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Learning Objective 1: list four limitations of evidence rating scales for evaluating nursing knowledge.
Learning Objective 2: describe an innovative evidence rating scale that is unique to nursing by including both quantitative and qualitative sources of evidence.
Evidence-based practice is the philosophical worldview underpinning today’s global healthcare arena. However, translation of research findings into practice can take decades. A critical step to translation is the evaluation of evidence.
One evaluation tool is an evidence rating scale (ERS) which ranks research findings according to methodological rigor. ERSs are usually anchored with randomized controlled trials at one end and expert opinion at the other. For nursing, ERSs have several limitations:
- A bias towards medicine and epidemiology
- A rigid stance favoring quantitative evidence
- Exclusive consideration of interventional research
- Omission of non-research evidence
Because ERSs do not include familiar sources of evidence, nurses are often unsure how to evaluate evidence. Therefore, the purpose of this project was to design a nurse-centric ERS.
Methods
Nurses at a large medical center participated in a three phase process to design an ERS. In phase one, a literature review identified 12 ERSs. Strengths and limitations of each scale were determined. In phase two, a new scale was constructed. In phase three, feedback was solicited from staff nurses and research experts. The final model was piloted to determine ease of use and adequate guidance.
Results
The NURSE Scale, an acronym for Nursing’s Unique Rating Scale of Evidence, uses a hierarchal 5-point system to assign strength to various forms of evidence. Innovations of the scale include:
- Terminology consistent with nursing science
- Inclusion of both quantitative and qualitative evidence
- Addition of non-interventional research
- Inclusion of non-research evidence
It has performed well in evidence projects, allowing nurses to assign rank to evidence and objectively determine best practice. In addition, it clearly shows when further research is warranted, thus encouraging a culture of nursing research. The NURSE Scale is now offered to the worldwide nursing community for input and critique.