(^156) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
■■ Were data sources for all costs reported?
■■ Were data sources and costs appropriate with respect to the program and
population being tested?
■■ Was the primary outcome measure clearly specified?
■■ Did outcomes include the effects or unintended outcomes of the
program?
■■ Was the analytic model reported in an explicit manner?
■■ Were sensitivity analyses performed?
Not all studies that include cost analysis are strictly financial evaluations. When
evaluating an article with a cost analysis, note that some articles may use rigor-
ous designs and should be appraised using the Research Evidence Appraisal Tool
(see Appendix E). An example of the use of a cost analysis is a report by Yang et
al. (2015) that evaluates the impact of different nursing staffing models on pa-
tient safety, quality of care, and nursing costs. Results indicated that units with a
76% proportion of RNs made fewer medication errors and had a lower rate of
ventilation weaning and that the units with a 92% RN proportion had a lower
rate of bloodstream infections. The 76% and 92% RNs groups showed increased
urinary tract infection and nursing costs (Yang, Hung, & Chen, 2015). After a re-
view of this study, the EBP team would discover that this was actually a descrip-
tive, retrospective cohort design study. Thus, it requires use of research appraisal
criteria to judge the strength and quality of evidence.
Expert Opinion (Level V Evidence)
The opinions of experts take the form of commentary articles, case reports, or
letters to the editor. Expert opinion can also be written and in the form of a con-
versation with a recognized expert. External recognition (state, regional, national,
international) that a professional is an expert is critical to determining the confi-
dence an EBP team has in the expert’s recommendations. Assessing expertise of
an author of commentaries and opinion pieces requires another step. The EBP
team can review the author’s education, work, university affiliations, and