Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition by See more from the Center for Nursing Inquiry on their YouTube playlist.
See more from the Welch Medical Library on our YouTube channel.
The JHNEBP Model is a powerful problem-solving approach to clinical decision-making, and is accompanied by user-friendly tools to guide individual or group use. It is designed specifically to meet the needs of the practicing nurse and uses a three-step process called PET: practice question, evidence, and translation. The goal of the model is to ensure that the latest research findings and best practices are quickly and appropriately incorporated into patient care.
Reference: The Johns Hopkins Nursing Center for Evidence-Based Practice: Models and Tools.
If your question doesn't fit into the PICO framework, review our Formulating Your Research Question page on our Expert Searching Guide.
When setting out to do an EBP project, you'll need to have a well-developed research question. The JHNEBP Model's Appendix A - PET Process Guide, supplies you with a checklist to ensure that you have thought through all the steps and have a winning team in place prior to the start. PET stands for Practice Question, Evidence, Translation.
When framing the EBP question, consider ideas such as:
Is your question a background question or a foreground question?
Background Questions - These are usually broad and used in the beginning. Background questions can be refined and adjusted as continue to develop the search. Background questions frequently assist in identifying best practices.
Foreground Questions - These types of questions are focused, with specific comparisons of ideas or interventions. Foreground questions can provide specific evidence related to the research question. Background questions can turn into foreground questions as the review progresses.
This process can be identified in the JHNEBP Model, Appendix B - Question Development Tool PICO. After you've completed Appendix A and Appendix B, complete Appendix C - Stakeholder Analysis and Communication Tool. This form is used to identify key stakeholders that can support decision-making, serve as subject matter experts, or implement change.
Reference: Dang, D., Dearholt, S.L. (2017). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines. Sigma Theta Tau.
To find the evidence, you will need to search for it. It will depend on what resources you have access to through your institution, but it is always a best practice to search more than one resource. This is because different resources index different topics and journals.
The section of this guide called Databases and Clinical Tools lists important databases for nursing research.
Use your question framework or JHNEBP Question Development Tool to determine the major elements of your question. Think about how authors might write about these concepts. There may be many terms to describe just one idea.
See the Welch Library's Expert Searching Guide for more tips and tricks on how to become an expert searcher.
Once you've formulated a question and reviewed how to search, try our PubMed Searching Practice Exercises or our CINAHL Plus Practice Exercises.
The Centre for Evidence Based Medicine at the University of Oxford provides worksheets and calculators to assess systematic reviews, diagnostic, prognosis, and RCT article types. See their specific Critical Appraisal tools.
Dartmouth provides a series of worksheets designed to aid you in formulating clinical questions, appraising the evidence, and applying the evidence to practice.
CASP provides worksheets to appraise randomized control trials, systematic reviews, cohort studies, case control studies, qualitative research, economic evaluations, diagnostic tests, and clinical prediction rules.
Links to the 'User's Guides to the Medical Literature' series of articles designed to promote incorporation of evidence into practice.
JBI's critical appraisal tools assist in assessing the trustworthiness, relevance, and results of published papers.
This set of eight critical appraisal tools are designed to be used when reading research, these include tools for Systematic Reviews, Randomised Controlled Trials, Cohort Studies, Case Control Studies, Economic Evaluations, Diagnostic Studies, Qualitative studies and Clinical Prediction Rule.
This set of eight critical appraisal tools are designed to be used when reading research, these include tools for Systematic Reviews, Randomised Controlled Trials, Cohort Studies, Case Control Studies, Economic Evaluations, Diagnostic Studies, Qualitative studies and Clinical Prediction Rule.
Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J., Gavaghan, D. J., & McQuay, H. J. (1996). Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled clinical trials, 17(1), 1–12. https://doi.org/10.1016/0197-2456(95)00134-4
The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) working group began in the year 2000 as an informal collaboration of people with an interest in addressing the shortcomings of grading systems in health care. The working group has developed a common, sensible and transparent approach to grading quality (or certainty) of evidence and strength of recommendations.
The Newcastle-Ottawa Scale (NOS) is an ongoing collaboration between the Universities of Newcastle, Australia and Ottawa, Canada. It was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the quality assessments in the interpretation of meta-analytic results.
The OHAT Risk of Bias Rating Tool can be used for human and animal studies.
The CEBM Levels of Evidence framework sets out one approach to systematizing this grading process for different question types.
This tool is based on the Cochrane RoB tool and has been adjusted for aspects of bias that play a specific role in animal intervention studies.
The U.S. Preventive Services Task Force (USPSTF) assigns one of five letter grades (A, B, C, D, or I). The USPSTF changed its grade definitions based on a change in methods in May 2007 and again in July 2012, when it updated the definition of and suggestions for practice for the grade C recommendation.
Now it's time to critically appraise and take action on the evidence you found through the search. The JHNEBP Model has several tools available to help you grade the evidence and see the process through to the finish line.
If you are a nurse working at Hopkins, the JHNEBP tools are linked on your intranet.
If you are a nurse working elsewhere, you can see a sample of tools here, and complete the copyright permission form for access to the full tools.
Use the Welch Medical Library's practice searching exercises to guide teaching the literature searching portion of the JHNEBP Model at your institution. All tools, unless otherwise noted, have a CC BY-NC 2.0 Creative Commons License, which means you are free to share and adapt with attribution for non-commercial purposes. Practice searching exercises for PubMed and for CINAHL Plus are linked below.
If you would like to practice comprehensive searching in PubMed, use the links below to access PubMed, and the three worksheets to achieve steps within the search process. See also the National Library of Medicine's Training Module on Using PubMed in Evidence-Based Practice.
If you would like to practice comprehensive searching in CINAHL Plus, use the link below to access CINAHL Plus, and the three worksheets to achieve steps within the search process.
