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Evidence-Based Nursing: Evidence Application

What is Evidence Application?

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.)

Evidence Application Links

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):

  -Funk’s Model of Research Dissemination

   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

 -Stetler Model of Research Utilization and 

   Evidence-Based Practice

   From the National Center for the Dissemination
                   of Nursing Research

              and Stetler
article from Nursing Outlook

   -Implementing evidence-based nursing: some misconceptions
    Evid Based Nurs. 1:38-39 doi:10.1136/ebn.1.2.38
    DiCenso A, Cullum N, Ciliska D.


Organizational Models

-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  

-Kitson Model