Evidence-Based Practice: Proposed Application of Facilitating Tools for Clinical Nurses
Phase: NA
Conditions: Evidence-Based Practice
Sponsor: Hospital Israelita Albert Einstein

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Researchers:  
Eliseth Ribeiro Leão  
Lidiane Soares Sodré da Costa 
 
 
 
Evidence-Based Practice: Proposed Application of Facilitating Tools 
for Clinical Nurses 
 
Plataforma Brasil – Approval Number:  26787019.5.0000.0071 
Board Affiliation: Research Ethics Committee of Hospital Israelita Albert 
Einstein 
 
 
 
 
 
 
 
 
 
 
 
 

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1. INTRODUCTION 
The adoption of Evidence-Based Practice (EBP) is widely used to 
improve the quality and safety of health care, including the reduction of 
avoidable costs. (1) 
A PBE has its origins in medicine used in tests and has been defined as 
"the conscientious and judicious use of the best discoveries made in decision-
making in the individual care of patients". (1, 2) 
Despite the fact that hospitals are considered responsible for delivering 
the best services available in the health area and based on use, signs of only a 
small percentage of health professionals are consistently doing this. (1, 2) 
Many barriers are encountered in real practice, including time 
constraints, lack of personal motivation, professional resistance to research and 
knowledge.        
An EBP is becoming an important issue in nursing, but it is poorly 
integrated into daily practice and its implementation is quite complex. Consider 
a process that consists of the following steps: 1) Translation of the clinical 
problem in the answered questions; 2) tracking with high efficiency in search of 
the best scientific evidence; 3) critical assessment of the findings regarding 
methodological quality; 4) integration of scientific evidence with clinical 
experience and patient values, with the implementation of findings in practice 
and; 5) evaluation of the implementation process and results.     
 

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In the national scenario, one of the main challenges for evidence-based 
care is its implementation, since the expression of knowledge in action is 
considered a difficult process to be completed due to its complexity. (3) 
In Brazil, the PBE movement is still not widespread in nursing work and 
in the process of training nurses. Few Brazilian institutions use a flow designed 
to guide their work processes in EBP, a movement that is occasionally found in 
the routine of health professionals. Still, with some resilience it has been used in 
professional practice, even if gradually. (3, 4) 
The implementation of PBE in a hospital environment is considered a 
challenge. It is known that the standardization of assistance based on the best 
available evidence improves the results of patients, which goes against the 
concept of value-based medicine that has been widely disseminated.        
Although the available literature on the subject points to positive attitudes 
of professional nurses and doctors regarding EBP, there is a disconnect 
between what these professionals believe and recognize with the actual 
implementation of EBP at the bedside.     
The main facilitating attitudes shared by nurses and doctors regarding 
EBP are: dedication of time to learn and practice, support from leadership, 
promotion of practice and easily accessible sources of evidence.     
These organizational and personal factors have a direct implication in the 
perception and development of this process in health institutions across the 
country. 
When we analyze, for example, the individual beliefs of nurses working in 
the United States, the literature indicates that less than half, 41% (n = 656 / 
1,564) agreed or strongly agreed that they knew how to implement PBE 

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sufficiently to make changes in practice clinic, and 44% (n = 701 / 1,564) were 
confident in their ability to implement. (5) 
In Brazil, with regard to the individual beliefs of nurses, we found data 
from those who work in primary care, they recognize the importance and the 
need to perform EBP, however, the results indicated in the available literature 
revealed that the search for evidence is mostly based on clinical experience. , 
patient preference and the use of opinions from colleagues in the profession or 
other institutions as the largest source of information to mediate clinical 
practice, as opposed to consultation with scientific sources.     
However, still exploring the Brazilian scenario, we find it a significant 
impediment to difficulties with the English language, as it is known that most of 
the relevant scientific productions in the area of health are produced and 
published in this language. (4) 
 We are experiencing a movement at the national level by some hospitals 
in the search for excellence in nursing practice. One of those responsible for 
this movement is the Magnet® recognition program that has encouraged 
institutions to seek the performance of nursing through PBE. 
This program is aimed at hospital organizations and proposes to 
distinguish hospitals designated for high quality patient care and excellence in 
nursing care. (6) 
Nursing research programs in organizations recognized as Magnet® 
have been growing, this growth is attributed to the requirements to achieve and 
maintain the designation that contribute to the science of nursing through 
research to discover new knowledge and implement PBE, in addition to training 
nurses. (6) 

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In comparison to unrecognized hospitals, nurses from Magnet® 
organizations report fewer difficulties associated with EBP, have more nurse 
research mentors designed to guide nurses at the bedside, with the 
development of a greater number of studies carried out by the clinical nurse as 
the main researcher, aligning three fundamental categories: research 
infrastructure, organizational research culture and construction of a research 
program for nursing. (6, 7) 
Most of the hospital organizations recognized as Magnet® are located in 
North America. In Brazil, some hospitals intend or are on the journey (the period 
before the report is sent for the program to be evaluated) to achieve Magnet 
recognition in their institutions. To meet the recognition objectives, efforts are 
concentrated that directly involve increasing the levels of PBE implementation in 
these hospitals.     
In 2010 the institution where we operate was the first to join the Jornada 
Magnet and since 2012, several measures for the training of clinical nurses for 
greater scientific engagement have been implemented, an example was the 
hiring of a nurse researcher who works at the Research Institute , which has 
helped in the process of guiding and monitoring the scientific production of 
nurses and the institution's multidisciplinary team. 
The initial diagnosis of the academic and scientific profile of clinical 
nurses at the institution revealed high heterogeneity of profiles, as well as some 
idiosyncrasies and beliefs in this population, which should be considered when 
implementing programs aimed at developing nursing research practices, as well 
as their Implementation. (9) 

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Basic level training programs with scientific methodology courses (8 
hours), bibliographic research (regular library programs) and scientific writing 
(16 hours) have been developed over the years. For intermediate and advanced 
experience levels, courses in critical analysis of articles and scientific writing (40 
hours) were also conducted. 
In 2014, the Professional Master's Program in Institutional Nursing was 
created, which has played a fundamental role in the scientific training of clinical 
nurses. However, translating the knowledge generated into organizational 
clinical practice remains a challenge and this has been the responsibility of the 
Evidence-Based Practice Council, composed of nursing care leaders and the 
coordinators of the Magnet New Knowledge, Innovation and Improvements 
component, a nurse clinic and a researcher and professor, respectively, author 
and advisor of the present study. 
This Council is designed to provide specialized guidance for clinical 
nurses, at all levels of training who want to gain experience in evidence-based 
practice, who work directly or indirectly in the care area, in conducting initiatives 
to elaborate and / or review protocols related to PBE directed to health care with 
quality and safety in several clinical outcomes. 
Together with the PBE Council, clinical nurses have the guidance of the 
Library Service, which assists in the entire process of bibliographic search in 
databases. Even so, we have observed the degree of difficulties for this task 
and, mainly, for the critical analysis of scientific articles by clinical nurses. 
The scenario of the Brazilian literature available on the topic of EBP 
presents mostly theoretical and reflective content, with few studies describing 

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changes in practice or interventions that support the dissemination of this 
practice in a hospital setting. (10) 
Education strategies for the development of EBP focused on nursing 
leaders can be effective in decreasing the perception of the main difficulties for 
implementation, but it proved to be ineffective in expanding the skills of these 
leaders, leading to the reflection that focus on the formation of graduation of 
these professionals on this subject are important and relevant. (11) 
The fact that we present the implementation of PBE as globally 
challenging, makes it necessary to investigate how the training of nurses has 
been developed by training institutions in this practice, in addition to discussions 
about the methodologies that best support this critical-reflective construction, 
the development of prospective studies that evaluate the impact of these 
methodologies in the training of professionals and the results in the quality of 
the assistance provided are essential to understand the best strategy to be 
adopted. (10, 11) 
Taking into account the educational and training scenario as mentioned 
earlier, there are also gaps in the training of professionals. 
 The investigation of the knowledge, attitudes and practices of nursing 
students in implementing PBE, has shown that undergraduate nursing students 
do not have a high average knowledge score, and it is essential that colleges 
not only focus on education, but also assist students nurses to implement it in 
the patient care process.      

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PBE education programs aimed at undergraduate nursing students are 
effective in improving knowledge, skills, attitudes and competencies, and are 
recommended to promote the necessary proficiency in PBE as part of 
professional training. On the other hand, how can we think of strategies aimed 
at clinical nurses who are already in the job market?          
There is a gap in the production of studies on knowledge, attitudes and 
practices, and the difficulties in implementing PBE both in Brazil and in Latin 
America. This makes us reflect on what really happens and what is the 
collaboration for this scenario. (14) 
The absence of a national model and facilitating instruments to assist this 
practice, considering that EBP is still under construction and growth in our 
environment, creates an even greater challenge for clinical nurses in our 
country, and that such reasoning may extend developing countries.      
In light of the above, this study aims to verify if the guide tools of the PBE 
model of the Johns Hopkins Nursing Evidence-based Practice, have a potential 
facilitator in the structuring and description of a PBE project conducted by 
Brazilian clinical nurses. 
 
 
 
 
 

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 . THEORETICAL FRAMEWORK 
2.1 The Johns Hopkins model of evidence-based practice 
The Johns Hopkins Evidence-Based Practice model resulted from the 
collaboration of nursing leaders in teaching and clinical practice at Johns 
Hopkins Hospital and Johns Hopkins University School of Nursing. The main 
objective of this model is to translate the best evidence for nurses who work at 
the bedside to use in care decisions.      
Your process has three steps called PET: Practical Questions, Evidence 
and Translation. This model is considered comprehensive, covering all 
important components of the PBE process. It is classified as individual, based 
on scientific and non-scientific evidence.      
In summary, the model includes tools divided into ten forms (Appendix 1) 
that serve as a guide to assist in the identification of an issue of care practice, to 
formulate the research question using terms appropriate to the search for 
evidence; seek, critically evaluate, summarize and classify the levels of 
evidence; and it also promotes the possibility of using non-scientific evidence 
(financial data, professional experience and patient preferences) for decision 
making. Based on that, the feasibility of applying the evidence is then 
determined, followed by the elaboration of an action plan for its translation, 
implementation of the change, evaluation and communication of results.      
        
The forms comprise: 
• Appendix A_PET Management Guide: Management guide with step by 
step description of the phases: practical question, evidence and translation, as 

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well as spaces for projecting start dates, end of the project and those 
responsible for each step. 
• Appendix B_Question Development Tool: Brings key questions to help 
describe the problem raised for the construction of the initial PBE question, in 
addition to helping the beginning of the base for the search for evidence with 
the description of search terms and plan for measuring results . At the end of 
this form are the instructions that guide the completion. 
• Appendix C_Stakeholder Analysis: It has elements to characterize the 
stakeholders in the PBE project and their role in guaranteeing resources for 
implementing the action plan at the end of the project through the 
responsibilities of approvals, consultations and information. 
• Appendix D_Evidence Level and Quality Guide: Composed of 
guidelines and examples to help classify the levels of evidence that were found 
and their quality. 
• Appendix E_Research Appraisal Tool: This is a form made available to 
assist the user in the critical evaluation process of each evidence found. In this 
form we find elements to classify from the type of evidence, as to its quality 
according to the different types of study designs, such as, for example, 
quantitative, qualitative studies, systematic reviews, etc. 
• Appendix F_Non_research Evidecen Appraisal Tool: The composition 
of this form assists in the classification of evidence considered ―non-research‖  
involves guidelines for clinical practices, consensus, expert opinions, in addition 
to the organizational experience of an institution. 
• Appendix G_Individual Evidence Tool: The purpose of this form is to 
document the key points of each evidence found in summary form, including 

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findings that help answer the clinical question and critical assessment data with 
level and quality classification, in order to prepare for the synthesis phase of this 
evidence. 
• Appendix H Evidence Synthesis and Recommendation Tool: Proposes 
assistance in the description of a synthesis of the evidence findings, compiling 
the results that answer the PBE clinical question, brings the general 
classification and the final recommendation according to the level and quality of 
the evidence found, this recommendation may be strong, with convincing 
evidence and consistent results with solid indication for change of practice, or 
even little or no evidence with change of practice not indicated. 
• Appendix I Action Planning Tool: This form has the purpose of guiding 
the construction of an action plan for planning the change in practice and 
guaranteeing a successful translation for all interested areas. 
• Appendix J Dissemination Tool: Used at the end of the PBE project, it is 
a guide to the dissemination plan. It has fields for identifying the most 
appropriate communication methods for the defined target audience, whether 
individual, organizational or networks that may be interested in the results of the 
project, or that are part of the process of implementing the new practice. 
In Brazil, the development of its own specific models is considered one of 
the main challenges, or the development of initiatives that portray the 
implementation and / or adaptation of the existing models proposed.      
 
 

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2.2 
The 
Magnet Model: 
New Knowledge, Innovations 
and 
Improvements Component 
In the 1980s, studies by the American Academy of Nursing aimed to 
identify which were the main organizational characteristics that attract nurses, 
whose profile was considered to be a professional of excellence. (18) 
The first research involving Magnet Hospitals was carried out in the 
1980s, whose objective was to assess what characteristics these hospitals had 
that hindered or facilitated professional nursing practice. (18) 
The results showed that some institutions had better results in recruiting 
and retaining the best nursing professionals. This study became a reference in 
the selection of the main attributes that underlie the direction patterns to 
determine the Magnet status. (18, 19) 
The term ―Magnet‖  which means ―attraction‖ in the Portuguese 
language, has been used over the years to point out which hospitals are 
recognized by nurses as the best hospitals to work for.          
In 1993, the Magnet Recognition Program® was established through the 
American Nurses Credentialing Center (ANCC), a subsidiary entity of the 
American Nursing Association (ANA) that is responsible for evaluating and 
recognizing health organizations that have Excellence Nursing Services.      
This program recommends actions that lead to the recognition and 
sharing of successful nursing practices and strategies. 
Currently, only 10% of the 5,000 American hospitals are recognized, in 
addition to another 10 institutions located in Belgium, Jordan, Saudi Arabia, 
Lebanon, Australia, Canada and China. (8, 19, 21) 

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This recognition process is based on quality indicators and standards of 
good nursing practices from the American Nurses Association- ANA, the main 
areas evaluated are: (8, 19) 
   Transformational leadership - The hospital environment has 
undergone reforms, including leadership, which were previously described as 
focused on stabilization and growth. Today's leaders are encouraged to 
transform the values, beliefs and behaviors of their institutions. (8) 
2) Structure of empowerment - Structures and processes developed by 
an influential leadership provide a transformative environment. It is observed 
that strong exemplary professional practice grows and that the results that are 
believed to be important are achieved through the living search for the 
institution's mission, vision and values. (8) 
3) Exemplary professional practice - the main essence of a Magnet 
institution is an exemplary professional practice in nursing. The objective of this 
component is more than the establishment of a strong professional practice, it is 
added what this professional practice can achieve. (8) 
4) Empirical results - Magnet institutions demonstrate results that must 
be categorized in terms of clinical results related to nursing practice: results of 
the workforce, results of patients, consumers and organizational results must be 
comparable with other institutions (subject to benchmarking) . (8) 
5) New knowledge, Innovation & Improvements - Transformational 
leadership, trained professionals and exemplary practice are essential for 
institutions recognized as Magnet, but they are not the ultimate goals. These 

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institutions have an ethical and professional responsibility to contribute to 
patient care and the profession in terms of new knowledge, innovations and 
improvements. This component includes the design of new care models, the 
application of existing evidence, the search for new evidence and visible 
contributions to nursing science. This is the component to which the present 
study is related. (8) 
The implementation of new knowledge, innovation and improvements 
brings reflections on how the clinical nurse who works in care and who is 
involved in research and EBP is able to implement changes in procedures and 
policies, positively impacting the outcomes resulting from nursing care to 
patients.      
It is framed and works side by side with another component previously 
described, called exemplary professional practice, which is able to demonstrate 
to the health community that the institution has achieved excellence and 
exemplary practice from the dedication of resources in order to continue on this 
path, acquiring new knowledge, using that knowledge to create innovations and 
improvements that help the patient, the institution where he works and the 
nursing profession.      
A Magnet® institution must support research and EBP, in addition to 
educating its nursing professionals in these elements. This is represented by 
the maintenance of researchers, educators and mentors who will assist in this 
process of supplying evidence and continuing education. (22, 23) 
As part of the guidelines, institutions on their way to the Magnet® 
journey, they should initially consider some research practices such as: 

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differentiating research, PBE and improvement processes; incorporate that 
nurses who have researched and published their research evaluate and use the 
best results in their clinical practice; increase guidance on research and PBE 
projects; disseminate all the knowledge generated to internal and external 
forums. (22, 23) 
2.3 The educational process in PBE: the four pillars of education 
The approach to the mentoring process in the institution, both focused on 
research and on PBE, is based on the four pillars of education proposed by 
Jacques Delors: learn to know, learn to do, learn to live and learn to be, 
presented below. (24) 
Learning to know, by combining a general culture, sufficiently broad, with 
the possibility of studying, in depth, a small number of subjects, that is: learning 
to learn, to benefit from the opportunities offered by lifelong education. (24) 
Learning to do, in order to acquire not only a professional qualification, 
but, in a more comprehensive way, the competence that makes the person able 
to face numerous situations and to work as a team. In addition, learning to do in 
the context of different social or work experiences, whether spontaneously 
following the local or national context, or formally, thanks to the development of 
education alternated with work. (24) 
Learning to live together, developing an understanding of the other and 
the perception of interdependencies - carrying out common projects and 
preparing to manage conflicts - while respecting the values of pluralism, mutual 
understanding and peace. (24) 
 

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Learning to be, in order to develop, as best as possible, the personality 
and to be in a position to act with an increasing capacity for self-autonomy, 
discernment and personal responsibility. For this purpose, education must take 
into account all the potential of each individual: memory, reasoning, aesthetic 
sense, physical capacities, ability to communicate. (24) 
Thus, when applying the four pillars of education in our proposal for a 
facilitating model for PBE, we understand the four pillars as follows: 
Learning to know: the search for evidence to establish the best nursing 
practices involves the development of skills in the search for information 
available in scientific publications, as well as the use of professional experience. 
Learning to do evidence-based practice, in a broad sense, presupposes 
the use of a creative methodology of interaction with science that concretely 
proposes challenges to be overcome by seeking the best available evidence. 
Therefore, it presupposes knowing, analyzing and reflecting on the processes 
inherent to the elaboration of a PBE project. Knowing yourself in relation to the 
other influences how to do it, which is also essential for this process. 
Learning to live is made possible, mainly, by the professional interaction 
that each nurse already develops in the health area, which enriches the 
teaching-learning process. However, when launching into the universe of EBP, 
nurses will go through one of the final phases that includes the dissemination of 
the findings of their search and application of the new practice based on the 
best evidence, this requires a broader capacity to live with other stakeholders 
involved in the studied process. 
And, finally, learning to be comes through experience during and after 
the conclusion of a PBE project, characterized by the dissemination of the 

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results found with all identified stakeholders. This stage is conducive to a 
reflective awakening for the nurse who developed the study regarding his 
relations with other nurses and managers during the activities developed, and 
planning future activities related to the development of new projects and 
professional development, thus awakening critical thinking to develop new 
clinical questions to search for evidence. 
 
