I have noticed that many nurse-writers, presenters, and those involved in developing evidence-based practice (EBP) programs use the definitions of evidence-based medicine offered by Sackett and colleagues:

1. "Evidence-based medicine [horizontal ellipsis] is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."1^(p2)

2. "Evidence-based medicine is the integration of the best research evidence with clinical expertise and patient values."2^(p1)

Although these are definitions of evidence-based medicine, they have been of value across the healthcare professions. In an elegant way, they have reminded healthcare professionals who provide direct services to the public to make an effort to bring scientific evidence into their care planning and decision making.

However, these definitions provide a limited and potentially misleading portrayal of EBP in nursing because they do not fully capture, or accommodate, EBP as it is being enacted in many clinical settings. The limitations of Sackett and colleagues' definitions as I see them are listed below:

1. The definitions' portrayals of how clinicians incorporate research into practice do not capture the full range of ways in which nurses and multidisciplinary teams engage research evidence-(a) Their portrayal of EBP is limited to individual clinicians seeking research evidence to incorporate into their decisions about the care of individual patients; (b) Generic evidence-based guidelines for populations or groups of patients and agency evidence-based protocols are not recognized as approaches central to EBP; and (c) The important role of organizational context in promoting EBP is not acknowledged. In particular, the definitions do not recognize that the aims and methods of evidence-based nursing and quality improvement programs are overlapping and complementary.

2. The definitions describe a form of EBP that is not widely achievable in nursing given the educational profile of the direct care nursing workforce and the pressures of nursing work environments.

Broader definitions and models of evidence-based nursing exist. Importantly, these more inclusive definitions accommodate both the organizational approach of setting evidence-based standards of care for specific patient populations and the individual clinician's use of research evidence in deciding what care to give to individual patients. For these reasons, they should be considered as working frameworks rather than the definitions of Sackett and colleagues.

Sarah Jo Brown, PhD, RN

EBP Consultant Practice-Research Integrations Norwich, Vermont, USA

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