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Evidence-Based Practice: Getting Started

Key Steps of Evidence-Based Practice

Use the five "A's" to remember the critical steps of the evidence-based practice process:

ASK the answerable clinical question.

ACQUIRE the most relevant and best evidence to answer the question.

APPRAISE the evidence critically for validity, relevance, and applicability.

APPLY the evidence, along with critical expertise and the patient's preferences and values.

ASSESS the effectiveness and efficiency of the previous four steps and seek ways to improve one's ability to ask, acquire, appraise, and apply.

Melnyk, B. M., & Fineout-Overholt, E. (2005). Making the case for evidence-based practice. In: B. M. Melnyk & E. Fineout Overholt (Eds.), Evidence-based practice in nursing & healthcare: a guide to best practice (pp. 3-24). Philadelphia: Lippincott Williams & Wilkins. For UH Manoa Hamilton RT42 .M44 2005)

Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Introduction. In: Evidence-based medicine: how to practice and teach EBM (2nd ed., pp. 1-12). Edinburgh: Churchill Livingstone. (UH Manoa Hamilton RC80 .E95 2000)

Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2011). Introduction. In: Evidence-based medicine: how to practice and teach it (4th ed., pp. 1-12). Edinburgh: Churchill Livingstone/Elsevier. (UH Manoa Hamilton Reference R723.7 .E954 2011)

IOWA Model of Evidence-Based Practice to Promote Quality Care

The Hawaii State Center for Nursing has adopted the Iowa Model to guide the process of evidence-based practice projects. The steps of the Iowa Model also fall into the five "A's" listed in the box to the above.


  • Recognize the existence of problems (trigger)
  • Form a team


  • Assemble relevant research and related literature


  • Critique and synthesize research


  • Determine the sufficiency of the research
  • Determine if change is appropriate to adopt into practice
    • Institute change if appropriate


  • Monitor and analyze the structure, process, and outcome data
    • Disseminate results throughout the unit or organization


Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, C. L. Q., ... Goode, C. J. (2001). The Iowa Model of Evidence-Based Practice to promote quality care. Critical Care Nursing Clinics Of North America, 13(4), 497-509. (PMID: 11778337)

Readings: Journal Articles

Readings: Selected Books at UH Manoa Library


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Web Resources

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