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Complete all five of the evidence appraisals using the the correct appraisal form. There are two different appraisal forms. The appropriate one should be used for the specific article. There are five articles that need to be appraised. I provided in the attachments the different appraisal forms, and the five articles.
Johns Hopkins Nursing Evidence-Based Practice
Appendix F: Non-Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
1
Evidence level and quality rating:
Article title: Number:
Author(s): Publication date:
Journal:
Setting: Sample
(composition and size):
Does this evidence address my EBP
question?
❑ Yes
❑ No
Do not proceed with appraisal of this evidence.
❑ Clinical Practice Guidelines LEVEL IV
Systematically developed recommendations from nationally recognized experts based on research
evidence or expert consensus panel
❑ Consensus or Position Statement LEVEL IV
Systematically developed recommendations, based on research and nationally recognized expert opinion,
that guide members of a professional organization in decision-making for an issue of concern
■■ Are the types of evidence included identified?
❑ Yes ❑ No
■■ Were appropriate stakeholders involved in the development of
recommendations?
❑ Yes ❑ No
■■ Are groups to which recommendations apply and do not apply
clearly stated?
❑ Yes ❑ No
■■ Have potential biases been eliminated? ❑ Yes ❑ No
■■ Does each recommendation have an identified level of evidence
stated?
❑ Yes ❑ No
■■ Are recommendations clear? ❑ Yes ❑ No
Complete the corresponding quality rating section.
Johns Hopkins Nursing Evidence-Based Practice
Appendix F: Non-Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
2
❑ Literature review LEVEL V
Summary of selected published literature including scientific and nonscientific such as reports of
organizational experience and opinions of experts
❑ Integrative review LEVEL V
Summary of research evidence and theoretical literature; analyzes, compares themes, notes gaps in the
selected literature
■■ Is subject matter to be reviewed clearly stated? ❑ Yes ❑ No
■■ Is literature relevant and up-to-date (most sources are within the past five
years or classic)?
❑ Yes ❑ No
■■ Of the literature reviewed, is there a meaningful analysis of the conclusions
across the articles included in the review?
❑ Yes ❑ No
■■ Are gaps in the literature identified? ❑ Yes ❑ No
■■ Are recommendations made for future practice or study? ❑ Yes ❑ No
Complete the corresponding quality rating.
❑ Expert opinion LEVEL V
Opinion of one or more individuals based on clinical expertise
■■ Has the individual published or presented on the topic? ❑ Yes ❑ No
■■ Is the author’s opinion based on scientific evidence? ❑ Yes ❑ No
■■ Is the author’s opinion clearly stated? ❑ Yes ❑ No
■■ Are potential biases acknowledged? ❑ Yes ❑ No
Complete the corresponding quality rating.
Organizational Experience
❑ Quality improvement LEVEL V
Cyclical method to examine workflows, processes, or systems with a specific organization
Economic evaluation that applies analytic techniques to identify, measure, and compare the cost and
outcomes of two or more alternative programs or interventions
Systematic assessment of the processes and/or outcomes of a program; can involve both
quaNtitative and quaLitative methods
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Appendix F: Non-Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
3
Setting Sample Composition/Size
■■ Was the aim of the project clearly stated? ❑ Yes ❑ No
■■ Was the method fully described? ❑ Yes ❑ No
■■ Were process or outcome measures identified? ❑ Yes ❑ No
■■ Were results fully described? ❑ Yes ❑ No
■■ Was interpretation clear and appropriate? ❑ Yes ❑ No
■■ Are components of cost/benefit or cost effectiveness analysis
described?
❑ Yes ❑ No ❑ N/A
Complete the corresponding quality rating.
❑ Case report LEVEL V
In-depth look at a person or group or another social unit
■■ Is the purpose of the case report clearly stated? ❑ Yes ❑ No
■■ Is the case report clearly presented? ❑ Yes ❑ No
■■ Are the findings of the case report supported by relevant
theory or research?
❑ Yes ❑ No
■■ Are the recommendations clearly stated and linked to the
findings?
❑ Yes ❑ No
Complete the corresponding quality rating.
