Evaluating Level of evidence.pdf - PRINCIPLES PRACTICE Evaluating the Level of Evidence of Qualitative Research Sandra Cesario RNC PhD Karen Morin DSN

Evaluating Level of evidence.pdf - PRINCIPLES PRACTICE...

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708 JOGNN Volume 31, Number 6 PRINCIPLES & PRACTICE Evaluating the Level of Evidence of Qualitative Research Sandra Cesario, RNC , PhD , Karen Morin, DSN , RN , Anne Santa-Donato, RNC , MSN Guidelines for evaluating the levels of evidence based on quantitative research are well established. However, the same cannot be said for the evaluation of qualitative research. This article discusses a process members of an evidence-based clinical practice guideline development team with the Association of Women’s Health, Obstetric and Neonatal Nurses used to create a scoring system to determine the strength of qualitative research evidence. A brief his- tory of evidence-based clinical practice guideline development is provided, followed by discussion of the development of the Nursing Management of the Second Stage of Labor evidence-based clinical prac- tice guideline. The development of the qualitative scor- ing system is explicated, and implications for nursing are proposed. JOGNN , 31 , 708–714; 2002. DOI: 10.1177/0884217502239216 Keywords: Evaluation of evidence—Evidence- based practice—Guideline development—Levels of evidence—Qualitative evidence—Qualitative research Accepted: December 2001 The nursing profession’s recognition of the importance of evidence-based practice is well docu- mented (Estabrooks, 1998; Gennaro, 1994; Hod- nett, Kaufman, O’Brien-Pallas, Chipman, & Wat- son-MacDonell, 1996; Mayberry & Strange, 1997; Morin et al., 1999). Furthermore, much has been written about how to evaluate the evidence, particu- larly relative to quantitative studies (Carlson, Kruse, & Rouse, 1999; Cooke, 1996; Haughey, 1994; Mitchell, 1999; Mulhall, Alexander, & le May, 1998; Simpson & Knox, 1999). However, much of what nursing does and what nurses investigate is qualitative in nature (Beck, 1993; Morse & Field, 1995; Sandelowski, 1997; Streubert & Carpenter, 1995). Thus, evaluation of research literature should include both qualitative and quantitative reports (Ford-Gilboe, Campbell, & Berman, 1995; Goode, 2000). The evaluation, however, requires different sets of criteria to determine the merits of either type of report (Green & Britten, 1998; Popay, Rogers, & Williams, 1998). The purpose of this article is to dis- cuss the process by which members of an Associa- tion of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) evidence-based clinical practice guideline development team created a scoring sys- tem, based on specific criteria, for the evaluation of qualitative studies. The scoring system was designed to place qualitative studies within specific levels of evidence. History of Evidence-Based Clinical Practice Guideline Development With more than 2 million health-related manu- scripts published in more than 20,000 health care journals every year, a mechanism was required to aid the health care provider in keeping abreast of this information explosion (Farquhar & Vandekerck- hove, 1996). Archie Cochrane (1909–1988), a British obstetrician, gynecologist, epidemiologist, and researcher, suggested that although the random- ized controlled trial was the research method most likely to yield reliable results, it was impossible for a clinician to easily access all of the latest studies potentially affecting practice in each clinical special-
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