Posted: September 7th, 2023
Sample Research Essay on Evidence-Based Practice and the Quadruple Aim
# Evidence-Based Practice and the Quadruple Aim
Evidence-based practice (EBP) is a strategy to assist healthcare providers in meeting the Quadruple Aim. The Quadruple Aim focuses on creating better outcomes for patients, improving the patient experience, lowering costs, and improving the overall clinician experience. EBP is defined as “the integration of clinical expertise, patient values and the best research evidence into the decision-making process for patient care”. EBP enables healthcare providers to translate research findings into clinical practice and apply existing scientific knowledge to each individual patient.
## Why Choose EBP?
EBP has many benefits for both patients and providers. Research has shown that when providers deliver evidence-based care, patient outcomes are markedly improved. For example, in a free clinic, evidence-based interventions led to a 597% increase in influenza vaccination rates. EBP also helps to improve the quality and safety of healthcare, as well as reduce unnecessary costs and variations in care. EBP can also enhance the work life and well-being of healthcare providers, as they feel more empowered, confident, and satisfied with their practice.
## How to Implement EBP?
EBP is a seven-step problem-solving approach that involves:
1. Asking a clinical question in PICO (Population, Intervention, Comparison, Outcome) format.
2. Searching for the best available evidence from relevant sources.
3. Appraising the quality and strength of the evidence using standardized tools.
4. Integrating the evidence with clinical expertise and patient preferences.
5. Implementing the evidence-based decision or intervention.
6. Evaluating the outcomes of the intervention.
7. Disseminating the results and sharing best practices.
## What are the Barriers and Facilitators of EBP?
Despite the benefits of EBP, many healthcare providers do not actively implement EBP strategies due to various barriers, such as:
– Lack of time, resources, and skills to search and appraise evidence.
– Lack of leadership support, investment, and culture for EBP.
– Lack of access to reliable and updated sources of evidence.
– Resistance to change and preference for tradition or intuition.
To overcome these barriers, some facilitators that can promote EBP include:
– Providing education and training on EBP skills and competencies.
– Creating dedicated time and space for EBP activities and projects.
– Establishing EBP mentors, champions, and teams to guide and support EBP implementation.
– Developing policies, protocols, and incentives that encourage EBP adoption.
– Engaging stakeholders, including patients, families, and communities, in EBP decision-making.
## Conclusion
EBP is a key strategy to achieve the Quadruple Aim in healthcare. It helps to improve patient outcomes, patient experience, provider experience, and cost-effectiveness of care. EBP requires a systematic and collaborative approach that integrates the best available evidence with clinical expertise and patient values. EBP also faces several challenges that need to be addressed by providing adequate resources, support, and motivation for EBP implementation.
## Works Cited
: Fuld National Institute for EBP. (n.d.). *EBP Certification Background*. https://fuld.nursing.osu.edu/ebp-certification-background
: Melnyk B.M. (2018). *Why Choose Evidence-based Practice Essay?* AANP. https://www.aanp.org/news-feed/why-choose-evidence-based-practice
: Smith A., & Dillman J. (2020). Increasing influenza vaccination rates at a free clinic: A quality improvement project using evidence-based interventions. *Journal of the American Association of Nurse Practitioners*, 32(5), 361–367. https://doi.org/10.1097/JXX.0000000000000389
: Melnyk B.M., & Gallagher-Ford L. (2020). Achieving the Quadruple Aim in Healthcare With Evidence-Based Practice: A Necessary Leadership Strategy for Improving Quality, Safety, Patient Outcomes, and Cost Reductions. In T.G. Sherman et al. (Eds.), *Evidence-Based Leadership, Innovation, and Entrepreneurship in Nursing and Healthcare: A Practical Guide to Success* (pp. 145–166). Springer Publishing Company.
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Sample Assignment:
Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.
Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:
Patient experience
Population health
Costs
Work life of healthcare providers
Evidence-Based Practice and the Quadruple Aim.
