Author: Elizabeth Kudzma, DNSc, MPH, RNC
Title: Professor, Division of Nursing
Institution: Curry College
Coauthors: Maureen L. Murphy Phd EdM CNM, Cathleen C. Santos MSN RN
Online or Web-based Modules
Learning Objectives modified from QSEN
- Identify reliable sources for locating evidence reports and clinical practice guidelines.
- Apply pertinent evidence-based reports related to clinical coursework.
- Level original research and evidence reports related to coursework.
- Distinguish clinical opinion and consensus from research and evidence summaries.
- Describe how the strength of available evidence influences the choice of interventions in provision of nursing care.
Students are exposed to a wide variety of evidence in their nursing classes. In many cases relevant current studies are cited and summarized in classes frequently in PowerPoint format. This simple strategy asks faculty to level the type of evidence used in the research study when discussing it in class. If PowerPoint format is used, the level of evidence can be cited at the bottom of the slide. Viewing the level of evidence with the research study summary should provide application of the information about levels of evidence to the current topic under study.
Students should be exposed to exemplars in evidence-based practice, PICO format and levels of evidence early in the nursing curriculum. For later classes, only a few slides (see PowerPoint presentation attachment) at the beginning of a course may be necessary to reacquaint the student with major principles of evidence-based practice and levels of evidence. Since there are several rating guides for levels of evidence, several sources might be used. We used the following sources for evidence-based nursing conceptual content and for grading level of evidence:
Melnyk, B. & Fine-Overholt, E. (2005). Evidence-Based Practice in Nursing and Healthcare. Lippincott, Williams & Wilkins.
Siwek, J., Gourlay, M., Slawson, D. & Shaughnessy, A. (2002). How to write an evidence-based clinical review article. Am Fam Physician 65, 251-258.
This strategy increases student engagement in nursing classes where study examples are cited. Instead of viewing use of evidence-based investigation as dry and involved primarily with the nursing research course, students found that they could actually level evidence and discuss why a study would fit into a particular level or category. Through use of this strategy, students became more thoughtful about levels of evidence and were able to discriminate levels of evidence. In an introduction to vital signs and blood pressure, students were able to recognize that the Siwek et al. (2002), Level C consensus/ expert opinion, applied to the Seventh Report of the Joint National committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) statement about categories of hypertension and pre hypertension. Also, as a result of this strategy, students became more discriminating and practical about use and issues surrounding randomization in various studies. The strategy assists students to see that evidence-based practice applies in a diversity of nursing curricular areas. Evaluation of the strategy can also be accomplished through exam questions on the various studies or focused papers in which the student is asked to discuss levels of evidence and rationales.