> Dear List
>
> Here is the Chief Nursing Officer in the forward to a recent book on
> clinical decision making and nursing:
> "It is right that as nurses we are exhorted to base our professional
> practice on sound evidence and to be open and transparent about our
> judgements and decisions. We must be able to explain and to justify what
> we propose and what we do because we claim to act in the interests of
> others. But being able to weigh up the relative merits of evidence from a
> number of sources and to apply a systematic approach to determine
> conclusions upon which to propose an appropriate course of action are
> acquired skills. Learning to reason is as much a professional competency
> as knowing the facts about a disease or a particular technique for
> delivering care."
>
> Guideline systems linking recommendations to levels of evidence are
> important precisely because they make explicit what is known and what is
> not. Many aspects of care do not have a good research knowledge base. But
> even when guidelines incorporate expert opinion it can be gathered in
> formal ways. This problem faced the Royal College of Nursing in the
> development of its guideline about pressure ulcer risk assessment and
> prevention (RCN 2000). The consensus development process is described in
> Rycroft-Malone, J. (2000). The challenge of a weak evidence base: formal
> consensus and guideline development. Journal of Clinical Excellence 2,
> 35-41.
>
> Ross Scrivener
> Information Manager, Quality Improvement Programme
> Royal College of Nursing Institute
> 20 Cavendish Square
> W1G 0RN
>
> Tel: 0207 647 3825
> e-mail: [log in to unmask]
>
> -----Original Message-----
> From: Donna Waters
> Sent: 14 October 2002 01:54
> To: [log in to unmask]
> Subject: Re: Grading of evidence for nursing guidelines
>
> Dear List
>
> Having had to struggle with this very issue in the development of evidence
> based guidelines for (the introduction of) Nurse Practitioners in NSW,
> Australia and using AGREE to conduct the independent evaluation of
> same...I do support what Kev has said in keeping to basic principles...the
> strength of evidence MUST be the same - did we not all recognise this in
> embracing the change from naming EB(Medicine) to EB(Health)or EB
> (Practice)? I understand nursing has a problem in identifying an evidence
> base but again - keeping to basic principles....
> 1. We are supposed to be professionals, do we not have clinical
> knowledge/experience and common sense? We should use it!
> 2. Use the 'best available' evidence and;
> 3. Tell others what that was so they can make up their own mind about the
> strength of that recommendation in their specific situation.
>
> Donna Waters
> Nursing and Health Services Research Consortium
> Sydney, Australia
>
> -----Original Message-----
> From: k.hopayian [mailto:[log in to unmask]]
> Sent: Saturday, 12 October 2002 11:32 PM
> To: [log in to unmask]
> Subject: Re: Grading of evidence for nursing guidelines
>
>
> The grading systems are not doctor focussed so much as certainty focussed
> -
> in other words, if you find a study or studies relating to your question,
> how certain can you be that they answer your question? How strong is the
> evidence is better expressed as how certain can we be it is valid?
>
> The same principle of strength of evidence applies whether you are talking
> about nurses, physiotherapists, doctors, or other clinicians. It does not
> matter whether you are talking about drugs and tests (which presumably
> prompted the doctor focus label in the first place) or how we communicate
> with people or how we teach (two other things all clinicians have in
> common!).
>
> Here's an example from communication: it was received wisdom (very low
> level
> of certainty) that encouraging parents to hold their dead infant would aid
> grieving. Yet actually looking at what happens yielded the opposite is
> true
> for the majority: "Women who had held their stillborn infant were more
> depressed than those who only saw the infant, while those who did not see
> the infant were least likely to be depressed" (Lancet 2002; 360: 114-18).
>
> Conclusion for me: this does not mean parents should never hold the baby,
> be
> sensitive, try to understand what is right for that couple, support them
> in
> whatever decision they make but for goodness sake do not encourage them as
> a
> matter of policy to hold the baby.
> --
> Kev (Kevork) Hopayian
> GP, The Surgery, Main St, Leiston, Suffolk, IP16 4ES, England
> Tel +44 (0)1728 830526
> Fax +44 (0)1728 832029
>
>
>
>
> on 11/10/02 2:11 pm, Watmough, Deborah at
> [log in to unmask] wrote:
>
> > Dear list members
> >
> > Does anyone know of a system for evaluating levels of evidence (or
> grading
> > of evidence) for guidelines for nursing practice?
> >
> > I'm aware of the grading system developed by the US Agency for Health
> Care
> > Policy and Research and which has been adapted by the Scottish
> > Intercollegiate Guideline Network and NICE. I also know about AGREE.
> >
> > However, a nursing colleague has said that these grading systems are
> very
> > 'doctor' focussed and weren't really or easily applicable to nursing.
> >
> > Perhaps another question is whether should nursing guidelines be graded
> > differently anyway?
> >
> > Many thanks
> >
> > Deborah
> >
> >
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