Internal and External Evidence


A critical review of nursing practice is essential in maximizing patient outcomes. Inherent in this phrase is the knowledge regarding how evidence-based practice (EBP) is implemented. EBP has been an issue of concern among healthcare administrators, researchers and staff. Within this concept is the aspect of external and internal evidence. Decisions regarding health-related issues are normally achieved after synthesizing the external and internal evidence (LoBiondo-Wood & Haber, 2017). The objective of this essay is to discuss the differences between internal evidence and external evidence and eventually explain how these types of evidence can be utilized for quality improvement in the clinical setting. 

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The Difference between Internal and External Evidence

Internal evidence consists of the knowledge obtained through training and formal education, specific experience due to the clinician-patient relationship and the generation experienced obtained through daily practice. It is normally created, utilized and retained within the organization of the client. Internal evidence entails clinical expertise, healthcare quality improvement projects at institutional level and outcome management initiatives (Porzsolt, et al. 2003). For instance, the internal evidence is normally applied especially in diagnostic reasoning like practice data available in healthcare records. 

On the other hand, external evidence includes best practice, clinical practice guidelines, systematic review, and randomized control trials that offer assistance in implementing clinical practice changes. It is any information that can be accessed through research. External evidence is therefore found in scientific research and randomized control trials (Porzsolt, et al. 2003). 

Utilization for Quality Improvement

The availability of sound evidence determines the effectiveness of quality improvement projects. The interventions influence the effectiveness of such initiatives or projects in terms of cost-effective and clinical importance as well as the utilization of sound evidence to implement predefined approaches or products. Internal and external evidence aims to fill translational gaps that establish a framework for implementation and quality improvement (Gillam & Siriwardena, 2014).  


Gillam, S., & Siriwardena, A. N. (2014). Evidence-based healthcare and quality improvement. Quality in primary care, 22(3), 125-132.

LoBiondo-Wood, G., & Haber, J. (2017). Nursing research-E-book: methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.Porzsolt, F., Ohletz, A., Thim, A., Gardner, D., Ruatti, H., Meier, H., … & Schrott, L. (2003). Evidence-based decision making—the six-step approach. BMJ Evidence-Based Medicine, 8(6), 165-166.

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