NRS 433 Topic 4 DQ 2 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
Describe the “levels of evidence” and provide an example of the type of practice change that could result from each.
The re-post is to include my second EB article thank you.
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.
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.
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.
References:
Glasofer, A., Townsend, A. B., (2019). Determining the level of evidence. Nursing Critical Care: Volume 14 – Issue 6 – p 22-25, doi: 10.1097/01.CCN.0000580120.03118.1d
Glasofer, A., Townsend, A. B., (2020)1. Determining the level of evidence. Nursing Critical Care: Volume 15 – Issue 1 – p 24-27, doi: 10.1097/01.CCN.0000612856.94212.9b
Glasofer, A., Townsend, A. B., (2020)2. Determining the level of evidence, Nursing Critical Care: Volume 15 – Issue 2 – p 22-26. doi: 10.1097/01.CCN.0000654792.71629.00
Grønning, K., Karlsholm, G., & André, B. (2022). Undergraduate Nursing Students’ Experiences of Conducting Clinical Research Projects in Their Bachelor Theses – a Qualitative Study. SAGE Open Nursing, 1–9. https://doi-org.lopes.idm.oclc.org/10.1177/23779608221094537
North Virginia Community College (NOVA) (2021, September 27th). Evidence-Based Practice for Health Professionals: Levels of Evidence. LibGuides. https://libguides.nvcc.edu/c.php?g=361218&p=2439383
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.
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Over time, how do you see yourself contributing to research?
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. https://doi.org/10.1186/s12912-021-00647-7
May 1, 2022, 9:32 PM(edited)
- Replies
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.
Reference
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
https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12052
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.
https://howardisms.com/wp-content/uploads/2018/04/LOEfull.jpeg
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.
https://www.youtube.com/watch_popup?v=iifoRQV_asE
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.
thank you,
Jana
Ahn, E., & Kang, H. (2018). Introduction to systematic review and meta-analysis. Korean journal of anesthesiology, 71(2), 103–112. https://doi.org/10.4097/kjae.2018.71.2.103
Glasofer, A., & Townsend, A. B. (2021, February 1). Determining the level of evidence: Nonexperimental research designs. Nursing, 51(2). https://doi-org.lopes.idm.oclc.org/10.1097/01.NURSE.0000731852.39123.e1
Nembhard, I. M., Buta, E., Lee, Y., Anderson, D., Zlateva, I., & Cleary, P. D. (2020). A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers. BMC health services research, 20(1), 137. https://doi.org/10.1186/s12913-020-4986-0
Replies
Thank you, Jana. I enjoyed how you gave examples of each level of evidence. Both levels five and four are thorough studies with the most negligible bias outcome due to their random control trials. The most significant difference I see from levels five and four is the meta-analysis or consistency of multiple studies where the conclusion and data are consistent. Whereas level four has numerous studies (Deaton & Cartwright, 2018). However, they may not all be conclusive, but the evidence is available, and the studies are adequate. The other levels of research that consist of one to three are great building blocks for the experimental data needed for the RCT studies. Level 3 looks at a specific group of people to collect data and anticipate outcomes before applying it to the larger population. They are considered well-designed trials without randomization, called quasi-experimental studies. Here, we assess risk and probability (John Hopkins School of Nursing, 2017). Level two, these are not a relationship to examine in the study, and there is no correlated cause and effect established. However, level one does not have to be a direct cause and effect. It does not have to be a study (The University of Michigan, 2015). Just well-developed and nationally known scientists do research via literature or small studies to create a hypothesis or idea supported by science and data.
Evidence-based practice is essential to ensuring the delivery of high-quality nursing care. One of the cornerstones of evidence-based practice is the concept of levels of evidence. These levels are used to describe the strength of the evidence supporting a particular practice change, with Level I being the strongest and Level VII being the weakest. This essay will describe each of the seven levels of evidence and provide an example of the type of nursing practice change that could result from each.
-Level I: Systematic Review of Randomized Controlled Trials (RCTs)
Systematic reviews of RCTs provide the highest level of evidence. RCTs are studies that randomly assign participants to receive either an experimental treatment or a control treatment. A systematic review is a comprehensive analysis of multiple RCTs. An example of a nursing practice change that could result from a systematic review of RCTs is the use of skin-to-skin contact after birth to improve breastfeeding rates (Moore et al., 2016).
-Level II: Single Randomized Controlled Trial
Single RCTs provide strong evidence but not as strong as a systematic review of RCTs. An example of a nursing practice change that could result from a single RCT is the use of chlorhexidine for skin antisepsis before surgery to reduce surgical site infections (Darouiche et al., 2010).
-Level III: Quasi-Experimental Studies
Quasi-experimental studies are similar to RCTs but do not use randomization to assign participants to treatment or control groups. An example of a nursing practice change that could result from a quasi-experimental study is the use of bedside reporting during shift change to improve patient safety (Griffiths et al., 2014).
-Level IV: Non-Experimental Studies
Non-experimental studies are observational studies that do not involve an intervention. An example of a nursing practice change that could result from a non-experimental study is the use of fall risk assessments to prevent falls in hospitalized patients (Oliver et al., 2010).
-Level V: Expert Opinion
Expert opinion is the lowest level of evidence but can still be useful in guiding nursing practice. An example of a nursing practice change that could result from expert opinion is the use of therapeutic hypothermia for patients after cardiac arrest (Callaway et al., 2015).
-Level VI: Case Reports and Case Series
Case reports and case series are descriptions of individual patients or small groups of patients. An example of a nursing practice change that could result from a case report or case series is the use of positive airway pressure for patients with obstructive sleep apnea (Punjabi et al., 2014).