 . OBJECTIVES 
3.1 General objective 
Provide clinical nurses with tools to be used as a guide with a structured 
process in stages as a facilitator for the implementation of EBP projects in 
search of best practice in nursing processes. 
3.2 Specific objectives 
1) Check the adequacy of the authorized translation of the Portuguese 
language version of the Johns Hopkins Center for Evidence-Based 
Practice guide tools; 
2) Analyze, from the perspective of the clinical nurse, if these tools are 
facilitators in the structuring and description of an EBP project; 
3) Analyze, from the researcher's perspective, whether the PBE project 
met the requirements of: elaboration of a clinical question, bibliographic 
survey, critical evaluation of the evidence, summary of the evidence and 
elaboration of the dissemination plan; 
4) Check if previous attitudes and knowledge regarding the 
implementation of PBE influence the structuring of a PBE project. 

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 . METHODOLOGY 
4.1 Study type and location 
Randomized study of educational intervention, comparative and 
prospective. The study will be carried out in the city of São Paulo at an Extra 
Large General Hospital that offers care from low to high complexity in several 
areas that include: critically ill patients unit, surgical medical clinic, oncology, 
surgical center, doctor's offices, various ambulatories and areas assistance 
support. 
4.2 Population and sample 
The target population of the study will be clinical nurses working in direct 
patient care, who meet the following inclusion and exclusion criteria. 
Inclusion criteria: 
- 
Clinical nurse working at the bedside with at least two years of training in 
undergraduate nursing 
- 
Intermediate self-reported English for reading 
Exclusion criteria: 
- 
Having previously participated in a PBE project, the PBE council or 
research project, or even having a master's or doctor's degree. 
For the recruitment of workshop participants, vacancies will be advertised 
through an invitation email addressed to the leaders of the institution, research 
location, with the proposed dates and times of PBE training, as well as the 
inclusion and exclusion criteria for selection. of the participants. 

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To calculate the sample, it will be taken into account that the variables of 
main interest in the study come from a questionnaire built by the researchers, 
so that we have no prior information about the distribution of the categories or 
the differences that we will find. With this data, 10 individuals in each group will 
be included in the study. After making comparisons between groups, if no 
evidence of differences is found, the observed data will be used to calculate the 
minimum sample size needed for a future study. 
4.3 Study variables 
Sociodemographic variables will be considered: age, training time and 
sex. Variable of interest: ease in structuring and describing an EBP project, 
from the perspective of the participating nurse and meeting the key elements of 
an EBP project, from the researcher's perspective. 
Control variable: clinical nurse's practices, attitudes and prior knowledge 
about EBP. 
4.4 Translation of tools 
The translation of the Johns Hopkins Nursing Evidence-based Practice 
guide tools was authorized on 03/16/2018 by a representative of the Institute for 
Johns Hopkins Nursing documented through institutional email (Appendix 1). 
The free translation was submitted for review by the Translation and 
Revision Service of the Einstein Integrated Library System, of the Albert 
Einstein Teaching and Research Institute, in February 2019. 
The tools constitute a guiding guide and although this study is not about 
psychometric validation (as the tools do not measure any attribute), we chose to 

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present the authorized translation, to verify the adequacy of the translation by 
nurses who make up the Council of Practice Based on Evidence from Hospital 
Israelita Albert Einstein. For this purpose, a questionnaire will be used, 
prepared by the authors of this study, with closed questions: Questionnaire to 
check the adequacy of the authorized translation of the Portuguese language 
version of the Johns Hopkins PBE guide tools (Appendix 2). 
The guide tools in the authorized version in Portuguese are: Appendix A - 
PET Management Guide, Appendix B - Question Development, Appendix C - 
Stakeholder Analysis, Appendix D - Evidence and Quality Level Guide, 
Appendix E - Assessment Tool Research Evidence Assessment, Appendix F - 
Non-Research Evidence Assessment Tool, Appendix G - Individual Evidence 
Tool, Appendix H - Evidence and Recommendations Synthesis Tool, Appendix I 
- Action Planning Tool, Appendix J - Dissemination tool. (Appendix 3). 
For the verification phase of the adequacy of the authorized translation of 
the Portuguese language version of the guide tools, five specialists who work 
on the PBE Council will be invited. An email will be sent with the original 
versions in English and the translated versions of each tool into Brazilian 
Portuguese, as well as the questionnaire with closed questions and suggestions 
for improvements. 
4.5 Educational strategies 
 
Group A): will receive theoretical and practical training in PBE through a 
structured model workshop with themes related to the introduction to PBE, 
formulation of a practical question, bibliographic survey to search for evidence, 
critical analysis of evidence, classification of level and quality of information. 

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evidence, summarization and dissemination plan, with the final proposal of a 
practical class that aims to structure and describe an individual case through an 
exercise designed to go through the phases of a PBE project, as the basis for 
this exercise we will use a finalized and consolidated project, this will be used 
as a template for the exercise, the description of this exercise can be found in 
the programmatic content (Appendix 6). Group B): will receive the same training 
as group A, plus the presentation and availability of the Johns Hopkins Nursing 
Evidence-based Practice guide tools to be used in the practical class for the 
structuring and individual description of the PBE exercise case. The same 
theme of the case will be used in both groups. 
Participants will be randomized and allocated to each of the educational 
intervention groups. For randomization, free software randomizer.org will be 
used.  
4.6 Data collection 
4.6.1 Data collection instruments 
The questionnaires that will be used in data collection are presented 
below. 
- Questionnaire to check the adequacy of the authorized translation of 
the Portuguese language version of the Johns Hopkins PBE guide 
tools: Prepared by the researchers with a closed question about the 
intelligibility of the translation for the specialists, in addition to an open field 
for suggestions for changes. In case of inadequacy (which we define as less 
than four yes answers for the tools), we will make the changes mentioned by 

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the experts and submit the changed tools to a new evaluation by the 
experts. (Appendix 2). 
- Evidence-Based Practice and Clinical Effectiveness Questionnaire 
(EBPQ): Validated and culturally adapted to the Brazilian Portuguese 
language in 2014 (25), it is a self-applicable instrument, considered 
important for assessing the use, opinions and knowledge of nurses about 
this practice. The 
instrument 
assesses 
attitudes, 
knowledge 
and 
implementation of PBE, uses a Likert-type scale with a score from one to 
seven in three domains: practice, attitudes and knowledge related to PBE. 
The objective of the applicability in this study will be for the variable of 
control of previous knowledge and through the analysis of the answers we 
will verify if the attitudes and previous knowledge in relation to the 
implementation of PBE influence in the structuring of a PBE project. (Annex 
    
- Questionnaire for the evaluation of the structuring process and 
description 
of 
an 
evidence-based 
practice 
project, 
from 
the 
perspective of the clinical nurse: Elaborated by the researchers 
considering the key elements of an EBP project (15) to verify the educational 
strategy to which was submitted facilitated the clinical nurse the process of 
elaborating an EBP project. The instrument consists of seven closed 
questions and one open for further comments. The closed questions are 
related to the description of a clinical question, ease in searching for 
evidence, understanding of scientific articles, ease in summarizing and 
classifying the levels of evidence, ease in describing the application of 
evidence and elaborating an action plan for disseminating the evidence. 

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evidence, in addition to the ease of going through all the phases of a PBE 
project in relation to the material offered during the workshop (with or without 
Johns Hopkins tools). (Appendix 4). 
- Compliance verification questionnaire in structuring exercise and 
description 
of 
an 
evidence-based 
practice 
project 
from 
the 
researcher's perspective: Prepared by the researchers with five closed 
questions to verify compliance with the basic requirements and key 
elements of an EBP project. (Appendix 5). Definition criteria were 
established to standardize responses according to the researcher's 
observation. As a basis for determining this compliance in the questionnaire 
responses, we used as a reference the description of compliance 
parameters of the Joint Commission International published in the Joint 
Commission International survey process guide for clinical care program 
certification, 2014 (26), which comprises: 
For yes and sufficient answers, compliance of> or equal to 90%. 
For partially sufficient and partially responses, compliance between 50 -      
For no or insufficient responses, compliance is less than 49%. 
 
For question 1: Was the participant able to elaborate a clinical question? 
One of the answers will be considered, yes or no. We will consider those who 
develop a clinical question according to the problem provided at the beginning 
of the exercise. It will be considered as an answer no, if the participant does not 
actually elaborate a clinical question, that is, an interrogative question about the 
problem received at the beginning of the exercise, or even, if the question 
elaborated is not using the problem provided as a basis. 
 

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For question 2: Regarding the survey of bibliographic articles, this was :. 
One of the answers will be considered sufficient, partially sufficient or 
insufficient. 
According to the compliance check, the values to be assigned and added to 
determine the response will be: 
a) Search terms previously consulted in the virtual health library in the section of 
health sciences descriptors for the search in the PubMed database - 50% value 
b) Use of the two PubMed and CINAHL databases - Value of 30% (Half the 
value will be considered if the search includes one of the two bases) 
c) Use of the advanced search module in the two databases - Value of 20%. 
(Half the value will be considered if the advanced search is in one of the two 
bases) 
 
For question 3: Regarding the classification of evidence according to the 
level of quality, was the participant able to carry out this classification? One of 
the answers will be considered: yes, partially or not. 
According to the compliance check, the values to be assigned and added 
to determine the response will be: 
a) Classification of the level of evidence I, II, III, IV and V by the 
participant in each of the articles provided for the exercise (total of 2 articles) - 
Value 20% for each article, total of 40% 

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b) Evidence quality rating, A, B or C by the participant in each of the 
articles provided for the exercise (total of 2 articles) - Value of 20% for each 
article, total of 40% 
c) Correct classification according to the exercise model - Value of 10% 
for each article, total of 20% 
For question 4: Was the participant able to elaborate a synthesis of the 
findings relating to the levels of evidence? One of the answers will be 
considered: yes, partially or not. 
According to the compliance check, the values to be assigned and added 
to determine the response will be: 
- Did the participant include the following points in the summary of the 
two articles provided for the exercise? 
a) Type of study - Value of 20% 
b) Sample size - Value of 20% 
c) Summary of results and recommendations of the article - Value of 20% 
d) Classification of level of evidence and quality - Value of 20% 
Half of the value described (10%) will be considered if the participant 
presents a synthesis of only one of the two articles provided for the exercise in 
each of the topics from a) to d). 

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For question 5: Was the participant able to develop a dissemination plan 
for implementing the PBE project? One of the answers will be considered, yes, 
partially or not. 
 
According to the compliance check, the values to be assigned and added 
to determine the response will be: 
- Did the participant include the following points in the dissemination plan for 
implementing the PBE project? 
- Project stakeholders - Value of 20% 
- Institution Leadership - Value of 20% 
- Department Leadership - Value of 20% 
- Front Line Team - Value of 20% 
- Dissemination methodology, example: online publication, presentation, 
meetings, etc. - Value of 20% 
 
The questionnaires will be inserted in the REDcap® digital platform, the 
participants will have access to the electronic resources notebook or tablet to 
insert their answers. 
 
4.6.2 Operationalization of data collection 
 
After recruiting the participants, workshops will be held, one for each 
group with a total workload of six hours divided into two consecutive days, 
lasting three hours each day. The first day will be theoretical and the second 

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day practical. The programmatic content of the workshops is described in the 
lesson plan. (Appendix 6). 
 
The workshops with theoretical content and practical classes will be held 
in rooms of the Albert Einstein Hospital, preferably and according to availability 
at the Abram Szajman Health Education Center located at the Hospital Israelita 
Albert Einstein - Morumbi Unit. 
 
All participants in both educational strategies will answer the same 
questionnaires. 
 
Before the start of educational activities: 
- Evidence-Based Practice and Clinical Effectiveness Questionnaire (EBPQ) 
(Annex 2). 
 
At the end of the practical activity (second class): 
- Evaluation Questionnaire on the structuring and description of an EBP project 
from the perspective of the clinical nurse (Appendix 4). 
 
Subsequently, the case exercise performed by each participant during 
the practical class will be assessed by the researcher as to the conformity in the 
elaboration of the key phases of a PBE project through the questionnaire: 
- Compliance verification questionnaire in the exercise of preparing a PBE 
project from the researcher's perspective (Appendix 5). 
 
 
 

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5. STATISTICAL ANALYSIS 
The data collected will be described for EBP specialists and nurses in 
each group by means of absolute and relative frequencies for qualitative 
variables and by means and standard deviations or medians and quartiles for 
quantitative variables, depending on the observed sample distribution, which 
will be described by boxplot charts by groups. (21) 
We will calculate the observed proportions of intelligibility for each 
translated tool and, in case of inadequacy (which we define as less than four 
yes answers for the tools), we will make the changes mentioned by the experts 
and submit the changed tools to a new evaluation by the experts. 
For comparisons between groups of nurses considering qualitative 
variables  such as the items in the ―questionnaire to assess the structuring and 
description of an evidence-based practice project from the perspective of the 
clinical nurse‖ and the ―questionnaire to verify compliance in exercise of 
structuring and describing an evidence-based practice project from the 
researcher's perspective ‖  we will use chi-square tests or Fisher's exact tests 
and for comparisons considering quantitative variables we will use Student's t 
tests or Mann-Whitney tests, depending on sample distribution observed for the 
variables.      
The analyzes will be performed with the aid of the R package and 
considering a 5% significance level.      
 
 
 

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6. ETHICAL ASPECTS 
The project will be submitted to the Research Project Management 
System (SGPP) and the Research Ethics Committee (CEP) of the institution, 
the numbers of the approval protocols will be included in this work item. 
In order to comply with the legal recommendations in force, the 
respective Terms of Free and Informed Consent (ICF) will be applied. 
- Informed Consent Form (ICF) - SPECIALIST IN EVIDENCE-BASED 
PRACTICE  
  - Informed Consent Form (ICF) - NURSE. 
Authorization was requested from the hospital's assistance director to 
conduct the study through the Term of Consent of the Area Managers, which 
met all institutional rules through the Term and Commitment of the Responsible 
Researcher in addition to the Term of Project Participants' Consent. 
 
 
 
 
 
 
 

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6. EXECUTION SCHEDULE 
Schedule of Deliveries / Activities 
     
     
     
Nov Jan Fev Mar Abr Mai Jun 
2º 
Sem 
  
Fev 
  SGPP Project Submission 
 X 
 
 
 
 
 
  Preparation of the content of the 
Workshops 
 
X 
 
 
 
 
 
 
 
  Submission of Johns Hopkins 
guides to expert judges 
  
 
X 
  
  
 
 
 
 
  Inclusion of participants 
 
 
 
X 
X 
 
 
 
 
  PBE workshops 
  
 
X 
X 
 
 
  Results analysis 
  
 
 
 
 
X 
 
  Preparation of the final report 
 
 
 
 
 
 
 
X 
X 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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7. BIBLIOGRAPHIC REFERENCES 
   
Pereira F, Salvi M, Verloo H. Beliefs, Knowledge, Implementation, and 
Integration of Evidence-Based Practice Among Primary Health Care Providers: 
Protocol for a Scoping Review. JMIR research protocols. 2017;6(8):e148. 
   
Friesen-Storms JH, Moser A, van der Loo S, Beurskens AJ, Bours GJ. 
Systematic implementation of evidence-based practice in a clinical nursing 
setting: a participatory action research project. Journal of clinical nursing. 
         -  :  -    
   
Danski MTR OG, Pedrolo E, Lind J, Johann D. A Importância da Prática 
Baseada em Evidências nos Processos de Trabalho do Enfermeiro. Cienc Cuid 
Saude 2017 Abr-Jun; 16(2). 2017. 
   
Schneider LR, Pereira RPG, Ferraz L. A prática baseada em evidência 
no contexto da Atenção Primária à Saúde. Saúde debate. 2018;42(118):594-
     
   
Warren JI, McLaughlin M, Bardsley J, Eich J, Esche CA, Kropkowski L, 
et al. The Strengths and Challenges of Implementing EBP in Healthcare 
Systems. Worldviews on evidence-based nursing. 2016;13(1):15-    
   
Pintz C, Zhou QP, McLaughlin MK, Kelly KP, Guzzetta CE. National 
Study of Nursing Research Characteristics at Magnet(R)-Designated Hospitals. 
The Journal of nursing administration. 2018;48(5):247-    
   
Wilson M, Sleutel M, Newcomb P, Behan D, Walsh J, Wells JN, et al. 
Empowering nurses with evidence-based practice environments: surveying 
Magnet(R), Pathway to Excellence(R), and non-magnet facilities in one 
healthcare system. Worldviews on evidence-based nursing. 2015;12(1):12-    
   
Magnet Recognition Program [homepage na internet]. ANCC Magnet 
Recognition 
Program® 
[acesso 
em 
15/          
https://www.nursingworld.org/organizational-programs/magnet/. 
   
