Reading

Schmidt & Brown (2021). Evidence-Based Practice for Nurses:

• Chapter 1.2: The Hierarchy of Evidence

• Chapter 15.3: How to Appraise Evidence for Strength

Objectives

• Explain the purpose of the hierarchy of evidence

• Distinguish among the types of evidence found in the seven levels of the hierarchy of evidence

• Rank the strength of evidence using a hierarchy of evidence

Hierarchy of Evidence

• = A seven-level scale used to rate the strength of evidence

• Using a hierarchy can be helpful strategy for rating the quality of evidence to make decisions about nursing practice

Level I

• Summaries

  • = Best practice recommendations based on an appraisal of information about a particular practice question

• Synopses

  • = Brief descriptions of evidence that provide an overview of key points from multiple sources

• Meta-analyses

  • = A research method that estimates the effect of an intervention by using statistical methods to analyze data from both published and unpublished single studies

• Systematic review

  • A rigorous and systematic synthesis of research findings from experimental and quasi-experimental studies about a clinical problem

• Clinical practice guidelines

  • = Statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options

Level II

• Randomized Controlled Trials (RCTs)

  • Clinical experimental studies that typically involve large samples and are sometimes conducted in multiple sites

Level III

• Quasi-experimental designs

  • Research designs involving the manipulation of the independent variable but lacking random assignment to experimental and comparison groups

Level IV

• Correlational

  • Nonexperimental designs used to study relationships among two or more variables

• Cohort studies

  • Epidemiological designs in which participants are selected based on their exposure to a particular factor

• Case-control studies

  • Epidemiological studies whereby participants are grouped on the presence or absence of a particular disease or condition and are then compared for similarities and differences

• Quantitative research

  • = Research that uses numbers to obtain precise measurements

• Mixed methods design

  • = A design that combined both quantitate and qualitative data gathering and evaluation

  • Quantitative findings from mixed methods design belong to Level IV

Level V

• Integrative review

  • Scholarly papers that include nonexperimental studies in the synthesis to answer clinical questions

• Metasynthesis

  • A systematic review of qualitative studies

Level VI

• Descriptive survey design

  • = Nonexperimental studies that involve asking questions of a sample of individuals who are representative of a group

• Qualitative study

  • = Research that uses words to describe human behaviors

• Mixed methods design

  • = A design that combined both quantitate and qualitative data gathering and evaluation

  • Qualitative findings from mixed methods design belong to Level VI

• EBP project

  • = An endeavor to change practice, based on best evidence, in a clinical setting

• Quality Improvement (QI) project

  • = Structured, continuous activities designed to systematically improve the ways care is delivered to patients

• Case series studies

  • = An epidemiological report used to describe rare diseases or outcomes

• Case studies

  • = A description about a single or novel event of interest

• Concept analysis

  • = A process that explores the attributes and characteristics of a concept

Level II

• Narrative review

  • = Papers based on common or uncommon elements of works without concern for research methods, designs, or settings

• Opinion of authorities

  • = Experts may express opinions in the forms of editorials or commentaries