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Research Guides

Evidence-Based Practice Portfolio

The goal of this guide is to provide nurses and others a resource to understand and carryout the steps of performing a EBP project.

Authors / Contributors

Eris Bill RN, MS, ACNS-BC, CHFN

Updated:  November 18, 2016 

References

Lewanowicz, W. (2011, Feb). What is .B..e..s..t Evidence? VCU Health Systems, Richmond, VA.

Newhouse, R.P., Dearholt, S.L., Poe, S.S., Pugh, L.C., & White, K.M. (2007). john hopkins nursing evidence-based practice model and  guidelines.  Indianapolis,  IN: Sigma Theta Tau  International.

Poe,S. & White, K.M. ( 2010).john Hopkins nursing evidence-based practice: implementation   and  translation. Indianapolis, IN: Sigma Theta Tau International.

Evidence-Based Practice Subgroup, Virginia Commonwealth University, Richmond, VA

Introduction

Sources of Evidence

Research Evidence Non-Research Evidence 
  • Randomized Control Trial

Meta-analysis / meta-synthesis Primary Research:

  • Experimental
  • Quasi-experimental
  • Non-experimental
  • Qualitative
  • Systematic reviews
  • Clinical Practice Guidelines
  • Expert opinion
  • Case studies
  • Performance Improvement report
  • Financial data
  • Program evaluations
  • Experience & Expertise (Clinician or Patient)

How Many Articles Do You Need to Move Forward?

The number of articles needed to make a practice change is based on a combination of factors.  

1. Level and quality of evidence found. 

  • Good idea to have team members evaluate same articles/evidence separately and then compare evaluations.  When there is a discrepancy you should discuss and come to a consensus as to the grade and level of the article/evidence.

           2. The decision is also influenced by the depth of clinical knowledge of the team.  

Johns Hopkins Nursing EBP: Levels of Evidence

 

Level I
Experimental study, randomized controlled trial (RCT)
Systematice review of RCTs, with or without meta-analysis

Level II
Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.

Level III
Non-experimental study
Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis.
Qualitative study or systematice review, with or without meta-analysis

Level IV
Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
    Includes:
         - Clinical practice guidelines
         - Consensus panels

Level V
Based on experiential and non-research evidence.
    Includes:
      - Literature reviews
      - Quality improvement, program or financial evaluation
      - Case reports
      - Opinion of nationally recognized expert(s) based on experiential evidence


Dearholt, S., Dang, Deborah, & Sigma Theta Tau International. (2012). Johns Hopkins Nursing Evidence-based Practice : Models and Guidelines.

Research or Non-Research Appraisal Tool

Which tool do I use?  Is it Research or Non-Research?

Research Evidence

Research Evidence Appraisal Tool

Which type of study is it?

Experimental - Must have 2 groups -1 group that has the intervention and 1 group that has NO intervention and the participants must be randomly chosen. Experimental studies must have all three -

  • Manipulation of a variable (they did an intervention)
  • Control group (a group with NO intervention)
  • Randomization (participants randomly chosen) (Newhouse, et al., 2007, p. 79)

Meta-analysis - quantitatively synthesizes & analyzes findings of multiple primary studies addressing a similar question (Newhouse, et al., 2007, p. 79)

Quasi-experimental - "performed when it is not practical, ethical, or possible to randomly assign subjects to experimental or control groups." (Newhouse, et al., 2007, p. 79)

  • Some manipulation  of a variable
  • Some control (a group with NO intervention)
  • No randomization Examples -
  • Non-equivalent control group: posttest only or pretest-posttest
  • One group: posttest only or pretest-posttest
  • Untreated control, repeated measures
  • Repeated treatment where subjects serve as their own controls
  • Crossover design

Non-experimental - studies what has already happened. "lt involves the study of naturally occurring phenomena (groups, treatments, and individuals) without the introduction of an intervention. (Newhouse, et al., 2007, p. 79)

  • No randomization
  • No manipulation
  • Little control Examples -
  • Descriptive
    • Exploratory
    • Survey
    • Descriptive comparative
    • Time dimensional
  • Correlational

Qualitative - "represent a category of descriptive research (historical, grounded theory, ethnographic) that challenges the traditional scientific worldview." (Newhouse, et al., 2007, p. 85)

  • No randomization
  • No manipulation
  • Little control

Meta-Synthesis - synthesizes & analyzes qualitative scientific evidence

  • Was the sample size appropriate? Subjective, based on the body of evidence that you find. (If most studies have 100 participants then a study with only 10 is not appropriate.)
  • Were study participants randomized ? The study should describe how they selected participants - if so, it should use the word randomized.
  • Was there an intervention? Did they do something to the patient?
  • Was there adequate description of the data collection methods? This is subjective - they should describe in detail how the collected the data so that it could be replicated
  • Were results clearly presented? This is subjective. Do you understand their findings?
  • Was an interpretation/analysis provided?  Did they adequately describe an analysis?
  • Were conclusions based on clearly presented results? This is subjective. Does it make sense?
  • Were study Jim;tations identified and discussed? Either they did or they didn't.‚Äč

PERTINENT STUDY FINDINGS AND RECOMMENDATIONS: This is the cliff notes of the article.  What are the most important things you learned about this study? Information here will be included in the summary of overall findings.


Quality of Evidence - See Evidence Level and Quality Guide

  • P Values and Confidence Intervals Simplified
    • P (probability value) indicates the probability of a "false positive." Think of it as the probability that the results of the study are NOT true.  Ideally, the p value is a very low number because you only want to accept what is true. A P value of <.OS or < .01 is deemed significant.
    • The confidence interval means that if the study was replicated using the same interventions and methods, it should result in the same findings within certain parameters.  Ideally, the CT is a very high percentage. A CJ o/ 95% or > is deemed significant.

The Cochrane Collaboration Library Glossary of Terms  

Non-Research Evidence

Non-Research  Evidence Appraisal Tool

Non Research Evidence  - Level V

Most questions in this tool are self-explanatory, below are tips on a few selected  questions.

  • Systematic Review
    • Is the question clear? Subjective
    • Are search strategies appropriate to include all pertinent studies?
  • Clinical Practice Guidelines
    • Were appropriate stakeholders involved in the development of this guideline? Look at credentials of stakeholders.
    • Are groups to which guidelines apply and do not ap ply clearly stated? For example, adult versus pediatric.
  • Individual expert opinion, case study, literature review
    • Is the individual an expert on the topic? Subjective - Look at the author's credentials, are they certified? Do they have significant experience in the study area?
    • Is author's opinion based on scientific evidence? Subjective - Did they cite numerous references to support their position?

PERTINENT CONCLUSIONS AND RECOMMENDATIONS

  • What are the most important things you learned about this study?
    • Information here will be included in the summary of overall findings.

Quality of Evidence - See Evidence Level and Quality Guide