DQ: Describe the “levels of evidence” and provide an example of the type of practice change that could result from each.

DQ: Describe the “levels of evidence” and provide an example of the type of practice change that could result from each.

NRS 433 Topic 4 DQ 2

There are several levels of strategies or research that can be used to determine the effectiveness of  evidence. The level is based on how it will be impacted by biases and its outcomes (Glasofer & Townsend, 2019).

The highest level 1 of research technique would use RCT, Systematic Review, and Meta Analysis. These have been noted to provide the best evidence. If used together it has an even stronger effectiveness (NOVA, 2021). These types of studies would be good for cause and evaluate the effect.

The next level 2 may involve Quasi experimental and Systematic Review, but it may be missing a criteria that would be found when doing an experimental research. This type of research does not have the same strength but can be used for comparison research like a pre and posttest effect (Glasofer & Townsend, 2019).

Level 3 is considered Non-experimental with no manipulation of the variables. This level can use Systematic Review, RCT and Meta Analysis but it is not required (Glasofer & Townsend, 2020)1. It can also be called observation research; the researcher observes but does not have an intervention. This type of research could be used to see the effect something has. They may ask the group to write a daily occurrence to see the effect. In this research area the researcher could use, case -control -look at a condition and compare with someone who does not have that condition (Glasofer & Townsend, 2020)1.

In level 4 the researcher is using opinions or statements. These could be found in clinical practice guidelines, position or consensus statements. The guideline is tested and reviewed by experts, consensus and position statements are as well but also go through peer reviews and are limited (Glasofer & Townsend, 2020)2. These options may not have the same quality as the levels before them. However, they are good for comparison information when looking for evidence-based documentation.

DQ: Describe the “levels of evidence” and provide an example of the type of practice change that could result from each.

The last level 5 and has the least quality of evidence is Literature Review which does not have set standards. Literature Review can give a helpful summary of information but should be used with caution (Glasofer & Townsend, 2020)2. This type of research could be used if you are just wanting to know more about a topic, but it is not peer reviewed and may have high bias.

DQ Describe the levels of evidence and provide an example of the type of practice change that could result from each.

Levels 1,2 and 3 are the best for obtaining evidence-based practice research information that may provide outcomes to improve healthcare and nursing interventions. An article by Gronning et al., (2022) conducted a study to support the importance of nursing students learning about evidence-based practice. Showing how to incorporate evidence-based information into their work and having the latest knowledge. They learned the importance of research to improve clinical practice as our patients depend on us having the most accurate and reliable information. Opinions, reviews and literature are good for comparisons and information but not for reliability as opinions can be wrong.

Wanda Felder

Posted Date

May 1, 2022, 6:44 PM

Replies to Gale Storm-Bryant

Research in healthcare is the standard behind practice change and improvements in patient care. As new researchers, one may feel that their impact on nursing is not felt. In actuality, participation in research progresses over time allowing a greater impact on patients, but also interprofessionally. With the inclusion of learning and research in nursing, learning environments help develop new practices and enhance engagement (Nasrabadi et al., 2021). The image below details how the effect of research is originally felt at the organizational level and leads to influences on healthcare policies. With further research, there are changes in health systems, which lead to societal and economic changes. Therefore, as nurses, and as researchers, we must acknowledge that our research is needed and that it is equally effective.  As a nurse, we are learning new techniques and practices regularly. Nasrabadi et al. (2021) discuss the importance of EBP in nursing and how research leads to nurses being lifelong learners.

Over time, how do you see yourself contributing to research?

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: DQ: Describe the “levels of evidence” and provide an example of the type of practice change that could result from each.

Nasrabadi, A. N., Mohammadi, N., Rooddehghan, Z. , Shabani, A., Bakhshi, F., & Ghorbani, A. (2021). The stakeholders’ perceptions of the requirements of implementing innovative educational approaches in nursing: A qualitative content analysis study. BMC Nursing, 20(131), 1-10.


  • Replies to Wanda Felder

Dr. Felder, According to Heydari et al. (2014), the evidence-based practice (EBP) approach has the potential to improve healthcare quality and is critical for nurses’ and midwives’ professional growth, responsibilities, and capacities. Furthermore, evidence-based practice can lower the costs associated with inefficient care while also lowering treatment risks for clients and patients in accordance with patient and community expectations of nursing practice. I believe that research leads to nurses being lifelong learners because we want the best for our patients, and therefore, we will do what has been studied to be the best practice to increase positive health outcomes. By continually learning, nurses are able to contribute to positive, quality patient care and outcomes. According to Heydari et al. (2014), few nurses thought they could find enough relevant data to incorporate into their clinical practice since they had not received training and had little experience searching for research evidence. Although nurses were aware of the research process and could use various levels of evidence in clinical practice, they were unfamiliar with the concepts and principles of evidence-based practice. Prior to taking this class, I was unaware of the existence of many evidence-based procedures and had no idea how to obtain information about them. However, I feel that this research class has shown me how essential research is to nursing and nursing care, and I plan to continue studying and searching for the best techniques to include in my nursing practice. I also aim to contribute to research as I get more knowledgeable and comfortable with it, and to be able to perform a study that will help many people.

