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KEY WORDS
Evidence based practice (EBP). Case reports, Cross-Sectional Studies, Cohort Studies, Random Control Trials, Systematic Reviews, Meta-analysis
ABSTRACT
Objective
This article provides a breakdown of the components of the hierarchy, or pyramid, of research designs. Its intention is to simplify the components of the hierarchy to enable novice readers of research to better understand the differing approaches and levels of evidence.
Primary Argument
Evidence-based Practice (EBP) is the integration of the best research evidence with clinical expertise and the patient's unique circumstances. This includes respect of patient values, and their needs, whilst delivering high-quality, cost effective health care. Understanding the differing levels of evidence, and their reliability, is paramount to making correct and appropriate health care decisions. Nurses are required to use evidencebased practice as they are responsible for a significant amount of judgments and decisions every day, and therefore, they must use research literature as part of their clinical decision-making.
Conclusion
The content, or levels of evidence, of the hierarchy will be discussed in a systematic, logical order from the base to the apex of the pyramid. A comparative grid at the end may lead the nurse to better understand the differing components of the seven levels of evidence or, depending on the source, eight.
INTRODUCTION
The nursing research pyramid, or nursing research hierarchy of evidence, provides a visual and systematic depiction of forms of research from the least reliable (base) to the most reliable (apex). The pyramid includes both qualitative and quantitative paradigms. Pyramids vary slightly from source to source which can be confusing. To further add to the varying hierarchies "there is currently no universally agreed upon hierarchy of evidence for study types that seek to answer questions about patient's experiences and concerns (Del Mar et al 2013 p.29). Figures 1 and 2 are discussed in the main part of this article.
At the Base of the Pyramid (Level 7): Ideas, Opinions, Anecdotes and Editorials
The least reliable evidence comes from ideas, opinions, anecdotes and editorials. Our knowledge comes from varying places and our practices can be from tradition and custom, with many practices ritualistic. We can accept those practices with little questioning (Usher and Fitzgerald 2008 p.7). Whilst personal ideas, opinions and experience can be useful, they may not...