Community standard, clinician experience, or consumer preference LEVEL V
❑ Community standard: Current practice for comparable settings in the community
❑ Clinician experience: Knowledge gained through practice experience
❑ Consumer preference: Knowledge gained through life experience
Information Source(s) Number of Sources
■■ Source of information has credible experience. ❑ Yes ❑ No
■■ Opinions are clearly stated. ❑ Yes ❑ No ❑ N/A
■■ Evidence obtained is consistent. ❑ Yes ❑ No ❑ N/A
Findings That Help You Answer the EBP Question
Johns Hopkins Nursing Evidence-Based Practice
Appendix F: Non-Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
4
Quality Rating for Clinical Practice Guidelines, Consensus, or Position Statements (Level IV)
A. High quality
Material officially sponsored by a professional, public, or private organization or a government agency;
documentation of a systematic literature search strategy; consistent results with sufficient numbers
of well-designed studies; criteria-based evaluation of overall scientific strength and quality of included
studies and definitive conclusions; national expertise clearly evident; developed or revised within the past
five years.
B. Good quality
Material officially sponsored by a professional, public, or private organization or a government agency;
reasonably thorough and appropriate systematic literature search strategy; reasonably consistent results,
sufficient numbers of well-designed studies; evaluation of strengths and limitations of included studies
with fairly definitive conclusions; national expertise clearly evident; developed or revised within the past five
years.
C. Low quality or major flaw
Material not sponsored by an official organization or agency; undefined, poorly defined, or limited
literature search strategy; no evaluation of strengths and limitations of included studies; insufficient
evidence with inconsistent results; conclusions cannot be drawn; not revised within the past five years.
Quality Rating for Organizational Experience (Level V)
A. High quality
Clear aims and objectives; consistent results across multiple settings; formal quality improvement or financial
evaluation methods used; definitive conclusions; consistent recommendations with thorough reference to
scientific evidence.
B. Good quality
Clear aims and objectives; formal quality improvement or financial evaluation methods used; consistent
results in a single setting; reasonably consistent recommendations with some reference to scientific
evidence.
C. Low quality or major flaws
Unclear or missing aims and objectives; inconsistent results; poorly defined quality;
improvement/financial analysis method; recommendations cannot be made.
Quality Rating for Case Report, Integrative Review, Literature Review, Expert Opinion, Community Standard,
Clinician Experience, Consumer Preference (Level V)
A. High quality
Expertise is clearly evident, draws definitive conclusions, and provides scientific rationale; thought
leader in the field.
B. Good quality
Expertise appears to be credible, draws fairly definitive conclusions, and provides logical argument
for opinions.
C. Low quality or major flaws
Expertise is not discernable or is dubious; conclusions cannot be drawn.
- ❑ Financial evaluation LEVEL V
❑ Program evaluation LEVEL V
Johns Hopkins Nursing Evidence-Based Practice
Appendix E: Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
1
Evidence level and quality rating:
Article title: Number:
Author(s): Publication date:
Journal:
Setting: Sample
(composition and size):
Does this evidence address my EBP
question?
❑ Yes
❑ No
Do not proceed with appraisal of this evidence.
■■ QuaNtitative (collection, analysis, and reporting of numerical data)
Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in
research, and generalize results from a larger sample population; provides observed effects of a
program, problem, or condition, measured precisely, rather than through researcher interpretation of data.
Common methods are surveys, face-to-face structured interviews, observations, and reviews of records or
documents. Statistical tests are used in data analysis.
Go to Section I: QuaNtitative
■■ QuaLitative (collection, analysis, and reporting of narrative data)
Rich narrative documents are used for uncovering themes; describes a problem or condition from the point
of view of those experiencing it. Common methods are focus groups, individual interviews (unstructured or
semistructured), and participation/observations. Sample sizes are small and are determined when data
saturation is achieved. Data saturation is reached when the researcher identifies that no new themes
emerge and redundancy is occurring. Synthesis is used in data analysis. Often a starting point for
studies when little research exists; may use results to design empirical studies. The researcher describes,
analyzes, and interprets reports, descriptions, and observations from participants.
■■ Mixed methods (results reported both numerically and narratively)
Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in
combination, provides a better understanding of research problems than using either approach alone.
Sample sizes vary based on methods used. Data collection involves collecting and analyzing
both quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and
can influence stages in the research process.
Go to Section I for QuaNtitative components and Section II for QuaLitative components
Johns Hopkins Nursing Evidence-Based Practice
Appendix E: Research Evidence Appraisal Tool
Section I: QuaNtitative
Level of Evidence (Study Design)
A. Is this a report of a single research study?
❑ Yes
❑ No
Go to B.
1. Was there manipulation of an independent
variable?
❑ Yes ❑ No
2. Was there a control group?
❑ Yes ❑ No
3. Were study participants randomly assigned to the
intervention and control groups?
❑ Yes ❑ No
If Yes to questions 1, 2, and 3, this is a randomized
controlled trial (RCT) or experimental study.