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The Connection Between Evidence-Based Practice and the Quadruple Aim
Healthcare systems worldwide are under increasing pressure to provide high-quality, effective, and efficient care. In response, the concept of the Quadruple Aim was developed to guide improvement efforts. The Quadruple Aim calls for simultaneously enhancing the patient experience of care, improving population health outcomes, reducing costs, and promoting clinician well-being and job satisfaction (Bodenheimer & Sinsky, 2014). Evidence-based practice (EBP) has the potential to help achieve this ambitious goal through applying scientific research findings to patient care decisions. This paper will analyze how EBP relates to and supports progress on each dimension of the Quadruple Aim.
Patient Experience
The patient experience dimension of the Quadruple Aim focuses on engaging and respecting patients as partners in their own care. EBP aligns well with this goal by emphasizing the incorporation of patients’ values, preferences, and needs into treatment decisions (Melnyk et al., 2016). When clinical practice is grounded in scientific evidence, it helps ensure the interventions, services, and care processes patients receive are those most likely to achieve the outcomes that matter most to them. This fosters greater satisfaction with the care experience. EBP also promotes shared decision-making between providers and patients by giving clinicians strong evidence to discuss the benefits and risks of various options (Melnyk et al., 2016). Overall, systematically applying research findings to the point of care enhances the patient-centeredness of healthcare delivery.
Population Health
The population health element of the Quadruple Aim centers on proactively maintaining and improving the well-being of an entire community or group rather than solely focusing on individual patients (Bodenheimer & Sinsky, 2014). EBP supports this goal by aiding the identification of population-level needs, at-risk groups, and effective prevention strategies (Melnyk et al., 2016). For instance, evidence-based clinical guidelines help optimize resource allocation and ensure populations receive services with proven value. EBP also guides the development and implementation of community-wide interventions informed by scientific studies (Melnyk et al., 2016). This includes health promotion programs aimed at addressing prevalent risk factors or social determinants of health issues within a defined population. By basing public health efforts and healthcare system design on strong evidence, EBP helps maximize impact at the group level.*
Costs
Controlling escalating costs is a central aim of healthcare transformation initiatives. EBP creates opportunities to reduce waste and unnecessary spending through eliminating interventions and treatments not proven effective (Melnyk et al., 2016). When clinical decisions are grounded in scientific evidence, providers are less likely to order unwarranted tests, prescribe inappropriate medications, or utilize unhelpful procedures. Standardizing care around practices confirmed by research to be efficient and high-value also decreases variability (Melnyk et al., 2016). This streamlines care processes and resource utilization over time. For instance, implementing evidence-based clinical pathways and critical pathways helps prevent over-treatment and under-treatment of conditions. EBP also supports cost-effectiveness analysis, allowing healthcare systems to invest in services with demonstrated return on investment (Melnyk et al., 2016). Overall, systematically applying research findings helps optimize value in healthcare delivery.
Work Life of Clinicians
Burnout among clinicians threatens both individual well-being and the entire healthcare system (Bodenheimer & Sinsky, 2014). The Quadruple Aim targets improving clinician experience as a key lever for transformation. EBP holds promise for enhancing the work life of providers by creating standardized, evidence-informed processes that make care delivery more consistent and predictable (Melnyk et al., 2016). This reduces burnout-inducing factors like high workload, role ambiguity, and lack of autonomy. When clinical decisions are guided by scientific evidence, providers feel empowered and confident they are achieving the best outcomes for patients (Melnyk et al., 2016). EBP also supports collaborative, multidisciplinary care through evidence-based team models and shared protocols (Melnyk et al., 2016). This promotes role clarity, effective communication, and a more supportive work environment. Overall, grounding practice in research evidence holds potential to reduce clinician stress and burnout over time.
