Johns Hopkins Nursing Evidence-Based Practice Thrid Edition: Model and Guidelines

(^130) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
(Taddio, Shah, & Katz, 2009). The researchers found that sucrose-treated infants
had significantly lower pain scores during post-venipuncture diaper change than
did water-treated infants (mean difference: –1.4 (95% CI: –2.4 to –0.4)). With re-
peated measurement of the population, the researchers would expect to find (with
a 95% degree of certainty) consistent differences in neonatal pain scores, with the
mean falling between –2.4 and –0.4. If the confidence interval includes 0, there is
no difference or association between the variables/groups.

Appraising the Level and Quality of Research Evidence

The use of rating scales assists the critical appraisal of evidence. Rating scales pres-

ent a structured way to differentiate evidence of varying strengths and quality. The

underlying assumption is that recommendations from higher levels of evidence of

high quality would be more likely to represent best practices. Table 6.7 presents

the rating hierarchy used in the Johns Hopkins Nursing Evidence-Based Practice

(JHNEBP) process to evaluate the level of research evidence. Table 6.8 presents the

JHNEBP rating guide for quantitative research evidence. (See also Appendix D for

quality ratings for qualitative and mixed methods research evidence.)

Table 6.7 Rating Hierarchy for Level of Research Evidence

LEVEL TYPE OF EVIDENCE

I An experimental study, randomized controlled trial (RCT), explanatory mixed

methods with only level I quantitative study, or systematic review of RCTs, with or

without meta-analysis

II A quasi-experimental study, explanatory mixed methods with only level II

quantitative study, or systematic review of a combination of RCTs and quasi-

experimental studies, or quasi-experimental studies only, with or without meta-

analysis

III A quantitative nonexperimental study; explanatory mixed methods with only level

III quantitative study; exploratory, convergent, or multiphasic mixed methods

studies; systematic review of a combination of RCTs, quasi-experimental, and

nonexperimental studies, or nonexperimental studies only; or qualitative study or

systematic review of qualitative studies, with or without a meta-synthesis