NUR 027 (Nursing Research 1-Lecture) BS

NURSING/SECOND YEAR
STUDENT ACTIVITY
Session # 6
SHEET

Materials:
Book, pen and notebook
LESSON TITLE: HIERARCHY OF EVIDENCE
Textbook:
LEARNING OUTCOMES:
Barrientos-Tan, C. (2011). A Research Guide in Nursing
Upon completion of this lesson, the nursing student will be
Education: Building an Evidence-Based Practice. Pasay
able to:
City: Philippines, Visprint Inc.
1. Discuss the hierarchy of evidence.
2. Explain the studies in the hierarchy of evidence.
References:
Polit, Denise F. & Beck, Cheryl T. (2012). Nursing
research: Generating and assessing evidence for nursing
research (9th ed.), Philadelphia, PA: Wolters Kluwer Health/
Lippincott Williams & Wilkins.
https://www.ajan.com.au/archive/Vol33/Issue3/5B
roomfield.pdf

LESSON REVIEW (5 minutes)

The instructor will open a box of rolled papers with your’ assigned numbers. The students whose numbers were picked
by the instructor will answer one of the following questions:
1. What does PICOT stands for?
2. What is the importance of identifying PICOT in a clinical problem?

MAIN LESSON (30 minutes)

Hierarchy of Evidence. This is also called the “pyramid of evidence”. provides a visual and systematic depiction of
forms of research from the least reliable to the most reliable.

Terminologies

Systematic Review. This refers to all published and unpublished studies on a particular area are assessed for
their scientific rigor, and the findings are summarized in an unbiased and balanced manner.

Randomized Controlled Trial (RCT). A form of experimental research (True Experimental) wherein the
subjects/participants are randomly allocated into 2 groups. The results of the trial are assessed by comparing
the outcomes in the 2 different groups:

1. Experimental group – receives the intervention or

treatment that is being tested
2. Control (or Comparison) group – receives an alternative
treatment or placebo
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Figure 2. Hierarchy of Evidence

Non-Randomized Controlled Trial (nRCT). A form of experimental research (Quasi-Experimental). It involves

an intervention without randomization

Meta-Analysis. A systematic review of multiple similar QUANTITATIVE studies addressing the same research
question, Level I evidence. Example: Cochrane Collaboration

Correlational Research. A type of non-experimental / observational research. It examines relationships

between variables

Descriptive Research. A type of non-experimental / observational research. Its purpose is to observe,

describe, and document aspects of a situation.
Qualitative Research. An in-depth investigation of phenomena through the collection of rich narrative
materials. Meta-Synthesis. Integrative reviews of QUALITATIVE studies, example of a Level V evidence.

Peer-Reviewed Journals. The journal articles reviewed or 'refereed' by experts within the field prior to
publication. This is viewed as more authoritative and of higher academic quality than journals that have not
been peer-reviewed.

Resources for EBP

Cochrane Database of Systematic Reviews (CDSR)

www.cochrane.org
www.thecochranelibrary.com

Agency for Healthcare Research and Quality (AHRQ)

www.ahrq.gov

Center for Reviews and Dissemination

Database of Abstracts of Reviews of Effects (DARE)
www.york.ac.uk/inst/crd/index.htm

This document and the information thereon is the property of PHINMA

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Joanna Briggs Institute
www.joannabriggs.edu.au

Effective Public Health Practice Project (EPHPP)

www.hamilton.ca/phcs/ephpp

CHECK FOR UNDERSTANDING (15 minutes)

Short Quiz. Students will be instructed to read and analyze the following research titles carefully and identify the
hierarchy of evidence in the following studies:
1. TB Infection Control Measures
ANSWER: The TB infection-control program should be based on the following three-level hierarchy of control measures:
Administrative controls. Environmental controls. Use of respiratory protective equipment.

2. An Analysis of the Cigarette Consumption among Adults: A Correlational Study

ANSWER: The cigarette affordability responsiveness differs by demographics, socioeconomic status, geolocations, and
cigarette price tiers. This study provides evidence that tax/price policies that reduce cigarette affordability could lead to a
decrease in cigarette consumption among middle-aged and elderly smokers in China.

3. Polypharmacy Practices Among the Elderly

ANSWER: Polypharmacy—the use of multiple drugs or more drugs than are medically necessary—causes adherence
problems in older patients, particularly those not residing in nursing homes.

4. A Systematic Review on the Effects of Antipsychotic Medications Among Clients with Delusional
Disorders ANSWER: Delusional disorder (DD) is defined in DSM-5 as a psychotic disorder characterized by the
persistence, for at least one month, of one or more delusions that do not markedly impair personal, social or
occupational function and that are present independently of schizophrenia, affective disorder or substance abuse
disorder.

5. Lived Experience of ER Nurses

ANSWER: The results of this study provided basic information about the lived experiences of nurses in different
dimensions. Nursing managers need to be aware of these needs and expectations and provide a variety of programs and
strategies not only to support nurses but also to ensure the quality of patient care.

6. Systematic Reviews of Kwashiorkor Among Toddlers

ANSWER: It's mostly found in developing countries with high rates of poverty and food scarcity. Poor sanitary conditions
and a high prevalence of infectious diseases also help set the stage for malnutrition. Kwashiorkor can affect all ages, but
it's most common in children, especially between the ages of 3 to 5.

7. Acculturative Stress Among Foreign Students: A Case Analysis

ANSWER: Those who are adjusting to a new culture can face acculturation stress such as a negative social context of
school, which may undermine their connections with others and devaluate their motivation [42] and thereby frustrating
psychological need.

8. Antibacterial Effects of Mango Leaf Extract

ANSWER: Mango leaf extracts are potent antibacterial, proving 100% MHE to be more effective, thus confirming the
presence of active constituents in medicinal plants.

9. Opinions of Medical Scientists in Covid 19 Cross-infectiion

ANSWER: The biological determinants of COVID-19 outcomes included CKD, C-reactive protein, diabetes, hypertension,
obesity, cancer, COPD, dyspnea, asthma, and coronary heart disease. Clinical data reveal that chronic conditions, such as
the above, decrease innate immune responses in humans (57, 58).

10. Correlates of Depression Among Menopausal Women

ANSWER: “Falling estrogen and progesterone levels can trigger mood swings that make you less able to cope with
things you'd normally let roll off your back,” says Payne. “For some women, these hormonal dips can set off a depressive
episode, especially for those who've gone through major depression in the past.”

RATIONALIZATION ACTIVITY
The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss
among their classmates.

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LESSON WRAP-UP (10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help
you track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: Numbered Heads Together

As part of the review of the lesson given, you will be grouped into 6. All of you will be assigned of a number so that
each team has numbers 1, 2, 3, 4, 5, & 6. The following question will be asked by the teacher:

How do nurses benefit from quantitative researches?

You have to discuss the answer in your respective group. After your group discussion, the instructor calls out
numbers. The students standing are the speaker for their team.

This document and the information thereon is the property of PHINMA

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