HCA 699 What levels of evidence are present in relation to research and practice and why are they important regardless of the method you use?

HCA 699 What levels of evidence are present in relation to research and practice and why are they important regardless of the method you use?

HCA 699 What levels of evidence are present in relation to research and practice and why are they important regardless of the method you use?

In relation to research and practice, evidence-based studies entails finding the most relevant evidence and applying it. As cornerstone of the EBP and research entails the hierarchical classification of the available evidence. Clinicians and researchers are thus encouraged to sea4rch for the highest level of evidence and use them to answer clinical questions. The assigning of levels to studies occur based on the methodological quality of the study design, its validity and applicability to patient care (Hande et al., 2017). As such, there are several levels of evidence. In level I, evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results exists (“Levels of Evidence”, 2020). Level II entails evidence obtained from at least one well-designed RCT (e.g. large multi-site RCT). Level III comprises evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental). Level IV encompasses evidence from well-designed case-control or cohort studies. Moreover, Level V comprises evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis). Further, Levels VI and VII comprise evidence from a single descriptive or qualitative study and evidence from the opinion of authorities and/or reports of expert committees respectively.

The segregation of evidence in varied levels is important as it ensures that a researcher or clinician will at least find an article that supports their research question irrespective of the level. Whereas the hierarchy is based on the rigor of research methods, the hierarchies and levels of evidence are important since they reveal the quality of research that one will use in their studies (Hande et al., 2017). Moreover, varied types of research studies are answered by varied types of research designs, which informs the categorization of evidence. As such, the presence of levels makes it easier for one to find the requisite studies.

References

Hande, K., Williams, C. T., Robbins, H. M., Kennedy, B. B., & Christenbery, T. (2017). Leveling evidence-based practice across the nursing curriculum. The Journal for Nurse Practitioners, 13(1), e17-e22.

Levels of evidence – Research hub – Winona state university. (2020, April 8). Retrieved from https://libguides.winona.edu/c.php?g=11614&p=61584

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The Centre for Evidenced-Based Medicine (CEBM) created a hierarchy for discerning levels of evidence to help

HCA 699 What levels of evidence are present in relation to research and practice and why are they important regardless of the method you use
HCA 699 What levels of evidence are present in relation to research and practice and why are they important regardless of the method you use

clinicians and other users quickly determine the best evidence (2016). This table is a helpful decision tool for appraising evidence and includes 5 levels. Level 1 evidence comprises of a local and current random sample for the problem incidence, and then a systematic review for all other appraisal components including accuracy of diagnostic test used, prognosis of not adding the therapy, whether the intervention helps, common harms of the treatment, rare harms of the treatment, and if the screening is worthwhile (CEBM, 2016). Level 2 involves the use of cross-sectional studies, cohort studies, and randomized trials, levels 3 and 4 are reduced to non-randomized trials, case studies or series, and level 5 with mainly mechanism-based reasoning (CEBM, 2016). Overall the effectiveness of using a tool like this likely depends on the understanding of the different types of research studies and how well each component is assessed.

Melnyk & Fineout-Overholt (2019) also review levels of evidence and explain that there is more to assigning the level than the type of study, and that quality and impact of the evidence must also be assessed. How valid the study is as well as its direct impact on the variables under study can contribute to the level of evidence. It is also important to understand that the appraisal of evidence can depend on its source. The source of knowledge, whether from quantitative research, qualitative, clinical judgement, or expert knowledge, can demand different appraisal approaches (Melnyk & Fineout-Overhold, 2019). Overall, systematic reviews appear to be the strongest level of evidence and should be used when possible, but the topic of study may also demand other types of evidence so using a valid process to appraise all sources of knowledge is ideal. Mastering the skill of appraising evidence is important for a clincian’s practice so that the process of incorporating evidence-based research is done appropriately.

References

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidenced-based practice in nursing & healthcare: a guide to best practice. Wolters Kluwer. Retrieved from https://www.gcumedia.com/digital-resources/wolters-kluwer/2018/evidence-based-practice-in-nursing-and-healthcare_a-guide-to-best-practice_4e.php

The Centre for Evidenced-Based Medicine. (2016). OCEBM levels of evidence. Retrieved from https://www.cebm.net/2016/05/ocebm-levels-of-evidence/

 

Amber, you offer a very wonderful insight into the levels of evidence. Indeed, the hierarchical categorization of evidence was designed to ensure only good quality evidence is adopted by researchers and clinicians. However, at the apex of the hierarchy is the randomized control trial studies. These studies are founded on rigorous research designs which ensure validity of the same (Melnyk & Fineout-Overholt, 2019). The bottom of the hierarchy encompasses opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. Having said that, all the studies are relevant and they have been adopted severally by clinicians and researchers irrespective of their level in the hierarchy. The reason for the widespread adoption of the studies irrespective of the levels is found in the fact that at least all of them have some level of rigor, which ensures applicability.

References

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidenced-based practice in nursing & healthcare: a guide to best practice. Wolters Kluwer. Retrieved from https://www.gcumedia.com/digital-resources/wolters-kluwer/2018/evidence-based-practice-in-nursing-and-healthcare_a-guide-to-best-practice_4e.php

 

Expert opinions play an important role during the creation of EBP. Controversies have surrounded the usage of expert opinions because they are not necessarily backed by research. Instead, they include point-of-care resources, textbooks, conference proceedings. However, expert opinions offer something to the creation of EBP. They offer a good introduction as well as offer generalized information about a condition or issue (Dang & Dearholt, 2017). Whereas expert opinions offer convenient summary, the fact that it takes three years for the information to be publicized demonstrates the rigorous nature of the process, which lends it validity hence applicability in EBP.

References

Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau.

CAT 1

Share the evidence (one source) you found to support your individual research project. How did this research validate your findings?

Brosey, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality30(2), 153-159.