The Evidence Hierarchy: A Change In Practice

An annotated bibliography is a catalogue of citations to books, documents and articles with the purpose of the annotation being to inform the reader of the precision, relevance and quality of the sources cited (Davis, 2009). Evidence based practice enables health care professionals to effectively use current verification during the decision-making procedure (Sacket et al 2000). Healthcare professionals use a hierarchy of evidence as a guide to define the reliability and importance of the evidence based research; with the evidence that is founded further upon

Nurses are responsible in providing holistic, quality care to their clients. In order to effectively provide such care Boswell and Cannon (2009, p. 2 & 7) states that nurses must base their provision of care on the most current, up-to-date health information available and sound nursing knowledge. This is where evidence-based practice (EBP) comes in. Polit and Beck (2010, p. 4) defined EBP as "the use of the best clinical evidence in making patient care desicions". This usually comes from research conducted by nurses and other healthcare professionals. Thus it is pertinent that research reports are critically analyzed.

Over the course of decades medical treatment has advanced causing an increase in the wellness of patient clinical outcomes. A large portion of the improvement is due to the vital role nurses play in the delivery of safe and quality care to their patients. For many years different methods of treating patients have evolved due to the continued research for the best practice. Nurses, researchers and people with questions have always tried to find better and efficient solutions to treat their patients detailing the best possible evidence-based practice. Evidence-based practice is an important tool to use for clinical decision making however one must understand it first. Interpreting Evidence-based practice allows nurses to comprehend the steps to determine if new evidence is needed and realize there are some benefits to utilizing up to date research and obstacles that may impeded the research into practice. .

Evidence based practice is the incorporation of individual clinical expertise with best research evidence and patient values and expectations. Health care decision of individual patients should be based on best available research evidence. A health decision made from a sound research evidence has the potential to ensure best practice and reduce variations in health care delivery. In health science, an ever increasing plethora of studies being published and is challenging for clinicians to keep up with the literature. Integrating research into practice is time consuming and need methods for easy access to such evidences for busy clinicians. Indeed, clinical decision should be based on the latest research evidence. Systematic reviews and meta-analyses summarize the research evidence, which is generally the best form of evidence, thereby making the available evidence more accessible to decision makers and are positioned

There are many versions of the hierarchical evidence levels. When deciding on basing clinical interventions on evidence, there are two specific models to look at. They both describe levels of evidence and are depicted as pyramids. The first is the 6S model, with the “more patient-specific” information listed at the top of the pyramid (Houser, 2015). The top of the pyramid has the least amount of information as compared to the base, it is more relevant, but it yields the least amount of information (2015). Conversely, the more abundant information found at the bottom is less relevant to the specific intervention in question (2015). Also, the searches conducted at the more basic levels typically take less time to yield results due to the broader relationship to the intervention in question (2015). The 6S model of hierarchical pyramid of evidence are listed as follows from highest to lowest:

The Advance Practice Nurse has a long and interesting history. Advanced practice nursing has gone from women being trained by physicians to administer chloroform to, in some states, having their very own practice. The term of advanced practice did not begin until the 1980s, prior to that the advanced practice nurse was described as having an extended or expanded role. While the advanced practice nurse had finally gained a name for their role there are currently several definitions to define this ever changing field. There is currently no standardized definition of the Advanced Practice Nurse (APN). Three definitions of advanced practice will be described and reviewed within this text.

QP provided Chase with the opportunity to participate in an evidence base practice geared toward understanding warning signs. QP explained to Chase that the activity will him to identify times when he need to take a time-out and how to use self-calming thoughts. QP explained to Chase, that Self-calming thoughts are used to help de-escalate one’s emotions and separate them from a potentially difficult situation. QP explained to Chase, what red flags are; that is, the signs that indicate to a person that a time-out is necessary or a situation may get abusive or escalates. QP explained to Chase that the goal of the intervention is, to teach him how to identify personal red flags and how to use self-calming thoughts in a situation. QP asked

It would seem a foregone conclusion that effective clinical practice is based on the best possible, rigorously tested evidence because the public assumes it, patients expect it and practitioners profess to value it. Yet the emphasis on evidence as a basis of clinical practice reached the forefront of health care only in the last two decades. The past decade has seen unprecedented advances in information technology, making research and other types of evidence widely available to healthcare practitioners. Technology has supported the rapid communication of best practice and afforded consumers open access to healthcare information as well. As a result, Evidence Based Practice (EBP) is quickly becoming the norm for effective clinical practice.

Utilizing evidence based practice in nursing is paramount today in the always evolving field of nursing. Having the clinical expertise and knowledge of a nurse is just the first step in making decisions for the treatment of a client. Adding the most recent and up to date evidence alongside with the client’s values and preferences is ideal to guiding the process of healthcare (Kelly & Tazbir, 2010). When evidence based guidelines are set forth in the plan of care for a client, the clinician has an abundant of amount of data to make sound decisions on. This allows the nurse to make the best decision or develop the best strategy to deliver care. Evidence based practice also allows

As every patient is unique and has his/her own condition, nurses and other health care providers need a source to follow as a guideline. Evidence based practice can be used as good guideline for health care provider, and it also can show different ways of care and their results. Evidence based practice has a huge role in the world of nursing profession. One of the biggest goals of nurses is to apply the evidence into their practice in a right way, even though a lot of nurses could not apply the evidence into their practice in the right way. ((Schmidt & Brown, 2015). Role of a professional nurse is to implement the evidence into practice in a right way, and create the right result from it. There are a lot aspects involved in evidence based practice

When Rebecca asks why the PICOT question is so important, Carlos explains that it's a consistent, systematic way to identify the components of a clinical issue. Using the PICOT format to structure the clinical question helps to clarify these components, which will guide the search for the evidence.6, 7 A well-built PICOT question increases the likelihood that the best evidence to inform practice will be found quickly and efficiently.5-8

The shortage of physician primary care provider, has created public awareness bringing about the demand of the advanced practice registered nurses (APRNs). The APRN has the necessary training to assess, diagnose and treat patients. As the role of APRN begin to expand the need to prescribe medications becomes very important. According to the American Association of Nurse Practitioners (AANP), APRN practice in the United States is divided into three groups: full practice, reduced practice, or restricted practice.

The data was analysed by a computer program, which was identified but not clarified the reason used. Polit and Beck (2006) argue researchers should clarify that the chosen instrument is the most appropriate for their study with evidence of validity and reliability. Futhermore if an established computer program that has already has established validity and reliability is used this should be outlined as stated by Wood et al, (2006) and in this case were not.

Advanced Practice Registered Nurses (APRNs) have the qualifications and education have an increased scope of practice that allows them to to take on many positions due to their clinical expertise. Their preparation allows them to fulfill the responsibilities to their patients and to provide a far more services in practice that other nursing professions. With recent changes in medical reimbursements and the focus on patient-centered preventive care, nurses can take on the role of nurse practitioner, clinical nurse specialist, nurse anesthetist, or nurse midwives, among others and can play a more meaningful role in the future of health care delivery. APRNs expand the delivery of primary care by becoming apt providers that are hastily confronting the need for providing effective preventative care to the general public.

A Descriptive research purpose was used to answer the quantitative research PICOT question. In human research, a descriptive study can provide naturally occurring health status, behavior, attitudes and other characteristics of a particular group. In descriptive studies, data is collected without interfering the environment and is also referred as observational study. Descriptive studies are conducted to examine