The fourth step, that of evidence application, involves the integration of relevant evidence with clinical experience. A decision is made regarding whether the evidence that has been obtained is relevant and valid research to be applied to the question that one seeks to answer. The effectiveness of a therapeutic intervention, based on the evidence, is determined by assessing the internal validity and external validity of a given study.
- Internal validity: Is it a high quality study in terms of its methods (does it measure what it was intended to measure)?
- External validity: Is the population and setting of the study similar to that of the one evaluated in the clinical question?
When these questions are answered, the evidence is applied by making a practice decision that integrates evidence, clinical expertise, and patient factors and preferences. Usually a model of evidence based practice is used to apply research findings in nursing practice.
(Adapted from Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.)
Centre for Evidence Based Medicine:
Describes the process of evidence application
Indiana Center for Evidence Based Nursing Practice:
Contains several links for information for evidence application/translation
Resources for Models of Evidence-Based Nursing Practice and Research Utilization
(Melnyk & Fineholt-Overholt, 2005):
West J Nurs Res. 1989 Jun;11(3):361-72.
A model for improving the dissemination of nursing research.
Funk SG, Tornquist EM, Champagne MT. PMID: 2750148
-Implementing evidence-based nursing: some misconceptions
DiCenso A, Cullum N, Ciliska D.
-The Iowa Model
Titler MG, Kleiber C, Steelman VJ, et al. The Iowa model of evidence-based practice to promote quality care.
Crit Care Nurs Clin North Am. 2001;13:497-509.
-Rosswurm and Larrabee Model article from
Image: Journal of Nursing Scholarship