Leão ER, Farah OG, Reis EAA, Barros CGd, Mizoi CS. Perfil acadêmico, 
crenças e autoeficácia em pesquisa de enfermeiros clínicos: implicações para o 
Programa de Pesquisa de Enfermagem de um Hospital na Jornada Magnet®. 
Einstein (São Paulo). 2013;11(4):507-    

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Camargo FC IH, Pereira GA, Souza RM, Garcia LAA, Monteiro DAT et 
al. . Estratégias para o ensino da prática baseada em evidências na formação 
de enfermeiros: Revisão Intergrativa. REFACS (online) 2018; 6(Supl 1):363-
     
    
Camargo FC PG, Iwamoto HH, Lorena LT, Goulart MB, Contim B. 
Oficinas para o desenvolvimento da prática baseada em evidências entre 
lideranças de enfermagem: estudo piloto. Rev Eletr Enf [Internet]. 2017;19:a50. 
    
Ashktorab T, Pashaeypoor S, Rassouli M, Alavi-Majd H. Nursing 
Students' Competencies in Evidence-Based Practice and Its Related Factors. 
Nursing and midwifery studies. 2015;4(4):e23047. 
    
Kim JS, Gu MO, Chang H. Effects of an evidence-based practice 
education program using multifaceted interventions: a quasi-experimental study 
with undergraduate nursing students. BMC medical education. 20        :    
    
Camargo FC, Iwamoto HH, Galvão CM, Pereira GdA, Andrade RB, 
Masso GC. Competences and Barriers for the Evidence-Based Practice in 
Nursing: an integrative review. Rev Bras Enferm. 2018;71(4):2030-   
    
Schaffer MA, Sandau KE, Diedrick L. Evidence-based practice models 
for organizational change: overview and practical applications. Journal of 
advanced nursing. 2013;69(5):1197-     
    
Camargo FC, Iwamoto HH, Galvão CM, Monteiro DAT, Goulart MB, 
Garcia LAA. Modelos para a implementação da prática baseada em evidências 
na enfermagem hospitalar. Texto contexto - enferm. 2018;26(4). 
    
Center for Evidence-Based Practice [homepage na internet]. Johns 
Hopkins 
Medicine 
[acesso 
em 
07/11/2019]. 
Disponível 
em: 
https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html 
    
Triolo PK, Scherer EM, Floyd JM. Evaluation of the Magnet Recognition 
Program. The Journal of nursing administration. 2006;36(1):42-   
    
BARROS CGL, E. R. ; REIS, E. A. A. ; FARAH, O. G. . Excelência 
Assistencial: a Designação Magnet. Prática Hospitalar. 2012:São Paulo, p. 59 - 
    

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McClure 
ML. 
Magnet 
hospitals: 
insights 
and 
issues. 
Nursing 
administration quarterly. 2005;29(3):198-     
    
Aiken LH, Poghosyan L. Evaluation of "magnet journey to nursing 
excellence program" in Russia and Armenia. Journal of nursing scholarship : an 
official publication of Sigma Theta Tau International Honor Society of Nursing. 
          :   -    
    
Barton SJ, Forster EK, Stuart ME, Patton AM, Rim JS, Torowicz DL. New 
knowledge, innovations, and improvement in a Magnet(R) Children's Hospital 
Cardiac Center. Journal of pediatric nursing. 2012;27(3):271-   
    
Tinkham MR. The road to magnet: implementing new knowledge, 
innovations, and improvements. AORN journal. 2013;97(5):579-    
    
Delors J. Learning: the treasure within; report to UNESCO of the 
International 
Commission 
on 
Education 
for 
the 
Twenty-first 
Century 
(highlights)2010. 
    
Rospendowiski K, Alexandre NMC, Cornélio ME. Cultural adaptation to 
Brazil and psychometric performance of the ―Evidence-Based Practice 
Questionnaire‖  Acta paul enferm            :   -    
    
Joint Commission International. Joint Commission International survey 
process guide for clinical care program certification. 3ª Edição, 2014 
 
 
 
 
 
 
 
 
 
 

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8. ATTACHMENTS: 
ANNEX 1: 
PBE guiding tools for the Johns Hopkins Nursing Evidence-based 
Practice (original English versions). 
2017_Appendix A_PET Management Guide 
2017_Appendix B_Question Development Tool 
2017_Appendix C_Stakeholder Analysis 
2017_Appendix D_Evidence Level and Quality Guide 
2017_Appendix E_Research Appraisal Tool 
2017_Appendix F_Non_research Evidecen Appraisal Tool 
2017_Appendix G_Individual Evidence Tool 
2017_Appendix H Evidence Synthesis and Recommendation Tool 
2017_Appendix I Action Planning Tool 
2017_Appendix J Dissemination Tool 
 
 
 
 
 
 
 
 
 
 
 
 
 

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2017_Appendix A_PET Management Guide 
PRACTICE QUESTION 
Step 1: Recruit interprofessional team 
Step 2: Define the problem 
Step 3: Develop and refine the EBP question 
Step 4: Identify stakeholders 
Step 5: Determine responsibility for project leadership 
Step 6: Schedule team meetings 
 
EVIDENCE 
Step 7: Conduct internal and external search for evidence 
Step 8: Appraise the level and quality of each piece of evidence 
 Step 9: Summarize the individual evidence 
Step 10: Synthesize overall strength and quality of evidence 
Step 11: Develop recommendations for change based on evidence 
synthesis 
 Strong, compelling evidence, consistent results  
 Good evidence, consistent results 
 Good evidence, conflicting results  
 Insufficient or absent evidence 
 
TRANSLATION  
Practice 
Question 
Evidence 
Translation 

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Step 12: Determine fit, feasibility, and appropriateness of 
recommendation(s) for translation path 
Step 13: Create action plan 
Step 14: Secure support and resources to implement action plan  
Step 15: Implement action plan 
Step 16: Evaluate outcomes 
Step 17: Report outcomes to stakeholders  
Step 18: Identify next steps 
Step 19: Disseminate findings 
 
Initial EBP Question: 
 
EBP Team Leader(s): 
EBP Team Members: 
Activities 
Start 
Date 
Days 
Required 
End 
Date 
Person 
Assigned 
Milestone 
Comment/ 
Resources 
Required 
PRACTICE QUESTION: 
Step 1: Recruit interprofessional team 
 
 
 
 
 
 
Step 2: Define the problem 
 
 
 
 
 
 
Step 3: Develop and refine the EBP 
question 
 
 
 
 
 
 
Step 4: Identify stakeholders 
 
 
 
 
 
 
Step 5: Determine responsibility for 
project leadership 
 
 
 
 
 
 
Step 6: Schedule team meetings 
 
 
 
 
 
 
EVIDENCE: 
Step 7:  Conduct internal and external 
search for evidence 
 
 
 
 
 
 
Step 8:  Appraise the level and quality of 
each piece of evidence 
 
 
 
 
 
 
Step 9:  Summarize the individual evidence  
 
 
 
 
 
Step 10: Synthesize overall strength and 
quality of evidence 
 
 
 
 
 
 

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2017_Appendix B_Question Development Tool 
Step 11: Develop recommendations for 
change based on evidence 
synthesis: 
 Strong, compelling evidence, 
consistent results 
 Good evidence, consistent 
results 
 Good evidence, conflicting 
results 
 Insufficient or absent 
evidence 
 
 
 
 
 
 
TRANSLATION: 
Step 12: Determine fit, feasibility, and  
appropriateness of 
recommendation(s) for 
translation path 
 
 
 
 
 
 
Step 13: Create action plan 
 
 
 
 
 
 
Step 14: Secure support and resources to 
implement action plan 
 
 
 
 
 
 
Step 15: Implement action plan 
 
 
 
 
 
 
Step 16: Evaluate outcomes 
 
 
 
 
 
 
Step 17: Report outcomes to stakeholders 
 
 
 
 
 
 
Step 18: Identify next steps. 
 
 
 
 
 
 
Step 19: Disseminate findings. 
 
 
 
 
 
 
1. What is the problem? 
 
 
 
 2. Why is the problem important and relevant? What would happen if it were not addressed? 
 
 3. What is the current practice? 
 

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 4. How was the problem identified?  (Check all that apply) 
❑ Safety and risk-management concerns 
❑ Quality concerns (efficiency, effectiveness, 
timeliness, equity, patient-centeredness) 
❑ Unsatisfactory patient, staff, or organizational 
outcomes 
❑ Variations in practice within the setting 
❑ Variations in practice compared to community 
standard 
❑ Current practice that has not been validated 
❑ Financial concerns 
  5. What are the PICO components? 
P – (Patient, population, or problem) 
I – (Intervention) 
C – (Comparison with other interventions, if foreground question) 
O – (Outcomes are qualitative or quantitative measures to determine the success of change) 
 6. Initial EBP question 
❑ Background   ❑ Foreground  
 
7. List possible search terms, databases to search, and search strategies. 
 
8. What evidence must be gathered?  (Check all that apply)  
❑ Publications (e.g., EBSCOHost, PubMed, CINAHL, Embase) 
❑ Standards (regulatory, professional, community) 
❑ Guidelines  
❑ Organizational data (e.g., QI, financial data, local clinical expertise, patient/family preferences) 
❑ Position statements 
   Revised EBP question 
(Revisions in the EBP question may not be evident until after the initial evidence review; the revision can 
be in the background question or a change from the background to a foreground question) 
 
10. Outcome measurement plan  

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Directions for Use of the Question Development Tool 
Purpose 
What is the problem, and why is it important? 
What is the current practice? 
What will we 
measure? 
(structure, 
process, 
outcome 
measure) 
How will we 
measure it? 
(metrics are 
expressed as 
rate or 
percent) 
How often will 
we measure 
it?  
(frequency) 
 Where will   we 
obtain the 
data? 
Who will collect 
the data? 
To whom will we 
report the 
data? 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
This form is used to develop an answerable EBP question and to guide the team  
in the evidence search process. The question, search terms, search strategy, and  
sources of evidence can be revised as the EBP team refines the EBP question. 
 
Indicate why the project was undertaken. What led the team to seek  
evidence? Ensure that the problem statement defines the actual problem and  
does not include a solution. Whenever possible, quantify the extent of the 
problem. Validate the final problem description with practicing staff. It is 
important for the inter-professional team to take the time together to reflect,  
gather information, observe current practice, listen to clinicians, visualize how  
the process can be different or improved, and probe the problem description in 
order to develop a shared understanding of the problem. 
 

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How was the problem identified? 
What are the PICO components? 
 
Initial EBP question 
A starting question (usually a background question) that is often refined and 
adjusted as the team searches through the literature: 
 Background questions are broad and are used when the team has 
little knowledge, experience, or expertise in the area of interest. 
Background questions are often used to identify best practices. 
 Foreground questions are focused, with specific comparisons of two 
or more ideas or interventions. Foreground questions provide specific 
bodies of evidence related to the EBP question. Foreground questions 
often flow from an initial background question and literature review. 
List possible search terms, databases to search, and search strategies. 
 
 
 
What evidence must be gathered? 
Define the current practice as it relates to the problem. Think about current 
policies and procedures. Observe practices. What do you see? 
Check all the statements that apply. 
P (patient, population, problem) e.g., age, sex, setting, ethnicity, condition, 
disease,  type of patient, or population 
I (intervention) e.g., treatment, medication, education, diagnostic test, or best 
practice(s) 
C (comparison with other interventions or current practice for foreground 
questions; is not applicable for background questions, which identify best 
practice) 
O (outcomes) stated in measurable terms; may be a structure, a process, or 
an outcome measure based on the desired change (e.g., decrease in 
falls, decrease in length of stay, increase in patient satisfaction) 
Using PICO components and the initial EBP question, list search terms.  
Terms can be added or adjusted throughout the evidence search.  
Document the search terms, search strategy, and databases queried in  
sufficient detail for replication. 

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Revised EBP question 
Often, the question that you start with may not be the final EBP question. 
Back- ground questions can be refined or changed to a foreground question 
based on the evidence review. Foreground questions are focused questions 
that include specific comparisons and produce a narrower range of evidence. 
 
Measurement plan 
 A measure is an amount or a degree of something, such as number of 
falls with injury. Each measure must be converted to a metric, which is 
calculated before and after implementing the change. 
 Metrics let you know whether the change was successful. They have a 
numerator and a denominator and are typically expressed as rates or 
percent. For example, a metric for the measure falls-with-injury would 
be the number of falls with injury (numerator) divided by 1,000 patient 
days (denominator). Other examples of metrics include the number of 
direct care RNs (numerator) on a unit divided by the total number of 
direct care staff (denominator); the number of medication errors 
divided by 1,000 orders. 
 
2017_Appendix C_Stakeholder Analysis 
Check the types of evidence the team will gather based on the PICO and  
initial EBP question. 
 
Measures can be added or changed as the review of the literature is completed 
and the translation planning begins: 
   Identify the key stakeholders. 
❑ Manager or direct supervisor 
❑ Finance department 
❑ Vendors 
❑ Patients and/or families; patient and family 
advisory committee 
❑ Professional organizations 
❑ Committees 
❑ Organizational leaders 
❑ Interdisciplinary colleagues (e.g. physicians, 
nutritionists, respiratory therapists, or OT/PT) 
❑ Administrators 
❑ Other units or departments 
❑ Others: ________________ 
2. Stakeholder roles and responsibilities.  
(The stakeholder roles—which include Responsibility, Consult, Approval, and Inform and their corresponding 
responsibilities, described here—guide completion of the table.) 

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Directions for Use of the Stakeholder Analysis Tool 
Purpose 
This form is used to identify key stakeholders. Key stakeholders are persons, 
groups, or departments in the organization that have an interest in, or 
concern about, your project and/or may assist you in securing resources to 
implement your action plan. Involve stakeholders early in the process to 
ensure their buy-in for implementation. 
Because stakeholders may change at different steps of the process, we 
recommend that you review this form as you proceed from step to step in 
your action plan. 
Definition 
Stakeholders are ―persons or groups that have a vested interest in a clinical 
[or nonclinical  decision and the evidence that supports that decision‖ 
(AHRQ, 2014). 
 
 
Responsibility 
 Completes identified tasks 
 Recommending authority 
Consult 
 Provides input (e.g., subject matter experts) 
 No decision-making authority 
Approval 
 Signs off on recommendations 
 May veto 
Inform 
 Notified of progress and changes 
 No input on decisions 
Project tasks 
Stakeholder name 
Stakeholder name 
Stakeholder name 
Stakeholder role 
Stakeholder role 
Stakeholder role 

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Identify the key stakeholders 
Identify the 5–7 key stakeholders who can most affect, or who will be most 
affected by, the project, actions, objectives, or change and who can influence 
the success of the translation work. Key stakeholders are individuals or 
groups who: 
 Make decisions about the project 
 Approve the project or aspects of the project 
 Serve as subject matter experts 
 
Provide resources such as support, policy changes, resources, and 
time 
 
Stakeholder analysis 
It is helpful to consider which of the four roles each stakeholder may play in 
your action planning and translation work. The possible roles are: 
 Responsibility 
 Approval 
 Consult 
 Inform 
Remember that one stakeholder may fill different roles, depending on the 
action. Completion of the Stakeholder Analysis Tool will help clarify roles and 
responsibilities. The descriptions of responsibilities for each role provided on 
the form will be helpful in this process. 
References: Agency for Healthcare Research and Quality. (2014) .Stakeholder Guide 
2014 .Retrieved from www.effectivehealthcare.ahrq.gov.AHRQ Publication No. 14-
EHC010-EF. Replaces Publication No. 11-EHC069-EF 
 
 
 
 
 
 
 
 

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2017_Appendix D_Evidence Level and Quality Guide 
 
 

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2017_Appendix E_Research Appraisal Tool 
Evidence level and quality rating:                    
 
 
Article title: 
Number: 
Author(s): 
Publication date: 
Journal: 
Setting: 
Sample (composition and size): 
Does this evidence address my EBP question? 
Yes 
No-Do not proceed with appraisal of this evidence 
Is this study: 
QuaNtitative 
(collection, 
analysis, 
and 
reporting 
of 
numerical 
data) 
Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in 
research, and generalize results from a larger sample population; provides observed effects of a 
program, problem, or condition, measured precisely, rather than through researcher interpretation of 
data. Common methods are surveys, face-to-face structured interviews, observations, and reviews of 
records or documents. Statistical tests are used in data analysis. 
Go to Section I: QuaNtitative 
QuaLitative 
(collection, 
analysis, 
and 
reporting 
of 
narrative 
data)  
Rich narrative documents are used for uncovering themes; describes a problem or condition from the 
point of view of those experiencing it. Common methods are focus groups, individual interviews 
(unstructured or semi structured), and participation/observations. Sample sizes are small and are 
determined when data saturation is achieved. Data saturation is reached when the researcher identifies 
that no new themes emerge and redundancy is occurring. Synthesis is used in data analysis. Often a 
starting point for studies when little research exists; may use results to design empirical studies. The 
researcher describes, analyzes, and interprets reports, descriptions, and observations from 
participants. 
Go to Section II: QuaLitative 
Mixed 
methods 
(results 
reported 
both 
numerically 
and 
narratively)  
Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in 
combination, provides a better understanding of research problems than using either approach alone. 
Sample sizes vary based on methods used. Data collection involves collecting and analyzing both 
quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and 
can influence stages in the research process.  
Go to Section I for QuaNtitative components and Section II for QuaLitative components 

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Section I: QuaNtitative 
Level of Evidence (Study Design) 
Is       This a report of a single research study? 
 Yes 
 No 
Go to B 
1. Was there manipulation of an independent variable? 
 Yes 
 No 
2. Was there a control group? 
 Yes 
 No 
3. Were study participants randomly assigned to the 
intervention and control groups? 
 Yes 
 No 
Yes to questions 1, 2, and 3, this is a randomized controlled trial (RCT) or 
experimental study. 
LEVEL I 
Yes to questions 1 and 2 and No to question 3 or Yes to question 1 and No to 
questions 2 and 3, this is quasi-experimental. 
(Some degree of investigator control, some manipulation of an independent 
variable, lacks random assignment to groups, and may have a control group). 
LEVEL II 
No to questions 1, 2, and 3, this is nonexperimental. 
(No manipulation of independent variable; can be descriptive, comparative, or 
correlational; often uses secondary data). 
LEVEL III 
Study Findings That Help Answer the EBP Question 
 
Complete the Appraisal of QuaNtitative Research Studies section 
A

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Is this a summary of multiple sources of research 
evidence? 
 Yes 
Continue 
 No 
Use Appendix F 
1. Does it employ a comprehensive search strategy and rigorous 
appraisal method? 
If this study includes research, nonresearch, and experiential 
evidence, it is an integrative review (see Appendix F). 
 Yes 
Continue 
 No 
Use Appendix F 
2. For systematic reviews and systematic reviews with meta-analysis 
(see descriptions below): 
a. Are all studies included RCTs? 
LEVEL I 
b. Are the studies a combination of RCTs and quasi-experimental, 
or quasi-experimental only? 
LEVEL II 
c. Are the studies a combination of RCTs, quasi-experimental, and 
nonexperimental, or non- experimental only? 
LEVEL III 
 
A systematic review employs a search strategy and a rigorous appraisal method, but does not 
generate an effect size. 
A meta-analysis, or systematic review with meta-analysis, combines and analyzes results from 
studies to generate a new statistic: the effect size. 
 
