Evidence-Based Practice in Social Work and Nursing

PART 1 – Introduction: Why every piece of evidence work starts with a good question

From gut feeling to question

Imagine a team meeting in a residential group. Someone says: “We should try life-story work.” Everyone nods. But what exactly is meant by that? Who would it be for? What would you compare it with? And how would you know later that it had done the young people any good? As long as these points remain open, you can neither research sensibly nor decide on good grounds. This is exactly where this module comes in: it is about the step that carries everything else, namely a question that can be answered.

You already know from Module 1 the definition of evidence-based practice by Sackett et al. (1996) and the building blocks of an evidence-based decision. Here we pick up at a practical point: before evidence can be appraised, weighed up or applied, it must be clear what it is meant to refer to. A good question is therefore not an optional extra but the steering wheel of the whole process.

Practice question, search question, research question – sorting out three terms

In your studies you will come across several terms that are easily mixed up. In this course we use them as working definitions. A practice question arises in the everyday language of a situation: “Does this actually help?” or “Is there anything better than bed rails?”. A search question is a question framed so precisely that search terms can be derived from it; Module 4 explains how to do this. The research question of a term paper, finally, is the guiding question of your argument. It can arise from a search question, but it is not automatically the same thing: in a term paper you also have to place the question in the professional debate and explain why it is relevant.

The idea behind evidence-based work explains why the route from an everyday question to a search question is worthwhile. The Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) describes it as follows: for questions about health, you do not rely on opinions alone but on findings obtained with scientific methods that are as objective as possible (IQWiG, 2025). Opinions and routines certainly have their place in a team, but they do not replace a targeted question. A vague question almost inevitably leads to vague results: too many hits that have nothing to do with your situation, or studies that answer a different question from the one you asked.

The overview: mind map of the module

Figure 1 shows how the contents of this module fit together. The EBP cycle is at the centre. Five branches lead away from it: the question itself, the PICO mnemonic, the steps of the cycle, the preferences of service users and the limits of the approach. Later you can use the mind map as a memory aid to recall the structure of the module.

PART 2 – Foundations: The EBP cycle in five steps

The model at a glance

In evidence-based nursing, nursing decisions rest on two sources of knowledge: external and internal evidence (general professional knowledge in nursing science). The steps there run from shared decision-making and formulating the problem, through searching and critical appraisal, to changing practice and evaluation. In this course we summarise this sequence in five steps: ask the question, acquire evidence, appraise it critically, apply it together with service users, and assess the result.

Figure 2 shows the five steps as a cycle. The arrow from the fifth step back to the first expresses that the work is never “finished”: what you learn during the evaluation becomes the basis for the next question.

The five steps in detail

Step 1 – Ask. You translate a situation from practice into a question that can be answered. This step is the topic of the present module. Service users should already be kept in mind here, because evidence-based practice in nursing begins with shared decision-making and formulating the problem.

Step 2 – Acquire. With your question in hand, you search in a targeted way for studies, reviews or guidelines. How to derive search terms and document a search is covered in Module 4.

Step 3 – Appraise. Sources you find are not automatically good or suitable. You judge how robust the findings are and whether they can be transferred to your situation. This includes study design (Module 3) and risks of bias (Module 5).

Step 4 – Apply. The findings meet a concrete life situation. Professional knowledge, evidence and the wishes of those involved are brought together; Module 7 looks in more depth at how this succeeds and where it becomes difficult.

Step 5 – Assess. After implementation you review what has happened in the concrete situation. A measure may look beneficial in a study and work differently in your field. Only the review on site shows whether the approach holds up.

External and internal evidence: two sources of knowledge in one question

The distinction between external and internal evidence is especially helpful for formulating the question. In evidence-based nursing, external evidence means scientifically tested experience of others, that is, what studies and reviews provide. Internal evidence covers the individual needs and experiences of people in need of care and of those who care for them. Applied to social work, this means that the views of service users and the experience of practitioners in the situation also belong to the knowledge that feeds into the decision. This transfer is an application of an idea from nursing; as you saw in Module 1, it is itself a subject of debate in social work.

For the question, this means: a good search question draws on both sources. It asks about external evidence (“What does research say about this?”) but is guided by internal evidence (“What matters to the people involved here?”). If you only consider the first half, you risk questions that miss the lifeworld.

Elaboration: Why a cycle and not a one-way street?

