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

(^254) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition

Appendix H: Synthesis Process and Recommendations Tool

Once Appendix G is completed, the team moves into evidence synthesis. The syn-

thesis process is described in Appendix H. Using this tool, the team outlines the

overall quality of the evidence to answer the EBP question, including the number

of sources for each level. This appendix is also where the team, through reason-

ing, evaluates evidence for consistency across findings; evaluates the meaning and

relevance of the findings; and merges findings that may either enhance the team’s

knowledge or generate new insights, perspectives, and understandings. In Appen-

dix H, the team identifies the recommendations for practice change. See Figure

11.7 for a completed Appendix H.

EBP Question: basin bathing, reduce the incidence of CAUTIs for adult patients on a medical/surgical unit.

Category (Level Type) Total

Number of

Sources/

Level

Overall

Quality

Rating

Synthesis of Findings

Evidence That Answers the EBP

Question

Level I

■■Experimental study

■■Randomized controlled trial (RCT)

■■Systematic review of RCTs with or

without meta-analysis

4 B

There was no significant difference

in rates of CAUTI between basin

cleaning and no care (2)

Cleansing wipes had statistically

significant impact on rates (3)

Secondary analysis found a

significant difference in the number

of CAUTI cases in units where wipes

are available (12)

Level II

■■Quasi-experimental studies

■■Systematic review of a combination of

RCTs and quasi-experimental studies,

or quasi-experimental studies only,

with or without meta-analysis

18 A-B

In hospitalized adults, self-care for

catheter cleansing is recommended

(5)

Level III

■■Non-experimental study

■■Systematic review of a combination of

RCTs, quasi-experimental and

nonexperimental studies, or non-

experimental studies only, with or

without meta-analysis

■■QuaLitative study or meta-synthesis

5 A-B

Basin cleansing had significantly

more infections (17) Cleansing wipes

more cost effective (8,10)

The total number of sources

for each level is entered

here.

Notice the overall quality rating. It is

not necessary to settle on one letter

if the team concludes the group of

evidence is between two grades.

As you can see here, Levels II, III,

and V have a mix of A and B quality

overall.