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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