either be meta-analyses or structured integrative reviews of evidence, and CPG’s based on Level I evidence. Evidence rated as Level II comes from a randomized controlled trial. A quasi-experimental study such as a nonrandomized controlled single Levels of quantitative evidence. Figure 1.1 Level I Systematic Reviews Level II Single experimental study (RCT’s) Level III Quasi-experimental studies Level IV Non-experimental studies Level V Case report/program evaluation/narrative literature reviews Level VI Opinions of respected authorities Systematic Reviews (Integrative/Meta-analyses/CPG’s based on systematic reviews) Adapted from Stetler, C. B., Morsi, D., Rucki, S., Broughton, S., Corrigan, B., Fitzgerald, J., . . . Sheridan, E. A. (1998). Utilization-focused integrative reviews in a nursing service. Applied Nursing Research, 11(4), 195–206; Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice (p. 608). Philadelphia, PA: Lippincott Williams & Wilkins. 8 Evidence-Based Geriatric Nursing Protocols for Best Practice group pretest and posttest time series or matched case-controlled study is considered Level III evidence. Level IV evidence comes from a nonexperimental study, such as correlational descriptive research and qualitative or case-control studies. A narrative literature review, a case report systematically obtained and of verifiable quality, or program evaluation data are rated as Level V. Level VI evidence is identified as the opinion of respected authorities (e.g., nationally known) based on their clinical experience or the opinions of an expert committee, including their interpretation of non-research-based information. This level also includes regulatory or legal opinions. Level I evidence is considered the strongest. For all topics, the results of literature searches were organized in a searchable, webbased RefWorks “shared” folder and coded for level of evidence. The authors were then charged with reviewing the evidence and deciding on its quality and relevance for inclusion in their chapter or protocol. The critical appraisal of research uses specialized tools designed to evaluate the methodology of the study. Examples are the AGREE instrument (which this volume of protocols conforms to) (AGREE Next Steps Consortium, 2009), the Critical Appraisal Skills Programme (CASP) (Solutions for Public Health), and the PRISMA Statement (PRISMA: Transparent reporting) among others. An additional feature implemented in the previous edition of this book is the inclusion of the level and type of evidence for each reference, which leads to a recommendation for practice (See Exhibit 1.1). Using this type of standard approach ensures that this book contains protocols and recommendations for use with geriatric patients and their families that are based on the best available evidence. SUMMARY The protocols contained in this edition, therefore, have been refined, revised, and/or developed by the authors using the best available research evidence as a foundation, An example of a coded literature citation supplied to protocol author. REF ID: 22449 Level IV Boltz, M., Capezuti, E., Bowar-Ferres, S., Norman, R., Secic, M., Kim, H. et al. (2008). Hospital nurses’ perception of the geriatric nurse practice environment. Journal of Nursing Scholarship, 40(3), 282-289. Purpose: To test the relationship between nurses’ perceptions of the geriatric nurse practice environment (GNPE) and perceptions of geriatric-care delivery, and geriatric nursing knowledge. Design: A secondary analysis of data collected by the New York University Hartford Institute Benchmarking Service staff using a retrospective, cross-sectional, design. Methods: Responses of 9,802 direct-care registered nurses from 75 acute-care hospitals in the US that administered the GIAP (Geriatric Institutional Assessment Profile) from January 1997 to December 2005 were analyzed using linear mixed effects modeling to explore associations between variables while controlling for potential covariates. Findings: Controlling for hospital and nurse characteristics, a positive geriatric nurse practice environment was associated with positive geriatric care delivery (F=4,686, p CHAPTER 1 THE HISTORY