Study Findings That Help Answer the EBP Question 
 
 
 
 
 
 
 
 
 
   Complete the Appraisal of Systematic Review (With or Without a Meta-Analysis) section 
B 

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Appraisal of QuaNtitative Research Studies 
Does the researcher identify what is known and not known about 
the problem and how the study will address any gaps in 
knowledge? 
 Yes 
 No 
 
Was the purpose of the study clearly presented? 
 Yes 
 No 
 
Was the literature review current (most sources within the past 
five years or a seminal study)? 
 Yes 
 No 
 
Was sample size sufficient based on study design and rationale? 
 Yes 
 No 
 
If there is a control group: 
 Were the characteristics and/or demographics similar in 
both the control and intervention groups? 
 Yes 
 No 
 
N/A 
 If multiple settings were used, were the settings 
similar? 
 Yes 
 No 
N/A 
 Were all groups equally treated except for the 
intervention group(s)? 
 Yes 
 No 
N/A 
Are data collection methods described clearly? 
 Yes 
 No 
 
Were the instruments reliable  Cronbach’s [alpha  >      ? 
 Yes 
 No 
N/A 
Was instrument validity discussed? 
 Yes 
 No 
N/A 
If surveys or questionnaires were used, was the response  
rate > 25%? 
 Yes 
 No 
N/A 
Were the results presented clearly? 
 Yes 
 No 
 
If tables were presented, was the narrative consistent with the 
table content? 
 Yes 
 No 
N/A 
Were study limitations identified and addressed? 
 Yes 
 No 
 
Were conclusions based on results? 
 Yes 
 No 
 
Go to Quality Rating for QuaNtitative Studies section 

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Appraisal of Systematic Review (With or Without Meta-Analysis) 
Were the variables of interest clearly identified? 
 Yes 
 No 
Was the search comprehensive and reproducible? 
 Key search terms stated 
 Yes 
 No 
 Multiple databases searched and identified 
 Yes 
 No 
 Inclusion and exclusion criteria stated 
 Yes 
 No 
Was there a flow diagram that included the number of studies eliminated 
at each level of review? 
 Yes 
 No 
Were details of included studies presented (design, sample, methods, 
results, outcomes, strengths, and limitations)? 
 Yes 
 No 
Were methods for appraising the strength of evidence (level and quality) 
described? 
 Yes 
 No 
Were conclusions based on results? 
 Yes 
 No 
 Results were interpreted 
 Yes 
 No 
 Conclusions flowed logically from the interpretation and systematic 
review question 
 Yes 
 No 
Did the systematic review include a section addressing limitations and 
how they were addressed? 
 Yes 
 No 
Complete Quality Rating for QuaNtitative Studies section 
Quality Rating for QuaNtitative Studies   
Circle the appropriate quality rating below: 
A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate
control; definitive conclusions; consistent recommendations based on comprehensive literature review 
that includes thorough reference to scientific evidence. 
B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, 
and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive 
literature review that includes some reference to scientific evidence. 
C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study 
design; conclusions cannot be drawn. 

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Section II: QuaLitative 
Level of Evidence (Study Design) 
 
          Is this a report of a single research study? 
 
 Yes  
go to Level III 
 
 No 
go to II B 
Study Findings That Help Answer the EBP Question 
 
 
Complete Appraisal of Single QuaLitative Research Study section 
Appraisal of a Single QuaLitative Research Study 
Was there a clearly identifiable and articulated: 
 
Purpose? 
❑ Yes 
❑ No 
 
Research question? 
❑ Yes 
❑ No 
 
Justification for method(s) used? 
❑ Yes 
❑ No 
 
Phenomenon that is the focus of the research? 
❑ Yes 
❑ No 
Were study sample participants representative? 
❑ Yes 
❑ No 
Did they have knowledge of or experience with the research area? 
❑ Yes 
❑ No 
Were participant characteristics described? 
❑ Yes 
❑ No 
Was sampling adequate, as evidenced by achieving saturation of data? 
❑ Yes 
❑ No 
Data analysis: 
 
Was a verification process used in every step by checking and confirming 
with participants the trustworthiness of analysis and interpretation? 
❑ Yes 
❑ No 
 
Was there a description of how data were analyzed (i.e., method), by 
computer or manually? 
❑ Yes 
❑ No 
Do findings support the narrative data (quotes)? 
❑ Yes 
❑ No 
Do findings flow from research question to data collected to analysis undertaken? 
❑ Yes 
❑ No 
Are conclusions clearly explained? 
❑ Yes 
❑ No 
Go to Quality Rating for QuaLitative Studies section 
A 

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For summaries of multiple quaLitative research studies 
(meta-synthesis), was a comprehensive search strategy and 
rigorous appraisal method used? 
 
Yes 
Level III 
 
No 
go to Appendix F 
Study Findings That Help Answer the EBP Question 
Complete the Appraisal of Meta-Synthesis Studies section 
Appraisal of Meta-Synthesis Studies 
Were the search strategy and criteria for selecting primary studies clearly defined? 
❑ Yes 
❑ No 
Were findings appropriate and convincing? 
❑ Yes 
❑ No 
Was a description of methods used to: 
 
 
Compare findings from each study? 
❑ Yes 
❑ No 
 
Interpret data? 
❑ Yes 
❑ No 
Did synthesis reflect: 
❑ Yes 
❑ No 
 
New insights? 
❑ Yes 
❑ No 
 
Discovery of essential features of phenomena? 
❑ Yes 
❑ No 
 
A fuller understanding of the phenomena? 
❑ Yes 
❑ No 
Was sufficient data presented to support the interpretations? 
❑ Yes 
❑ No 
Complete the Quality Rating for QuaLititative Studies section 
B 

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Quality Rating for QuaLitative Studies   
Circle the appropriate quality rating below: 
No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective 
process based on the extent to which study data contributes to synthesis and how much information is 
known about the researchers’ efforts to meet the appraisal criteria  
For meta-synthesis, there is preliminary agreement that quality assessments should be made before 
synthesis to screen out poor-quality studies . 
A/B High/Good quality is used for single studies and meta-syntheses . 
The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in 
sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry.  
Evidence of some or all of the following is found in the report: 
 Transparency: Describes how information was documented to justify decisions, how data were 
reviewed by others, and how themes and categories were formulated. 
 Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple sources 
to corroborate evidence. 
 Verification: The process of checking, confirming, and ensuring methodologic coherence. 
 Self-reflection and self-scrutiny: Being continuously aware of how a researcher’s experiences  
background, or prejudices might shape and bias analysis and interpretations. 
 Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and 
interpretation give voice to those who participated. 
 Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature. 
C Lower-quality studies contribute little to the overall review of findings and have few, if any, of the 
features listed for High/Good quality. 
Section III: Mixed Methods 
Level of Evidence (Study Design) 
You will need to appraise both the quaNtitative and quaLitative parts of the study independently, before 
appraising the study in its entirety. 
1. Evaluate the quaLitative part of the study using Section I.  
Level 
Quality 
Insert here the level of evidence and overall quality for this part: 
 
 
2. Evaluate the quaLitative part of the study using Section II.  
Level 
Quality 

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Insert here the level of evidence and overall quality for this part: 
3. To determine the level of evidence, circle the appropriate study design: 
 Explanatory sequential designs collect quaNtitative data first, followed by the quaLitative data; and their 
purpose is to explain quaNtitative results using quaLitative findings. The level is determined based on the 
level of the quaNtitative part. 
 Exploratory sequential designs collect quaLitative data first, followed by the quaNtitative data; and their 
purpose is to explain quaLitative findings using the quaNtitative results. The level is determined based on 
the level of the quaLitative part, and it is always Level III. 
 Convergent parallel designs collect the quaLitative and quaNtitative data concurrently for the purpose of 
providing a more complete understanding of a phenomenon by merging both datasets. These designs are 
Level III. 
 Multiphasic designs collect quaLitative and quaNtitative data over more than one phase, with each phase 
informing the next phase. These designs are Level III. 
Study Findings That Help Answer the EBP Question 
Use the Appraisal of Mixed Methods Studies section 
Appraisal of Mixed Methods Studies  
Was the mixed-methods research design relevant to address the quaNtitative 
and quaLitative research questions (or objectives)? 
❑ Yes 
❑ No 
❑ N/A 
Was the research design relevant to address the quaNtitative and quaLitative 
aspects of the mixed-methods question (or objective)? 
❑ Yes 
❑ No 
❑ N/A 
For convergent parallel designs, was the integration of quaNtitative and 
quaLitative data (or results) relevant to address the research question or 
objective? 
❑ Yes 
❑ No 
❑ N/A 
For convergent parallel designs, were the limitations associated with the 
integration (for example, the divergence of quaLitative and quaNtitative data or 
results) sufficiently addressed? 
❑ Yes 
❑ No 
❑ N/A 
Go to Quality Rating for Mixed-Method Studies section 

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Appraisal of Meta-Synthesis Studies 
Were the search strategy and criteria for selecting primary studies clearly defined? 
❑ Yes 
❑ No 
Were findings appropriate and convincing? 
❑ Yes 
❑ No 
Was a description of methods used to: 
 
 
Compare findings from each study? 
❑ Yes 
❑ No 
 
Interpret data? 
❑ Yes 
❑ No 
Did synthesis reflect: 
❑ Yes 
❑ No 
 
New insights? 
❑ Yes 
❑ No 
 
Discovery of essential features of phenomena? 
❑ Yes 
❑ No 
 
A fuller understanding of the phenomena? 
❑ Yes 
❑ No 
Was sufficient data presented to support the interpretations? 
❑ Yes 
❑ No 
Complete the Quality Rating for QuaLtitative Studies section 
Quality Rating for Mixed-Methods Studies 
Circle the appropriate quality rating below 
A High quality: Contains high-quality quaNtitative and quaLitative study components; highly relevant study 
design; relevant integration of data or results; and careful consideration of the limitations of the chosen 
approach. 
B Good quality: Contains good-quality quaNtitative and quaLitative study components; relevant study 
design; moderately relevant integration of data or results; and some discussion of limitations of 
integration. 
C Low quality or major flaws: Contains low quality quaNtitative and quaLitative study components; 
study design not relevant to research questions or objectives; poorly integrated data or results; and no 
consideration of limits of integration. 

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2017_Appendix F_Non_research Evidecen Appraisal Tool 
 
 
      Evidence level and quality rating: 
 
  
Article title: 
Number: 
Author(s): 
Publication date: 
Journal: 
Setting: 
Sample (composition and size): 
Does this evidence address my EBP question? 
Yes 
No- Do not proceed with appraisal of this evidence 
❑ Clinical Practice Guidelines LEVEL IV 
Systematically developed recommendations from nationally recognized experts based on research 
evidence or expert consensus panel 
❑ Consensus or Position Statement LEVEL IV 
Systematically developed recommendations, based on research and nationally recognized expert 
opinion, that guide members of a professional organization in decision-making for an issue of 
concern 
 Are the types of evidence included identified? 
 Yes 
 No 
 Were appropriate stakeholders involved in the development of 
recommendations? 
 Yes 
 No 
 Are groups to which recommendations apply and do not apply clearly 
stated? 
 Yes 
 No 
 Have potential biases been eliminated? 
 Yes 
 No 
 Does each recommendation have an identified level of evidence stated? 
 Yes 
 No 
 Are recommendations clear? 
 Yes 
 No 
 Findings That Help Answer the EBP Question 
Complete the corresponding quality rating section. 
 

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❑ Literature review LEVEL V 
Summary of selected published literature including scientific and nonscientific such as reports of 
organizational experience and opinions of experts 
❑ Integrative review LEVEL V 
Summary of research evidence and theoretical literature; analyzes, compares themes, notes gaps 
in the selected literature 
 Is subject matter to be reviewed clearly stated? 
 Yes 
 No 
 Is literature relevant and up-to-date (most sources are within the past five 
years or classic)? 
 Yes 
 No 
 Of the literature reviewed, is there a meaningful analysis of the 
conclusions across the articles included in the review? 
 Yes 
 No 
 Are gaps in the literature identified? 
 Yes 
 No 
 Are recommendations made for future practice or study? 
 Yes 
 No 
F Findings That Help Answer the EBP Question 
Complete the corresponding quality rating section. 
❑ Expert opinion LEVEL V 
Opinion of one or more individuals based on clinical expertise 
 Has the individual published or presented on the topic? 
 Yes 
 No 
 Is the author’s opinion based on scientific evidence? 
 Yes 
 No 
 Is the author’s opinion clearly stated? 
 Yes 
 No 
 Are potential biases acknowledged? 
 Yes 
 No 
F  Findings That Help Answer the EBP Question 
Complete the corresponding quality rating section. 

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Organizational Experience 
 Quality improvement LEVEL V 
Cyclical method to examine workflows, processes, or systems with a specific organization 
 Financial evaluation LEVEL V 
Economic evaluation that applies analytic techniques to identify, measure, and compare the cost and 
outcomes of two or more alternative programs or interventions 
 Program evaluation LEVEL V 
Systematic assessment of the processes and/or outcomes of a program; can involve both 
quaNtitative and quaLitative methods 
Setting: 
Sample Size/Composition: 
 
Was the aim of the project clearly stated? 
❑ Yes 
❑ No 
 
 
Was the method fully described? 
❑ Yes 
❑ No 
 
 
Were process or outcome measures identified? 
❑ Yes 
❑ No 
 
 
Were results fully described? 
❑ Yes 
❑ No 
 
 
Was interpretation clear and appropriate? 
❑ Yes 
❑ No 
 
 
Are components of cost/benefit or cost effectiveness 
analysis described? 
❑ Yes 
❑ No 
❑ N/A 
Findings That Help Answer the EBP Question 
Complete the corresponding quality rating section. 
 Case report LEVEL V 
In-depth look at a person or group or another social unit 
 Is the purpose of the case report clearly stated? 
❑ Yes 
❑ No 
 Is the case report clearly presented? 
❑ Yes 
❑ No 
 Are the findings of the case report supported by relevant theory 
or research? 
❑ Yes 
❑ No 

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Community standard, clinician experience, or consumer preference LEVEL V 
❑ Community standard: Current practice for comparable settings in the community 
❑ Clinician experience: Knowledge gained through practice experience 
Consumer preference: Knowledge gained through life experience 
Information Source(s) 
Number  of Sources 
 Source of information has credible experience 
❑ Yes 
❑ No 
❑ N/A 
 Opinions are clearly stated 
❑ Yes 
❑ No 
❑ N/A 
 Evidence obtained is consistent 
❑ Yes 
❑ No 
❑ N/A 
Findings That Help You Answer the EBP Question 
Complete the corresponding quality rating section. 
 
 
 
 
 
 
 
 
 
 Are the recommendations clearly stated and linked to the 
findings? 
❑ Yes 
❑ No 
Findings That Help Answer the EBP Question 
Complete the corresponding quality rating. 

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Quality Rating for Clinical Practice Guidelines, Consensus, or Position Statements (Level IV) 
A High quality 
Material officially sponsored by a professional, public, or private organization or a government 
agency; documentation of a systematic literature search strategy; consistent results with sufficient 
numbers of well-designed studies; criteria-based evaluation of overall scientific strength and 
quality of included studies and definitive conclusions; national expertise clearly evident; developed 
or revised within the past five years. 
B Good quality 
Material officially sponsored by a professional, public, or private organization or a government 
agency; reasonably thorough and appropriate systematic literature search strategy; reasonably 
consistent results, sufficient numbers of well-designed studies; evaluation of strengths and 
limitations of included studies with fairly definitive conclusions; national expertise clearly evident; 
developed or revised within the past five years. 
C Low quality or major flaw 
Material not sponsored by an official organization or agency; undefined, poorly defined, or limited 
literature search strategy; no evaluation of strengths and limitations of included studies; insufficient 
evidence with inconsistent results; conclusions cannot be drawn; not revised within the past five 
years. 
Quality Rating for Organizational Experience (Level V) 
A High quality 
Clear aims and objectives; consistent results across multiple settings; formal quality improvement or 
financial evaluation methods used; definitive conclusions; consistent recommendations with 
thorough reference to scientific evidence. 
B Good quality 
Clear aims and objectives; formal quality improvement or financial evaluation methods used; 
consistent results in a single setting; reasonably consistent recommendations with some reference 
to scientific evidence. 
C Low quality or major flaws 
Unclear or missing aims and objectives; inconsistent results; poorly defined quality; 
improvement/financial analysis method; recommendations cannot be made. 
Quality Rating for Case Report, Integrative Review, Literature Review, Expert Opinion, 
Community Standard, Clinician Experience, Consumer Preference (Level V) 

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2017_Appendix G_Individual Evidence Tool 
 
 
 
 
 
A High quality 
Expertise is clearly evident, draws definitive conclusions, and provides scientific rationale; thought 
leader in the field. 
B Good quality 
Expertise appears to be credible, draws fairly definitive conclusions, and provides logical argument 
for opinions. 
C Low quality or major flaws 
Expertise is not discernable or is dubious; conclusions cannot be drawn. 