Ask yourself the following question and answer it briefly for yourself before reading on: why is the evaluation a step of its own and not simply the end? One possible line of thought: studies describe results under particular conditions. Whether these conditions apply to your service users is something you only learn by observing it in your own practice. At the same time, situations change, and an answer often gives rise to new questions. The cycle therefore keeps the work flexible and protects against the assumption that a decision, once made, holds for ever.

PART 3 – Method: Building the search question with PICO

Distinguishing two question types: background and foreground

Not every question needs a study search. Some questions call for basic knowledge; others call for a decision between options. We call the first group background questions (“What is …? How does … work?”) and the second foreground questions (“Does A help, compared with B, for C?”). The distinction is a teaching aid in this course; it is not attributed to any particular person here. You usually clarify a background question in textbooks or review articles. Only when you want to weigh up options for action does the foreground question become relevant, and PICO is intended for it.

There is also a third case that you should not overlook: questions that ask not about effectiveness but about experience or meaning, for example “How do young people experience moving into a residential group?”. These too are legitimate and important questions. However, they need different types of study from comparison studies; Module 3 explains which ones. Figure 3 helps you match your practice question to the right type, and Figure 4 sets the three types side by side with examples from child and youth services and from nursing.

PICO: four elements for a clear foreground question

The acronym PICO stands for population, interventions, comparators, outcomes, in German roughly Population, Interventionen, Vergleiche and Endpunkte. In the Cochrane Handbook it serves as a mnemonic for defining the question and the inclusion criteria of a systematic review (Higgins et al., 2024). The handbook is aimed at review authors. If you transfer the pattern to a practice question, this is an application of the idea and not something the handbook prescribes for practice questions. It does help you break the question down so that nothing important stays vague. For getting started, PICO is enough as a basic framework.

The table shows the four elements, each with a guiding question and an example from child and youth services and from nursing. The examples are question elements. They say nothing about whether the services mentioned actually help.

Narrowing down population and intervention

The population decides which studies are relevant to you at all. “Young people” is too broad, because a residential group, a school setting and outpatient counselling are different life situations. “Young people in a residential group home” is much better. The population should not be too narrow either: if you fix age, gender, background and diagnosis all at once, you may find nothing. What is needed is a well-reasoned balance. The same applies to the intervention: describe so precisely what is meant that another team would understand the same thing by it. A word like “life-story work” can mean very different things, and this vagueness carries over into every search.

Comparison and outcome: the often forgotten part

Many practice questions contain not a word about the comparison. “Does it help?” sounds like a complete question but is incomplete: does it help compared with what? With the usual support? With another method? With nothing additional? Only the comparison intervention makes a statement about a difference possible. The answer can also simply be “what we have done so far”, as long as it is said out loud.

The outcome is the result by which you recognise whether there is a difference. Good outcomes are clearly named and can be observed, asked about or measured. They should also be something that matters to service users. This brings us to preferences: IQWiG describes evidence-based decisions as a combination of evidence, the condition and circumstances of a person, and their preferences and attitudes, with professional expertise bringing these elements together (IQWiG, 2025). If you already think about what matters to those involved when you formulate the question, you avoid the classic mistake of measuring something that plays no role for them. Which studies later evaluate your outcomes and how effects are presented is something you learn in Module 5.

Worked example: from the team’s question to a PICO question

Before you practise yourself, we go through one fictional example in full. Mira Winter works in a residential group home. In the team, the question comes up: “Does life-story work help young people in the residential group?” Mira wants to turn this into a search question. Figure 5 shows the five working steps that we go through one after another.

Step 1: Mira first clarifies the question type. The team’s question wants to set two options side by side, namely with and without life-story work. So it is a foreground question; PICO is the right tool. Step 2: She narrows down the population. The team does not mean all young people, but young people who live in the residential group. Step 3: She clarifies the intervention. In conversation it becomes clear that the team means a planned, structured service and not every conversation about the past. Step 4: She names the comparison: the usual support in everyday group life without such a service. Step 5: Together with the team, she defines a few outcomes, for example the young people’s self-reported wellbeing and self-esteem. Ideally the team first asks what would matter to the young people themselves.

The result reads: “Compared with the usual support without this service, does structured life-story work improve self-reported wellbeing and self-esteem in young people in a residential group home?” Note what deliberately stays open in this example: whether life-story work helps is not something this course states. The example shows only how a question comes about. In Module 4 you will derive search terms and synonyms from the four elements, so it is worth formulating them precisely now.