-Level VII: Animal and In Vitro Studies
Animal and in vitro studies provide the weakest level of evidence. An example of a nursing practice change that could result from an animal or in vitro study is the use of a new wound dressing to promote wound healing (Maan et al., 2017).
In conclusion, evidence-based practice requires a careful consideration of the strength of the evidence supporting a particular practice change. The seven levels of evidence provide a framework for evaluating the quality of the evidence. By using this framework, nurses can make informed decisions about the best course of action to improve patient outcomes.
The levels of evidence are research methods that are ranked based on quality of results (Helbig, 2022). The levels of evidence are increased in proportion to the quality of the research design. Randomized control studies are one of the highest research designs and thus they yield some of the highest levels of evidence. The randomized control studies are often used in research and have a positive impact in providing evidence based practice within the nursing profession. Evidence based practice is the driving force behind making changes within the medical community, this helps to ensure that all medical personnel are providing safe, effective, and efficient care to patients. Evidence based practice aims to improve processes and positively affect patient outcomes and improve the care that is provided (Stevens, 2013). The types of practice change that can be observed from using evidence based practice is the need to use sterile technique when inserting a foley catheter instead of clean technique and how that lowers the risk of urinary tract infections.
Stevens, K., (2013). The impact of evidence- based practice in nursing and the next big ideas. (OJIN). Retrieved from https://doi.org/10.3912/OJIN.Vol18No02Man04
Helbig, J. (2022). Nursing Research: Understanding Methods for Best Practice. (GCU). https://bibliu.com/app/#/view/books/1000000000588/epub/Chapter1.html
Evidence-based practice helps to solve problems in clinical practice to provide the best evidence for the patient and the clinical decisions on patient care and it starts strongest level to the weakest least on the scale (Nurse, 2023). The levels on the evidence-based scale start from the highest most reliable research to the least most reliable research. Level I is systematic and meta-analysis are quantitative research that reviews consistently randomized control trial, and the systematic review tend to do more in-depth assessments of any existing evidence that is directed toward clinical questions and include other quality studies, and the meta-analysis will use statistical methods to bring together any analyze data by involving all the randomized control trials (Nurse, 2023). An example of a practice change is a researcher testing a medication such as dexamethasone to see if it causes any recurring events such as acute severe migraine headaches in adults. Level II is randomized controlled trials and it is also considered to be one of the strongest levels in clinical research that is on the hierarchy level to be the golden standard in clinical research because it compares one or more treatments, and the participants are assigned in control group treatment or control by chance (Zabor et al., 2020).
An example is patients who get a diagnostic bronchoscopy will have better treatment when using a thin bronchoscope and a radial endobronchial ultrasound versus doing the standard bronchoscopy and fluoroscopy for better outcomes (Zabor et al., 2020). Level III is cohort studies that look to examine through observational study a set of groups of subjects or people over a period of time that are observed to see if the people were exposed or at risk of developing an outcome (Glasofer & Townsend, 2021). An example is nurses exposed to bullying or nurses who are not exposed to bullying caused medication errors (Glasofer & Townsend, 2021). Level IV is a case-control study that uses research from a person’s medical condition that is compared by control from a person without a medical condition (Glasofer & Townsend, 2021). An example is a patient who was diagnosed with colon cancer from eating high-fat food versus a patient who doesn’t have colon cancer and eats high-fat food. Level V is a case report and case series studies fall under the lowest level of evidence.
The case report discusses a person or patient disease management and starts to look into investigating the outcome of a rare disease, and the case series will start to document along with doing a follow-up on each subject in the report (Ganesan, 2022). An example is health care providers or clinicians evaluating a rare disease from a patient who wants to improve the condition or needs more understanding of the disease by using different possibilities with treatment options (Ganesan, 2022). An example was at the time patients with Kaposi’s sarcoma in homosexual men had led identifying HIV diagnosis (Ganesan, 2022). Level VI is at the weakest level in evidence research is expert opinion and background information this is when experts and professionals have information as evidence from their professional expertise and opinions and certain novels, books, and encyclopedias provide general information, and the background information is needed for a simple easy outline of a summary but this type of literature tends to take a long time to published and research it not present (Northern Virginia Community College [NVCC], 2023).
An example is nurses reading a publishing book from an expert opinion in regards to patients getting support from acute respiratory distress syndrome (Glasofer & Townsend, 2021). The last level VII is animal research and lab studies, this is also at the lowest level of evidence and ideas and research from a laboratory can be performed in therapy and also from diagnostics that need to be tested from animals and lab tests (NVCC, 2023). An example is a laboratory doing research on animals to cure or treat a disease.
Ganesan, P. (2022). How to Write Case Reports and Case Series. International Journal of Advanced Medical and Health Research 9(1), p 55-58. https:// doi.org/10.4103/ijamr.ijamr_58_22
Glasofer, A. & Townsend, B. A. (2021). Determining the level of evidence: Nonexperimental research designs. Nursing 51(2), p 62-65. https://doi.org/10.1097/01.NURSE.0000731852.39123.e1
Northern Virginia Community College (2023, October 19). Evidence-Based Practice. https://libguides.nvcc.edu/c.php?g=361218&p=2439383#s-lg-box-7437123
Nurse (2023). Evidence-Based Practice. https://nurse.com/evidence-based-practice
Zabor, E. C., Kaizer, A. M., & Hobbs, B. P. (2020). Randomized Controlled Trials. Chest, 158(1 Suppl), S79. https://doi.org/10.1016/j.chest.2020.03.013