NRS 433 Topic 4 DQ 2 

Topic 4 DQ 2 

Apr 25-29, 2022 

Describe the “levels of evidence” and provide an example of the type of practice change that could result from each. 

Gale Storm-Bryant 

Posted Date 

May 3, 2022, 6:45 PM 

Dr. Felder, 

The re-post is to include my second EB article thank you. 

There are several levels of strategies or research that can be used to determine the effectiveness of  evidence. The level is based on how it will be impacted by biases and its outcomes (Glasofer & Townsend, 2019).  

The highest level 1 of research technique would use RCT, Systematic Review, and Meta Analysis. These have been noted to provide the best evidence. If used together it has an even stronger effectiveness (NOVA, 2021). These types of studies would be good for cause and evaluate the effect. 


The next level 2 may involve Quasi experimental and Systematic Review, but it may be missing a criteria that would be found when doing an experimental research. This type of research does not have the same strength but can be used for comparison research like a pre and posttest effect (Glasofer & Townsend, 2019).  


Level 3 is considered Non-experimental with no manipulation of the variables. This level can use Systematic Review, RCT and Meta Analysis but it is not required (Glasofer & Townsend, 2020)1. It can also be called observation research; the researcher observes but does not have an intervention. This type of research could be used to see the effect something has. They may ask the group to write a daily occurrence to see the effect. In this research area the researcher could use, case -control -look at a condition and compare with someone who does not have that condition (Glasofer & Townsend, 2020)1. 


In level 4 the researcher is using opinions or statements. These could be found in clinical practice guidelines, position or consensus statements. The guideline is tested and reviewed by experts, consensus and position statements are as well but also go through peer reviews and are limited (Glasofer & Townsend, 2020)2. These options may not have the same quality as the levels before them. However, they are good for comparison information when looking for evidence-based documentation. 


The last level 5 and has the least quality of evidence is Literature Review which does not have set standards. Literature Review can give a helpful summary of information but should be used with caution (Glasofer & Townsend, 2020)2. This type of research could be used if you are just wanting to know more about a topic, but it is not peer reviewed and may have high bias. 


Levels 1,2 and 3 are the best for obtaining evidence-based practice research information that may provide outcomes to improve healthcare and nursing interventions. An article by Gronning et al., (2022) conducted a study to support the importance of nursing students learning about evidence-based practice. Showing how to incorporate evidence-based information into their work and having the latest knowledge. They learned the importance of research to improve clinical practice as our patients depend on us having the most accurate and reliable information. Opinions, reviews and literature are good for comparisons and information but not for reliability as opinions can be wrong. 



Glasofer, A., Townsend, A. B., (2019). Determining the level of evidence. Nursing Critical Care: Volume 14 – Issue 6 – p 22-25, doi: 10.1097/01.CCN.0000580120.03118.1d 


Glasofer, A., Townsend, A. B., (2020)1. Determining the level of evidence. Nursing Critical Care: Volume 15 – Issue 1 – p 24-27, doi: 10.1097/01.CCN.0000612856.94212.9b 


Glasofer, A., Townsend, A. B., (2020)2. Determining the level of evidence, Nursing Critical Care: Volume 15 – Issue 2 – p 22-26. doi: 10.1097/01.CCN.0000654792.71629.00 


Grønning, K., Karlsholm, G., & André, B. (2022). Undergraduate Nursing Students’ Experiences of Conducting Clinical Research Projects in Their Bachelor Theses – a Qualitative Study. SAGE Open Nursing, 1–9. 


North Virginia Community College (NOVA) (2021, September 27th). Evidence-Based Practice for Health Professionals: Levels of Evidence. LibGuides. 

Wanda Felder 

Posted Date 

May 1, 2022, 6:44 PM 

Replies to Gale Storm-Bryant 

Research in healthcare is the standard behind practice change and improvements in patient care. As new researchers, one may feel that their impact on nursing is not felt. In actuality, participation in research progresses over time allowing a greater impact on patients, but also interprofessionally. With the inclusion of learning and research in nursing, learning environments help develop new practices and enhance engagement (Nasrabadi et al., 2021). The image below details how the effect of research is originally felt at the organizational level and leads to influences on healthcare policies. With further research, there are changes in health systems, which lead to societal and economic changes. Therefore, as nurses, and as researchers, we must acknowledge that our research is needed and that it is equally effective.  As a nurse, we are learning new techniques and practices regularly. Nasrabadi et al. (2021) discuss the importance of EBP in nursing and how research leads to nurses being lifelong learners.  