PART 4 – Application: Data as context, cases and an exercise

A practice question has a context: residential care and full-time foster care

Questions do not arise in a vacuum. Anyone working in child and youth services moves in a field in which many young people are looked after outside their family of origin. For 2024, the Federal Statistical Office (Statistisches Bundesamt, Destatis) reports that across Germany around 134,000 young people were looked after in a residential home and just under 87,500 in a foster family; in total, around 221,500 young people grew up, at least temporarily, outside their family of origin, around 7,000 or 3% more than in 2023 (Destatis, 2026a). Figure 6 places the two larger figures side by side.

In summary: in 2024, around 134,000 young people were looked after in a residential home and just under 87,500 in a foster family. These figures should be read soberly. They describe an order of magnitude and so give an indication of how many people are affected by decisions in the field. But they say nothing about why the number has risen, nor about which form of support works better or worse. Anyone who draws a statement about effectiveness from the statistics is answering a foreground question with data that were not meant for it.

Two case studies

The following cases are fictional. In both, the focus is expressly only on formulating the question and not on an answer from studies.

Exercise with step-by-step hints

Now it is your turn. The exercise is built on the worked example: you apply the same five working steps to three new, deliberately vague questions.

PART 5 – Critical perspective: Limits, tensions and consequences

Not every good question is an effectiveness question

PICO is a strong tool, but a one-sided one: it thinks in terms of interventions, comparisons and measurable outcomes, that is, in questions about effectiveness. Many questions in social work and nursing are of a different kind. How do people experience a situation? What does a move or a service mean to them? Such questions are hard to capture with a comparison pattern, and it would be a mistake to discard them because they do not fit the pattern. The choice of question determines which form of knowledge comes into view at all. If you ask only foreground questions in PICO format, you systematically screen out whatever cannot be expressed in outcomes. This is why Module 3 takes up the question of which type of study suits which question.

The choice of outcomes is not neutral either. What counts as success is a value judgement: is it the behaviour that practitioners see as progress, or the wellbeing that those affected report? Involving service users in formulating the question does not solve the problem, but it makes it visible. It may also be that there is simply no suitable study for your precise question. That is not a failure of the question but a result that you can name in a term paper as a research gap.

The debate in social work

You already learned in Module 1 that this approach is the subject of controversial debate in German-language social work: supportive, critical and mediating positions face each other. For this module, the critical arguments matter most: the technology deficit of social interaction and the limited transferability of causal models.

For formulating the question, this gives rise to an interpretation that is flagged as such: anyone who approaches practice only with the question “Which method works?” tacitly adopts a technical understanding of social work, as if help could be called up at the push of a button. Anyone who instead uses PICO as one of several questioning techniques and involves service users in the question stays closer to what the critics call for. In a term paper you do not have to take sides, but you should be able to explain why you choose a particular form of question.

Typical stumbling blocks

• Several questions in one: “Does it help, and how do those involved experience it, and what does it cost?” – separate the questions and work on them one after another.
• Unclear intervention: a term like “counselling” or “support” can mean many things; describe what exactly is supposed to happen.
• Missing comparison: without a comparison, “helps” remains an empty word.
• Outcomes that nobody wanted: measurable is not automatically meaningful; clarify with those involved what counts.
• Bending the question afterwards: if you only phrase the question to fit after reading the results, you merely justify what was already settled.

Consequences for term paper, presentation, timed written paper and practical placement

In the term paper a clean question helps you limit the scope and justify your choice of literature. Whether PICO is required or useful there depends on the task and on the requirements of your degree programme; there is no rule that every term paper must contain a PICO question. In the presentation the practice question works well as a common thread: you first present the question, then your search path and finally what you draw from it. In the timed written paper you can name the five steps of the cycle, explain the PICO elements and reformulate a vague question as a precise one. In the practical placement you can raise questions in the team as search questions without attacking routines: asking a question is not criticism but an invitation to think together. This course does not replace any lecture or any practical placement; it helps you organise and practise what you have learned.

Consolidation: Flashcards for the module

The flashcards help you with retrieval. For each card, first think of an answer of your own and only then open it. Retrieving from memory consolidates more than reading again.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and nobody evaluates them. Click an answer; the explanation helps you judge your own understanding.