Module 2 Flashcards
Level 1 hierarchy of evidence
Level I evidence summarizes more than one study.
Level I includes summaries, synopses, meta-analyses, systematic reviews of randomized controlled trials (RCTs), and clinical practice guidelines.
Summaries
Level I
Best practice recommendations based on an appraisal of information about a particular practice question.
After stating a clinical question, key findings are identified and ranked.
Summaries end with best practice recommendations. Usually limited to one to three pages, summaries are particularly helpful for nurses to quickly find evidence for practice in their clinical settings.
Synopses
Level I
A brief description of evidence that provides an overview of key points of evidence from multiple sources. Basically, a synopsis is a shorter version of a summary.
Synopses look like abstracts and are typically only a paragraph. The difference between an abstract and a synopsis is that an abstract summarizes a single study, whereas a synopsis is about more than one study.
Meta-analysis
Level I
A research method that estimates the effect of an intervention by using statistical methods to analyze data from both published and unpublished single studies.
Because a meta-analysis involves statistical analysis, it is unique from other types of evidence in Level I. Another unique factor is that a meta-analysis can include unpublished studies, making for a more robust sample of evidence.
Systematic Review
Level I
A rigorous and systematic synthesis of research findings from experimental and quasi-experimental studies about a clinical problem.
In a systematic review, the authors will provide a very detailed account about how they searched the literature and selected studies to be included in their review. However, systematic reviews are different from meta-analyses because only published works are used and there is no statistical analysis.
Clinical Practice Guidelines
Level I
Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options
Various care options are based on patient subgroups and patient preferences.
Level II hierarchy of evidence
Includes one type of evidence: randomized controlled trials (RCTs).
Defined as designs involving random assignment to groups and manipulation of the independent variables, RCTs are considered the highest quality for study designs.
RCT: Clinical experimental studies that typically involve large samples and are sometimes conducted in multiple sites
The hallmark of this type of design is that participants are assigned to groups by chance, and thus the groups are equal on various characteristics.
Level III hierarchy of evidence
Includes one type of evidence: quasi-experimental designs.
Definition: Research designs involving the manipulation of the independent variable but lacking random assignment to experimental and comparison groups.
What distinguishes them from RCTs is the lack of random assignment of participants to experimental and comparison groups.
Also known as controlled trials without randomization, comparison studies, or cohort designs.
Level IV hierarchy of evidence
The evidence in Level IV does not involve manipulation of an independent variable
Includes correlational designs, epidemiological cohort and case-control studies, as well as quantitative data from mixed methods studies
Correlational designs
Level IV
Nonexperimental designs used to study relationships among two or more variables
Designed to answer the question, “Is there a relationship among the variables?”
Because there are no comparison groups and no random assignment, one cannot make claims about causality.
Cohort studies
Level IV
Epidemiological designs in which participants are selected based on their exposure to a particular factor
Designed to observe patterns of disease in populations.
Like experimental and quasi-experimental designs, cohort studies have two or more groups, but differ because there is no manipulation of an independent variable.
Case-control studies
Level IV
Epidemiological studies whereby participants are grouped on the presence or absence of a particular disease or condition and are then compared for similarities and differences
There is only observation without any intervention; therefore, researchers do not measure the amount of the exposures, nor do they manipulate individuals or the environment.
Mixed methods design
Level IV
A design that combines both quantitative and qualitative data gathering and evaluation
Findings from the quantitative part of the study would be considered Level IV, and findings from the qualitative portion of the study would be in a lower level.
Level V Hierarchy of Evidence
Evidence in Level V, like the evidence in Level I, consists of syntheses. What makes this level different from Level I is that evidence included for synthesis is lower-level evidence.
This level includes integrative reviews and metasyntheses.
Integrative review
Level V
Scholarly papers that include published nonexperimental studies in the synthesis to answer clinical questions
A strength of integrative reviews is that they involve a systematic search of the literature and include stringent criteria for selecting studies for synthesis. Through analysis and synthesis, themes and categories can be developed to answer the clinical question.
Metasynthesis
Level V
A systematic review of qualitative studies
They shed light on patient perceptions and experiences. Like systematic reviews, metasyntheses aim to identify high-quality recommendations for patient care.
Level VI
Level VI includes descriptive research. Most studies in this level answer the question, “What is it?” Studies typically involve a single group and include observation without interventions.
Although evidence in this level can help nurses better understand clinical problems, it cannot be used to make claims about cause and effect.
Single descriptive survey studies, single qualitative studies, qualitative findings from mixed methods studies, EBP projects, quality improvement (QI) projects, case series studies (epidemiologic), case studies, and concept analysis are different types of descriptive research.
Descriptive survey designs
Level VI
Nonexperimental studies that involve asking questions of a sample of individuals who are representative of a group
May have a variety of purposes, such as describing, comparing, or correlating characteristics. This is the most commonly used design for descriptive research. Data, collected through questionnaires or personal interviews, are typically about attitudes, perceptions, or attributes of individuals.
Qualitative research
Level VI
Research that uses words to describe human behaviors
Different qualitative approaches: phenomenology, grounded theory, ethnography, and historical.
Using in-depth interviews with or without observation, thick, rich descriptions can be generated about human behaviors.
Qualitative findings can also be used to develop or refine theories