Over time, how do you see yourself contributing to research?  


Nasrabadi, A. N., Mohammadi, N., Rooddehghan, Z. , Shabani, A., Bakhshi, F., & Ghorbani, A. (2021). The stakeholders’ perceptions of the requirements of implementing innovative educational approaches in nursing: A qualitative content analysis study. BMC Nursing, 20(131), 1-10. 


Jumyr Kangleon 

replied toWanda Felder 

May 1, 2022, 9:32 PM(edited) 

Replies to Wanda Felder 

Dr. Felder, According to Heydari et al. (2014), the evidence-based practice (EBP) approach has the potential to improve healthcare quality and is critical for nurses’ and midwives’ professional growth, responsibilities, and capacities. Furthermore, evidence-based practice can lower the costs associated with inefficient care while also lowering treatment risks for clients and patients in accordance with patient and community expectations of nursing practice. I believe that research leads to nurses being lifelong learners because we want the best for our patients, and therefore, we will do what has been studied to be the best practice to increase positive health outcomes. By continually learning, nurses are able to contribute to positive, quality patient care and outcomes. According to Heydari et al. (2014), few nurses thought they could find enough relevant data to incorporate into their clinical practice since they had not received training and had little experience searching for research evidence. Although nurses were aware of the research process and could use various levels of evidence in clinical practice, they were unfamiliar with the concepts and principles of evidence-based practice. Prior to taking this class, I was unaware of the existence of many evidence-based procedures and had no idea how to obtain information about them. However, I feel that this research class has shown me how essential research is to nursing and nursing care, and I plan to continue studying and searching for the best techniques to include in my nursing practice. I also aim to contribute to research as I get more knowledgeable and comfortable with it, and to be able to perform a study that will help many people. 


Heydari, A., Mazlom, S.R., Ranjbar, H., and Scurlock-Evans, L. (2014). A study of Iranian nurses’ and midwives’ knowledge, attitudes, and implementation of evidence-based practice: The time for change has arrived. Worldviews on Evidence-Based Nursing, 11(5), 325–331 

Wanda Felder 

Posted Date 

May 1, 2022, 6:44 PM 

Hi Class,  

Review this chart to understand how the different levels of evidence are measured. This might be helpful in ascertaining the various articles you find for your papers, as well as your discussion posts. 


Wanda Felder 

Posted Date 

May 1, 2022, 6:44 PM 

Hi Class,  

Let’s review this video to gain an understanding of levels of research. Remember that viewing this video is optional and is to allow you additional opportunities for participation. 

Jana Garcia 

Posted Date 

Apr 30, 2022, 10:26 PM 

Replies to Gale Storm-Bryant 

Research design is studied in many forms, and they are not all “equally effective in determining cause and effect” (Glasofer, 2021). For this reason, “evidence can be organized into hierarchies based on its strength” ( Glasofer, 2021). The John Hopkins hierarchy of evidence is a model of evidence that is measured from the bottom being the weakest and the top of the hierarchy being the strongest. Beginning from the top and working down, level 1 and level 2 are experimental design and quasi-experimental research. Experimental design includes as study that is “retrospective, prospective, or longitudinal studies”( Glasofer, 2021). quasi-experimental design is “systematic reviews and meta-analyses present results by combining and analyzing data from different studies conducted on similar research topics” (Ahn, 2018). Level 3 and level 4 includes non-experimental study and expert opinion. A Non-experimental study there is ” no manipulation of the independent variable, and do not require a control group” ( Glasofer, 2021). Expert opinion is the studies opinion of a professional or a panel of professionals and finally, level 5 is literature review, which is a review of previous research studies by evaluating and comparing the data and determining the outcome.  

