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DNP in Practice

Evidence-Based Practice (EBP) is the framework for your clinical decision-making process. It is the integration of:

Clinical Expertise: your knowledge, skills, and past experience

Patient Characteristics: the unique preferences, concerns and expectations of your patient

Best Evidence: valid and clinically relevant research

Types of Clinical Questions

Therapy - What is the treatment for a disease?

Diagnosis - power of a test to differentiate between those with and without a disease?

Prognosis - a patient’s likely course over time due to factors other than interventions?

Etiology/Harm - effects of potentially harmful agents on the patient?

5 A's of acquiring information5 A's - Steps for Acquiring Information

  • Review the Situation (Assess)
  • Define the clinical problem as a question (Ask)
  • Select resources, design a strategy, and search for the answer (Acquire)
  • Summarize the evidence yield (Appraise)
  • Apply the evidence (Apply)

Study Design

Type of Question Suggested Best Type of Study
Therapy RCT > prospective cohort
Diagnosis Prospective, blind comparison to a gold standard
Etiology/Harm RCT > cohort > case control > case series
Prognosis cohort study > case control > case series
Prevention RCT > cohort study > case control > case series
Clinical Exam prospective, blind comparison to gold standard
Cost economic analysis

Heirarchy of Evidence

AACN Levels of Excellence

Research design and evidence

AACN new levels of evidence