According to Cook, Jaeschke, Guyatt, the ‘five steps of EBP were first described in 1992 and most steps have now been subjected to trials of teaching effectiveness’ (1992 p. 275-82) The process of EBP includes the following steps:
1. converting information needs into answerable questions;
2. tracking down, with maximum efficiency, the best evidence with which to answer them (whether from clinical examination, diagnostic laboratory, research evidence or other sources);
3. critically appraise that evidence for its validity and usefulness;
4. apply the results of this appraisal in our clinical practice; and
5. evaluate our performance
(Sacket et al 1997, p. 3).
This five-step model forms the basis for both clinical practice and teaching EBP, and as Rosenberg and Donald have observed ‘an immediate attraction of evidence-based medicine is that it integrates medical education with clinical practice’ (1995, p. 1122- 3). Good practice including effective clinical decision-making, step 4 of the EBP process, requires the explicit research evidence and non-research knowledge (tacit knowledge or accumulated wisdom). Clinical decision-making is the ‘end point of a process that includes clinical reasoning, problem solving, and awareness of patient and health care context’ (Maudsley 2000, p. 63).
Since 1990, when EBP was introduced, it has broadened to reflect the benefits of entire health care teams and organisations adopting a shared evidence-based approach. This emphasises the fact that evidence-based practitioners may share more attitudes in common with other evidence-based practitioners than with non evidence-based colleagues from their own profession who do not embrace an evidence-based paradigm (American Medical Association 1992, p.4).