A Guide to Nursing - Evidence-Based Practice Research: What Are the EBP Steps?

Rating System for the Hierarchy of Levels of Evidence

• Level I — Evidence from a systematic review or meta-analysis of all relevant RCTs
• Level II — Evidence obtained from well-designed RCTs
• Level III — Evidence obtained from one well-designed controlled trials without Randomization
• Level IV — Evidence from well-designed case-control and cohort studies
• Level V — Evidence from systematic reviews of descriptive or qualitative study
• Level VI — Evidence from single descriptive or qualities study
• Level VII — Evidence from the opinion of authorities and/or reports of expert committees

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Step One: Ask a Question using PICO format - Ask a clinical question.

Step Two: Search Resources for the Best Evidence - Search for best evidence to answer question.

Step Three: Appraise Evidence - Critically appraise evidence, assess study quality, etc.

Step Four: Apply Evidence - Integrate evidence with clinical expertise and patient preferences/values to apply in practice.

These are the first four steps of Evidence-Based Practice according to Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step: The seven steps of evidence-based practice. The American Journal of Nursing, 110(1), 51-53.

Step One: Ask a Question using PICO format - Ask a clinical question.

Step Two: Search Resources for the Best Evidence - Search for best evidence to answer question.

Step Three: Appraise Evidence - Critically appraise evidence, assess study quality, etc.

Step Four: Apply Evidence - Integrate evidence with clinical expertise and patient preferences/values to apply in practice.

These are the first four steps of Evidence-Based Practice according to Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step: The seven steps of evidence-based practice. The American Journal of Nursing, 110(1), 51-53.

SUNY Downstate Medical Research Library of Brooklyn

MEDLINE and the other online medical literature databases try to be as comprehensive as possible in their coverage. As a result, indexed material may have little direct application to present-day medical practice.

The different types of material indexed in MEDLINE are labeled in the pyramid diagram, with the least clinically relevant at the bottom and the most clinically relevant at the top. The four layers above case reports and case series represent actual clinical research; the layers below are least clinically relevant and can be useful as background resources.

The links below provide basic definitions and examples of clinical research designs to help the medical student or new clinician understand how the design of a research study may affect whether or not to accept its findings in caring for a patient.

More detail on each level is available by reading the pages in sequential order or by selecting from the topics below:

NAU Librarians are available and can assist you by chat or email. You can schedule an individual research appointment.  We will reply to emails within 24 hours, Monday through Friday (excluding holidays or other closures).   View all hours.

Centre for Evidence Based Medicine Glossary.