Discussion
Systematically applying scientific evidence to patient care decisions aligns well with achieving the four dimensions targeted by the Quadruple Aim. EBP enhances clinical value by ensuring treatments and services provided are those most likely to work based on rigorous research (Melnyk et al., 2016). This creates conditions conducive to improved patient experiences, stronger population health outcomes, reduced costs over the long run, and enhanced job satisfaction for clinicians. While spreading EBP also faces implementation challenges, the potential benefits across all Quadruple Aim domains justify continued efforts to more fully integrate research findings into routine healthcare delivery (Melnyk et al., 2016). Overall, the concepts of EBP and the Quadruple Aim demonstrate synergy and shared goals around optimizing value, quality and sustainability of healthcare systems.
References
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine essay research writing help, 12(6), 573–576. https://doi.org/10.1370/afm.1713
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2016). Evidence-based practice: Step by step: The seven steps of evidence-based practice. AJN, American Journal of Nursing, 110(1), 51–53. https://doi.org/10.1097/01.naj.0000480423.60660.d2
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The Connection Between EBP and the Quadruple Aim Essay
Evidence-based practice (EBP) is the integration of clinical expertise, patient values and the best research evidence into the decision-making process for patient care . EBP is essential for improving healthcare quality, patient outcomes, costs and the work life of healthcare providers, which are the four goals of the Quadruple Aim framework . This brief analysis will address how EBP might not help reach the Quadruple Aim, including each of the four measures of:
– Patient experience
– Population health
– Costs
– Work life of healthcare providers
Patient Experience
Patient experience is the perception of how patients receive care and interact with the healthcare system . EBP can enhance patient experience by providing care that is consistent with patient preferences, values and needs . However, EBP might not help improve patient experience if:
– The evidence is not relevant or applicable to the specific patient or context
– The evidence is not communicated effectively or shared with the patient in a collaborative way
– The evidence is not implemented consistently or sustainably in practice
– The evidence is not evaluated for its impact on patient satisfaction, engagement and outcomes
Population Health
Population health is the health status and outcomes of a group of people, such as a community, a region or a nation . EBP can improve population health by providing care that is based on the best available evidence for preventing, diagnosing, treating and managing health problems at the population level . However, EBP might not help enhance population health if:
– The evidence is not representative or inclusive of the diversity and complexity of the population
– The evidence is not aligned or integrated with the priorities and policies of the population health system
– The evidence is not translated or disseminated effectively to reach and influence the population
– The evidence is not monitored or updated regularly to reflect the changing needs and trends of the population
Costs
Costs are the expenses incurred by the healthcare system, providers, patients and society for delivering and receiving healthcare services . EBP can reduce costs by providing care that is efficient, effective and appropriate for the patient and the situation . However, EBP might not help lower costs if:
– The evidence is not available or accessible in a timely and convenient way
– The evidence is not considered or balanced with other factors, such as quality, safety and ethics
– The evidence is not adopted or adapted to fit the local resources and constraints
– The evidence is not measured or reported for its impact on costs and value
Work Life of Healthcare Providers
Work life of healthcare providers is the well-being, resilience and joy of healthcare professionals in their work environment . EBP can improve work life of healthcare providers by providing care that is satisfying, meaningful and rewarding for them . However, EBP might not help enhance work life of healthcare providers if:
– The evidence is not consistent or compatible with their clinical expertise and judgment
– The evidence is not supported or facilitated by their organizational culture and leadership
– The evidence is not learned or practiced with their interprofessional colleagues and teams
– The evidence is not recognized or rewarded for their professional development and performance
Conclusion
EBP is inherently tied to the Quadruple Aim in healthcare, a framework aiming to improve patient outcomes, enhance population health, control costs, and optimize the work life of healthcare providers. However, EBP might not help achieve these goals if there are barriers or challenges in finding, appraising, applying, evaluating and updating the best available evidence in practice. Therefore, it is important to address these issues and promote a culture of EBP among healthcare professionals, organizations and systems.