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Directions for Use of the Individual Evidence Summary Tool 
Purpose 
This form is used to document the results of evidence appraisal in preparation for 
evidence synthesis. The form provides the EBP team with documentation of the 
sources of evidence used, the year the evidence was published or otherwise 
communicated, the information gathered from each evidence source that helps the 
team answer the EBP question, and the level and quality of each source of evidence. 
Article Number 
Assign a number to each reviewed source of evidence. This organizes the individual 
evidence summary and provides an easy way to reference articles. 
Author and Date 
Indicate the last name of the first author or the evidence source and the 
publication/communication date. List both author/evidence source and date. 
Evidence Type 
Indicate the type of evidence reviewed (e.g., RCT, meta-analysis, mixed methods, 
quaLitative, systematic review, case study, narrative literature review). 
Sample, Sample Size, and Setting 
Provide a quick view of the population, number of participants, and study location. 
Findings That Help Answer the EBP Question 
Although the reviewer may find many points of interest, list only findings that directly 
apply to the EBP question. 
Observable Measures 
QuaNtitative measures or variables are used to answer a research question, test a 
hypothesis, describe characteristics, or determine the effect, impact, or influence. 
QuaLitative evidence uses cases, context, opinions, experiences, and thoughts to 
represent the phenomenon of study. 
Limitations 
Include information that may or may not be within the text of the article regarding 
drawbacks of the piece of evidence. The evidence may list limitations, or it may be 
evident to you, as you review the evidence, that an important point is missed or the 
sample does not apply to the population of interest. 
Evidence Level and Quality 
Using information from the individual appraisal tools, transfer the evidence level and 
quality rating into this column. 
 

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2017_Appendix H Evidence Synthesis and Recommendation Tool 
 
 
Key Points:  
 Evidence synthesis is best done through group discussion. All team members 
share their perspectives, and the team uses critical thinking to arrive at a 
judgment based on consensus during the synthesis process. The synthesis 
process involves both subjective and objective reasoning by the full EBP team. 
Through reasoning, the team: 
 Reviews the quality appraisal of the individual pieces of evidence 
 Assesses and assimilates consistencies in findings 
 Evaluates the meaning and relevance of the findings 
 Merges findings that may either enhance the team’s knowledge or 
generate new insights, perspectives, and understandings 
 Highlights inconsistencies in findings 
 Makes recommendations based on the synthesis process 
 
When evidence includes multiple studies of Level I and Level II evidence, there 
is a similar population or setting of interest, and there is consistency across 
findings, EBP teams can have greater confidence in recommending a practice 
change. However, with a majority of Level II and Level III evidence, the team 
should proceed cautiously in making practice changes. In this instance, 
recommendation(s) typically include completing a pilot before deciding to 
implement a full-scale change. 
 
Generally, practice changes are not made on Level IV or Level V evidence 
alone. Nonetheless, teams have a variety of options for actions that include, but 
are not limited to: creating awareness campaigns, conducting informational and 
educational updates, monitoring evidence sources for new information, and 
designing research studies. 
 
The quality rating (see Appendix D) is used to appraise both individual quality of 
evidence and overall quality of evidence. 
 

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Based on your synthesis, which of the following four pathways to translation 
represents the overall strength of the evidence? 
❑ Strong, compelling evidence, consistent results: Solid indication for a practice change 
is indicated. 
❑ Good and consistent evidence: Consider pilot of change or further investigation. 
❑ Good but conflicting evidence: No indication for practice change; consider further 
investigation for new evidence or develop a research study. 
❑ Little or no evidence: No indication for practice change; consider further investigation for 
new evidence, develop a research study, or discontinue project. 

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If you selected either the first option or the second option, continue. If not, STOP, translation is 
not indicated. 
Recommendations based on evidence synthesis and selected translation 
pathway 
 
 
Consider the following as you examine fit: 
Are the recommendations: 
 Compatible with the unit/departmental/organizational cultural values or norms? 
 Consistent with unit/departmental/organizational assumptions, structures, attitudes, 
beliefs, and/or practices? 
 Consistent with the unit/departmental/organizational priorities? 
Consider the following as you examine feasibility: 
 
Can we do what they did in our work environment? 
 
Are the following supports available? 
 
Resources 
 
Funding 
 
Approval from administration and clinical leaders 
 
Stakeholder support 
 
Is it likely that the recommendations can be implemented within the 
unit/department/organization? 
 
 
Directions for Use of This Form 
Purpose of form 
 
Total number of sources per level 
Record the number of sources of evidence for each level. 
 
Use this form to compile the results of the individual evidence appraisal to answer the  
EBP question. The pertinent findings for each level of evidence are synthesized, and a  
quality rating is assigned to each level. 

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Overall quality rating 
Synthesis of findings: evidence that answers the EBP question 
 Include only findings from evidence of A or B quality. 
 Include only statements that directly answer the EBP question. 
 Summarize findings within each level of evidence. 
 Record article number(s) from individual evidence summary in parentheses 
next to each statement so that the source of the finding is easy to identify. 
Develop recommendations based on evidence synthesis and the 
selected translation pathway 
Review the synthesis of findings and determine which of the following four pathways 
to translation represents the overall strength of the evidence: 
 Strong, compelling evidence, consistent results: Solid indication for a 
practice change. 
 Good and consistent evidence: Consider pilot of change or further 
investigation. 
 Good but conflicting evidence: No indication for practice change; consider 
further investigation for new evidence or develop a research study. 
 Little or no evidence: No indication for practice change; consider further 
investigation for new evidence, develop a research study, or discontinue the 
project. 
Fit and feasibility 
Even when evidence is strong and of high quality, it may not be appropriate to 
implement a change in practice. It is crucial to examine feasibility that considers the 
resources available, the readiness for change, and the balance between risk and 
benefit  Fit refers to the compatibility of the proposed change with the organization’s 
mission, goals, objectives, and priorities. A change that does not fit within the 
organizational priorities will be less likely to receive leadership and financial support, 
making success difficult. Implementing processes with a low likelihood of success 
wastes valuable time and resources on efforts that produce negligible benefits. 
 
 
 
 
 
Summarize the overall quality of evidence for each level. Use Appendix D to rate the  
quality of evidence. 
 

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2017_Appendix I Action Planning Tool 
 
 
1. Complete the following activities to ensure successful translation: 
❑ Secure a project leader. 
❑ Identify change champions. 
❑ Consider whether translation activities require different or additional members. 
❑ Schedule time to complete milestones. 
❑ Identify critical milestones and related tasks.  
❑ Identify observable pre or post measures.                                                                                             
2. Identify barriers to the success of the change, and then identify strengths that 
can be leveraged to overcome barriers. 
Barriers 
Resources or Strengths 
Plan to Overcome Barriers by 
Leveraging Strengths as Appropriate 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
3. Consider whether or how this change will affect the following: 
  ❑ Electronic health record   
    ❑ Workflow 
        ❑  Policies and/or procedures 
4. Confirm support and/or availability of funds to cover expenses.  
(Check all that apply) 
❑ Personnel costs 
 
❑ Supplies/equipment 
❑ Technology 
❑ Photocopying 
 
 
 
❑ Education or further training 
❑ Content or external experts  
❑ Dissemination costs (conference costs, 
travel) 
❑  Other:   
 

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Directions for Use of the Action Planning Tool 
Purpose of form 
 
Activities to ensure successful translation 
5. Identify critical milestones and related tasks: 
 
(Insert Milestone 1) 
(Insert Milestone 2) 
(Insert Milestone 3) 
(Insert Milestone 4)
Tasks 
(Insert task) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
This form is used to guide you as you create an action plan. 
These are all activities that must be completed as you plan the change. 
Consider pre- and post-observable measures that can be used to determine 
whether the change was successful. In addition, identifying critical milestones 
allows the team to see whether they are on track to accomplish the goals. 

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Identify strengths/resources and barriers to the success of the 
change 
Consider whether or how the change will impact workflows and 
processes 
Confirm support and/or availability of funds to cover expenses 
Identify critical milestones and related tasks 
 
 
 
 
 
 
 
 
 
 
This analysis allows teams to identify barriers to implementation and 
potentially mitigate them using inherent strengths and resources. You may find 
specific challenges that will likely impact the ability to deliver on the action 
plan. Though these obstacles can get in the way, knowing about them up 
front is helpful so that you can engage support and create a plan to address 
them. 
Be mindful of the impact of the change downstream. For example, will 
changes need to be made to the electronic medical record to accommodate 
the change, or will this change impact the workflow of any other staff who 
have not been considered? 
Use this as a guide to prompt thoughtfulness about financial obligations that 
may be a part of the rollout. 
Consider all the categories of work (milestones) necessary to implement this 
change. What tasks must be accomplished first for each milestone in order to 
move forward? When must they be completed to stay on track? For example, if 
a milestone is to implement a protocol, list all tasks to accomplish it. 

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2017_Appendix J Dissemination Tool 
 
1. Think about the project findings and practice change initiative. What is the most 
important information you need to convey? 
2. Align key messages with audiences. 
Audience 
Key Message 
Communication Method 
Interdisciplinary stakeholders 
Organizational leadership 
Departmental leadership 
Frontline staff 
External community 
(publications, posters, and 
presentations) 
3. Review examples below to identify appropriate communication methods. 
 Written publication 
 Online program 
 External conference 
 Podium presentation 
 Poster presentation 
 Social media blast 
 Internal meeting/inservice 
 
 Audio/video content 
 Others: 

Evidence-Based Practice. Version 1 - Nov2019 
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Directions for Use of the Dissemination Tool 
Purpose 
This form is useful at various points in the EBP project process. It is usually 
completed toward the end of the project, when findings are known and efforts have 
produced a product, tool, program, or policy. 
 
Align key message with audience 
Think about the project findings. What has the project effort accomplished? What 
products, policy changes, or outcomes can you report? Identify the end users—
who is your audience? Your audience may be individuals, organizations, or 
networks who might have an interest in the project outcomes. 
 
Communication method 
This is the communication plan, and it can occur on many levels. Think about 
reaching the varied audiences using a multitude of methods. These can include, 
but are not limited to, written text, audio / visual content, online programs, and 
poster presentations. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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ANNEX 2: 
Clinical Effectiveness and Evidence Based Practice Questionnaire 
(EBPQ).  
This questionnaire is designed to gather information and opinions on the use of 
evidence based practice amongst health professionals. There are no right or 
wrong answers for we are interested in your opinions and your own use of 
evidence in your practice.  
1) Considering your practice in relation to an individual patient’s care over the 
past year, how often have you done the following in response to a gap in your 
knowledge (please √ or X): 
 
a) Formulated a clearly answerable question as the beginning of the process towards 
filling this gap:  
 
 
   
Never 
 
   
 
   
 
   
 
   
 
   
 
   
Frequently  
  
 
 
b) Tracked down the relevant evidence once you have formulated the question  
  
 
 
   
Never 
 
   
 
   
 
   
 
   
 
   
 
   
Frequently  
  
 
 
c) Critically appraised, against set criteria, any literature you have discovered  
 
 
   
Never  
 
   
 
   
 
   
 
   
 
   
 
  
 Frequently  
 

Evidence-Based Practice. Version 1 - Nov2019 
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d) Integrated the evidence you have found with your expertise:  
 
 
   
Never  
 
   
 
   
 
   
 
   
 
   
 
   
Frequently  
 
e) Evaluated the outcomes of your practice:  
 
 
 
   
Never  
 
   
 
   
 
   
 
   
 
   
 
   
Frequently  
 
f) Shared this information with colleagues:  
 
 
   
Never 
 
   
 
   
 
   
 
   
 
   
 
   
Frequently  
 
 
2) Please indicate (by √ or X) where on the scale you would place yourself for each 
of the following pairs of statements: 
My workload is too great 
for me to keep up to date 
with all the new evidence  














New evidence is so 
important that I make 
the time in my work 
schedule  
I resent having my clinical 
practice questioned  














I welcome questions 
on my practice  
Evidence based practice is 
a waste of time  














Evidence based 
practice is 
fundamental to 
professional practice  
 
I stick to tried and trusted  
methods rather than 
changing to anything new  
 














My practice has 
changed because of 
evidence I have found  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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3) On a scale of 1 to 7 (with 7 being the best) how would you rate your 
 
Research skills  
  
Poor 
  
  
  
  
  
  
Best 
 
IT skills  
  
Poor 
  
  
  
  
  
  
Best 
 
Monitoring and reviewing of practice skills  
  
Poor 
  
  
  
  
  
  
Best 
 
Converting your information needs into a 
research question  
  
Poor 
  
  
  
  
  
  
Best 
 
Awareness of major information types and 
sources  
  
Poor 
  
  
  
  
  
  
Best 
 
Ability to identify gaps in your professional 
practice  
  
Poor 
  
  
  
  
  
  
Best 
 
Knowledge of how to retrieve evidence  
  
Poor 
  
  
  
  
  
  
Best 
 
Ability to analyse critically evidence against 
set standards  
  
Poor 
  
  
  
  
  
  
Best 
 
Ability to determine how valid (close to the 
truth) the material is  
  
Poor 
  
  
  
  
  
  
Best 
 
Ability to determine how useful (clinically 
applicable) the material is  
  
Poor 
  
  
  
  
  
  
Best 
 
Ability to apply information to individual cases  
  
Poor 
  
  
  
  
  
  
Best 
 
Sharing of ideas and information with 
colleagues  
  
Poor 
  
  
  
  
  
  
Best 
 
Dissemination of new ideas about care to 
colleagues  
  
Poor 
  
  
  
  
  
  
Best 
 
 
Ability to review your own practice  
  
Poor 
  
  
  
  
  
  
Best 
 
4) Finally, some information about you: 
Your profession: Year qualified:  
Your position/grade: Your speciality:  
Please circle the most appropriate answer as it concerns you:  
Your sex: Male Female  
Your age range: 20-     -     -     -     -    
 

Evidence-Based Practice. Version 1 - Nov2019 
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ANNEX 3: 
Managers' Consent Form
 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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Annex 4: 
Researcher's Term of Commitment
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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Annex 5: 
Participants' Term of Consent
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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APPENDICES 
Appendix 1: Authorization document for translating the Johns Hopkins Center 
for Evidence-Based Practice tools 
 
 
 
 
 
 
 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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Appendix 2: 
QUESTIONNAIRE TO CHECK THE SUITABILITY OF THE AUTHORIZED 
TRANSLATION OF THE PORTUGUESE LANGUAGE VERSION OF THE 
JOHNS HOPKINS PBE GUIDE TOOLS 
Sociodemographic data 
Expert name:_________________________________________________________________ 
Length of experience in Evidence-based practice:____________________________________ 
Highest academic level: _________________________________________________________ 
Occupation area: _______________________________________________________________ 
 
Check the answer that most closely matches your assessment regarding the tradition of the 
content of the following tools: 
APPENDIX A: PET Management Guide 
APPENDIX B: Development of the question 
APPENDIX C: Stakeholder analysis 
APPENDIX D: Evidence and quality level guide 
APPENDIX E: Research Evidence Assessment Tool 
APPENDIX F: Non-Research Evidence Assessment Tool 
APPENDIX G: Individual Evidence Tool 
APPENDIX H: Evidence and Recommendations Synthesis Tool 
APPENDIX I: Action Planning Tool 
APPENDIX J: Dissemination Tool 
 
 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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1)Are the translations intelligible? 
           (    )YES                  (    )NO 
 
2)Are there any suggestions for changes? 
           (    )YES                  (    )NO 
 
3)If yes, 
 
Which tool               
Which change 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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Appendix 3: 
 
PBE guiding tools for the Johns Hopkins Nursing Evidence-based 
Practice (versions translated into Portuguese) 
 
Apêndice A - PET Guia de Gerenciamento 
Apêndice B - Desenvolvimento da Pergunta 
Apêndice C - Análise de Partes Interessadas 
Apêndice D - Guia de Nível de Evidência e Qualidade 
Apêndice E - Ferramenta de Avaliação de Evidência de Pesquisa 
Apêndice F - Ferramenta de Avaliação de Evidências que não sejam de 
Pesquisa 
Apêndice G - Ferramenta de Evidência Individual 
Apêndice H - Ferramenta de Síntese de Evidências e Recomendações 
Apêndice I - Ferramenta de Planejamento de Ações 
Apêndice J - Ferramenta de Disseminação 
 
 
 
 
 
 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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Apêndice A - PET Guia de Gerenciamento 
Pergunta Prática 
Passo 1: Recrutar equipe multiprofissional 
Passo 2: Definir o problema 
Passo 3: Desenvolver e refinar a questão de PBE 
Passo 4: Identificar as partes interessadas 
Passo 5: Determinar a responsabilidade da liderança do projeto 
Passo 6: Agendar reuniões da equipe 
 
Evidência 
Passo 7: Realizar buscas internas e externas por evidências 
Passo 8: Avaliar o nível e a qualidade de cada evidência 
 Passo 9: Resumir individualmente a evidência 
Passo 10: Sintetizar a força geral e a qualidade da evidência 
Passo 11: Desenvolver recomendações para mudanças baseadas na 
síntese de evidências 
 Evidência forte e convincente, resultados consistentes. 
 Boa evidência, resultados consistentes 
 Boa evidência, resultados conflitantes  
 Evidência insuficiente ou ausente 
 
Tradução  
Pergunta
Prática 
Evidência 
Tradução 

Evidence-Based Practice. Version 1 - Nov2019 
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Passo 12: Determinar ajustes, viabilidade e adequação das 
recomendações para implementação / tradução. 
Passo 13: Cria plano de ação 
Passo 14: Garantir apoio e recursos para implementar plano de ação 
Passo 15: Implementar plano de ação 
Passo 16: Avaliar resultados 
Passo 17: Relatar resultados para as partes interessadas 
Passo 18: Identificar os próximos passos 
Passo 19: Divulgar os achados 
 

Evidence-Based Practice. Version 1 - Nov2019 
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Pergunta (PBE) Inicial: 
 
Lider da equipe de PBE: 
Membros da equipe de PBE: 
Atividades  
Data 
Início 
Dias 
Requeridos 
Data 
Final 
Respon- 
sável 
Marco 
Histórico 
Comentários / 
Recursos 
Necessários 
PERGUNTA PRÁTICA: 
Passo 1:  Recrutar equipe multiprofissional 
 
 
 
 
 
 
Passo 2:  Definir o problema 
 
 
 
 
 
 
Passo 3:  Desenvolver e refinar a questão de 
PBE 
 
 
 
 
 
 
Passo 4:  Identificar as partes interessadas 
 
 
 
 
 
 
Passo 5: Determinar a responsabilidade da 
liderança do projeto 
 
 
 
 
 
 
Passo 6: Agendar reuniões da equipe 
 
 
 
 
 
 
EVIDÊNCIA: 
Passo 7:   Realizar buscas internas e externas 
por evidências 
 
 
 
 
 
 
Passo 8:   Avaliar o nível e a qualidade de 
cada evidência 
 
 
 
 
 
 
Passo 9:   Resumir individualmente a evidência 
 
 
 
 
 
 
Passo 10: Sintetizar a força geral e a 
qualidade da evidência 
 
 
 
 
 
 
Passo 11: Desenvolver recomendações para 
mudanças na prática com base na síntese 
de evidências 
 
Evidência forte e convincente, 
resultados consistentes. 
 
