The modern evolution of Evidence-Based Practice (EBP) is frequently tied to Cochrane’s 1972 publication ‘Effectiveness and Efficiency: Random Reflections on Health Services.” Cochrane admonished the medical profession for not examining all of the evidence for an intervention, and encouraged the creation of a “critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials” (Cochrane, 1979). Though randomized controlled trials represent a strong source of clinical evidence, the concept of EBP encourages exploration and discussion of the many types of evidence available.
An excellent definition of evidence-based practice is "a total process beginning with knowing what clinical questions to ask, how to find the best practice, and how to critically appraise the evidence for validity and applicability to the particular care situation. The best evidence then must be applied by a clinician with expertise in considering the patient's unique values and needs. The final aspect of the process is evaluation of the effectiveness of care and the continual improvement of the process" (DePalma, 2000). A more recent definition of evidence-based nursing affirms these aspects, and also suggests evaluation of the resources available in the environment where the care is provided (Cullum, Ciliska, Marks & Haynes, 2008).
These definitions illustrate the importance of not only incorporating multiple sources of evidence, but also including consideration of the context where the decision making is taking place, such as the availability of high-quality services and equipment, as well as the patient’s preferences and circumstances (Cullum et al, 2008).
The Evidence-Based Nursing Decision: Judgment and Expertise of the Nurse (Clinician Experience) + Valid, Relevant Research Evidence (Scientific Findings) + Patient Preferences and Circumstances + Available Resources = Clinical Decision (Cullum et al, 2008).
Combining the strongest evidence from all sources for a specific health problem improves the care of current and future patients who share that problem.
Clinician Experience: A clinician who makes trustworthy observations, carefully analyzes care situations, knows individual patients' preferences, applies pertinent learnings from previous clinical situations to the current one, and has relevant knowledge can offer insights that improve patient care (Wakefield et al., 1998).
Scientific Findings: Rigorous, credible, clinically relevant research that, when applied to a specific health situation, contributes to improved care. (Haynes, Deveraux & Guyatt, 2002).
Patient Preferences: When clinicians solicit and respect the treatment-related desires of patients, the most appropriate health care decisions can be made. Patient preferences are influenced by values, beliefs, culture, and previous personal or family experiences (Haynes et al., 2002).
Available Resources: The ability of the patient and clinician to obtain and use recommended materials and services may influence the treatment plan (Cullum et al., 2008).