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Johns Hopkins Nursing Evidence-Based Practice

Upstate's companion guide for Johns Hopkins Nursing Evidence-Based Practice.

Step 1: Recruit an Interprofessional Team

The use of interprofessional teams to examine clinical practice questions is encouraged. Interprofessional teams may include nurses, physicians, pharmacists, or other professionals. Having a variety of perspectives included will make it easier to identify your stakeholders. 

Step 2: Define the Problem

Problems typically fall into three categories: clinical, managerial, or educational

Image of Clinical, Managerial, and Educational problem examples.


EBP Projects and questions are typically based on identified knowledge gaps. If you already know the answer, you may want to reframe the problem or pursue a different or related initiative. 


  • Is one practice better than another for achieving a desired outcome?
  • Think in terms of a knowledge gap versus the solutionImage with examples of question framing

Step 3: Develop and Refine your EBP Question

PICO Questions

In the practice of  evidence-based nursing, the most common way of framing a clinical question is called "PICO".  The PICO format helps you to define specific, answerable question that will lead to relevant results when you search the medical literature.

"P" Patient or Population being addressed

Who is your patient? 

"I" Intervention of Exposure being considered

What do you plan to do for the patient?

"C" Comparison Intervention or Exposure (when relevant) 

What is the alternative to your plan?

"O" Outcome(s) of interest

What is the goal of the intervention?





  • Answer: Who, What, When, Where, Why, For Whom, How Well
  • Produce a wide range of evidence
  • No comparisons to other interventions
  • Provide a starting point
  • Include specific comparisons between two or more methods
  • Produce a more limited body of evidence
  • Build on background knowledge


PLEASE NOTE: The Johns Hopkins Model of EBP recommends beginning with a background question before moving on to a foreground question. 

Johns Hopkins EBP Question Development tool

The Johns Hopkins Nursing Evidence-Based Practice Model provides a Question Development Tool to provide you guidance with navigating the above steps in creating an answerable clinical question. It can be downloaded here.

Step 4: Identify the Stakeholders

A stakeholder is a person or group of people who have an interest in an activity or decision made by an organization. In healthcare, these can be people who carry out the process under review or people who are affected by a change in practice. Some examples of stakeholders may include: nurses, physicians, HCTs, pharmacists, social work, environmental services. 

Identifying your stakeholders early in the EBP process is important because stakeholder buy-in is important for the success of the practice change implementation.

Engaging stakeholders early and often is key to success!

Johns Hopkins EBP Stakeholder Analysis tool

The Johns Hopkins Nursing Evidence-Based Practice Model provides a stakeholder analysis tool. It can be downloaded here.

Step 5: Determine Responsibility for Project Leadership

Choosing an appropriate leader is important for the project's success. The leader should have experience in evidence-based practice and working with interprofessional teams. 

Step 6: Schedule Team Meetings

Teams that meet regularly are more likely to see EBP initiatives through to completion. 

This guide was created by adapting materials from The Johns Hopkins Nursing Center for Evidence-Based Practice.