Response to the discussion board, 1 resource
Margaret Onojafe posted Feb 17, 2024 12:59 PM
Evidence-based practice in nursing involves translating knowledge gained through research and the latest/best possible scientific evidence into practice to improve patient outcomes and overall patient experience (Evidence-Based Practice, 2023). Evidence-based practice utilizes both internal and external scientific evidence. Internal evidence is generated within the clinical setting including data systematically collected directly from clients to ensure they are making progress and the objective performance data gathered through quality improvement and outcome management (American Speech-Language-Hearing Association, n.d.). External evidence is the evidence based on research results (Melnyk & Fineout-Overholt 2023). External evidence may be retrieved from different scientific literatures including research articles, textbooks, journals, and clinical guidelines. For example, research findings documented in research articles and journals can be retrieved from different databases including CINAHL, ERIC, MEDLINE, and Google scholar, (Melnyk & Fineout-Overholt 2023).
The main levels of evidence utilized for making decisions in clinical practice includes Systematic Review or meta-analysis of RCTs (randomized control trials), Randomized Control Trials, Quasi-experimental Studies, and Non-experimental Studies (Melnyk & Fineout-Overholt 2023). The different levels of evidence rank differently in credibility and John Hopkins used the pyramidal hierarchy to rate their credibility. John Hopkins placed different levels of evidence required for clinical application into 5 hierarchical categories rated as levels one to five, the most credible evidence being level one and the least being level five (Tsistinas, 2022). The highest level of evidence (level 1) which is at the peak of the hierarchal pyramid includes experimental study, randomized controlled trial (RCT), systematic review of RCT, with or without meta-analysis; followed by the level 2 evidence which includes Quasi-experimental study, systematic review of a combination of RCTs and Quasi-experimental studies only, with or without meta-analysis (Tsistinas, 2022). Level 3 evidence is Non-experimental study systematic review of a combination of randomized controlled trials, quasi-experimental and non-experimental studies, or non-experimental studies only, with or without meta-analysis, Qualitative study, or systematic review with or without a meta-synthesis” (Tsistinas, 2022). This is mid-level evidence in credibility. The level 4 evidence includes opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence. This includes clinical practice guidelines and consensus panels. The level 5 evidence is based on experience and non-research evidence including literature reviews, quality improvement programs, financial evaluation, case reports, and opinions of nationally recognized experts (Tsistinas, 2022).
To this point, the evidence retrieved regarding my clinical question has been predominantly mid-level or level three evidence in the John Hopkins evidence rating. For example, Wang et al., (2021) evidence was based on observational self-controlled study and falls under the category of mid-evidence (level 3). PICOT Question: In hospitalized mentally ill adult patients aged 40 to 65 years (P), does implementing fall prevention clinical guidelines (I) compared to without fall prevention strategies (C), influence fall incidents (O) during 3 months period of hospitalization (T)? Going forward, I shall be seeking materials in the level 1 category in John Hopkins ranking.
References
American Speech-Language-Hearing Association. (n.d.). EBP process – Step 2: Gather evidence. https://www.asha.org/research/ebp/gather-evidence
Evidence-Based Practice. (2023). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/evidence-based-practice
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare:
A guide to best practice (Fifth edition.). Wolters Kluwer.
Tsistinas, O. (2022, March 19). Subject Guides: Johns Hopkins Nursing Evidence-Based Practice: Searching for the Evidence. Guides.upstate.edu. https://guides.upstate.edu/c.php?g=1023176&p=7411259
Wang, G. H., Man, K. K. C., Chang, W., Liao, T., & Lai, E. C. (2021). Use of antipsychotic drugs and cholinesterase inhibitors and risk of falls and fractures: self-controlled case series. The BMJ, n1925. https://doi.org/10.1136/bmj.n1925
