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Level of Evidence

Introduction
The standardization of nursing policies involves the review and revision of current policy documents in order to achieve a standardise policy that can be put to general use by all practitioners. It also involves identification of polices that should be used on various topics. The general objective is to create a holistic system wide policy touching on all aspects of nursing.
Interview summary
The general mechanisms put in place to determine whether policies and procedures adhere to evidence are in constant change. These processes continue changing and it depends whether he procedure or policy just involves one nursing unit or many. The guidelines involving the perinatal world have greatly evolved over the past in several ways. If a guideline is needed a literature review is done. Some professional guidelines such as ACOG/AWHONN etc. have policies and procedures that they recommend based on the literature review done. They have different criteria for levels of evidence. When deciding how an organization will carry out a particular task, there may not always be evidence that you may use as a guideline. A person may want to choose another level but may later be forced to go with the opinion of an expert level B/C since there is no research done which has negated or supported a particular practice. When looking at a particular practice we look at what has been collected by our professional organizations and their recommendations. A literature review is then carried out and if no information supporting is obtained then further information is sort from other medical institutions about their practice. Lastly the guidelines are reviewed in conjunction with the nursing and medical directors, while some issues will be reviewed by the OB executive committee. If the policy involves other departments in the hospital, the same procedure is followed but experts from the other department are tasked with the review of the policy. Finally the policy is approved by the hospital clinical practice council. Currently as a system we are developing policies and procedures that have already been approved. The same happens with expert clinicians, educators or whoever has been identified from each hospital to examine the evidence, write and approve the policy. From this point it goes to all COPICS, infection control, risk management, directors and CNOs where it is finally approved and put to use.
Designation of evidence and practice policy and procedures
Melnyk’s Hierarchy of Evidence holds that various organizations have advanced levels or hierarchy of evidence based on scientific relevance and scientific models. These levels assist medical staff rank knowledge through assessing the strength of the evidence being reviewed. Evidence is valued basing on the strength; strength is evaluated by validity and relevance of the evidence to a particular case. Evidence can be from research and non-research sources, classified in to seven levels ranked from the strongest to the weakest. That is i-vii with (i) as the strongest and (vii) as the weakest. The stronger the evidence the more likely it is to be valid and relevant to a case. In practice strong evidence would be the first choice. Some levels are classified on the basis of opinion or single studies instead of systematic methods or mega-analysis (Melnyk., & Fineout-Overholt ).
In Joanne Briggs Institute Levels of Evidence, classification is made on grades of recommendation A B C. grade A should include at least one randomized research as part of the literature reviewed (levels Ia, Ib), grade B should have a well conducted clinical research with no randomized research (IIa, IIb, III), grade C should include evidence from expert committee reports (levels IV). A major weakness is not conforming to empirical scientific research methods (Levels of Evidence).
American Association of Critical-Care Nurses (AACN) this system prefers alphabetical too numerical scale, starting with letter A and ending with letter M. the evidence ranking systems has alphabets A-E, with level A as the highest and M the lowest represents recommendations from manufacturers (Armola, et al, 2009).
Conclusion
            There is no clear guideline yet to be put in place to govern the leveling of evidence. Clinicians should make use of the most appropriate scale of ranking basing on the validity and relevance to a particular case.

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