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

(^52) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
Step 10: Synthesize overall strength and quality of evidence
Next, the team determines the overall quality for each level of evidence and re-
cords it on the Synthesis Process and Recommendations Tool. Through synthesis,
the team makes a determination of the overall strength and quality of the collected
body of evidence, taking into consideration the (a) level, (b) quantity, (c) consisten-
cy of findings across all pieces of evidence, and (d) applicability to the population
and setting. The team can use the quality criteria for individual evidence appraisal
as a guide for determining overall quality. Making decisions about the overall
strength and quality is both an objective and a subjective process. The EBP team
should devote the necessary time to thoughtfully evaluate the body of evidence
and come to agreement on the overall strength and quality. Refer to Chapters 6
and 7 and Appendix H for more information on evidence synthesis.
Step 11: Develop recommendations for change based on evidence synthesis
Based on the overall appraisal and synthesis of the evidence, the team considers
possible pathways to translate evidence into practice. A team has four common
pathways to consider when developing a recommendation (Poe & White, 2010):
■■ Evidence may be compelling, with consistent results that support a prac-
tice change.
■■ Evidence may be good, with consistent results that support a practice
change.
■■ Evidence may be good, but with conflicting results that may or may not
support a practice change.
■■ Evidence may be nonexistent or insufficient to support a practice change.
Based on the selected translation pathway, the team then determines whether to
make the recommended change or investigate further (see Table 3.4). The team
lists its recommendations on the Synthesis Process and Recommendations Tool
(see Appendix H). Carefully consider the risks and benefits of making the change.
We strongly recommended piloting changes in several representative areas/settings
to determine possible unanticipated effects or barriers.