NRS 433 Describe the seven “levels of evidence” and provide an example of the type of practice change that could result from each

NRS 433 Describe the seven “levels of evidence” and provide an example of the type of practice change that could result from each

NRS 433 Describe the seven “levels of evidence” and provide an example of the type of practice change that could result from each

Levels of evidence is a ranking system used in research to classify the reliability and credibility of the research that has been done. The levels of evidence form a pyramid model that show how evidence stems off from each other by levels, by filtered and unfiltered information. As you get higher on the pyramid, you might not might a lot of information and research on your clinical question, so you keep moving down the pyramid until you find enough (Nova, 2022).

Level 1: is evidence that is collected from a systematic review or a meta-analysis of all the relevant randomized control trials.

Level 2: is evidence obtained by well-designed randomized control trials.

Level 3: same as level 2, but without randomization.

Level 4: evidence obtained by well-designed case-control and cohort studies.

Level 5: Evidence from systematic reviews of descriptive and qualitative studies

Level 6: Evidence obtained from single descriptive or qualitative studies.

Level: 7: Evidence from the direct opinion of authorities and/or reports of experts and committees. ((LibGuides: Evidence-Based Practice: Levels of Evidence. (n.d.)).

LibGuides: Evidence-Based Practice: Levels of Evidence. (n.d.). https://libguides.mskcc.org/ebp/evidence

 

NOVA (2022) Levels of Evidence Based Practice for Health Professionals. https://libguides.nvcc.edu/c.php?g=361218&p=2439383

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Evidence-based practice (EBP) is the integration of the best available evidence with clinical expertise and patient values and preferences to inform decision-making and improve patient outcomes. The levels of evidence describe the quality and strength of the research studies, and they range from level I (systematic reviews of randomized controlled trials) to level VII (expert opinion and consensus statements). Nurses play a critical role in EBP by using the best available evidence to inform their clinical practice and improve patient outcomes.

Level I evidence is considered the strongest type of evidence, and it includes systematic reviews and meta-analyses of randomized controlled trials (RCTs). An example of a nursing practice change that could result from level I evidence is the use of evidence-based interventions to prevent pressure ulcers in hospitalized patients.

Level II evidence includes individual RCTs with high-quality methods. An example of a nursing practice change that could result from level II evidence is the use of a fall prevention program in long-term care facilities. An RCT showed that implementing a fall prevention program, which included staff education, environmental modifications, and patient assessments, reduced the number of falls in long-term care facilities (Oliver et al., 2010).

Level III evidence includes non-randomized controlled studies. An example of a nursing practice change that could result from level III evidence is the use of music therapy to reduce anxiety and pain in patients undergoing medical procedures.

Level IV evidence includes case-control and cohort studies. An example of a nursing practice change that could result from level IV evidence is the implementation of a hand hygiene program in a hospital unit.

Level V evidence includes case series and case reports. An example of a nursing practice change that could result from level V evidence is the recognition of the potential neurological manifestations of COVID-19. A case series of hospitalized patients with COVID-19 showed that neurological symptoms, such as dizziness and confusion, were present in a significant proportion of patients (Mao et al., 2020).

Level VI evidence includes expert opinion and consensus statements. An example of a nursing practice change that

NRS 433 Describe the seven levels of evidence and provide an example of the type of practice change that could result from each
NRS 433 Describe the seven levels of evidence and provide an example of the type of practice change that could result from each

could result from level VI evidence is the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). A consensus statement from the American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine provided guidance on the use of mechanical ventilation in adult patients with ARDS (Fan et al., 2017).

The levels of evidence provide a framework for evaluating the quality and strength of research studies. Nurses should use the best available evidence to inform their clinical practice and improve patient outcomes. Evidence-based practice is a continuous process that involves critical appraisal of the evidence, consideration of patient preferences and values, and integration of clinical expertise. By using EBP, nurses can ensure that they are providing the best possible care to their patients.

Fan, E., Del Sorbo, L., Goligher, E. C., Hodgson, C. L., Munshi, L., Walkey, A. J., … & Brower, R. G. (2017). An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. American journal of respiratory and critical care medicine, 195(9), 1253-1263. https://doi.org/10.1164/rccm.201703-0548ST

Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q., … & Hu, B. (2020). Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA neurology, 77(6), 683-690. https://doi.org/10.1001/jamaneurol.2020.1127

Oliver, D., Hopper, A., Seed, P., & Doody, R. (2010). The NHS Safety Thermometer: a simple yet powerful tool for safer patient care. Quality and safety in health care, 19(5), 1-5. https://doi.org/10.1136/qshc.2010.042986

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