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Research Guides

Evidence-Based Practice Portfolio

The goal of this guide is to provide nurses a resource to understand and carryout the steps of performing an evidence-based practice (EBP) project.

Contributors

Updated:  November  27,2018  

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  translationIndianapolis, IN: Sigma Theta Tau International.

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

Place on the Diagram

Johns Hopkins Form - Levels of Evidence and Quality

How Many Articles or Evidence Do You Need to Move Forward?

The number of articles or amount of evidence needed to make a practice change is based on a combination of factors:

1. The Level and Quality of Evidence Found.

  • It is a good practice to have team members evaluate the 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.
  • Remember that some questions will not have Level I evidence.  Keep in mind the type of question you are asking will help to dictate the type of primary studies or level of evidence that may be available to answer the question. 

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

  • The composition of your team is critical because the knowledge of the team may help to fill in the blanks of the evidence you have found.  The team members will also be key when it comes to properly evaluate the evidence and gaining buy-in from the stakeholders on the unit or patient.  

3. The willingness of Patient or Unit to Adopt of Go Along with the Practice Change.

  • Important to have an interdisciplinary team and be sure you are communicating with the person or persons that the intervention will affect.  Communication is key as to whether the practice change or intervention will be adopted.

Types of Evidence


Research 

 

Summaries of Multiple Studies

(Summative Research Techniques)

  • Systematic Reviews
  • Meta-Analysis 
  • Meta-Synthesis 

Individual Research Studies 

  • Randomized Controlled Trials (Experimental) 
  • Quasi-Experimental
  • Non-Experimental (Quantative)
  • Qualitative
  • Mixed Methods 

Nonresearch 

Summaries of Evidence 

  • Practice Guidelines and Consensus / Position Statements 
  • Literature Review 
  • Integrative Review 

Organizational Experience 

  • Quality Improvement Reports 
  • Financial Evaluation 

Expert Opinion 

  • Case Report 

Community Standard 

Clinical Experience 

Patient / Consumer Experience 

 

 

Johns Hopkins Nursing EBP: Levels of Evidence

 

Evidence Levels Quality Ratings

 

Level I

Experimental study, randomized controlled trial (RCT)

Explanatory mixed method design that includes only a level I quantitative study

   A systematic review of RCTs, with or without meta-analysis

 

 

QuaNtitative Studies

A. High quality:   Consistent, generalizable results; sufficient sample size for the study design; adequate control; definitive conclusions; consistent recommendations based on a comprehensive literature review that includes thorough reference to scientific evidence.

B. Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, fairly definitive conclusions; reasonably consistent recommendations based on a fairly comprehensive literature review that includes some reference to scientific evidence.

C. Low quality or major flaws:  Little evidence within consistent results; insufficient sample size for the study design; conclusions cannot be drawn.

 

 

Level II

Quasi-experimental study

Explanatory mixed method design that includes only a level II quantitative study

 A systematic review of a combination of RCTs and quasi-experimental studies, or  quasi-experimental studies only, with or without meta-analysis

_________________________

Level III

Non-experimental study

A systematic review of a combination of RCTs, quasi-experimental and non-experimental studies, or non-experimental studies only, with or without meta-analysis

Exploratory, convergent, or multiphasic mixed methods studies

Explanatory mixed method design that includes only a level III quantitative study

  QuaLitative study Meta-synthesis

 

 

 

QuaLitative Studies

No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective process based on the extent to which study data contributes to synthesis and how much information is known about the researchers’ efforts to meet the appraisal criteria.

For meta-synthesis, there is preliminary agreement that quality assessments of individual studies should be made before synthesis to screen out poor-quality studies(1).

 

A/B. High/Good quality is used for single studies and meta-syntheses (2).

The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in sufficient detail, and it describes the specific techniques used to enhance the quality of the inquiry. Evidence of some or all of the following is found in the report:

  • Transparency: Describes how information was documented to justify decisions, how data were reviewed by others, and how themes and categories were formulated.
  • Diligence: Reads and rereads data to check interpretations; seeks an opportunity to find multiple sources to corroborate evidence.
  • Verification: The process of checking, confirming, and ensuring methodologic coherence.
  • Self-reflection and -scrutiny: Being continuously aware of how a researcher’s experiences, background, or prejudices might shape and bias analysis and interpretations.
  • Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and interpretation give voice to those who participated.
  • Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature.

C. Lower-quality: studies contribute little to the overall review of findings and have few, if any, of the features listed for High/Good quality.

 

 

Level IV

The opinion of respected authorities and/or nationally recognized expert committees or consensus panels based on scientific evidence

Includes:

  • Clinical practice guidelines
  • Consensus panels/position statements

 

 

 

A. High-quality: Material officially sponsored by a professional, public, or private organization or a government agency; documentation of a systematic literature search strategy; consistent results with sufficient numbers of well-designed studies; criteria-based evaluation of overall scientific strength and quality of included studies and definitive conclusions; national expert is clearly evident; developed or revised within the past five years

B. Good quality: Material officially sponsored by a professional, public, or private organization or a government agency; reasonably thorough and appropriate systematic literature search strategy; reasonably consistent results, sufficient numbers of well-designed studies; evaluation of strengths and limitations of included studies with fairly definitive conclusions; national expert is clearly evident; developed or revised within the past five years

C. Low quality or major flaws: Material not sponsored by an official organization or agency; undefined, poorly defined, or limited literature search strategy; no evaluation of strengths and limitations of included studies, insufficient evidence with inconsistent results, conclusions cannot be drawn; not revised within the past five years

 

 

Level V

Based on experiential and non-research evidence

Includes:

  • Integrative reviews
  • Literature reviews
  • Quality improvement, program, or financial evaluation
  • Case reports

An opinion of nationally recognized expert(s)based on experiential evidence

 

 

Organizational Experience (quality improvement, program or financial evaluation)

A. High-quality: Clear aims and objectives; consistent results across multiple settings; formal quality improvement, financial, or program evaluation methods used; definitive conclusions; consistent recommendations with thorough reference to scientific evidence

B. Good quality: Clear aims and objectives; consistent results in a single setting; formal quality improvement, financial, or program evaluation methods used; reasonably consistent recommendations with some reference to scientific evidence

C. Low quality or major flaws: Unclear or missing aims and objectives; inconsistent results; poorly defined quality improvement, financial, or program evaluation methods; recommendations cannot be made

Integrative Review, Literature Review, Expert Opinion, Case Report, Community Standard, Clinician Experience, Consumer Preference

A. High-quality: Expertise is clearly evident; draws definitive conclusions; provides scientific rationale; thought leader(s)in the field

B Good quality: Expertise appears to be credible; draws fairly definitive conclusions; provides a logical argument for opinions

C  Low quality or major flaws: Expertise is not discernable or is dubious; conclusions cannot be drawn