Evicence Based practice’s goal is to improve patient care, safely, and effectively by evidence found in research. An example of practice change based on level 5, evidence review, was published in Korean Journal of anesthesiology. care based on research on the PICOT “in non-ventilated patients, how does consistent versus inconsistent oral care impact patient outcomes” (Ahn, 2018). Research was 13 articles was reviewed, based on their findings, policies were written to provide guidance to floor nurses providing care. Level 4, expert opinion example could include eliminating pacifiers from all nurseries based on studies conducted by lactation consultants. Change of care by level 3, non-experimental policy change could include a nonsmoking policy based on statistics of lung disease by active smokers. Level 2 quasi-experimental research practice change example could include adding care coordinators to the units to improve long term health outcomes to prevent acute care readmission” (Nembhard, 2020). Finally, an example of level 1 would be changing hand sanitizer on the units by conducting an experimental design comparing 3 brands and excluding the two that eliminate the least germs. The most effective research of all of these examples in level 1, experimental design of hand sanitizer, the outcome is quantitative and evidence by statistical outcome.  


thank you,  




Ahn, E., & Kang, H. (2018). Introduction to systematic review and meta-analysis. Korean journal of anesthesiology, 71(2), 103–112. 


Glasofer, A., & Townsend, A. B. (2021, February 1). Determining the level of evidence: Nonexperimental research designs. Nursing, 51(2). 


Nembhard, I. M., Buta, E., Lee, Y., Anderson, D., Zlateva, I., & Cleary, P. D. (2020). A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers. BMC health services research, 20(1), 137. 


Tracy Tibbs-Briggs 

replied toJana Garcia 

May 1, 2022, 7:55 AM 

Replies to Jana Garcia 

Thank you, Jana. I enjoyed how you gave examples of each level of evidence.  Both levels five and four are thorough studies with the most negligible bias outcome due to their random control trials.  The most significant difference I see from levels five and four is the meta-analysis or consistency of multiple studies where the conclusion and data are consistent. Whereas level four has numerous studies (Deaton & Cartwright, 2018).  However, they may not all be conclusive, but the evidence is available, and the studies are adequate. The other levels of research that consist of one to three are great building blocks for the experimental data needed for the RCT studies. Level 3 looks at a specific group of people to collect data and anticipate outcomes before applying it to the larger population.  They are considered well-designed trials without randomization, called quasi-experimental studies.  Here, we assess risk and probability (John Hopkins School of Nursing, 2017). Level two, these are not a relationship to examine in the study, and there is no correlated cause and effect established.  However, level one does not have to be a direct cause and effect. It does not have to be a study (The University of Michigan, 2015).  Just well-developed and nationally known scientists do research via literature or small studies to create a hypothesis or idea supported by science and data.  



Deaton, A., & Cartwright, N. (2018). Understanding and misunderstanding randomized controlled trials. Social Science & Medicine, 210, 2–21. 


John Hopkins School of Nursing. (2017). Appendix d evidence level and quality guide of nursing evidence levels quality ratings level. 


The University of Michigan. (2015). Research Guides: Nursing: Levels of Evidence. 


Tamara Houston 

Posted Date 

Apr 30, 2022, 9:39 AM 

Replies to Gale Storm-Bryant 

Evidence-based practice is now widely recognized as the key to improving healthcare quality and patient outcomes (Chien, 2019). Its main purpose is to aide in clinical decision making. Within evidence-based practice is a hierarchy system known as levels of evidence utilized for the classification or ratings of evidence. These levels are broken down into five with level one being the highest level. Writers at John Hopkins University Dang & Dearholt (2018) outline the hierarchies as such: Level I include RCT (randomized control trial), a systemic review of RCTs, or a meta-analysis of RCTs. This level is the most experimental level. Level II contains quasi-experimental research. This level is also experimental because it involves manipulation or an intervention introduced by research, but lacks criteria necessary for true design (Glasofer & Townsend 2019). Level III contains nonexperimental studies with or without a meta synthesis. Level IV consist of expert opinions based on scientific evidence, clinical practice guidelines and a consensus panel. Level V is the lowest level which contains literature review and program evaluations. To apply these levels, nurses and clinicians should have a basic understanding of research design as evidence will be used to guide practice. 




Chien, L. Y. (2019). Evidence-based practice and nursing research. The Journal of Nursing Research, 27(4), e29. 


Dang, D., & Dearholt, S.L. (2018). Johns Hopkins nursing evidence-based practice : Model & guidelines (3rd ed). Sigma Theta Tau International. Retrieved from 


Glasofer, Amy DNP, RN, NE-BC; Townsend, Ann B. DrNP, RN, ANP-C, CNS-C Determining the level of evidence, Nursing Critical Care: November 2019 – Volume 14 – Issue 6 – p 22-25 doi: 10.1097/01.CCN.0000580120.03118.1d  


Gale Storm-Bryant 

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