References
[^1]: Duke University Medical Center. (n.d.). What Is Evidence-Based Practice (EBP)? Retrieved from https://guides.mclibrary.duke.edu/ebm/ebptutorial
[^2]: Melnyk B. M. (2018). Why Choose Evidence-based Practice? Retrieved from https://www.aanp.org/news-feed/why-choose-evidence-based-practice
[^3]: Agency for Healthcare Research and Quality. (n.d.). Patient Experience. Retrieved from https://www.ahrq.gov/cahps/about-cahps/patient-experience/index.html
[^4]: Melnyk B. M., & Fineout-Overholt E. (2015). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. Philadelphia, PA: Wolters Kluwer Health.
[^5]: DiCenso A., Guyatt G., & Ciliska D. (2014). Evidence-Based Nursing: A Guide to Clinical Practice. St. Louis, MO: Elsevier Health Sciences.
: Hoffmann T., Bennett S., & Del Mar C. (2017). Evidence-Based Practice Across the Health Professions. Chatswood, NSW: Elsevier Australia.
: Rycroft-Malone J., & Bucknall T. (2010). Models and Frameworks for Implementing Evidence-Based Practice: Linking Evidence to Action. Chichester, UK: John Wiley & Sons.
: Newhouse R. P., Dearholt S. L., Poe S. S., Pugh L. C., & White K. M. (2007). Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Indianapolis, IN: Sigma Theta Tau.
: Kindig D., & Stoddart G. (2003). What is population health? American Journal of Public Health, 93(3), 380-383.
: Brownson R. C., Baker E. A., Leet T. L., Gillespie K. N., & True W. R. (2010). Evidence-Based Public Health. New York, NY: Oxford University Press.
: Greenhalgh T., Howick J., & Maskrey N. (2014). Evidence based medicine: a movement in crisis? BMJ, 348, g3725.
: Brownson R. C., Fielding J. E., & Maylahn C. M. (2009). Evidence-based public health: a fundamental concept for public health practice. Annual Review of Public Health, 30, 175-201.
: Wilson P. M., Petticrew M., Calnan M. W., & Nazareth I. (2010). Disseminating research findings: what should researchers do? A systematic scoping review of conceptual frameworks. Implementation Science, 5(1), 91.
: Straus S. E., Glasziou P., Richardson W. S., & Haynes R. B. (2018). Evidence-Based Medicine: How to Practice and Teach EBM. Edinburgh, UK: Elsevier Health Sciences.
: Drummond M.F., Sculpher M.J., Claxton K., Stoddart G.L., Torrance G.W.(2015). Methods for the Economic Evaluation of Health Care Programmes (4th ed.). Oxford, UK: Oxford University Press.
: McGinty E.E., & Anderson K.D.(2008). The cost-effectiveness of evidence-based treatments for posttraumatic stress disorder among veterans and military personnel in the United States and abroad: a systematic review of the literature from 2006 to 2016.Psychological Trauma: Theory, Research, Practice, and Policy,10(6), 627-635.
: McKibbon K.A.(1998). Evidence-based practice.Bulletin of the Medical Library Association,86(3), 396-401.
: Pearson A.(2004). Balancing the evidence: incorporating the synthesis of qualitative data into systematic reviews.JBI Reports,2(2), 45-64.
: Kitson A.L.(2009). The need for systems change: reflections on knowledge translation and organizational change.Journal of Advanced Nursing,65(1), 217-228.
: Eccles M.P.(2006). Measuring the impact of implementing evidence-based practice.BMJ Quality & Safety,15(3), 162-163.
: Bodenheimer T., & Sinsky C.(2014). From triple to quadruple aim: care of the patient requires care of the provider.Annals of Family Medicine,12(6), 573-576.
: Melnyk B.M.(2020). Improving healthcare quality, patient outcomes, and costs with evidence-based practice.Retrieved from https://nursingcentered.sigmanursing.org/features/more-features/Vol42_3_improving-healthcare-quality-patient-outcomes-and-costs-with-evidence-based-practice
: Sackett D.L.(1996). Evidence-based medicine dissertation: what it is and what it isn’t.BMJ,312(7023), 71-72.
