Discussion: Levels of Evidence
Describe the seven “levels of evidence” and provide an example of the type of practice change that could result from each.
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NRS 433 Topic 4 DQ 2 Levels of Evidence Sample
Nursing professionals should continually engage in practice change to achieve high patient outcomes consistently. Since evidence-based practice (EBP) requires nursing nurses to use scientific evidence to guide decision-making, awareness of evidence levels is essential. Glasofer and Townsend (2019) described evidence levels as the hierarchy of evidence quality based on how research designs minimize the impact of bias. Therefore, high-level evidence has minimal bias and a high chance of valid conclusions.
Level 1 evidence is the highest in the hierarchy and includes evidence from systematic reviews or meta-analyses of randomized controlled trials (RCTs). NRS 433 Topic 4 DQ 2 Levels of Evidence Such evidence can be used to guide practice change on the appropriateness of motivation programs on nurses’ productivity. Level II includes evidence from at least one well-designed randomized controlled trial. Nair (2019) illustrated RCTs as experimental studies comparing outcomes between an intervention and a control group. Such evidence can be used to guide practice in scenarios where outcomes between two groups are being compared. Level III evidence is sourced from quasi-experimental studies, defined as well-designed controlled trials without randomization (Miller et al., 2020). The evidence is effective in guiding practice change on the effect of an intervention among a group with similar characteristics. A suitable example is the effect of tailored phones on medication adherence. Level IV involves evidence from non-experimental studies such as case-control or cohort studies (LoBiondo-Wood & Haber, 2021). Such studies can be conducted when studying the incidence or causes of a clinical problem without experimentation.
Level V evidence is sourced from systematic reviews of qualitative and descriptive studies. NRS 433 Topic 4 DQ 2 Levels of Evidence Such evidence lacks the depth required to guide intensive practice change, although it contains supporting information. For instance, research supporting policy interventions to address workplace incivility is extensively studied via systematic reviews of qualitative studies. Level VI is evidence from single qualitative studies, while Level VII contains evidence from case reports, opinions from expert committees, and narrative reviews (LoBiondo-Wood & Haber, 2021). Due to its low quality, this evidence is not highly recommended for practice change. However, it can be used to demonstrate the significance of a clinical problem like patient falls and the need for evidence-based intervention.
NRS 433 Topic 4 DQ 2 Levels of Evidence References
Glasofer, A., & Townsend, A. B. (2019). Determining the level of evidence: experimental research appraisal. Nursing2020 Critical Care, 14(6), 22-25. DOI: 10.1097/01.CCN.0000580120.03118.1d
LoBiondo-Wood, G., & Haber, J. (2021). Nursing research E-book: Methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.
Miller, C. J., Smith, S. N., & Pugatch, M. (2020). Experimental and quasi-experimental designs in implementation research. Psychiatry Research, 283, 112452. https://doi.org/10.1016/j.psychres.2019.06.027
Nair, B. (2019). Clinical trial designs. Indian Dermatology Online Journal, 10(2), 193–201. https://doi.org/10.4103/idoj.IDOJ_475_18 NRS 433 Topic 4 DQ 2 Levels of Evidence
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