If Yes to questions 1 and 2 and No to question 3, or Yes
to question 1 and No to questions 2 and 3, this is quasi-
experimental (some degree of investigator control,
some manipulation of an independent variable, lacks
random assignment to groups, and may have a control
group).
If No to questions 1, 2, and 3, this is nonexperimental (no
manipulation of independent variable; can be
descriptive, comparative, or correlational; often uses
secondary data).
❑ LEVEL I
❑ LEVEL II
❑ LEVEL III
Study Findings That Help Answer the EBP Question
Complete the Appraisal of QuaNtitative Research Studies section.
Johns Hopkins Nursing Evidence-Based Practice
Appendix E: Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
1
B. Is this a summary of multiple sources of
research evidence?
❑ Yes
Continue
❑ No
Go to Appendix F
1. Does it employ a comprehensive
search strategy and rigorous appraisal
method?
If this study includes research,
nonresearch, and experiential
evidence, it is an integrative review.
See Appendix F.
❑ Yes ❑ No
Go to Appendix F
2. For systematic reviews and
systematic reviews with meta-
analysis (see descriptions below):
a. Are all studies included RCTs?
b. Are the studies a combination
of RCTs and quasi-
experimental, or quasi-
experimental only?
c. Are the studies a
combination of RCTs,
quasi-experimental, and
nonexperimental, or non-
experimental only?
A systematic review employs a search
strategy and a rigorous appraisal method,
but does not generate an effect size.
A meta-analysis, or systematic review with
meta-analysis, combines and analyzes
results from studies to generate a new
statistic: the effect size.
❑ Level I
❑ Level II
❑ Level III
Study Findings That Help Answer the EBP Question
Complete the Appraisal of Systematic Review (With or Without a Meta-Analysis) section.
Johns Hopkins Nursing Evidence-Based Practice
Appendix E: Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
2
Appraisal of QuaNtitative Research Studies
Does the researcher identify what is known and not known about the
problem and how the study will address any gaps in knowledge?
❑ Yes ❑ No
Was the purpose of the study clearly presented? ❑ Yes ❑ No
Was the literature review current (most sources within the past five years
or a seminal study)?
❑ Yes ❑ No
Was sample size sufficient based on study design and rationale? ❑ Yes ❑ No
If there is a control group:
■■ Were the characteristics and/or demographics similar in both the control
and intervention groups?
❑ Yes
❑ No
❑ N/A
■■ If multiple settings were used, were the settings similar?
❑ Yes ❑ No ❑ N/A
■■ Were all groups equally treated except for the intervention group(s)? ❑ Yes ❑ No ❑ N/A
Are data collection methods described clearly? ❑ Yes ❑ No
Were the instruments reliable (Cronbach’s α [alpha] > 0.70)? ❑ Yes ❑ No ❑ N/A
Was instrument validity discussed? ❑ Yes ❑ No ❑ N/A
If surveys or questionnaires were used, was the response rate > 25%? ❑ Yes ❑ No ❑ N/A
Were the results presented clearly? ❑ Yes ❑ No
If tables were presented, was the narrative consistent with the table
content?
❑ Yes ❑ No ❑ N/A
Were study limitations identified and addressed? ❑ Yes ❑ No
Were conclusions based on results? ❑ Yes ❑ No
Go to Quality Rating for QuaNtitative Studies section
Appraisal of Systematic Review (With or Without Meta-Analysis)
Were the variables of interest clearly identified? ❑ Yes ❑ No
Was the search comprehensive and reproducible?
■■ Key search terms stated
❑ Yes
❑ No
■■ Multiple databases searched and identified ❑ Yes ❑ No
■■ Inclusion and exclusion criteria stated ❑ Yes ❑ No
Was there a flow diagram that included the number of studies
eliminated at each level of review?
❑ Yes ❑ No
Johns Hopkins Nursing Evidence-Based Practice
Appendix E: Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
3
Were details of included studies presented (design, sample,
methods, results, outcomes, strengths, and limitations?
❑ Yes ❑ No
Were methods for appraising the strength of evidence (level and
quality) described?
❑ Yes ❑ No
Were conclusions based on results? ❑ Yes ❑ No
■■ Results were interpreted. ❑ Yes ❑ No
■■ Conclusions flowed logically from the interpretation and systematic
review question.
❑ Yes ❑ No
Did the systematic review include a section addressing limitations
and
how they were addressed?
❑ Yes ❑ No
Quality Rating for QuaNtitative Studies
Complete quality rating for quaNtitative studies section.
Circle the appropriate quality rating below
A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate control;
definitive conclusions; consistent recommendations based on comprehensive literature review that includes
thorough reference to scientific evidence.
