Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
Evidence level and quality rating:
Enter level and quality rating
Article title: Enter article title here
Number: Enter article number here
Author(s): Authors names
Publication date: Calendar
Journal: Journal name
Setting: Setting
Sample: (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 state
? Yes
? No
?
Has potential biases been eliminated?
? Yes
? No
?
Does each recommendation have an identified level of evidence stated?
? Yes
? No
? Yes
? No
?
Are recommendations clear?
Findings That Help Answer the EBP Question
Click or tap here to enter text.
Complete the corresponding quality rating section.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
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
• 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
? Yes
? No
Findings That Help Answer the EBP Question
Click or tap here to enter text.
Complete the corresponding quality rating section.
Expert opinion LEVEL V
Opinion of one or more individuals based on clinical expertise
• Are potential biases acknowledged?
Findings That Help Answer the EBP Question
Click or tap here to enter text.
Complete the corresponding quality rating section.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
Organizational Experience
Quality improvement LEVEL V
Cyclical method to examine workflows, processes, or systems with a specific organization
Financial evaluation LEVEL V
Economic evaluation that applies analytic techniques to identify, measure, and compare the cost and
outcomes of two or more alternative programs or interventions
Program evaluation LEVEL V
Systematic assessment of the processes and/or outcomes of a program; can involve both quaNtitative
and quaLitative methods
Sample Size/Composition:
Setting:
Setting
(Sample composition and 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
Findings That Help Answer the EBP Question
Click or tap here to enter text.
Complete the corresponding quality rating section.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
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
Findings That Help Answer the EBP Question
Click or tap here to enter text.
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
Information sources
Number of Sources
•
Source of information has credible experience
•
Opinions are clearly stated
• Evidence obtained is consistent
Findings That Help You Answer the EBP Question
Click or tap here to enter text.
? Yes
? No
?N/A
? Yes
? No
?N/A
? Yes
? No
?N/A
Complete the corresponding quality rating section.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
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.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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POI: Assessing the Long-Term Management of Diabetes in Minority/Low-Income
patients in a Community setting
Step 1: Introduction
A good introduction should be no more than 1 paragraph grabbing the reader’s attention
providing insight to the POI and significance to the APN’s role. End with a strong thesis
or purpose statement. Note: the thesis should be condensed to 1 brief purpose
statement.
Step 2: POI Significance:
Discuss why this POI is significant to your role as an APN. How will it change practice?
Why did you select this topic? What expected structural, process OR outcome
measures are you hoping to see with instituting a change in practice? To see a more
thorough discussion on these measures, review the following information.
AHRQ Structural, Process or Outcome Measures- (Links to an external site.)this link
provides an overview of process, structural and outcome measures. Be sure to specify
the type of measure you would expect with your implementation of EBP into practice.
Step 3 PICO :
Outline the PICO framework by listing (do not use write in a paragraph format) Ppopulation or patients, I-intervention, C-comparison, and O-outcomes as it relates to
your POI. Then develop the clinical question by including all parts of the PICO
framework in the question. Be as specific as possible in both the PICO framework
development and clinical question and avoid phrases such as: “compared to the
standard practice” , or “compared to the current practice” because faculty do not know
what the normal practice or standard practice is at your facility.
EXAMPLE:
Be sure to include a heading for this section i.e. PICO/Clinical Question.
PICO -center this heading p. 48-49 APA book
P: children in the acute care setting that are between 3 and 18 years of age, not
including non-verbal children
I: implementation of non-pharmacologic pain interventions i.e. (art therapy,
music, dim lights, etc.).
C: pharmacologic interventions (Tylenol, motrin, narcotics)
O: more effective at reducing pain as measured by decreased pain ratings on
approved pain scales, stable vital signs, behavior
Clinical Question: In pediatric patients aged 3 years to 18 years (P) is the
implementation of non-pharmacologic pain interventions (I) more effective (O) than
pharmacologic interventions (C ) in reducing pain as evidence by: decreased pain
ratings, stable vital signs, behavior assessments?
