One of the most important foundations of scientific for effective nursing practice is knowledge, skills and integrative capabilities related to evidence based practices. Evidence based practice can be understood as a method of combining research, clinical knowledge and the preferences of the patient in order to decide the healthcare practice (DiCenso, Guyatt & Ciliska, 2014). The levels of evidence can also be understood as a hierarchy of evidence are used is studies due to their analytical quality of the layout, effectiveness and appropriateness towards the care provided to the patient.
Given below are the levels of evidence based of the Grade/Strength of Recommendation:
Level 1: collected from meta analysis of all pertinent randomized controlled trials (RCT) or evidence based clinical practices based on organized analysis RCT or three or more RCT of accepted quality having comparable outcomes.
Level 2: Collected from at least one well planned RCT
Level 3: Collected from well designed controlled trials but with no randomization (quasi experiential)
Level 4: Collected from well designed case control or cohort analysis
Level 5: Collected from systematic reviews of descriptive and qualitative analysis
Level 6: Collected from a single descriptive qualitative analysis
Level 7: Collected from opinions or reports
Different clinical queries can be addressed by different types of research analysis, and a single highest level of evidence might not always be applicable to address the query. In such circumstances, the next level of evidence should be selected. A certain level of problem solving and analytical reasoning is also needed to correlate results from different studies (Hamric, Hanson, Tracy & O’Grady, 2013).
Grading of evidence allows a deeper dive into the knowledge; skills and integrative abilities required for evidence based nursing practices.
Grade A: Systematic Reviews, Critically appraised topics, critically appraised individual articles
Grade B: Randomized control trials, Cohort Studies, Case controlled studies
Grade C: Background information/ expert opinion
[Figure 1: Grading Pyramid. Glover, Odato and Wang, 2006]
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences. Pp 4-17
Glover, J., Odato, K. and Wang, L. (2006). Research Guides: Evidence-Based Medicine Subject Guide: EBM Pyramid. [online] Guides.lib.uci.edu. Available at: https://guides.lib.uci.edu/ebm/pyramid [Accessed 10 Nov. 2017].
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2013). Advanced Practice Nursing-E-Book: An Integrative Approach. Elsevier Health Sciences.pp 67-84