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NURS 4321: Health Systems Leadership: Evidence Based Practice

What is Evidence Based Practice


 

EBP is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system (Newhouse, Dearholt, Poe, Pugh, & White, 2007).

Dearholt, Sandra L., and Dang, Deborah. Johns Hopkins Nursing Evidence-Based Practice : Models and Guidelines (2nd Edition).

Levels of Evidence

 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
orsystematice
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

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

Source: Dreker, P. (2018). "MSN - Masters of Science in Nursing: Evidence Based Practice". Retrieved from https://libguides.rutgers.edu/c.php?g=534440&p=3655922

Evidence Based Pyramid

The "evidence pyramid" is often used to illustrate the levels of evidence in the literature. When beginning your search for evidence, begin at the highest possible tier. 

Filtered information is "pre-appraised." This means that the content has been filtered to include studies and reviews that are of higher quality. Keep in mind that the amount of available literature and the number of problems covered gets smaller as you move up the pyramid.

Unfiltered information represents the original studies. These tiers may not contain studies of high quality and strong evidence, but they cover a much broader range of clinical problems and are much more available.

Source: Dreker, P. (2018). "MSN - Masters of Science in Nursing: Evidence Based Practice". Retrieved from https://libguides.rutgers.edu/c.php?g=534440&p=3655922