Step 4: Apply the Evidence
Applying the evidence brings the PICO question components to the forefront of decision-making. This decision-making involves the three factors of EBP bringing us full circle to the definition of this practice. This is the step in which you synthesize your clinical expertise with the client’s perspective and the scientific evidence. As you may now see, this is not a cookbook approach. The intervention under study may provide successful outcomes however it may be contrary to a client’s cultural beliefs and values. For example, in the CIMT scenario the intervention requires a highly motivated and intrinsically driven client. Your client may be depressed. In another scenario, a client may benefit from pre-medication for pain prior to your intervention however your client has a stoic personality and doesn’t believe in taking medication.
Additionally, when looking at the intervention your skills and expertise are considered. Do your skills match the abilities required for implementing the intervention? Is the intervention cost-effective and feasible in your setting? Finally, your CAT review will indicate the quality of the evidence you gleaned from the article. You will know if there was a researcher or study bias. These are just a few examples of the factors that contributes to applying the evidence. Consider these questions summarized by Heneghan and Badenoch (2006)[14] within the PICO/PIO:
Population (Client):
Is your client similar to the clients in the study?
How much of the study results can you expect for your patient
Intervention
Is the study intervention realistic in your setting?
Does the intervention align with your client’s values and preferences?
Outcomes
Have you included all the right outcomes of those available?
Will you do no harm?
Are the outcomes appropriate to your patient?
With your CAT results in hand, you may want to use Heneghan and Badenoch's (2006)[14] worksheet for applying the evidence found on the resource page to answer these questions.
Now that you've applied the evidence you're ready to Evaluate Performance and Outcome.
Applying the evidence brings the PICO question components to the forefront of decision-making. This decision-making involves the three factors of EBP bringing us full circle to the definition of this practice. This is the step in which you synthesize your clinical expertise with the client’s perspective and the scientific evidence. As you may now see, this is not a cookbook approach. The intervention under study may provide successful outcomes however it may be contrary to a client’s cultural beliefs and values. For example, in the CIMT scenario the intervention requires a highly motivated and intrinsically driven client. Your client may be depressed. In another scenario, a client may benefit from pre-medication for pain prior to your intervention however your client has a stoic personality and doesn’t believe in taking medication.
Additionally, when looking at the intervention your skills and expertise are considered. Do your skills match the abilities required for implementing the intervention? Is the intervention cost-effective and feasible in your setting? Finally, your CAT review will indicate the quality of the evidence you gleaned from the article. You will know if there was a researcher or study bias. These are just a few examples of the factors that contributes to applying the evidence. Consider these questions summarized by Heneghan and Badenoch (2006)[14] within the PICO/PIO:
Population (Client):
Is your client similar to the clients in the study?
How much of the study results can you expect for your patient
Intervention
Is the study intervention realistic in your setting?
Does the intervention align with your client’s values and preferences?
Outcomes
Have you included all the right outcomes of those available?
Will you do no harm?
Are the outcomes appropriate to your patient?
With your CAT results in hand, you may want to use Heneghan and Badenoch's (2006)[14] worksheet for applying the evidence found on the resource page to answer these questions.
Now that you've applied the evidence you're ready to Evaluate Performance and Outcome.