Boa evidência, resultados 
consistentes 
 
Boa evidência, resultados 
conflitantes  
 
Evidência insuficiente ou ausente 
 
 
 
 
 
 
 
TRADUÇÃO: 
 Passo 12: Determinar ajustes, viabilidade e 
adequação das recomendações para 
implementação / tradução. 
 
 
 
 
 
 
 
Passo 13: Criar plano de ação 
 
 
 
 
 
 
Passo 14: Garantir apoio e Recursos para 
implementar plano de ação. 
 
 
 
 
 
 
Passo 15: Implementar plano de ação. 
 
 
 
 
 
 
Passo 16: Avaliar resultados. 
 
 
 
 
 
 
Passo 17: Relatar os resultados para as partes 
interessadas 
 
 
 
 
 
 
Passo 18: Identificar os próximos passos 
 
 
 
 
 
 
Passo 19: Divulgar os achados. 
 
 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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Apêndice B - Desenvolvimento da Pergunta 
 
1. Qual é o problema? 
 
 
 2. Porque o problema é importante ou relevante? O que aconteceria se não fosse abordado? 
 3. Qual é a prática atual? 
 4. Como o problema foi identificado?  (Marque todos os itens que se aplicam) 
❑ Questões de segurança e gestão de riscos 
❑ Preocupações com a qualidade (eficiência, eficácia, 
oportunidade, equidade, centralização no paciente) 
❑ Insatisfação do paciente, colaboradores  ou 
resultados organizacionais 
❑ Variações da prática com o preconizado 
❑ Variações da prática comparado aos padrões da 
comunidade 
❑ Prática atual não validada 
❑ Preocupações financeiras 
  5. Quais são os componentes do PICO? 
P – (Paciente, população, ou problema) 
I – (Intervenção) 
C – (Comparação com outras intervenções, se necessário) 
   O – (Resultados: Os resultados são medidas qualitativas ou quantitativas para determinar o sucesso 
da mudança) 
 6. Pergunta Inicial de PBE 
❑ Questão Básica   ❑ Questão Clínica  

Evidence-Based Practice. Version 1 - Nov2019 
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7. Listar possíveis descritores, base de dados para pesquisa e estratégias de pesquisa. 
 
8. Quais evidências devem ser coletadas?  (Marque todos os itens que se aplicam) 
 
❑ Publicações (e.g., PubMed, MEDLINE, LILACS, Cochrane, etc) 
❑ Padrões (regulatórios, profissionais, comunitários) 
❑ Diretrizes  
❑ Dados organizacionais (e.g., dados financeiros, experiência clínica local, preferências do paciente e 
família) 
❑ Declaração de posicionamento 
   Pergunta clínica de PBE revisada 
(Revisões na pergunta clínica podem não ser evidentes até após a revisão inicial das evidências; a 
revisão pode estar na formulação da questão básica (background question) ou até nas mudanças da 
questão básica (background) para questão clínica (foreground question). 
 
10. Plano de medeição dos resultados 
O que vamos 
medir? 
(Estrutura, 
processo, 
resultado) 
Como vamos 
medir isso? 
(métricas 
expressas como 
taxas ou 
porcentagens) 
Qual será a 
periodicidade da 
medição?  
(frequência) 
 Onde vamos 
obter os 
dados? 
  Quem coletará 
os dados? 
Para quem 
vamos relatar os 
dados? 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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Instruções para o uso da Ferramenta de Desenvolvimento da Pergunta 
Clínica 
 
Objetivo 
Este formulário é utilizado para Desenvolvimento de pergunta de PBE, guia a equipe 
no processo de busca de evidências.  A pergunta, os descritores, a estratégia de 
pesquisa e as fontes de evidencias podem ser revisadas à medida que a equipe de 
PBE refina a pergunta de PBE.  
 
Qual é o problema e porque ele é importante? 
Indique porque o projeto foi realizado. O que levou a equipe a buscar evidências? 
Certifique-se que a formulação do problema defina o problema atual e não inclua 
uma solução. Sempre que possível quantifique a extensão do problema e valide a 
descrição final do problema com a equipe envolvida na prática. É importante que a 
equipe multiprofissional dedique tempo em grupo para refletir, reunir informações, 
observar a prática atual, ouvir o corpo clínico, visualizar como o processo poder ser 
diferente ou melhorado, sondar e analisar a descrição do problema de modo que 
desenvolva uma compreensão compartilhada da equipe com a descrição do 
problema. 
 
Qual é a prática atual? 
Defina a prática atual no que se refere ao problema. Reflita sobre as políticas e 
procedimentos atuais, observe as práticas. O que você vislumbra? 
 
Como o problema foi identificado? 
Verifique todas as descrições que se aplicam. 
 
Quais são os componentes do PICO? 
 
P (Paciente, população, problema) Por exemplo: idade, sexo, cenário, etnia, 
condição, 
doença,  
tipo de paciente ou população. 
I (Intervenção) Por exemplo: tratamento, medicação, educação, exames 
diagnósticos ou melhores práticas.  
C (Comparação com outras intervenções ou prática atual para questões clínicas 
(Foreground questions), não é aplicável para questões básicas (Background 
questions) que identificam as melhores práticas). 
O (Resultados) Descritos em termos mensuráveis, pode ser uma estrutura, um 
processo ou uma medida de resultado com base na mudança desejada (por 
exemplo: diminuição de quedas, diminuição no tempo de hospitalização, 
aumento na satisfação do paciente. 
 
 

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Pergunta Inicial de PBE 
Uma pergunta inicial (geralmente uma pergunta básica [background question] que é 
frequentemente refinada e ajustada à medida que a equipe realiza a pesquisa na 
literatura): 
 
Perguntas Básicas (Background questions) são amplas e adotadas quando a 
equipe tem pouco conhecimento ou experiência na área de interesse. As 
perguntas básicas são utilizadas geralmente para identificar as melhores 
práticas.  
 
Perguntas Clínicas (Foreground questions) são focadas, com comparações 
específicas de duas ou mais ideias ou intervenções. Perguntas clínicas 
fornecem um conjunto (corpo) específico relacionado à pergunta de PBE. As 
perguntas clínicas geralmente fluem da pergunta básica somada à revisão da 
literatura.  
 
Lista de possíveis descritores, base de dados para pesquisa e estratégias 
de pesquisa 
Usando os componentes do PICO e a pergunta inicial de PBE, liste os descritores. 
Os descritores podem ser adicionados ou ajustados por meio da pesquisa de 
evidências. Documente os descritores, a estratégia de pesquisa e os bancos de base 
de dados consultados com detalhes suficientes para replicação. 
 
Quais evidências devem ser coletadas?    
Verifique os tipos de evidências que a equipe coletará com base no PICO e na 
pergunta inicial de PBE.  
 
Pergunta de PBE revisada 
Muitas vezes a pergunta que você começa pode não ser a pergunta final de PBE. 
Perguntas básicas podem ser refinadas e modificadas para perguntas clínicas 
baseado na revisão de evidências. As perguntas clínicas são perguntas focalizadas 
que incluem comparações específicas e produzem uma faixa de evidência mais 
restrita.  
 
Plano de mensuração 
As mensurações podem ser adicionadas ou modificadas à medida que a revisão da 
literatura é completada, iniciando o planejamento da tradução:  
 Uma medida é uma quantidade ou um grau de algo, como por exemplo, 
número de quedas com dano. Cada medida deve ser convertida em uma 
métrica, que deve ser calculada antes e depois da implementação da 
alteração.   
 As métricas permitem que você saiba se a mudança foi bem sucedida. 
Possuem um numerador e um denominador e são normalmente expressos 
como taxas ou porcentagens. Um exemplo de métrica quanto ao número de 
quedas 
com 
dano 
(numerador) 
dividido 
por 
1.000 
pacientes-dia 
(denominador). Outros exemplos de métricas incluem o número de RNs que 
recebem assistência direta (numerador) dividido pelo número de 
funcionários que prestam assistência direta, ou o número de erros de 
medicações dividido por 1.000 prescrições.    
 

Evidence-Based Practice. Version 1 - Nov2019 
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Apêndice C - Análise de Partes Interessadas 
 
 
1. Identifique os principais interessados 
 
❑ Gerente ou coordenador direto 
❑ Departamento Financeiro 
❑ Fornecedores 
❑ Pacientes e / ou famílias, comitê consultivo de 
pacientes e familiares.  
❑ Organizações profissionais 
❑ Comitês  
❑ Líderes organizacionais 
❑ Membros da equipe multidisciplinar (por exemplo: 
médicos, nutricionistas, fisioterapeutas, terapeuta 
ocupacional) 
❑ Administradores  
❑ Outras unidades ou departamentos 
❑ Outros: ____________________________ 
   Funções e responsabilidades dos principais interessados 
(As funções das partes interessadas incluem: responsabilidade, consulta, aprovação e informes. As 
responsabilidades correspondentes estão descritas aqui como guia para completar a tabela) 
Responsabilidade 
 Identificar tarefas completas 
 Recomendar uma autoridade 
Consulta 
 Fornece contribuições (por ex. especialistas no 
assunto) 
 Sem autoridade decisória 
Aprovação 
 
Sinaliza recomendações 
 
Poder de veto 
Informação 
 Notificação de progresso e mudanças 
 Sem contribuições decisórias  
Tarefas do 
Projeto 
Nome do interessado 
Nome do interessado 
Nome do interessado 
Função do interessado 
Função do interessado 
Função do interessado 

Evidence-Based Practice. Version 1 - Nov2019 
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Instruções para uso da Ferramenta de Análise das partes interessadas 
Este formulário é utilizado para identificar os principais interessados. Esse são 
pessoas, grupos ou departamentos da organização que têm interesse ou 
preocupação com seu projeto e / ou podem ajuda-lo a garantir recursos para 
implementar seu plano de ação. Envolva as partes interessadas no início do seu 
processo para garantir adesão.   
Definição 
Os Stakeholders são ―pessoas ou grupos que possuem interesse em uma decisão 
clínica [ou não clínica  e nas evidências que apoiam essa decisão‖  AHRQ         
Identifique os principais interessados 
Identifique os 5-7 principais interessados que mais podem afetar, ou quem serão 
mais afetados pelo projeto, ações, objetivos ou mudanças e quem pode influenciar 
no sucesso do trabalho de tradução  Os principais ―stakeholders‖ são indivíduos ou 
grupos que:  
 Tomam decisões sobre o projeto 
 Aprovam o projeto ou aspectos do projeto 
 Servem como especialista no assunto 
 Fornecem recursos como: suporte, mudanças em políticas, 
recursos e tempo. 
Análise das partes interessadas 
É útil considerar quais dos quarto papéis que cada parte interessada pode 
desempenhar no seu planejamento de ação e trabalho de tradução. As possíveis 
funções são: 
 Responsabilidade 
 Aprovação 
 Consulta 
 Informação 
Lembre-se de que uma parte interessada pode preencher papéis diferentes, 
dependendo da ação. A conclusão da ferramenta de análise das partes 
interessadas ajudará a esclarecer papéis e responsabilidades. As descrições de 
responsabilidades para cada função fornecida no formulário serão úteis nesse 
processo. 
 
Referências: Agency for Healthcare Research and Quality. (2014) .Stakeholder Guide 
2014. Retrieved from www.effectivehealthcare.ahrq.gov.AHRQ Publication No. 14-
EHC010-EF. Replaces Publication No. 11-EHC069-EF 
 
 
 
 

Evidence-Based Practice. Version 1 - Nov2019 
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Apêndice D - Guia de Nível de Evidência e Qualidade 
 
 

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Apêndice E - Ferramenta de Avaliação de Evidência de Pesquisa 
 
Nível de evidência e classificação de qualidade:  
 
 
Título do artigo: 
Número: 
Autor (es): 
Data de publicação: 
Revista / Períodico: 
Configuração: 
Amostra (composição e tamanho): 
Essa evidência aborda minha pergunta de PBE? 
Sim  
Não – Não prossiga com a avaliação dessa evidência 
Este estudo é:  
Quantitativo 
(Coleta, 
análise 
e 
relato 
de 
dados 
numéricos). 
Dados mensuráveis (quantos; qual quantidade; ou quantas vezes) utilizados para formular fatos, descobrir 
padrões de pesquisa, e generalizar os resultados de uma amostra maior de população; fornece observação de 
efeitos de um programa, problema ou condição, medida com precisão, ao invés de interpretação dos dados pelo 
pesquisador. Métodos comuns são pesquisas, entrevistas face a face estruturadas, observações e revisões de 
registros ou documentos. Testes estatísticos são utilizados na análise dos dados.   
Ir para Seção I: QuaNtitativo 
QuaLitativo 
(Coleta, 
análise 
e 
relato 
de 
dados 
narrativos).  
Documentos narrativos ricos são utilizados para descobrir temas; descrever problema ou condição do ponto de 
vista dos que  experimentam. Os métodos comuns são grupos focais, entrevistas individuais (não estruturadas 
ou semi-estruturadas) e participação / observações. Tamanhos de amostras são pequenos e são determinados 
quando a saturação de dados é alcançada. A saturação de dados é atingida quando o pesquisador identifica que 
não surgem novos temas e a redundância está ocorrendo. A síntese é utilizada na análise dos dados. 
Frequentemente é um ponto de partida para estudos com pouca pesquisa existente; pode utilizar os resultados 
para projetar estudos empíricos. O pesquisador descreve, analisa e interpreta relatórios, descrições e 
observações dos participantes.   
Ir para Seção II: QuaLitativo 
Métodos 
mistos 
(resultados 
relatados 
numericamente 
e 
narrativamente).  
Ambos os métodos quantitativo e qualitativo são utilizados em projeto de estudo. Usando ambas as abordagens, 
em combinação, fornecem uma melhor compreensão dos problemas de pesquisa do que usar qualquer 
abordagem sozinha. Os tamanhos de amostras variam com base nos métodos utilizados. A coleta de dados 
envolve coletar e analisar dados quantitativos e qualitativos em único estudo ou série de estudos. A interpretação 
é continua e pode influenciar estágios no processo de pesquisa.  
Ir para Seção I para componentes QuaNtitativos e Seção II para componentes QuaLitativos 

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Seção I: QuaNtitativo 
Nível de Evidência (Desenho do Estudo) 
Isto é um relatório de um único estudo de pesquisa?  
 Sim 
 Não 
Ir para B 
1. Houve manipulação de uma variável independente?  
 Sim 
 Não 
2. Havia um grupo controle? 
 Sim 
 Não 
3. Os participantes foram randomizados aos grupos de 
intervenção e controle? 
 Sim 
 Não 
Se Sim para as questões 1, 2, e 3, este é um estudo experimental controlado 
randomizado (RCT) ou estudo experimental. 
NÍVEL I 
Se Sim para questões 1 e 2 e Não para questão 3 ou Sim para questão 1 e Não 
para questões 2 e 3, este é quase-experimental. 
(Algum grau de controle do investigador, alguma manipulação de uma variável 
independente, falta de randomização aos grupos, e pode ter um grupo controle). 
NÍVEL II 
Se Não para questões 1, 2, e 3, este é não-experimental. 
(Nenhuma manipulação de variável independente; pode ser descritivo, comparativo 
ou correlacional; frequentemente usa dados secundários). 
NÍVEL III 
Achados do Estudo que ajudam a responder a pergunta de PBE: 
Complete a Avaliação da seção de Estudos QuaNtitativos de Pesquisa 
A 

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Isto é um resumo de várias fontes de evidências de 
pesquisa?  
 Sim 
Continue 
 Não 
Use Apêndice F 
1. Será que emprega uma estratégia de pesquisa abrangente e 
método de avaliação rigorosa?  
Se este estudo inclui pesquisa, não pesquisa, e evidências 
experienciais, é uma revisão integrativa (ver Apêndice F). 
  