Step 4 Tool Completion:
To provide an overview of the guideline OR position statement use the tool below. You
will need to address each question or section of the tool; missing information may cause
you to lose points. Attach the completed tool to the paper or submit separately with the
assignment. Faculty need to see your analysis of the guideline for full credit.
Evaluation tool for Guideline OR Position statement PDF
Evaluation Tool for Guideline OR Position Statement Word Document
Step 5 Critique of Guideline/Position Statement:
Critique the guideline or position statement by discussing the following and including
appropriate support from your guideline/statement selection:
(a) purpose/aim, and recommendations-are they clear, current and relevant to your
population?
(b) who developed the guideline/statement-was any bias present, how did you know,
consider funding sources
(c) what levels of evidence were used to support each recommendation statement?
How does this information influence the quality of the evidence used in the guideline or
position statement?
(d) is the source of the information credible, how do you know?
(e) what is the overall Level of Evidence rating and Quality of evidence rating? Describe
why you selected the ratings to support your answer.
Step 6 Quality Improvement:
Explain how this guideline or position statement would be used in your practice area or
APN role to support change. How do these changes support bio ethical principles of
autonomy, justice, beneficence, maleficence (discuss 2)? If changes are needed before
implementing into practice, explain what and how you would address them.
Step 7 Conclusion:
Conclude the entire paper by summarizing each section. Do not repeat what you did in
the paper, but summarize the findings. Never include new findings in the conclusion.
Step 8 Guideline/Position Statement Link or Attachment:
Include a direct and working link to the guideline or Position Statement. Option: If you
are having difficulty providing a direct link, you may provide a hard copy of the full
guideline or position statement as an attachment or merged to the paper after the
resources. Faculty must be able to have full and direct access to your guideline or
position statement to determine if you selected and analyzed accordingly on your tool to
receive full credit. See format example below:
Guideline/Position Statement Link – center this heading p. 48-49 in the APA book
https://www.guidelinecentral.com/summaries/best-evidence-statement-best-supportfrom-bedside-nurses-for-caregivers-of-children-newly-diagnosed-with-type-1-diabetesmellitus/
OR use the following info.:
Guideline/Position Statement Link – center this heading p. 48-49 in the APA book
See guideline/position statement submitted with paper or merged to the paper
Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
Evidence level and quality rating:
Enter level and quality rating
Article title: Enter article title here
Number: Enter article number here
Author(s): Authors names
Publication date: Calendar
Journal: Journal name
Setting: Setting
Sample: (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 state
? Yes
? No
?
Has potential biases been eliminated?
? Yes
? No
?
Does each recommendation have an identified level of evidence stated?
? Yes
? No
? Yes
? No
?
Are recommendations clear?
Findings That Help Answer the EBP Question
Click or tap here to enter text.
Complete the corresponding quality rating section.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
1
Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
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
• 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
? Yes
? No
Findings That Help Answer the EBP Question
Click or tap here to enter text.
Complete the corresponding quality rating section.
Expert opinion LEVEL V
Opinion of one or more individuals based on clinical expertise
• Are potential biases acknowledged?
Findings That Help Answer the EBP Question
Click or tap here to enter text.
Complete the corresponding quality rating section.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
2
Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
Organizational Experience
Quality improvement LEVEL V
Cyclical method to examine workflows, processes, or systems with a specific organization
Financial evaluation LEVEL V
Economic evaluation that applies analytic techniques to identify, measure, and compare the cost and
outcomes of two or more alternative programs or interventions
Program evaluation LEVEL V
Systematic assessment of the processes and/or outcomes of a program; can involve both quaNtitative
and quaLitative methods
Sample Size/Composition:
Setting:
Setting
(Sample composition and 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
Findings That Help Answer the EBP Question
Click or tap here to enter text.
Complete the corresponding quality rating section.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
3
Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
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
Findings That Help Answer the EBP Question
Click or tap here to enter text.
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
Information sources
Number of Sources
•
Source of information has credible experience
•
Opinions are clearly stated
• Evidence obtained is consistent
Findings That Help You Answer the EBP Question
Click or tap here to enter text.
? Yes
? No
?N/A
? Yes
? No
?N/A
? Yes
? No
?N/A
Complete the corresponding quality rating section.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
4
Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
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.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
5

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