Rating Systems for Nursing Practice Based on Evidence
Nursing practice is a complex and dynamic process that requires the integration of scientific knowledge, clinical skills, patient preferences, and available resources to provide high-quality care. However, not all nursing practices are equally effective or efficient, and some may even be harmful or wasteful. Therefore, it is essential to evaluate and compare different nursing practices based on the best available evidence and to implement those that are proven to be beneficial and cost-effective.
One way to evaluate and compare nursing practices is to use rating systems that assign levels of evidence to different sources of information, such as research studies, clinical guidelines, expert opinions, or patient experiences. Rating systems can help nurses to identify the most reliable and relevant evidence for their clinical questions, to critically appraise the quality and validity of the evidence, and to apply the evidence in their decision making.
There are several rating systems for nursing practice based on evidence, each with its own strengths and limitations. Some of the most commonly used rating systems are:
– AACN Levels of Evidence: This system was developed by the American Association of Critical-Care Nurses (AACN) to guide the development and implementation of practice alerts, which are brief summaries of evidence-based recommendations for critical care nursing practice. The AACN Levels of Evidence range from A (meta-analysis of multiple controlled studies) to E (multiple sources of evidence or expert opinion) .
– NICE Principles for Putting Evidence-Based Guidance into Practice: This system was developed by the National Institute for Health and Care Excellence (NICE) in the UK to support health and social care professionals in using evidence-based guidance and improving practice. The NICE Principles include seven steps to quality improvement, such as setting clear direction and priorities based on evidence, measuring and publishing quality, recognising and rewarding quality, building capability, and staying ahead .
– EIP Model: This system was developed by Kumah et al. (2022) to simplify and apply the concept of evidence-informed practice (EIP) for nursing students and academics. EIP is an alternative approach to evidence-based practice (EBP) that considers not only the best available research evidence, but also the context of care, the values and preferences of patients and stakeholders, and the professional judgement and experience of nurses. The EIP Model consists of four components: a) defining the practice question or problem; b) searching for and appraising relevant evidence; c) synthesising and applying the evidence; and d) evaluating and disseminating the outcome .
These rating systems can help nurses to adopt a systematic and rigorous approach to using evidence in their practice, but they also have some challenges and limitations. For example, some rating systems may be too complex or time-consuming to use in busy clinical settings, some may not reflect the diversity or uncertainty of evidence sources, some may not account for the feasibility or acceptability of implementing evidence in different contexts or cultures, and some may not address the ethical or legal implications of using evidence in practice.
Therefore, nurses need to be aware of these challenges and limitations, and use their professional judgement and critical thinking skills to select and adapt the most appropriate rating system for their specific practice situation. They also need to collaborate with other health professionals, patients, families, managers, policy makers, researchers, educators, and other stakeholders to ensure that their use of evidence is consistent, transparent, relevant, valid, reliable, ethical, legal, safe, effective, efficient, equitable, person-centred, and sustainable.
: Kumah EA et al (2022) Evidence-informed practice: simplifying and applying the concept for nursing students and academics. British Journal of Nursing 31(6): 362-368.
: NICE (2021) Principles for write my nursing thesis putting evidence-based guidance into practice. Available at: https://www.nice.org.uk/Media/Default/About/what-we-do/Into-practice/Principles-for-putting-evidence-based-guidance-into-practice.pdf
: AACN (2019) AACN Levels of Evidence. Available at: https://www.aacn.org/clinical-resources/practice-alerts/aacn-levels-of-evidence