Evidence-based practice (EBP) is the deliberate use of “a problem-solving approach to clinical decision-making within a healthcare organization that integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence, considers internal and external influences on practice, and encourages critical thinking in the judicious application of such evidence to the care of the individual patient, patient population or system” (Newhouse, Dearholt, Poe, Pugh, & White, 2007). EBP is an approach that enables clinicians to provide the highest quality of care to meet the multifaceted needs of their patients and families by using highquality evidence to inform decision-making in their nursing practice (Melnyk & Fineout-Overholt, 2005).

EBP uses explicit methods to critically appraise and rate both the level (strength) and quality of evidence to answer a practice issue or question. In addition, to build an EBP, nurses use specific methods for incorporating evidence into practice as they consider the level of evidence and the implications for incorporating that evidence into the environmental context of care. The implications consider local practitioner expertise and practice patterns, organizational culture and experience data, and specific patients’ preferences and values.

The EBP movement began in the 1970s when Archie Cochrane, a British epidemiologist, criticized his own profession for failing to implement the latest research into practice. The term evidence-based medicine was first used at the McMaster Medical School in Canada. In 1992, the Cochrane Collaboration was developed to synthesize available current clinical research to make it easier for clinicians to evaluate evidence for use in their practice. As the EBP movement became more widely adopted, it moved health care from a more traditional “do something or anything” focus to one of questioning clinicians’ practice. Nursing began focusing on EBP strategies with the work of Stetler et al. (1998) and Titler et al. (2001).

However, even with the current emphasis on EBP for nursing, many nurses still continue to rely on outdated knowledge and traditions that they acquired as nursing students. Parahoo (2000) found that nurses lack confidence in their skills to evaluate the quality of research and lack confidence to implement change in the practice setting. Pravikoff, Tanner, and Pierce (2005) found that 61% of nurses need to seek information at least one time a week, but found that 67% of those nurses always or frequently sought information from a colleague instead of a reference text. Leasure, Stirlen, and Thompson (2008) surveyed nurse executives to identify the presence or absence of provider and organizational variables associated with use of EBP among nurses. The facilitators included staff members who read journals that publish original research and who participate in a journal club. Specific supportive infrastructure from the organization included the presence of a nursing research committee and a facility research committee as well as facility access to the Internet. The barriers to EBP were lack of staff involvement in projects, absence of communication about completed projects, and lack of knowledge about project outcomes. Among the respondents, 34% did not know what literature-searching capabilities were available to them in their facility.

Grounding nursing practice in evidence, rather than tradition, is necessary to meet nursing’s social obligation of accountability to use current evidencebased nursing knowledge—including research findings—to guide their practice. Registered nurses are educated to evaluate and incorporate evidence into practice; to initiate appropriate changes to their practice on the basis of evidence; and to participate, as appropriate to their education level and position, in developing evidence through research. The graduate-level prepared specialty nurse or the advanced practice registered nurse (APRN) promotes a culture of clinical inquiry during clinical rounds and through mentoring of other nurses. Staff development, external presentations, and publications are important vehicles of communication of research results or EBP project
synthesis. Both levels of nurses have the obligation to disseminate EBP findings to their peers and other health professionals. Improvement of outcomes is the goal of evidence-based practice.