NSG456 Phoenix Evidence Based Practice and Clinical Decision Making Paper

Levels of Research Evidence The strength or validity of the best research evidence in an area depends on the quality

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and quantity of the studies that have been conducted in an area. Quantitative studies, especially experimental studies such as the RCT, provide the strongest research evidence (see Chapter 8). Also, the replication or repeating of studies with similar methodology increases the strength of the research evidence generated. The levels of the research evidence are a continuum, with the highest quality of research evidence at one end and weakest research evidence at the other (Brown, 2014, Craig & Smyth, 2012, Melnyk & Fineout-Overholt, 2011; Figure 1-3). The systematic research reviews and meta-analyses of high-quality experimental studies provide the strongest or best research Fig 1-3 Levels of Research Evidence. evidence for use by expert clinicians in practice. Meta-analyses and integrative reviews of quasiexperimental, experimental, and outcomes studies also provide very strong research evidence for managing practice problems. Mixed-methods systematic reviews and meta-syntheses provide quality syntheses of quantitative, qualitative, and/or mixed-methods studies. Correlational, descriptive, and qualitative studies often provide initial knowledge, which serves as a basis for generating quasi-experimental and outcomes studies (see Figure 1-3). The weakest evidence comes from expert opinions, which can include expert clinicians’ opinions or the opinions expressed in committee reports. When making a decision in your clinical practice, be sure to base that decision on the best research evidence available. The levels of research evidence identified in Figure 1-3 (also included in the front cover of this text) will help you determine the quality of the evidence that is available for practice. The best research evidence generated from systematic reviews, meta-analyses, meta-syntheses, and mixed-methods systematic reviews is used to develop standardized, evidence-based guidelines for use in practice. Introduction to Evidence-Based Guidelines Evidence-based guidelines are rigorous, explicit clinical guidelines that have been developed based on the best research evidence available in that area. These guidelines are usually developed by a team or panel of expert clinicians (nurses, physicians, pharmacists, and other health professionals), researchers, and sometimes consumers, policy makers, and economists. The expert panel works to achieve consensus on the content of the guideline to provide clinicians with the best information for making clinical decisions in practice. There has been a dramatic growth in the production of evidence-based guidelines to assist healthcare providers in building an EBP and improving healthcare outcomes for patients, families, providers, and healthcare agencies. Every year, new guidelines are developed, and some of the existing guidelines are revised based on new research evidence. These guidelines have become the gold standard (or standard of excellence) for patient care, and nurses and other healthcare providers are encouraged to incorporate these standardized guidelines into their practice. Many of these evidence-based guidelines have been made available online by national and international government agencies, professional organizations, and centers of excellence. When selecting a guideline for practice, be sure that the guideline was developed by a credible agency or organization and that the reference list reflects the synthesis of extensive number of studies. An extremely important source for evidence-based guidelines in the United States is the National Guideline Clearinghouse (NGC), initiated in 1998 by the AHRQ. The NGC started with 200 guidelines and has expanded to more than 1400 evidence-based guidelines (see http://www.guideline.gov). Another excellent source of systematic reviews and evidence-based guidelines is the Cochrane Collaboration and Library in the United Kingdom, which can be accessed at http://cochrane.org. Professional nursing organizations, such as the Oncology Nursing Society (http://www.ons.org) and National Association of Neonatal Nurses (http://www.nann.org), have also developed evidence-based guidelines for nursing practice. Their websites will introduce you to some of evidence-based guidelines that exist nationally and internationally. Chapter 13 provides you with direction when critically appraising the quality of an evidence-based guideline and implementing that guideline in your practice. Strongest or best research evidence Systematic review of experimental studies (well designed randomized controlled trials (RCTs]) Meta-analyses of experimental (RCT) and quasi-experimental studies Integrative reviews of experimental (RCT) and quasi-experimental studies Single experimental study (RCT) Single quasi-experimental study Meta-analysis of correlational studies Integrative reviews of correlational and descriptive studies Qualitative research meta-synthesis and meta-summaries Single correlational study Single qualitative or descriptive study Opinions of respected authorities based upon clinical evidence, reports of expert committees Weakest research evidence
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