  • where to search for the best evidence;
  • how to appraise the evidence you find.

Source: Strauss, S. E.  Evidence-Based Medicine: How to Practice and Teach EBM.  New York: Churchill Livingstone, 2005.

Asking your Question

 Fill in the blanks with information from your clinical scenario:

In_______________, what is the effect of ________________on _______________ compared with _________________?


For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?

Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?

Does ____________ influence ______________ in patients who have _____________?

Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ 


How do _______________ diagnosed with _______________ perceive __________________?

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

TRIP Database PICO Wizard:
You may find this helpful.  Click on the PICO Search button for help building a PICO question.

Asking a Clinical Question

Using the PICO format can be instructive!

Patient Population
Comparison Intervention

Types of Questions: Etiology, Diagnostic, Prevention, Prognosis/Prediction, Therapy, Qualitative

Prevention Example:
For patients with systolic heart failure (P) do exercise programs (I) reduce the future risk of hospital admission due to heart failure (O) compared with patients without exercise programs (C)?
Therapy Example:
In patients with chronic wounds (P) what is the effect oftopical negative pressure (TNP) (I) on promoting healing (O) compared with traditional moisturized gauze (C) dressing?

Element of the clinical question


Describe as accurately as possible the patient or group of patients of interest.

Intervention (or cause, prognosis)

What is the main intervention or therapy you wish to consider?
Including an exposure to disease, a diagnostic test, a prognostic factor, a treatment, a patient perception, a risk factor, etc.

Comparison (optional)

Is there an alternative treatment to compare?
Including no disease, placebo, a different prognotic factor, absence of risk factor, etc.


What is the clincial outcome, including a time horizon if relevant?

Example In patients with acute bronchitis, do antibiotics none reduce sputum production, cough or days off?
Example In children with cancer what are the current treatments   in the management of fever and infection?
Example Among family-members of patients undergoing diagnostic procedures does standard care, listening to tranquil music, or audiotaped comedy routines make a difference in the reduction of reported anxiety.


PICO chart