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NURS303/307 - Nursing Seminar/Nursing Trends: EBP


PICOT is an acronym that helps us to form a good evidence-based research question.

Example: In adults with knee osteoarthritis, is water exercise (versus no water exercise) effective in improving pain symptoms in 8 weeks?


In patients with...

Example: adults with knee osteoarthritis


is/does the use of...

Example: water exercise

Control/Comparison  (optional)

when compared to... (may be standard treatment or no treatment)

Example: no water exercise


effective in controlling...
lead to...
cause adverse effect...

Example: improved pain

Time (optional)

In a specified time period... time it takes for the intervention to achieve an outcome, or how long participants are observed.

Example: with 8 weeks of treatment


Evidence-Based Practice Process PET

  1. Identify an EBP question
  2. Search for evidence (evaluate, make recommendations for change)
  3. Create an action plan to implement the change

Newhouse, R.P., Dearholt, S.L., Poe, S.S., Pugh, L.C., & White, K.M. (2007). Johns Hopkins nursing evidence-based practice model and guidelines. Indianapolis, IN: Sigma Theta Tau International.

Levels of Evidence

Evidence Pyramid

The Evidence Pyramid is an easy way to visualize levels of evidence for types of research articles. At the base is animal research and expert opinion. These are still important, but are low in the evidence-based hierarchy.

The next step up, from case reports to randomized control trials, is unfiltered evidence. These are individual reports and studies, also known as the primary literature

At the top of the pyramid, representing the strongest evidence, is filtered evidence. Systematic reviews and meta-analyses are literature reviews that analyze multiple research studies. Clinical Practice Guidelines can be added to this list of secondary literature

When doing evidence-based research, seek the highest level of evidence available. Just remember that the top levels may not be available for your particular clinical question. In that case, seek the next level down!

Primary & Secondary Sources

primary source in science is a document or record that reports on a study, experiment, trial or research project. Primary sources are usually written by the person(s) who did the research, conducted the study, or ran the experiment, and include hypothesis, methodology, and results.

Primary Sources include:

  • Pilot/prospective studies
  • Cohort studies
  • Survey research
  • Case studies
  • Lab notebooks
  • Clinical trials and randomized clinical trials/RCTs
  • Dissertations

[From University of Washington | Tacoma Library]

Secondary sources list, summarize, compare, and evaluate primary information and studies so as to draw conclusions on or present current state of knowledge in a discipline or subject. Sources may include a bibliography which may direct you back to the primary research reported in the article.

Secondary Sources include:

  • reviews, systematic reviews, meta-analysis
  • newsletters and professional news sources
  • practice guidelines & standards
  • clinical care notes
  • patient education Information
  • government & legal Information
  • monographs
  • entries in nursing or medical encyclopedias

Quick Links

What is Evidence-Based Practice?

Evidence based practice (EBP) is the conscientious use of current best evidence in making decisions about patient care (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000).

Types of Research Studies

What is a case study? What is a cohort study? And what about a randomized controlled trial? 

Evidence-Based Nursing Concepts