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Defining Internal and External Evidence

Defining Internal and External Evidence

Internal and external evidence are important components of Evidence-Based Practice in the nursing profession because they serve as the foundation for nursing professionals’ decisions. Further research is carried out using evidence, thereby increasing the knowledge and referencing base for decision-making and improving healthcare services. Various databases, such as Cochrane, Medline, and CINAHL, contain systematic peer-reviewed articles that are used as evidence by healthcare providers after the formulation of PICOT questions. This paper will look at the databases’ strengths and weaknesses, as well as their role in answering PICOT questions.

External evidence is information that supports clinical changes, such as systematic reviews, clinical guidelines, and randomised control trials, as well as information obtained from research. Internal evidence, on the other hand, includes a person’s clinical expertise as well as quality improvement projects in a healthcare setting (Fineout-Overholt & Mazurek-Melnyk, 2011). The use of reliable external and internal evidence defines evidence-based clinical decisions (Porzsolt et al., 2003). The external evidence may provide a different finding than what the patient had in mind in the case of the PICOT question on the prevalence of uterine rupture in subsequent pregnancies in mothers who had a caesarean section. In this case, the nurse and patient may consider the length of time between the two pregnancies and associate it with the occurrence of a uterine rupture, resulting in different outcomes. In some cases, the external evidence obtained from these databases may contradict the internal evidence; therefore, the nurse may change their mind and align it with the external evidence, dismiss the external evidence due to inadequacy, or discuss both pieces of evidence with the patients, allowing the patient to participate in decision-making (Porzsolt et al., 2003).

Journal articles, research papers, and newspapers are examples of published information found in databases. They can be general, containing information from multiple fields, or specific, such as the psychology database PsycNET. Web-based search engines, on the other hand, include general information such as published articles, rumours, and blog posts. Some of the advantages of databanks over web-based search engines include the availability of relevant and reliable peer-reviewed articles. Databanks also lend credibility by providing background information on the author. Published content in journals does not change, and articles can be retrieved even after a long period of time, whereas information placed on web-based search engines can change or be modified over time. Users can access systematic reviews summarised from a large number of articles using keywords provided by the user in databases such as the Cochrane database (Fineout-Overholt & Mazurek-Melnyk, 2011).

The limitation of research papers on minor or less common subject areas is one of the databank’s shortcomings. Some databanks, such as CINAHL, charge subscription fees, which may be difficult for some students who are unable to pay for these services. Some databases may also be more difficult to use than web-based search engines. Some users may find it difficult to conduct a Medline databank search using PICO (Fineout-Overholt & Mazurek-Melnyk, 2011).

Cochrane et al. were the databases I looked into while looking for evidence for my PICOT question. I preferred using the Cochrane database based on the information found in these databases. The Cochrane Library contains peer-reviewed articles of high quality that serve as evidence for clinical care decision-making. The database also categorises its resources by topics, such as geriatrics, pregnancy, and childbirth, narrowing the search to what is relevant. Aside from that, it offers sub-topics such as caesarean section, antepartum haemorrhage, and antenatal care, allowing one to easily find their areas of interest (Pregnancy and Childbirth, n.p). When looking for evidence, it’s best to start at the top of the evidence hierarchy with a meta-analysis before looking at evidence from single descriptive or qualitative studies (Burns, Rohrich, & Chung, 2011). A study on women’s preference for caesarean section received a level of evidence of 1 due to insufficient information and wide confidence intervals, making it unreliable in decision-making.

Correct evidence is critical for decision-making and ensuring that a patient receives the best possible outcome. Evidence-Based Practice in clinical settings has improved patient outcomes and paved the way for more research into grey areas. This essay has examined the databases’ strengths and weaknesses, as well as their role in answering PICOT questions in order to improve patients’ health outcomes.


Burns, P., Rohrich, R.J. & Chung, K.C. (2011). The Levels of Evidence and their Role in Evidence-Based Medicine. PubMed Central, 128(1): 305–310. Retrieved 15 January 2017 from

Fineout-Overholt, E. & Mazurek-Melnyk, B. (2011). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice (2nd ed.). Lippincott Williams & Wilkins Publishers.

Porzsolt, F., Ohletz, A., Thim, A., Gardner, D., Ruatti, H., Meier, H., …Schrott, L. (2003). Evidence-Based Decision Making—the Six-Step Approach. British Medical Journal, 8 (6):165-166. Retrieved 15 January 2017 from

Pregnancy and Childbirth: Cochrane Library. (n.p). Retrieved 15 January 2017 from


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Defining Internal and External Evidence

Review the difference between types of evidence available in clinical practice. Refer to the evidence-based levels chart as you discuss the evidence related to your clinical question.

See the evidence-based pyramid chart in the textbook.

Defining Internal and External Evidence

Defining Internal and External Evidence

Instructions: In APA format, at least 3 references, one of them being from the textbook. ill provide a picture of the pyramid chart. 1-2 pages.

book:  Physical Title: Evidence-Based Practice in Nursing & Healthcare: A Guide to Best  Practice Edition: 4th (2018) Author: Fineout-Overholt, Melnyk

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