B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, and
fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive
literature review that includes some reference to scientific evidence.
C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study
design; conclusions cannot be drawn.
Section II: QuaLitative
Level of Evidence (Study Design)
A. Is this a report of a single quaLitative research study?
❑ Yes
Level
III
❑ No
Go to Section
II. B
Study Findings That Help Answer the EBP Question
Complete the Appraisal of Single QuaLitative Research Study section.
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Appendix E: Research Evidence Appraisal Tool
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4
Complete the Appraisal of Meta-Synthesis Studies section.
Appraisal of a Single QuaLitative Research Study
Was there a clearly identifiable and articulated:
■■ Purpose? ❑ Yes ❑ No
■■ Research question? ❑ Yes ❑ No
■■ Justification for method(s) used? ❑ Yes ❑ No
■■ Phenomenon that is the focus of the research? ❑ Yes ❑ No
Were study sample participants representative? ❑ Yes ❑ No
Did they have knowledge of or experience with the research area? ❑ Yes ❑ No
Were participant characteristics described? ❑ Yes ❑ No
Was sampling adequate, as evidenced by achieving saturation of data? ❑ Yes ❑ No
Data analysis:
■■ Was a verification process used in every step by checking and
confirming with participants the trustworthiness of analysis and
interpretation?
❑ Yes
❑ No
■■ Was there a description of how data were analyzed (i.e., method), by computer
or manually?
❑ Yes ❑ No
Do findings support the narrative data (quotes)? ❑ Yes ❑ No
Do findings flow from research question to data collected to analysis
undertaken?
❑ Yes ❑ No
Are conclusions clearly explained? ❑ Yes ❑ No
Go to Quality Rating for QuaLitative Studies section.
B. For summaries of multiple quaLitative research studies (meta-synthesis), was a
comprehensive search strategy and rigorous appraisal method used?
❑ Yes
Level
III
❑ No Go to
Appendix F.
Study Findings That Help Answer the EBP Question
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Appendix E: Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
5
Appraisal of Meta-Synthesis Studies
Were the search strategy and criteria for selecting primary studies clearly
defined?
❑ Yes ❑ No
Were findings appropriate and convincing? ❑ Yes ❑ No
Was a description of methods used to:
■■ Compare findings from each study? ❑ Yes ❑ No
■■ Interpret data? ❑ Yes ❑ No
Did synthesis reflect:
■■ New insights? ❑ Yes ❑ No
■■ Discovery of essential features of phenomena? ❑ Yes ❑ No
■■ A fuller understanding of the phenomena? ❑ Yes ❑ No
Was sufficient data presented to support the interpretations? ❑ Yes ❑ No
Complete Quality Rating for QuaLtitative Studies section.
Quality Rating for QuaLitative Studies
Circle the appropriate quality rating below
No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective
process based on the extent to which study data contributes to synthesis and how much information is
known about the researchers’ efforts to meet the appraisal criteria.
For meta-synthesis, there is preliminary agreement that quality assessments should be made before synthesis to screen out poor-quality studies1.
A/B High/Good quality is used for single studies and meta-syntheses)2.
The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in
sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry.
Evidence of some or all of the following is found in the report:
■■ Transparency: Describes how information was documented to justify decisions, how data were reviewed by
others, and how themes and categories were formulated.
■■ Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple sources to
corroborate evidence.
■■ Verification: The process of checking, confirming, and ensuring methodologic coherence.
■■ Self-reflection and self-scrutiny: Being continuously aware of how a researcher’s experiences,
background, or prejudices might shape and bias analysis and interpretations.
■■ Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and
interpretation give voice to those who participated.
■■ Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature.
C Lower-quality studies contribute little to the overall review of findings and have few, if any, of the
features listed for High/Good quality.
Johns Hopkins Nursing Evidence-Based Practice
Appendix E: Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
6
Section III: Mixed Methods
Level of Evidence (Study Design)
You will need to appraise both the quaNtitative and quaLitative parts of the
study independently, before appraising the study in its entirety.
1. Evaluate the quaNtitative portion of the study using Section I. Insert here
the level of evidence and overall quality for this part:
2. Evaluate the quaLitative part of the study using Section II. Insert here the
level of evidence and overall quality for this part:
3. To determine the level of evidence, circle the appropriate study design:
(a) Explanatory sequential designs collect quaNtitative data first,
followed by the quaLitative data; and their purpose is to explain
quaNtitative results using quaLitative findings. The level is
determined based on the level of the quaNtitative part.
(b) Exploratory sequential designs collect quaLitative data first, followed
by the quaNtitative data; and their purpose is to explain quaLitative
findings using the quaNtitative results. The level is determined based
on the level of the quaLitative part, and it is always Level III.