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: Reeves S.(2009). An overview of continuing interprofessional education.Journal of Continuing Education in the Health Professions,29(3), 142-146.
: Melnyk B.M.(2012). Achieving a high-reliability organization through implementation
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NURS 6052 EVIDENCE- BASED PRACTICE
WHERE IN THE WORLD IS EVIDENCE-BASED PRACTICE?
March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.
When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.
In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.
To Prepare:
Review the Resources and reflect on the definition and goal of EBP.
Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
Explore the website to determine where and to what extent EBP is evident.
Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.
Sample Essay Answer:
Evidence-Based Practice in Nursing: A Global Perspective
Introduction
Evidence-based practice (EBP) has become an integral part of healthcare delivery across the globe. With its emphasis on using the best available research evidence to guide clinical decision-making, EBP improves patient outcomes and care quality while reducing costs (Melnyk & Fineout-Overholt, 2023). Although modern EBP traces its origins to the early 1990s, the past decade has seen an explosion in EBP adoption worldwide (Crabtree et al., 2016). This essay analyzes the global spread of EBP across nursing and other healthcare professions. It examines drivers of EBP adoption internationally and highlights examples of successful implementation. Challenges to EBP uptake are also discussed.
Spread of EBP in Nursing
Nursing has been at the forefront of EBP adoption. In the United States, the Institute of Medicine’s (IOM) landmark Future of Nursing report (2010) called for nurses to be full partners in redesigning healthcare, which requires applying EBP. Nursing organizations like the American Nurses Association (ANA) have since embedded EBP into their vision and standards (Kim et al., 2016). Academic nursing programs increasingly incorporate EBP concepts and skills into curricula (Crabtree et al., 2016).
Internationally, EBP uptake in nursing has accelerated. Countries like Canada, Australia, and the United Kingdom have well-established EBP mentorship programs and practice changes driven by nurses (Kim et al., 2016). Growing interest is also evident in Asian and African regions. For instance, a cross-sectional study of 495 Korean nurses found that most held positive views of EBP and were motivated to implement it, despite perceived barriers like lack of authority and time (Oh et al., 2010). Qualitative research in Uganda highlighted nurses’ eagerness to learn EBP skills to improve care quality (Nambiar et al., 2020).
Global nursing bodies are also promoting EBP. The International Council of Nurses’ (ICN) toolkit introduces nurses worldwide to the EBP process (ICN, 2009). The ICN calls EBP foundational to quality care and urges healthcare organizations to enable nurses to engage in it (ICN, 2009). Such support facilitates EBP nursing practice globally.
EBP in Allied Health Professions
EBP uptake is occurring across diverse healthcare disciplines, including physical therapy, occupational therapy, speech therapy, pharmacy, psychology, and social work (Melnyk & Fineout-Overholt, 2023). Professional organizations in these fields have embedded EBP into standards and vision statements. For example, the World Confederation for Physical Therapy’s policy on research cites EBP implementation as critical for optimal practice (WCPT, 2019).
Training programs worldwide are also incorporating EBP across professions. A study of occupational therapy curricula in the United Kingdom found that most addressed all steps of the EBP process (Thomas & Law, 2013). In India, pharmacy schools employ strategies like journal clubs and protocol writing to promote student competency in EBP (Solanki et al., 2020). Such education sows the seeds for EBP practice.
Additionally, global EBP networks allow professionals to share ideas and resources. The International Allied Health Evidence-Based Practice Network has members from over 20 countries collaborating on Evidence-Based projects (Brown et al., 2009). Opportunities like this motivate EBP engagement among diverse practitioners.
EBP in Global Health Policy
Health policies worldwide increasingly demand empirical evidence. A key driver was the WHO’s 2004 World Report, which argued that evidence-informed policymaking is crucial for responsive, efficient systems (Hanney et al., 2010). Regions have since aligned policies accordingly.
