8 Translation 171
Strong, compelling evidence, consistent results: When strong, compelling evidence
is available, the application to practice is quite clear, particularly if the evidence
includes several Level I research studies. For example, it is easy to recommend a
practice change if you have three, high-quality, randomized, controlled trials with
consistent results or if there is a meta-analysis (Level I) related to the question.
However, this is not often the case with nursing questions.
Good evidence, consistent results. In many cases, the EBP team encounters good
overall evidence yielding consistent findings across studies, but the design and
quality may vary. There may be concerns about control of bias (i.e., internal
and external validity); adequate comparisons; or study design and methods for
which conclusions cannot be drawn. For example, the team may find only non-
experimental studies without comparison groups or only descriptive correlational
surveys, or the evidence may include multiple study designs such as quasi-
experimental, nonexperimental, and expert opinion. In these circumstances, and
particularly in the absence of Level I evidence, evaluation of the potential risks
and benefits is in order before recommending a change in practice. If the ben-
efits outweigh the risks, the EBP team should develop a pilot to test any practice
change and evaluate outcomes prior to full-scale implementation.
Good evidence, but conflicting results. In this situation, the overall evidence
summary includes studies with conflicting findings. Such evidence is difficult to
interpret. When this is the case, undertaking a practice change cannot be recom-
mended. The EBP team may decide to review the literature periodically for new
evidence to answer the question or perhaps to conduct their own research study.
Insufficient or absent evidence. Where little or no evidence exists in the public do-
main to answer the EBP question, the team cannot recommend a practice change.
The team may decide to search for new evidence periodically, design their own
research study, or cancel the project entirely.
Determine Fit, Feasibility, and Appropriateness of Recommendation(s) for
Translation
Practice recommendations made in the evidence phase, even if based on strong
evidence, cannot be implemented in all settings. The EBP team is responsible for
