The 5 Steps of EBP Decision Making 

There are 5 steps in judging evidence, and then determining the circumstances and patient values for guiding application to patient care.  The 5 A's are: Ask Acquire Appaise Apply Analyze & Adjust

Levels of Evidence

AJN's EBP Series

This series was published in the American Journal of Nursing, 2009-2011.  It came from The Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice.

"Evidence-Based Practice (EBP) is a problem solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values.  When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.

The purpose of this series it to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time."

 -from "Igniting a Spirit of Inquiry," the first article in the series.

Part I: Developing the Clinical Question

• Igniting a Spirit of Inquiry : An Essential Foundation for Evidence-Based Practice
• The Seven Steps of Evidence-Based Practice
• Asking the Clinical Question : A Key Step in Evidence-Based Practice
• Searching for the Evidence

Part II: Evaluating the Evidence

• An Introduction to Gathering, Evaluating, and Recording the Evidence
• Digging Deeper -- Examining the "Keeper" Studies
• The Process of Synthesis : Seeing Similarities and Differences Across the Body of Evidence

Part III: Implementation

• Following the Evidence : Planning for Sustainable Change
• Implementing an Evidence-Based Practice Change
• Rolling Out the Rapid Response Team
• Evaluating and Disseminating the Impact of an Evidence-Based Intervention : Show and Tell
• Sustaining Evidence-Based Practice Through Organizational Policies and an Innovative Model

Critical Appraisal from the Center of Evidence-Based Management 

Critical appraisal is the process of carefully and systematically assessing the outcome of scientific research (evidence) to judge its trustworthiness, value and relevance in a particular context. Critical appraisal looks at the way a study is conducted and examines factors such as internal validity, generalizability and relevance.

Some initial appraisal questions you could ask are:

1. Is the evidence from a known, reputable source?

2. Has the evidence been evaluated in any way? If so, how and by whom?

3. How up-to-date is the evidence?

Second, you could look at the study itself and ask the following general appraisal questions:

1. How was the outcome measured?

2. Is that a reliable way to measure?

3. How large was the effect size?

4. What implications does the study have for your practice? Is it relevant?

5. Can the results be applied to your organization?

For more information on appraisal of article types : https://cebma.org/resources-and-tools/what-is-critical-appraisal/

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