(c) Convergent parallel designs collect the quaLitative and quaNtitative
data concurrently for the purpose of providing a more complete
understanding of a phenomenon by merging both datasets. These
designs are Level III.
(d) Multiphasic designs collect quaLitative and quaNtitative data over
more than one phase, with each phase informing the next phase. These
designs are Level III.
Level
Level
Quality
Quality
Study Findings That Help Answer the EBP Question
Use the Appraisal of Mixed Methods Studies section.
Johns Hopkins Nursing Evidence-Based Practice
Appendix E: Research Evidence Appraisal Tool
The Johns Hopkins Hospital/ The Johns Hopkins University
7
Appraisal of Mixed Methods Studies3
Was the mixed-methods research design relevant to address the
quaNtitative and quaLitative research questions (or objectives)?
❑ Yes ❑ No ❑ N/A
Was the research design relevant to address the quaNtitative and
quaLitative aspects of the mixed-methods question (or objective)?
❑ Yes ❑ No ❑ N/A
For convergent parallel designs, was the integration of quaNtitative
and quaLitative data (or results) relevant to address the research
question or objective?
❑ Yes ❑ No ❑ N/A
For convergent parallel designs, were the limitations associated
with the integration (for example, the divergence of quaLitative and
quaNtitative data or results) sufficiently addressed?
❑ Yes ❑ No ❑ N/A
Quality Rating for Mixed-Methods Studies
Circle the appropriate quality rating below
A High quality: Contains high-quality quaNtitative and quaLitative study components; highly relevant study
design; relevant integration of data or results; and careful consideration of the limitations of the chosen
approach.
B Good quality: Contains good-quality quaNtitative and quaLitative study components; relevant study design;
moderately relevant integration of data or results; and some discussion of limitations of integration.
C Low quality or major flaws: Contains low quality quaNtitative and quaLitative study components; study design
not relevant to research questions or objectives; poorly integrated data or results; and no consideration of limits
of integration.
1 https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALITATIVE_RESEARCH.htm
2 Adapted from Polit & Beck (2017).
3 National Collaborating Centre for Methods and Tools. (2015). Appraising Qualitative, Quantitative, and Mixed Methods Studies included
in Mixed Studies Reviews: The MMAT. Hamilton, ON: McMaster University. (Updated 20 July, 2015) Retrieved from http://www.nccmt.ca/
resources/search/232
http://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALITATIVE_RESEARCH.htm
http://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALITATIVE_RESEARCH.htm
http://www.nccmt.ca/
- Is this study:
- The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry. Evidence of some or all of the following is …
- ■■ Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and interpretation give voice to those who participated.
- C Lower-quality studies contribute little to the overall review of findings and have few, if any, of the features listed for High/Good quality.
Go to Section II: QuaLitative
Running Head: FIVE SOURCES OF BEST EVIDENCE 1
FIVE SOURCES OF BEST EVIDENCE 3
Five Sources of Best Evidence
PICO
P – (Patient, Population, or Problem): Hospitalized patients with indwelling catheters from any age, ethnicity, or sex.
I – (Intervention): Early removal of indwelling catheters.
C – (Comparison with other treatments, if applicable): Daily chlorhexidine baths and frequent assessments.
O – (Outcomes): Decrease in the number of catheter-associated urinary tract infections.
Question: For patients with indwelling urinary catheters, will the early removal of indwelling catheters decrease the incidence of CAUTI?
References
Bell, M. M., Alaestante, G., & Finch, C. (2016). A multidisciplinary intervention to prevent catheter-associated urinary tract infections using education, continuum of care, and systemwide buy-in. The Ochsner Journal, 16(1), 96–100.
Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A review of strategies to decrease the duration of indwelling urethral catheters and potentially reduce the incidence of catheter- associated urinary tract infections. Urologic Nursing, 32(1), 29-37.
Clarke, K., Tong, D., Pan, Y., et al. (2012). Reduction in catheter-associated urinary tract infections by bundling interventions. International Journal For Quality In Health Care, 25(1), 43-49. doi: 10.1093/intqhc/mzs077
Parker V, Giles M, Graham L, et al. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study. BMC Health Services Research. 2017;17:314. doi:10.1186/s12913-017-2268-2.
Tripepi-Bova, K., Sun, Z., Mason, D., & Albert, N. (2013). Early removal of urinary catheters in patients with thoracic epidural catheters. Journal Of Nursing Care Quality, 28(4), 340-344. doi: 10.1097/NCQ.0b013e3182922b2d
