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EBP - Nursing

Resources for Evidence Based Practice, Professional Accountability, and Inter-professional Practice

Evidence Informed Nursing Practice

Evidence-informed nursing practice analyzes the best evidence available to make a clinical decision, considering the availability of resources, taking into account the values and wishes of the patient, and evaluating outcomes.

“Posing clinical questions also can help nurses identify and fill in gaps in knowledge, keep up with advances in clinical practice, and strengthen interactions with their peers, team members, and patients and their families”.
McKibbon, KA and Marks, S. (2001) Posing clinical questions:  Framing the question for scientific inquiry. AACN Clinical Issues, 12(4):477-481.

Steps in Evidence-Informed Practice


Appraising the best evidence you have found

Analyzing the clinical situation


Asking a focused clinical question


Accessing the clinical research literature (i.e. the evidence


Applying the evidence to the care of the patient


Assessing the effectiveness of care based on this evidence


6S Pyramid: A Tool that helps you find evidence quickly and efficiently

6S Pyramid Search Tool - NCCMT (National Collaborating Centre for Methods and Tools)

Provides an interactive version of the 6S Pyramid focused on free, pre-appraised resources

Interactive 6S Pyramid

Pre-Appraised Evidence

Pre-appraised research evidence: resources that have undergone a filtering process to include only research of higher quality, and that are regularly updated so that the evidence is current.

DiCenso, A., Bayley, L., & Haynes, B. (2009). Accessing pre-appraised evidence: fine tuning the 5S model into a 6S model. Evidence-based nursing, 12(4), 99-101.

Evidence-Based Practice

From: Applied Evidence Based Medicine Guide

The image below is from chapter 5 of Users' Guides to the Medical Literature (full reference below, under Further Reading). The Hierarchy of Evidence box shows which types of study are considered best (in descending order of quality) for therapy and harm studies (RCTs, for example, are better than observational studies as a general rule). Because there are way too many primary studies published for anyone to keep up with, there are more "processed" publications, such as guidelines and systematic reviews, that attempt to summarize/synthesize evidence and give you an answer you can apply in your practice.

On the right, the pyramid ranks the order in which practitioners should consult clinical resources: first try to find the answer in a guideline or summary tool such as DynaMed or UpToDate. If that doesn't yield an answer, try to find a systematic review or synopsis (such as those published in BMJ's Evidence-Based Medicine . If you're still not finding answers, you may need at that point to delve into the primary literature and do a PubMed search to find original studies.

Further reading:

6S Pyramid of Evidence:

The 6S Pyramid of Evidence is a hierarchical approach with 6 levels of organisation of evidence. Evidence is ‘ranked’ in relation to quality when it is used to make evidence-based clinical decisions. This is often known as the evidence ‘hierarchy’, and is illustrated in the pyramid below.

The levels are in descending order of usefulness to busy clinicians. The idea is to start at the top and work your way down until you find an answer to your clinical problem, with the primary or original research at the base of the pyramid.

If every other ‘S’ level fails to provide an answer to your question it is time to look for original studies. These include randomised controlled trials (RCTs), cohort studies, case control studies, and cross sectional studies.

  • NCMMT (National Collaborating Centre for Methods and Tools)
    6S Pyramid: A tool that helps you find evidence quickly and efficiently
    VIDEO on 6S





Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence-Based Nursing, 2009, 12(4): 99-101.

Farrell, A.  (2008) An evaluation of the five most used evidence-based bedside information tools in Canadian health librariers.  Evidence Based Library and Information Practice.  3(2):3-17.
Link to Article

Understanding the Evidence