DQ Describe the levels of evidence and provide an example of the type of practice change that could result from each.


Heydari, A., Mazlom, S.R., Ranjbar, H., and Scurlock-Evans, L. (2014). A study of Iranian nurses’ and midwives’ knowledge, attitudes, and implementation of evidence-based practice: The time for change has arrived. Worldviews on Evidence-Based Nursing, 11(5), 325–331

Wanda Felder

Posted Date

May 1, 2022, 6:44 PM

Hi Class,

Review this chart to understand how the different levels of evidence are measured. This might be helpful in ascertaining the various articles you find for your papers, as well as your discussion posts.


Wanda Felder

Posted Date

May 1, 2022, 6:44 PM

Hi Class,

Let’s review this video to gain an understanding of levels of research. Remember that viewing this video is optional and is to allow you additional opportunities for participation.

Jana Garcia

Posted Date

Apr 30, 2022, 10:26 PM

Replies to Gale Storm-Bryant

Research design is studied in many forms, and they are not all “equally effective in determining cause and effect” (Glasofer, 2021). For this reason, “evidence can be organized into hierarchies based on its strength” ( Glasofer, 2021). The John Hopkins hierarchy of evidence is a model of evidence that is measured from the bottom being the weakest and the top of the hierarchy being the strongest. Beginning from the top and working down, level 1 and level 2 are experimental design and quasi-experimental research. Experimental design includes as study that is “retrospective, prospective, or longitudinal studies”( Glasofer, 2021). quasi-experimental design is “systematic reviews and meta-analyses present results by combining and analyzing data from different studies conducted on similar research topics” (Ahn, 2018). Level 3 and level 4 includes non-experimental study and expert opinion. A Non-experimental study there is ” no manipulation of the independent variable, and do not require a control group” ( Glasofer, 2021). Expert opinion is the studies opinion of a professional or a panel of professionals and finally, level 5 is literature review, which is a review of previous research studies by evaluating and comparing the data and determining the outcome.

Evicence Based practice’s goal is to improve patient care, safely, and effectively by evidence found in research. An example of practice change based on level 5, evidence review, was published in Korean Journal of anesthesiology. care based on research on the PICOT “in non-ventilated patients, how does consistent versus inconsistent oral care impact patient outcomes” (Ahn, 2018). Research was 13 articles was reviewed, based on their findings, policies were written to provide guidance to floor nurses providing care. Level 4, expert opinion example could include eliminating pacifiers from all nurseries based on studies conducted by lactation consultants. Change of care by level 3, non-experimental policy change could include a nonsmoking policy based on statistics of lung disease by active smokers. Level 2 quasi-experimental research practice change example could include adding care coordinators to the units to improve long term health outcomes to prevent acute care readmission” (Nembhard, 2020). Finally, an example of level 1 would be changing hand sanitizer on the units by conducting an experimental design comparing 3 brands and excluding the two that eliminate the least germs. The most effective research of all of these examples in level 1, experimental design of hand sanitizer, the outcome is quantitative and evidence by statistical outcome.

DQ Describe the levels of evidence and provide an example of the type of practice change that could result from each.

Implementation of EBP in the nursing practice provides scientifically proven evidence that allows nurses to provide quality and safe care to their patients. When searching for evidence-based information, nurses must consider the levels of evidence and select the highest level of evidence. The seven levels of evidence include:

Level I  Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs. A systematic review that uses quantitative methods to summarize the results. Systematic evidence reviews of comparative effectiveness research to learn what is known and not known about the potential benefits and harms of alternative drugs, devices, and other healthcare services provide the best evidence to inform clinical decisions (National Library of Medicine, n.d.).

Level II – Evidence obtained from well-designed Randomized Controlled Trials (RCTs) include a randomized group of patients in an experimental group and a control group. These groups are followed up for the variables/outcomes of interest.

