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A guide for locating nursing information resources for nursing education, practice and research.

EBN Process and the Evidence-Based Medicine Pyramid

Definition of Evidence-based Nursing

“An ongoing process by which evidence, nursing theory and the practitioners’ clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide delivery of optimum nursing care for the individual.”

Scott, K. & McSherry, R. “Evidence Based Nursing: clarifying the concepts for nurses in practice.” Journal of Clinical Nursing 2009; 18(8): 1085-95.


A triangle showing the quality of evidence. The highest level indicated at the top is systematic reviews, at the second levels is Critically-Appraised Topics (Evidence Syntheses), at the third level is Critically-Appraised Individual Articles (article synopsis). The aforementioned levels are considered filtered information. The next three levels are considered unfiltered information (in this order) randomized controlled trials (RCTs), cohort studies, case-controlled studies, case series/reports. The base of the pyramid is Background Information and Expert Opinion.


•ASK:  PICOT Question: Population, Intervention, Comparison, Outcome, Time
•ACQUIREDevelop a search strategy, using the level of evidence guidelines to find resources to answer the question(s).
•APPRAISE:  Are the individual results valid, reliable, applicable? Synthesize and rate the evidence and recommendations.
•APPLY: Determine the clinical significance of research to the target population, including benefits and risks of the implementation.
•ASSESS:  Self reflection, data collection, audit and peer assessment.

Also consider the type of question you are asking and determine what study type might be most relevant.
Most Clinical Questions:  
Meta-analyses, systematic reviews
Randomized Controlled Trial
Diagnosis:  Prospective, blind controlled trial compared to gold standard
Prognosis:  Cohort study, case control, case series/case report

Resources to Locate the Evidence

Meta -Search Engine

Systematic Reviews/Meta-Analyses

Evidence Synthesis/Guidelines, Summaries (Critically Appraised Topics)

Critically Appraised Individual Articles/E-Journals

Individual Research Studies

Background Information (Cross-searchable resources including online textbooks, reference sources)