 Sim 
Continue 
 Não 
Use Apêndice F 
2. Para revisões sistemáticas e revisões sistemáticas com meta-análise (veja as descrições abaixo): 
a. Todos os estudos incluídos são RCTs? 
NÍVEL I 
b. Os estudos são uma combinação de RCTs e quase-experimental, ou 
somente quase-experimental? 
NÍVEL II 
c. Os estudos são uma combinação de RCTs, quase-experimental, e não-
experimental, ou não experimental somente? 
NÍVEL III 
Uma revisão sistemática emprega estratégia de busca e método de avaliação rigoroso, mas não 
gera um tamanho de efeito. 
Uma meta-análise, ou revisão sistemática com meta-análise, combina e analisa os resultados de 
estudos para gerar uma nova estatística: o tamanho de efeito.   
Achados do Estudo que ajudam a responder a pergunta de PBE: 
Complete Avaliação da seção de Revisão Sistemática (com ou sem uma meta-análise)  
B 

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Avaliação dos estudos de pesquisa QuaNtitativa  
O pesquisador identifica o que é conhecido e o que não é 
conhecido sobre o problema e como o estudo irá abordar 
quaisquer lacunas no conhecimento?  
 Sim  
 Não 
 
O objetivo do estudo foi claramente apresentado? 
 Sim 
 Não 
 
A revisão da literatura foi atual? (a maioria das fontes dentro dos 
últimos 5 anos ou um estudo seminal)? 
 Sim 
 Não 
 
O tamanho da amostra foi suficiente com base no projeto de 
estudo e racional? 
 Sim 
 Não 
 
Se houver um grupo controle: 
 As características e/ou demografia são similares nos 
grupos de controle e de intervenção? 
 Sim 
 Não 
 
N/A 
 Se múltiplas configurações foram utilizadas, foram 
configurações semelhantes? 
 Sim 
 Não 
N/A 
 Todos os grupos foram tratados igualmente com 
exceção do (s) grupo (s) de intervenção?  
 Sim 
 Não 
N/A 
Os métodos de coleta de dados são descritos claramente? 
 Sim 
 Não 
 
Os instrumentos foram confiáveis? (Alpha de Cronbach >      ? 
 Sim 
 Não 
N/A 
A validade do instrumento foi discutida? 
 Sim 
 Não 
N/A 
Se foram utilizados surveys / questionários, a taxa de resposta foi 
> que 25%? 
 Sim 
 Não 
N/A 
Os resultados foram apresentados claramente? 
 Sim 
 Não 
 
Se tabelas foram apresentadas, a narrativa foi consistente com o 
conteúdo da tabela?  
 Sim 
 Não 
N/A 
As limitações do estudo foram identificadas e abordadas? 
 Sim 
 Não 
 
As conclusões foram baseadas nos resultados? 
 Sim 
 Não 
 
Ir para seção de Classificação de qualidade de estudos QuaNtitativos 

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Avaliação de Revisão Sistemática (com ou sem uma meta-análise) 
As variáveis de interesse foram claramente identificadas? 
 Sim 
 Não 
A pesquisa foi abrangente e reproduzível? 
 Principais termos de pesquisa indicados 
 Sim 
 Não 
 Múltiplos bancos de dados pesquisados e identificados 
 Sim 
 Não 
 Critérios de inclusão e exclusão indicados 
 Sim 
 Não 
Houve um diagrama de fluxo que incluía o número de estudos eliminados 
em cada nível de revisão?  
 Sim 
 Não 
Os estudos incluídos apresentados foram detalhados (desenho, amostra, 
métodos, resultados, desfechos, pontos fortes, e limitações)? 
 Sim 
 Não 
Os métodos para avaliar a força e evidência (nível e qualidade) foram 
descritos?  
 Sim 
 Não 
As conclusões foram baseadas nos resultados? 
 Sim 
 Não 
 Os resultados foram interpretados 
 Sim 
 Não 
 As conclusões fluíram logicamente da interpretação e questão da 
revisão sistemática.  
 Sim 
 Não 
A revisão sistemática incluiu uma seção de endereçamento de limitações 
e como eles foram abordados?   
 Sim 
 Não 
Complete seção Classificação de Qualidade para Estudos QuaNtitativos 
Classificação de Qualidade para Estudos QuaNtitativos 
Circule abaixo a classificação de qualidade apropriada: 
A Alta qualidade: Resultados consistentes e generalizados; tamanho de amostra suficiente para o desenho do 
estudo; controle adequado; conclusões definitivas; recomendações consistentes baseadas na revisão abrangente 
da literatura que inclui uma referência completa à evidência científica.  
B Boa qualidade: Resultados razoavelmente consistentes; tamanho de amostra suficiente para o desenho do estudo; 
algum controle, e conclusões bastante definitivas; recomendações razoavelmente consistentes baseadas em 
revisão de literatura bastante abrangente que inclui alguma referência à evidências científicas.  
C Baixa qualidade ou grandes falhas: Pouca evidência com resultados inconsistentes; tamanho de amostra 
insuficiente para o projeto de estudo; as conclusões não podem ser delineadas.   

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Seção II: QuaLitativo 
Nível de Evidência (Desenho do Estudo) 
 
             Isto é um relatório de um único estudo de pesquisa?        
 
 Sim  
Ir para Nível III  
 
 
 Não 
Ir para II B 
Achados do Estudo que ajudam a responder à pergunta de PBE: 
 
 
Seção de Avaliação Completa de Estudo Único de Pesquisa QuaLitativa 
Avaliação de um Estudo Único de Pesquisa QuaLitativa 
Havia claramente identificável e articulado:  
 
Objetivo? 
❑ Sim 
❑ Não 
 
Pergunta de pesquisa? 
❑ Sim 
❑ Não 
 
Justificativa para método (s) utilizado (s)? 
❑ Sim 
❑ Não 
 
Fenômeno que é o foco da pesquisa? 
❑ Sim 
❑ Não 
A amostra de participantes foi representativa? 
❑ Sim 
❑ Não 
Possuem conhecimento ou experiência com a área da pesquisa? 
❑ Sim 
❑ Não 
As características dos participantes foram descritas? 
❑ Sim 
❑ Não 
A amostragem foi adequada, como evidenciado pela obtenção de saturação de 
dados?  
❑ Sim 
❑ Não 
Análise dos Dados: 
 
Foi utilizado um processo de verificação a cada passo, verificando e 
confirmando com os participantes a confiabilidade da análise e 
interpretação?  
❑ Sim 
❑ Não 
 
Havia uma descrição de como os dados foram analisados (isto é, 
método), pelo computador ou manualmente? 
❑ Sim 
❑ Não 
Os achados suportam os dados narrativos (citações)? 
❑ Sim 
❑ Não 
Os achados fluem da pergunta da pesquisa aos dados coletados para a análise 
efetuada?  
❑ Sim 
❑ Não 
As conclusões são claramente explicadas? 
❑ Sim 
❑ Não 
Ir para seção Classificação de Qualidade para Estudos QuaLitativos 
A 

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Para resumos de múltiplos estudos de pesquisas 
qualitativas (meta-síntese) utilizou-se estratégia de 
pesquisa abrangente e um método de avaliação rigorosa?  
 
Sim 
Nível III 
 
Não 
Ir para Apêndice F 
Achados do Estudo que ajudam a responder à pergunta de PBE: 
 
Complete a seção de Avaliação dos Estudos de Meta-Síntese 
Avaliação dos Estudos de Meta-Síntese 
A estratégia de busca e os critérios para a seleção de estudos primários foram 
claramente definidos?  
❑ Sim 
❑ Não 
Os achados foram apropriados e convincentes? 
❑ Sim 
❑ Não 
A descrição dos métodos foram usadas para: 
 
 
Comparar os resultados de cada estudo? 
❑ Sim 
❑ Não 
 
Interpretar dados? 
❑ Sim 
❑ Não 
A síntese refletiu: 
❑ Sim 
❑ Não 
 
Novas idéias? 
❑ Sim 
❑ Não 
 
Descoberta de características essenciais dos fenômenos? 
❑ Sim 
❑ Não 
 
Uma compreensão mais completa dos fenômenos? 
❑ Sim 
❑ Não 
Os dados apresentados foram suficientes para apoiar as interpretações? 
❑ Sim 
❑ Não 
Complete seção Classificação de Qualidade para Estudos QuaLitativos 
B 

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Classificação de Qualidade para Estudos QuaLitativos   
  Circule abaixo a classificação de qualidade apropriada: 
Não existem princípios comumente acordados para julgar a qualidade dos estudos qualitativos. É um 
processo subjetivo baseado na extensão em que os dados do estudo contribuem para a síntese e 
quanta informação é conhecida sobre os esforços dos pesquisadores para atender aos critérios de 
avaliação.  
Para meta-sínteses, há concordância preliminar de que avaliações de qualidade individual dos estudos devem ser 
feitas antes da síntese para excluir estudos de baixa qualidade . 
A/B Alta/Boa qualidade é utilizada para estudos únicos e meta-sínteses . 
O relatório discute os esforços para melhorar ou avaliar a qualidade e a investigação geral com 
detalhes suficientes, descreve as técnicas específicas usadas para melhorar a qualidade da 
pesquisa.  
Evidência de alguns ou todos os itens a seguir são encontrados no relatório: 
 
Transparência: Descrevem como as informações foram documentadas para justificar 
decisões, como os dados foram revisados por outras pessoas e como os temas e categorias 
foram formuladas. 
 
Diligência: Lê e reler os dados para checar interpretações, busca oportunidades para 
buscar múltiplas fontes para corroborar evidencias.  
 
Verificação: O processo de verificação, confirmação, e garantia de coerência 
metodológica. 
 
Auto-reflexão e escrutínio: Estar continuamente consciente de como as experiências, 
antecedentes ou preconceitos de um pesquisador pode moldar e influenciar análises e 
interpretações.  
 
Pesquisa orientada por participantes: Os participantes moldam o escopo e a 
abrangência das perguntas, análise e interpretação dão voz aqueles que participaram.  
 
Interpretação perspicaz: Dados e conhecimentos estão ligados de maneira significativa à 
literatura relevante.   
C Baixa qualidade: Estudos de baixa qualidade contribuem pouco para a revisão geral dos resultados e 
tem pouco, se algum, dos recursos listados c alta / boa qualidade. 
Seção III: Método Misto 
Nível de Evidência (Desenho do Estudo) 
Você precisará avaliar de forma independente as partes quaNtitativas e quaLitativas do estudo, antes de 
avaliar o estudo em sua totalidade.  
a. Avalie a parte quaNtitativa do estudo usando a Seção I.  
Nível 
Qualidade 
Insira aqui o nível de evidência e qualidade geral para esta parte. 
 
 

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b. Avalie a parte quaLitativa do estudo usando a Seção II.  
Nível 
Qualidade 
Insira aqui o nível de evidência e qualidade geral para esta parte. 
c. Para determinar o nível de evidência, circule o desenho de estudo apropriado:  
 Explanatório sequenciais recolhem dados quaNtitativos primeiro, seguidos dos dados qualitativos; e seu 
objetivo é explicar os resultados quaNtitativos usando os resultados quaLitativos. O nível é determinado 
baseado no nível da parte quaNtitativa.  
 Exploratório sequenciais coletam dados quaLitativos primeiro, seguido dos dados quantitativos; e o seu 
objetivo é explicar os resultados quaLitativos usando os resultados quaNtitativos.  O nível é determinado 
com base no nível da parte quaLitativa, e é sempre nível III. 
 Convergentes desenhos paralelos coletam os dados quaLititativos e quaNtitativos simultaneamente com 
a finalidade de fornecer uma compreensão mais completa de um fenômeno, mesclando ambos os bancos 
de dados. Estes projetos são nível III.  
 Multifásico coletam dados quaLitativos e quaNtitativos em mais de uma fase, com cada fase informando 
a próxima fase. Estes projetos são nível III. 
Achados do Estudo que ajudam a responder à pergunta de PBE: 
 
Use a seção de Avaliação de Estudos de Métodos Mistos 
Avaliação dos estudos de métodos mistos  
O desenho da pesquisa de métodos mistos foi relevante para abordar as 
questões de pesquisa quaNtitativa e quaLitativa (ou objetivos)? 
❑ Sim 
❑ Não 
❑ N/A 
O desenho da pesquisa foi relevante para abordar os aspectos quaNtitativos 
e quaLitativos da pergunta de métodos mistos (ou objetivos)?  
❑ Sim 
❑ Não 
❑ N/A 
Para projetos paralelos convergentes, a integração dos dados quaNtitativos e 
quaLitativos (ou resultados) foram relevantes para abordar a pergunta da 
pesquisa ou objetivos?  
❑ Sim 
❑ Não 
❑ N/A 

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3 National Collaborating Centre for Methods and Tools. (2015). Appraising Qualitative, Quantitative, and Mixed Methods Studies included in 
Mixed Studies Reviews: The MMAT. Hamilton, ON: McMaster University. (Updated 20 July, 2015) Retrieved from http://www.nccmt.ca/ 
resources/search/232 
 
 
 
 
 
 
 
Para projetos paralelos convergentes, as limitações associadas à integração 
(por exemplo, a divergência de dados quaLitativos e quaNtitativos ou 
resultados) foram suficientemente tratados?  
❑ Sim 
❑ Não 
❑ N/A 
Ir para seção Classificação de Qualidade para Estudos de Métodos-Mistos 
Avaliação de Estudos Meta-Sínteses 
As estratégias de busca e os critérios para seleção dos estudos primários foram 
claramente definidos? 
❑ Sim 
❑ Não 
Os achados foram apropriados e convincentes? 
❑ Sim 
❑ Não 
A descrição dos métodos utilizados foi: 
 
 
Comparar os resultados de cada estudo? 
❑ Sim 
❑ Não 
 
Interpretar dados? 
❑ Sim 
❑ Não 
A síntese refletiu: 
❑ Sim 
❑ Não 
 
Novas idéias? 
❑ Sim 
❑ Não 
 
Descoberta de características essenciais dos fenômenos? 
❑ Sim 
❑ Não 
 
Uma compreensão mais completa dos fenômenos? 
❑ Sim 
❑ Não 
Os dados apresentados foram suficientes para apoiar as interpretações? 
❑ Sim 
❑ Não 
Complete a seção de classificação de Qualidade de Estudos QuaLitativos 

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Apêndice F - Ferramenta de Avaliação de Evidências que não sejam de 
Pesquisa 
 
Classificação de Qualidade para Estudos de Métodos-Mistos 
Circule a classificação de qualidade apropriada abaixo 
A Alta Qualidade: Contém componentes de estudos quaNtitativos e quaLitativos de alta qualidade; 
projeto de estudo altamente relevante; integração relevante de dados ou resultados; consideração 
cuidadosa das limitações da abordagem escolhida.  
B Boa Qualidade: Contém componentes de estudos quaNtitativos e quaLitativos de boa qualidade; 
projeto de estudo relevante; integração moderadamente relevante dos dados ou resultados; algumas 
discussões sobre as limitações da integração.  
C Baixa qualidade ou grandes falhas: Contém componentes de estudos quaNtitativos e qualitativos 
de baixa qualidade; projeto de estudo não é relevante para as questões da pesquisa ou objetivos; 
dados ou resultados mal integrados; nenhuma consideração dos limites de integração. 
      Nível de Evidência e Classificação de Qualidade: 
 
  
Título do Artigo: 
Número: 
Autor(es): 
Data de Publicação: 
Revista / Periódico: 
Configuração: 
Amostra (composição e tamanho): 
A evidência aborda minha pergunta de PBE? 
Sim 
Não- Não prossiga com a avaliação desta evidência 
❑ Diretrizes de Prática Clínica - NÍVEL IV 
Recomendações sistematicamente desenvolvidas por especialistas reconhecidos nacionalmente 
com base em evidências de pesquisa ou painel de consenso de especialistas 
❑ Consenso ou Declaração de Posição - NÍVEL IV 
Recomendações sistematicamente desenvolvidas, baseadas em pesquisas e opiniões de 
especialistas reconhecidos nacionalmente, que orientam os membros de uma organização 
profissional na tomada de decisões para uma questão preocupante 
 Os tipos de evidências inclusos estão identificados? 
 Sim 
 Não 

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 As partes interessadas (stakeholders) se envolveram no 
desenvolvimento de recomendações? 
 Sim 
 Não 
 As recomendações dos grupos aplicam-se e não se aplicam de forma 
clara? 
 Sim 
 Não 
 Os possíveis vieses foram eliminados? 
 Sim 
 Não 
 Cada recomendação tem nível de evidência identificado? 
 Sim 
 Não 
 As recomendações são claras? 
 Sim 
 Não 
Achados que ajudam a responder à pergunta de PBE: 
Preencha a seção de classificação de qualidade correspondente 
❑ Revisão de Literatura NÍVEL V 
Resumo da literatura publicada selecionada, incluindo científica e não científica, como relatórios de 
experiência organizacional e opiniões de especialistas 
❑ Revisão Integrativa NÍVEL V 
Resumo das evidências de pesquisa e literatura teórica; analisa, compara temas, aponta lacunas na 
literatura selecionada  
 O assunto deve ser revisado claramente? 
 Sim 
 Não 
 A literatura é relevante e atualizada (a maioria das fontes está nos últimos 
cinco anos ou clássica)? 
 Sim 
 Não 
 Da literatura revisada, há uma análise significativa das conclusões nos 
artigos incluídos na revisão? 
 Sim 
 Não 
 Há lacunas identificadas na literatura? 
 Sim 
 Não 
 As recomendações são feitas para a prática futura ou para o estudo? 
 Sim 
 Não 
Achados que ajudam a responder à pergunta de PBE: 
Preencha a seção de classificação de qualidade correspondente. 

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❑ Opiniões de especialistas - NÍVEL V 
Opinião de um ou mais indivíduos com base em experiência clínica 
 O indivíduo publicou ou apresentou sobre o tópico? 
 Sim 
 Não 
 A opinião do autor é baseada em evidências científicas? 
 Sim 
 Não 
 A opinião do autor é claramente expressa? 
 Sim 
 Não 
 Os possíveis vieses são reconhecidos? 
 Sim 
 Não 
Achados que ajudam a responder à pergunta de PBE: 
Preencha a seção de classificação de qualidade correspondente. 
Experiência Organizacional 
 Melhoria da qualidade - NÍVEL V 
Método cíclico para examinar fluxos de trabalho, processos ou sistemas com uma organização 
específica 
 Avaliação financeira - NÍVEL V 
Avaliação econômica que aplica técnicas analíticas para identificar, medir e comparar os custos e os 
resultados de dois ou mais programas ou intervenções alternativas 
 Avaliação do programa - NÍVEL V 
Avaliação sistemática dos processos e/ou resultados de um programa; pode envolver métodos 
quantitativos e qualitativos 
Configuração: 
Tamanho da amostra/ Composição: 
 
O objetivo do projeto foi claramente identificado? 
 Sim 
 Não 
 
 
O método foi totalmente descrito? 
 Sim 
 Não 
 
 
As medidas de processo ou resultado foram identificadas? 
 Sim 
 Não 
 
 
Os resultados foram totalmente descritos? 
 Sim 
 Não 
 
 
A interpretação foi clara e apropriada? 
 Sim 
 Não 
 
 
Os componentes da análise de custo/benefício ou custo-
eficácia estão descritos?  
 Sim 
 Não 
❑ N/A 

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Padrão da comunidade, experiência do clínico ou preferência do consumidor - NÍVEL V 
❑ Padrão da comunidade: Prática atual para ambientes comparáveis na comunidade 
❑ Experiência do clínico: Conhecimento adquirido através da experiência prática 
❑ Preferência do consumidor: Conhecimento adquirido através da experiência de vida 
Fontes de Informação (ões):  
Número de Fontes: 
 Fonte de informação tem experiência 
credível 
 Sim 
 Não 
❑ N/A 
 As opiniões estão claramente 
indicadas 
 Sim 
 Não 
❑ N/A 
 A evidência obtida é consistente 
 Sim 
 Não 
❑ N/A 
Achados que ajudam a responder à pergunta de PBE: 
Preencha a seção de classificação de qualidade correspondente. 
 Relato de caso - NÍVEL V 
Olhar aprofundado para pessoa, grupo ou outra unidade social 
 O objetivo do relato de caso é claramente indicado? 
 Sim 
 Não 
 O relato de caso está claramente apresentado? 
 Sim 
 Não 
 As descobertas do relato de caso são apoiadas por teoria ou pesquisa 
relevante? 
 Sim 
 Não 
 As recomendações estão claramente indicadas e estão associadas aos 
resultados? 
 Sim 
 Não 
Achados que ajudam a responder à pergunta de PBE: 
Preencha a seção de classificação de qualidade correspondente. 
 