Level III – Evidence obtained from well-designed controlled trials without randomization.A controlled clinical trial that randomly (by chance) assigns participants to two or more groups. There are various methods to randomize study participants to their groups (LibGuides: Evidence-Based Practice: Levels of Evidence. (n.d.)).

Level IV – Evidence from well-designed case-control and cohort studies.A type of clinical trial comparing the effectiveness of one medication or treatment with the effectiveness of another medication or treatment. In many controlled trials, the other treatment is a placebo (an inactive substance) and is considered the “control.” A clinical research study in which people who presently have a certain condition or receive a particular treatment are followed over time and compared with another group of people who are not affected by the condition (LibGuides: Evidence-Based Practice: Levels of Evidence. (n.d.)).

Level V – Evidence from systematic reviews of descriptive and qualitative studies. A qualitative systematic review brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together. There is a debate over whether the search needs to be exhaustive (Seers, K. 2015).

Level VI – Evidence from single descriptive or qualitative studies. Data from observation, interviews, or interaction with participants.

Level VII – Evidence from the opinion of authorities and/or reports of expert committees. It can be in an expert report, or the expert can give evidence (testify) at a hearing. Usually, the Tribunal will only receive evidence about facts, such as what happened and when it happened (Experts Evidence, n.d.)





LibGuides: Evidence-Based Practice: Levels of Evidence. (n.d.).

About Systematic Evidence Reviews and Clinical Practice Guidelines | NHLBI, NIH. (n.d.). NHLBI, NIH.,of%20similar%20but%20separate%20studies.

Expert Evidence. (n.d.).,happened%20and%20when%20it%20happened

Seers K. (2015). Qualitative systematic reviews: their importance for our understanding of research relevant to pain. British journal of pain, 9(1), 36–40.


Evidence-based practice (EBP) in healthcare is the cornerstone of delivering high-quality and safe patient care. At the heart of EBP lies the hierarchy of evidence, represented by seven distinct “levels of evidence.” These levels help healthcare professionals assess the strength and reliability of research findings, enabling them to make informed decisions and implement practice changes


Level I: Systematic Reviews and Meta-Analyses

Level I represents the pinnacle of evidence, characterized by systematic reviews and meta-analyses. These studies synthesize data from multiple sources to provide a comprehensive overview of a specific topic. For example, a systematic review may lead to the adoption of a new clinical guideline for hypertension management, based on a comprehensive review of the most effective antihypertensive medications.


Level II: Randomized Controlled Trials (RCTs)

Randomized Controlled Trials, the gold standard of clinical research, are classified under Level II. RCTs are often responsible for groundbreaking practice changes. Imagine a healthcare team embracing a new surgical technique for appendectomy after an RCT demonstrated reduced complications and quicker recovery times.


Level III: Quasi-Experimental Studies

Level III encompasses quasi-experimental studies, such as controlled before-and-after designs, which are particularly useful when RCTs are challenging. In a practical sense, a healthcare facility may implement a falls prevention program following a before-and-after study that showed a significant reduction in patient falls with the intervention.


Level IV: Case-Control Studies

Case-control studies, found at Level IV, compare individuals with a specific condition (cases) to those without it (controls). These studies can lead to practical changes in health recommendations. For instance, public health campaigns may promote sun-protective behaviors after a case-control study links sun exposure to an increased risk of melanoma.


Level V: Cohort Studies

Cohort studies, which follow groups of individuals over time, are placed at Level V. These studies have a forward-looking perspective and can shape public health interventions. Recommendations for lifestyle modifications, such as dietary changes, may be encouraged for heart disease prevention based on a cohort study linking specific dietary patterns to reduced cardiovascular risk.


Level VI: Case Series and Reports

Level VI comprises case series and reports, often the starting point for innovative changes. Healthcare professionals may explore a novel therapy for a rare disease based on compelling case reports showing remarkable patient outcomes.


Level VII: Expert Opinion

At the base of the evidence pyramid is Level VII, which relies on the consensus and expertise of seasoned professionals. In rapidly evolving medical fields, expert opinion guides clinical practice when empirical evidence is limited. For example, clinicians may turn to expert consensus when managing emerging conditions with limited research.



Forrest, J. L., Miller, S. A., Miller, G. W., Elangovan, S., & Newman, M. G. (2019). Evidence-based decision making. In Newman, Michael G., Takei, Henry H., Klokkevold, Perry R., & Carranza, Fermin A. (Eds.), Newman and carranza’s clinical periodontology (Thirteenth ed., pp. 1-9.e1). Elsevier.


Harvey E. (2020). Can we use levels of evidence to make a decision?. Canadian journal of surgery. Journal canadien de chirurgie, 63(1), E86.