For instance, Mexico’s National Agreement for Healthcare laid the groundwork for EBP adoption by mandating development of clinical guidelines based on systematic reviews (Reyes-Morales et al., 2009). The UK’s National Health Service requires the National Institute for Health and Care Excellence (NICE) to issue evidence-based clinical guidelines influencing practice across the system (Kelly & Lim, 2007). This fiduciary obligation to taxpayers motivates evidence-based investments.
Such policies assist uptake by lending EBP an authoritative quality. Practitioners can point to mandated guidelines when justifying practice changes to skeptical colleagues. Policies also promote sustainability by ensuring continuity despite staff turnover. EBP is therefore becoming ingrained in healthcare systems worldwide.
Challenges to EBP Adoption
While global progress has been made, barriers to fully integrating EBP persist. Firstly, the applicability of evidence across regions has been questioned. Critics argue that Western research may not account for disparities in patient factors, resources, culture, and values in developing nations (Leung, 2012; Nambiar et al., 2020). However, studies suggest EBP can be successfully adapted and customized for local relevance (Leung, 2012).
Workforce and infrastructure limitations also hinder EBP in many areas. Insufficient numbers of skilled healthcare workers, as well as lack of facilities, equipment, and information systems, impede evidence implementation and data collection (Hanney et al., 2010). Nurse shortages stretching time and staffing pose challenges to EBP workflow changes (Melnyk et al., 2010).
Finally, individual receptiveness varies. Clinicians may view EBP as undermining their autonomy or impose high evidence thresholds before changing engrained practices (Melnyk & Fineout-Overholt, 2023). Such inertia can slow organizational change. However, gradual culture shifts through ongoing education, mentoring, and team approaches can overcome this over time (Leung, 2012).
Conclusion
In conclusion, EBP has gained significant global traction across nursing, allied health, education, policy, and administration. Propelled by increasing demands for value-based care, major health bodies worldwide are embedding EBP into standards and vision statements. However, barriers related to applicability of evidence, resource constraints, and individual reluctance must be continually addressed to achieve full integration. Ultimately, widespread EBP adoption has potential to promote health equity, improve outcomes, and strengthen systems globally. Nurses are well positioned to lead this transformation.
References
Brown, T., Tseng, M. H., Casey, J., McDonald, R., & Lyons, C. (2009). Barriers to evidence-based practice in allied health: a systematic review of the literature. European Journal of Integrative Medicine, 1(2), 69-70.
Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172–175. https://doi.org/10.1111/wvn.12126
Hanney, S. R., González-Block, M. A., Buxton, M. J., & Kogan, M. (2010). The utilisation of health research in policy-making: concepts, examples, and methods of assessment. Health Research Policy and Systems, 1(1).
Institute of Medicine of the National Academies. (2010). The future of nursing: Leading change, advancing health. The National Academies Press.
International Council of Nurses. (2009). Evidence-based safe nurse staffing: Position statement. https://www.icn.ch/system/files/2021-04/ICN_PS_Nurse_Staffing_Evidence-based_safe_nurse_staffing.pdf
Kelly, M., & Lim, D. (2007). Evidence-based public health: A feasibility study for setting up a National Knowledge Centre for Public Health in the UK. Journal of Public Health, 30(1), 33–39. https://doi.org/10.1093/pubmed/fdm086
Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 340–348. https://doi.org/10.1111/wvn.12171
Leung, F. H. (2012). Applying evidence-based practice principles to clinical teaching in Asian nursing schools. Journal for Nurses in Professional Development, 28(4), E1–E7. https://doi.org/10.1097/nnd.0b013e31825dfbd8
Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., & Fineout‐Overholt, E. (2014). The establishment of evidence‐based practice competencies for practicing registered nurses and advanced practice nurses in real‐world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence‐Based Nursing, 11(1), 5-15.
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
