Distinguish between the organization of articles by evidence level and organization of articles by clinical question. Please utilize Figure 1 John Hopkins Evidence Based-Practice Model for Nursing and Health Care Professionals.
Once all the articles considered important to answer the clinical question have been gathered, the DNP should be able organize the articles by level of evidence and type of evidence.
What is the purpose of the article organization?
How do you compare the article organization by type of evidence vs the organization based on the type of clinical question?
What is the best way to organize the studies when the organization is based on the clinical question?
Sample Answer
When it comes to evidence-based practice (EBP) in healthcare, a key component is the organization of articles to inform a clinical decision. This is done in two main ways: by evidence level and by clinical question. The Johns Hopkins EBP Model for Nursing and Health Care Professionals, which follows the Practice, Evidence, and Translation (PET) framework, emphasizes both of these approaches.
Purpose of Article Organization
The primary purpose of organizing articles is to streamline the process of synthesizing evidence and to ensure that the strongest, most relevant information is used to answer a clinical question. Without a clear organizational system, a DNP or other healthcare professional would be overwhelmed by the sheer volume of literature available. By organizing the articles, you can:
Determine the strength of the evidence for a particular intervention or question
Identify gaps in the research where high-level evidence is lacking.
Facilitate the creation of a comprehensive evidence summary that will guide a practice change or a new protocol.
Prevent bias by ensuring a systematic and transparent review of all gathered sources.
Comparing Organization by Evidence Level vs. Clinical Question
Organizing articles by evidence level and by clinical question are two interconnected but distinct methods. They work in tandem to provide a complete picture of the available evidence.
Organization by Evidence Level
This method, often represented by an evidence hierarchy or pyramid, ranks studies based on their research design and the potential for bias.
Licensed by Google
The higher a study is on the pyramid, the less likely it is to be influenced by bias and the stronger its evidence is considered.
Highest Level (Top of the Pyramid): Systematic reviews and meta-analyses. These combine the findings of multiple high-quality studies on the same topic, providing the most reliable evidence.
Mid-Level: Randomized controlled trials (RCTs). These studies randomly assign participants to different groups (e.g., an intervention group and a control group) to minimize bias.
Lower Levels: Cohort studies, case-control studies, and case series. These observational studies are more susceptible to bias and are considered weaker forms of evidence.
Lowest Level (Bottom of the Pyramid): Expert opinion and anecdotal evidence. This type of information is not based on rigorous research and should be considered the weakest form of evidence.
Organizing by evidence level allows you to quickly assess the quality and trustworthiness of the information you have gathered. It helps you prioritize the strongest studies while still considering all available evidence.
Organization by Clinical Question
This method is less about the type of study and more about the specific topic and components of the question you are trying to answer. The Johns Hopkins EBP Model, for example, utilizes a PICO(T) format to frame clinical questions: Population, Intervention, Comparison, Outcome, and Time.
Organizing articles by clinical question involves grouping studies that address a particular aspect of your PICO(T) question. For example:
Population: Studies focusing on a specific patient demographic.
Intervention: Articles about a particular treatment or procedure.
Comparison: Studies that compare the intervention to an alternative or to standard care.