(^146) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
■■ Recommends approaches for building nurses’ capacity to appraise non-
research evidence to inform their practice
Summaries of Research Evidence
Summaries of research evidence such as clinical practice guidelines, consensus
or position statements, integrative reviews, and literature reviews are excellent
sources of evidence relevant to practice questions. These forms of evidence review
and summarize all research, not just experimental studies. They are not classified
as research evidence because summaries of research evidence are often not com-
prehensive and may not include an appraisal of study quality.Clinical Practice Guidelines and Consensus/Position Statements
(Level IV Evidence)
Clinical practice guidelines (CPGs) are systematically developed statements that
guide clinical practice and evidence-based decision-making (Polit & Beck, 2017).
CPGs, which are recommendations that synthesize available experimental and
clinical evidence with bedside experience, are open to comment, criticism, and
updating (Deresinski & File, 2011). Consensus or position statements (CSs) are
similar to CPGs in that they are systematically developed recommendations that
may or may not be supported by research. CSs are broad statements of best prac-
tice; are most often meant to guide members of a professional organization in
decision-making; and do not provide specific algorithms for practice (Lopez-
Olivio, Kallen, Ortiz, Skidmore, & Suarez-Almazor, 2008).
The past two decades have seen an exponential increase in CPGs and CSs. To
help practitioners determine the quality of CPGs, the Institute of Medicine (IOM)
identified eight desirable attributes, which include validity; reliability and re-
producibility; clinical applicability; clinical flexibility; clarity; documentation;
development by a multidisciplinary process; and plans for review (IOM, 1992).
Many of these attributes were absent from published guidelines, resulting in the
Conference on Guideline Standardization to promote guideline quality and to
facilitate implementation (Shiffman et al., 2003). The Appraisal of Guidelines
Research and Evaluation (AGREE) Collaboration, using a guideline appraisal