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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 application of evidence and assess one's ability to ask, acquire, appraise, and apply in order to improve one's ability to conduct EBP.

Melnyk, B. M., & Fineout-Overholt E. (2015). 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 (3rd ed., pp. 3-23). Wolters Kluwer. (UH Manoa Hamilton RT42 .M44 2015)

Straus, S. E., Glasziou, P., Richardson, W. S., Haynes, R. B., Pattani, R., & Veroniki, A. A. (2019). Evidence-based medicine: How to practice and teach EBM (5th ed.). Elsevier. (UH Manoa Hamilton E-book)

IOWA Model of Evidence-Based Practice to Promote Quality Care

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


  • Identify triggering issues / opportunities
  • State the question or purpose
  • Determine if the topic is a priority
  • Form a team


  • Assemble, appraise and synthesize body of evidence


  • Assemble, appraise and synthesize body of evidence


  • Determine the sufficiency of the research
  • Design and pilot the practice change


  • Determine if change is appropriate to adopt into practice
  • Integrate and sustain the practice change
  • Disseminate the results


Iowa Model Collaborative, Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp-Reimer, T., Tucker, S., & Authored on behalf of the Iowa Model Collaborative (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on evidence-based nursing, 14(3), 175–182. (PMID: 28632931)

Readings: Journal Articles

Below are links to PubMed citation records for article series about EBP.

Readings: Selected Books at UH Manoa Library


The resources below are unrestricted.

Web Resources

The resources below are unrestricted.

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