Tag Archives: Evidence hierarchy

Missing in Action: The Pyramid foundation

Last post I commented on the potentially misleading terms of Filtered & Unfiltered Filtered Unfiltered jpgresearch.  My key point?  Much so-called “unfiltered research” has been screened (filtered) carefully through peer-review before publication; while some “filtered research”  may have been ‘filtered’ only by a single expert & be out of date. If we use the terms filtered and unfiltered we should not be naive about their meanings. (Pyramid source:  Wikimedia Commons )

This week, I address what I see as a 2nd problem with this evidence based medicine pyramid.  That is, missing in action from it are descriptive, correlation, & in-depth qualitative research are not mentioned.  Where are they?  This undercuts the EBM pyramid as a teaching tool and also (intentionally or not) denigrates the necessary basic type of research on which stronger levels of evidence are built.  That foundation of the pyramid, called loosely “background information,” includes such basic, essential research.

Ask an ExpertYou may have heard of Benner’s Novice to Expert  theory.  Benner used in-depth, qualitative interview descriptions as data to generate her theory.  Yet that type of research evidence is missing from medicine’s pyramid!  Without a clear foundation the pyramid will just topple over.  Better be clear!

I recommend substituting (or at least adding to your repertoire) an Evidence Based NURSING (EBN) pyramid.  Several versions exist & one is below that includes some of the previously missing research!  This one includes EBP & QI projects, too! Notice the explicit addition of detail to the below pyramid as described at https://www.youtube.com/watch?v=MfRbuzzKjcM.EBN

Critical thinking:  #1List some EBM & EBN pyramid differences.  #2 Figure out where on the hierarchy this project would go: Crowell, J., OʼNeil, K., & Drager, L. (2017). Project HANDS: A bundled approach to increase short peripheral catheter dwell time. Journal of Infusion Nursing, 40(5), 274-280. doi: 10.1097/NAN.0000000000000237.   1st use medicine’s EBM pyramid; & then 2nd use nursing’s EBN pyramid.  #3 Label Crowell et al.’s study as filtered or unfiltered and explain what you mean by that.

For more info:  Watch the YouTube video at the link above.

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