(^140) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
inadvertent double counting or inappropriate weighting^ of the results of a single
study, which distorts the available^ evidence” (International Committee of Medical
Journal Editors, 2010, IIID2).
A Practical Tool for Appraising Research Evidence
The Research Evidence Appraisal Tool (see Appendix E) gauges the strength and
quality of research evidence. The tool contains questions to guide the team in
determining the level of strength of evidence and the quality of the primary stud-
ies included in the review. Strength (level and quality) is higher (Level I) with
evidence from at least one well-designed (quality), randomized controlled trial
(RCT) than from at least one well-designed quasi-experimental (Level II), nonex-
perimental (Level III), or qualitative (Level III) study. The tool also contains ques-
tions to guide appraisal and to determine the quality of the research.
An EBP team can use the Individual Evidence Summary Tool (see Appendix G)
to summarize key findings from each of the individual pieces of evidence that
answers the EBP question. This enables team members to view pertinent informa-
tion related to each source (author, evidence type, sample, setting, findings that
answer the EBP question, limitations, level of evidence, and quality ratings) in
one document.
An EBP team can use the Synthesis and Recommendations Tool (see Appendix
H) to document the quantity or number of evidence sources for each level of evi-
dence, determine the overall quality rating for each level, and synthesize findings
to conclude if practice, process, or system changes should be made. The team’s
final recommendations are listed at the bottom of the tool. A guide to how to
synthesize evidence is provided in Appendix H.Recommendation for Nurse Leaders
Knowledge gained from research studies is valuable only to the extent that it is
shared with others and appropriately translated into practice. Professional stan-
dards have long held that nurses need to integrate the best available evidence,