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Achados que ajudam a responder à pergunta de PBE: 
Preencha a seção de classificação de qualidade correspondente. 
 
Classificação de Qualidade para Diretrizes de Prática Clínica (Guidelines), Consenso ou 
Declarações de Posição (Nível IV) 
A Alta Qualidade 
Material oficialmente patrocinado por uma organização profissional, pública ou privada ou por uma 
agência governamental; documentação de uma estratégia sistemática de uma pesquisa 
bibliográfica; resultados consistentes com um número suficiente de estudos bem desenhados; 
avaliação baseada em critérios de força científica geral e qualidade dos estudos incluídos e 
conclusões definitivas; perícia nacional claramente evidente; desenvolvidos ou revisados nos 
últimos cincos anos. 
B Boa Qualidade 
Material oficialmente patrocinado por organização profissional, pública ou privada ou por uma 
agência governamental; estratégia de busca sistemática de literatura razoavelmente completa e 
apropriada; resultados razoavelmente consistentes, número suficiente de estudos bem 
desenhados; avaliação das forças e limitações dos estudos incluídos com conclusões bastante 
definitivas; perícia nacional claramente evidente; desenvolvidos ou revisados nos últimos cinco 
anos. 
C Baixa Qualidade ou Grandes Falhas 
Material não patrocinado por organização ou agência oficial; estratégia de busca da literatura 
indefinida, mal definida ou limitada; nenhuma avaliação das forças e limitações dos estudos 
incluídos; evidência insuficiente com resultados inconsistentes; conclusões não podem ser 
delinadas; não revisado nos últimos cinco anos. 
Classificação de Qualidade para Experiência Organizacional (Nível V) 
A  Alta Qualidade 
Objetivos e metas claras; resultados consistentes em várias configurações; melhoria formal da 
qualidade ou métodos utilizados de avaliação financeira; conclusões definitivas; recomendações 
consistentes com referência completa à evidências científicas. 
B  Boa Qualidade 
Objetivos e metas claras; melhoria formal da qualidade ou métodos utilizados de avaliação 
financeira; resultados consistentes em uma única configuração; recomendações razoavelmente 
consistentes com alguma referência e evidências científicas. 
C  Baixa Qualidade ou Grandes Falhas 
Objetivos e metas pouca claras ou ausentes; resultados inconsistentes; qualidade mal definida; 
melhoria/ métodos de análise financeira; recomendações não podem ser feitas. 
 
 
 

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Apêndice G - Ferramenta de Evidência Individual 
 
 
 
 
 
 
Classificação de Qualidade para Relato de Caso; Revisão Integrativa, Revisão da Literatura, 
Opinião de Especialista, Padrão da Comunidade, Experiência Clínica, Preferência do 
Consumidor (Nível V) 
A  Alta Qualidade 
O domínio é claramente evidente, tira conclusões definitivas e fornece uma justificativa científica; 
torna-se líder na área. 
B  Boa Qualidade 
O domínio parece ter credibilidade, delineia conclusões bastante definitivas e fornece opiniões e 
argumentos lógicos. 
C  Baixa Qualidade ou Grandes Falhas 
O domínio não é discernível ou é duvidoso; conclusões não podem ser delineadas. 

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Instruções para utilizar a Ferramenta resumida de Evidência Individual 
 
Propósito 
Este formulário é utilizado para documentar os resultados da avaliação de evidências 
em preparação para a síntese de evidências. 
O formulário fornece à equipe de PBE a documentação das fontes de evidências 
utilizadas, o ano que a evidência foi publicada ou de outra forma comunicada, a 
informação coletada de cada fonte de evidência que ajuda a responder à questão de 
PBE, e o nível e qualidade de cada fonte de evidência. 
Artigo Número 
Atribua um número a cada fonte de evidência revisada. Isto organiza o resumo 
individual da evidência e possibilita uma maneira fácil de referenciar os artigos. 
Autor e Data 
Indique o sobrenome do primeiro autor ou a fonte de evidência e a data 
publicação/comunicação. Liste ambos autor/evidência e a data. 
Tipo de Evidência 
Indique o tipo de evidência revisada (e.g., RCT, meta-análise, métodos mistos, 
qualitativo, revisão sistemática, estudo de caso, revisão narrativa de literatura). 
Amostra, Tamanho da Amostra, e Localização 
Forneça uma rápida visualização da população, número de participantes, e local do 
estudo. 
Achados que ajudam a responder a questão de PBE 
Embora, o revisor possa encontrar muitos pontos de interesse, liste apenas achados 
que aplicam diretamente para questão PBE. 
Medidas observáveis 
Medidas quantitativas ou varáveis que são utilizadas para responder a pergunta de 
pesquisa, teste de hipóteses, descrever características, ou determinar o efeito, 
impacto ou influência. Evidência qualitativa utiliza casos, contextos, opiniões, 
experiências, e reflexões para representar o fenômeno do estudo. 
Limitações 
Inclui informação que pode ou não estar dentro do texto do artigo sobre as 
desvantagens de uma parte da evidência. A evidência pode listar limitações, ou isto 
pode evidenciar para você, como rever a evidência, que um importante ponto é 
perdido ou a amostra não se aplica para a população de interesse. 
Nível de Evidência e Qualidade 
Utilize informação de ferramentas de avaliações individuais, transfira o nível de 
evidência e a classificação de qualidade para esta coluna. 
 
 
 

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Apêndice H - Ferramenta de Síntese de Evidências e Recomendações 
 
Pontos-Chaves: 
 Síntese de Evidência é o melhor executada por meio da discussão em grupo. 
Todos os membros da equipe dividem suas perspectivas, e a equipe utiliza o 
pensamento crítico para chegar a um julgamento consensuado durante o 
processo de síntese. O processo de síntese envolve tanto razões subjetivas 
quanto objetivas de raciocínio de toda a equipe de PBE. 
Por meio do raciocínio, a equipe: 
 Revisar a avaliação da qualidade de peças individuais de evidência 
 Avalia e assimila consistências nos resultados 
 Avalia o significado e a relevância dos resultados 
 Mescla resultados que podem aprimorar o conhecimento da equipe ou 
gerar novos insights, perspectivas e entendimentos 
 Destaca inconsistências nos resultados 
 Faz recomendações com base no processo de síntese 
 
Quando a evidência inclui múltiplos estudos de evidência no Nível I e Nível II, 
há uma população semelhante ou definição de interesse, e há consistência por 
meio de resultados, o time de PBE pode ter maior confiança em recomendar 
uma mudança na prática. No entanto, com a maioria das evidências de Nível II 
e Nível III, a equipe deve proceder com cautela ao fazer mudanças na prática. 
Neste instante, as recomendações tipicamente incluem a conclusão de um 
piloto antes de decidir implementar uma mudança em grande escala. 
 
Geralmente, mudanças na prática não são feitas na evidência de Nível IV ou V. 
No entanto, as equipes têm uma variedade de opções para ações que incluem, 
mas não se limitam a: criação de campanhas de conscientização, realização de 
atualizações informativas e educacionais, monitoramento de fontes de 
evidência para novas informações e elaborações de estudos de pesquisa. 
 
A classificação de qualidade (veja Apêndice D) é para avaliar tanto evidências 
de qualidade individuais quanto gerais. 

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Baseado em sua síntese, quais dos quatros caminhos a seguir traduzem 
a representação da força total da evidência? 
❑ Forte, evidência convincente, resultados consistentes: Indicação sólida para uma 
mudança de prática é indicada. 
❑ Evidência boa e consistente: Considere piloto de mudança ou investigação adicional. 
❑  Evidência boa, mas conflitante: Não indicado para mudança de prática; considere 
investigação adicional para nova evidência ou desenvolver um estudo de pesquisa. 
❑ Pouca ou nenhuma evidência: Não indicado para mudança de prática; considere 
investigação adicional para nova evidência, desenvolver estudo de pesquisa, ou 
descontinuação de projeto. 
Se você selecionou a primeira opção ou a segunda opção, continue. Do contrário, PARE, a 
tradução não é indicada. 
Recomendações baseadas na síntese de evidência e caminho de tradução 
selecionado 
 
Considere o seguinte ao examinar os ajustes:  
As recomendações são: 
 Compatível com a cultura, os valores ou normas da unidade / departamento / 
organização? 
 Consistente com os assuntos, as estruturas, atitudes, crenças e/ou práticas da unidade 
/ departamento / organização? 
 Consistente com as prioridades da unidade/departamento/organização? 
Considere o seguinte ao examinar a viabilidade: 
 
Podemos fazer o que eles fizeram no nosso ambiente de trabalho? 
 
Os seguintes suportes estão disponíveis? 
 Recursos 
 Financiamento 
 Aprovação de líderes administrativos e clínicos 
 Suporte de partes interessadas 
 É provável que as recomendações possam ser implementadas dentro da unidade / 
departamento / organização? 
 
 
 

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Instruções para uso deste formulário: 
 
Objetivo do formulário 
Utilize este formulário para compilar os resultados da avaliação individual de 
evidências para responder à pergunta da PBE. Os achados pertinentes para cada 
nível de evidência são sintetizadas, e uma classificação de qualidade é atribuída a 
cada nível. 
Número total de fontes por nível 
Registre o número de fontes de evidência para cada nível. 
Classificação geral de qualidade 
Resume a qualidade geral da evidência para cada nível. Utilize o Apêndice D para 
classificar a qualidade da evidência. 
Síntese de achados: evidência de respostas da pergunta PBE 
 Inclua somente achados de qualidade de evidência A ou B. 
 Inclua apenas declarações que respondem diretamente a questão PBE. 
 Resuma os resultados/achados dentro de cada nível de evidência. 
 Registro o(s) número(s) de artigo(s) do resumo de evidência individual entre 
parênteses ao lado de cada declaração para que a origem do resultado seja 
fácil de identificar. 
Desenvolver recomendações baseadas na síntese de evidência e o 
caminho da tradução selecionada 
Revise os achados da síntese e determine quais dos quatro caminhos para tradução 
representam a força total da evidência: 
 Forte, evidência convincente, resultados consistentes: Indicação sólida para 
mudança de prática. 
 Evidência boa e consistente: Considere piloto de mudança ou investigação 
adicional. 
 Evidência boa, mas conflitante: Não indicada para mudança de prática, 
considere investigação adicional para nova evidência ou desenvolvimento 
de pesquisa 
 Pouca ou nenhuma evidência: Não indicado para mudança de prática; 
considere investigação adicional para nova evidência, desenvolver um 
estudo de pesquisa, ou descontinue o projeto. 
Ajuste e viabilidade 
Mesmo quando a evidência é forte ou de alta qualidade, pode não ser apropriado 
implementar mudança na prática. É crucial examinar a viabilidade que considera os 
recursos disponíveis, a prontidão para a mudança e o equilíbrio entre o risco e o 
benefício. O ajuste refere-se à compatibilidade da mudança proposta com a missão, 
metas, objetivos e prioridades da organização. Uma mudança que não se enquadre 
nas prioridades organizacionais terá menos probabilidade de receber suporte da 
liderança e apoio financeiro, dificultando o sucesso. A implementação de processos 
com baixa probabilidade de sucesso desperdiça tempo e recursos valiosos em 
esforços que produzem benefícios negligenciáveis. 

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Apêndice I - Ferramenta de Planejamento de Ações 
 
 
 
1. Complete as seguintes atividades para garantir uma tradução bem sucedida: 
❑ Identifique um líder do projeto. 
❑ Identifique responsáveis pelas mudanças. 
❑ Considere incluir membros ou diferentes atividades durante a tradução do projeto. 
❑ Agende tempo suficiente para completar as tarefas principais. 
❑ Identifique tarefas cruciais e atividades relacionadas. 
❑ Identifique medidas pré ou pós observacionais. 
2. Identifique barreiras para o sucesso da mudança, e então identifique forças que 
podem alavancar e superar barreiras 
 
Barreiras 
Pesquisas ou Forças 
Planeje superar barreiras, aproveitando 
os pontos fortes como apropriado 
3. Considere ou como esta mudança afetará o seguinte: 
  ❑ Registro eletrônico de saúde      
❑ Fluxo de trabalho 
        ❑ Políticas e/ou procedimentos 
4. Confirme o suporte e/ou disponibilidade de fundos para cobrir as despesas. 
(Verifique todos que se aplicam) 
❑ Custos pessoais  
❑ Suprimentos/Equipamentos 
❑ Tecnologia 
❑ Fotocópias 
 
 
 
❑ Educação ou aperfeiçoamento 
❑ Conteúdo ou especialistas externos 
❑ Custos da Disseminação (custos de viagem 
custos da conferência) 
❑  Outro:   
 

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5. Identificar pontos críticos e tarefas relacionadas: 
(Inserir ponto 1) 
(Inserir ponto 2) 
(Inserir ponto 3) 
(Inserir ponto 4) 
Tarefas 
(Inserir tarefa) 

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Instruções para uso da ferramenta de planejamento de ações 
 
Objetivo do formulário 
Este formulário é utilizado para guia-lo ao criar um plano de ação. 
Atividades para garantir uma tradução bem-sucedida 
Essas são todas as atividades que devem ser concluídas à medida que você 
planeja a mudança. Considere as medidas pré e pós-observáveis que podem 
ser usadas para determinar se a mudança foi bem-sucedida. Além disso, a 
identificação de pontos críticos permite que a equipe veja se eles estão no 
caminho certo para atingir as metas. 
Identifique pontos fortes/ recursos e barreiras para o sucesso da 
mudança 
Análise que permite as equipes identificarem barreiras à implementação e, 
potencialmente reduzi-las por meio de forças e recursos inerentes. Pode-se 
encontrar desafios específicos que provavelmente afetarão a capacidade de 
cumprir o plano de ação. Embora esses obstáculos possam atrapalhar, o 
conhecimento deles é útil para que você possa envolver o suporte e criar 
um plano para resolvê-los. 
Considere se ou como a alteração afetará fluxos de trabalhos e 
processos 
Esteja ciente do impacto da mudança. Por exemplo, será necessário fazer 
alterações no prontuário eletrônico para acomodar a alteração ou essa 
mudança afetará o fluxo de trabalho de qualquer outra equipe que tenha 
sido considerada? 
Confirme o apoio e/ou disponibilidade de fundos para cobrir despesas 
Use isso como um guia para alertar sobre as obrigações financeiras que 
podem fazer parte do lançamento. 
Identificar pontos críticos e tarefas relacionadas 
Considere todas as categorias de trabalho (pontos) necessários para 
implementar essa mudança. Quais tarefas devem ser realizadas em um 
primeiro momento para cada ponto a fim de avançar? Quando eles devem ser 
concluídos para permanecer no caminho certo? Por exemplo, se o ponto for 
implementar protocolo, listar todas as tarefas para realiza-lo. 
 
 
 
 
 
 

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Apêndice J - Ferramenta de Disseminação 
 
 
1. Pense sobre as descobertas do projeto e pratique a iniciativa de mudança. Qual é a 
informação mais importante que você precisa transmitir? 
2. Alinhar mensagens-chaves com os públicos-alvo 
Público Alvo 
Mensagem-chave 
Método de Comunicação 
Interdisciplinaridade das partes 
interessadas (stakeholders) 
Liderança Organizacional 
Liderança por Departamento 
Equipe da Linha de Frente 
Comunidade Externa 
(publicações, pôsteres, e 
apresentações) 
3.   Análise dos exemplos abaixo para identificar os métodos de comunicação 
apropriados 
 Publicação Escrita 
 Programa Online 
 Conferência Externa 
 Apresentação oral 
 Apresentação de poster 
 Publicação em mídia social 
 Reunião interna/ no serviço 
 
 Conteúdo de áudio/vídeo 
 Outros: 

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Instruções para uso da ferramenta de disseminação 
 
Objetivo 
Esta forma é útil de vários pontos no processo do projeto PBE. Geralmente é 
concluída no final do projeto, quando os achados são conhecidos e os esforços 
produziram um produto, uma ferramenta, um programa ou uma política.  
 
Alinhar a mensagem chave com o público-alvo 
Pense sobre os achados do projeto. Qual foi a conquista obtida com o projeto? 
Quais os produtos, as mudanças da política ou resultados que você pode relatar? 
Identificar os usuários finais – quem é seu público alvo? Seu público alvo pode ser 
individual, organizacional ou redes que possam ter interesse nos resultados do 
projeto. 
 
Método de comunicação 
Este é o plano de comunicação e pode ocorrer em muitos níveis. Pense sobre 
alcançar diversos públicos utilizando uma infinidade de métodos. Estes podem 
estar inclusos, mas não é limitado para escrita, para o conteúdo visual/áudio, 
programas online e apresentações de pôster. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Appendix 4: 
 
STRUCTURING ASSESSMENT QUESTIONNAIRE AND DESCRIPTION OF A 
PRACTICE PROJECT BASED ON EVIDENCE FROM THE CLINICAL 
NURSE'S PERSPECTIVE 
 
Full name:_______________________________________________________  
 
1. Think about the time to describe the clinical question based on the 
example of a problem, this was:  
(  ) very slow  (  ) slow   (  ) fast  (  ) very fast 
 
2. Looking for an evidence in the database was: 
           (  ) challenging  (  ) difficult  (  ) easy  (  ) very easy  
3. In relation to critical analysis and quality classification, the                                          
understanding of scientific articles was: 
           (  ) not understandable   (  ) partially understandable   
           (  ) understandable         (  ) totally understandable  
4. Summarize and classify the levels of evidence was: 
   (  ) challenging  (  ) difficult  (  ) easy  (  ) very easy  
 
5. The description of the feasibility of applying the evidence was: 
    (  ) challenging  (  ) difficult  (  ) easy  (  ) very easy  
 
6. The development of an action plan for the dissemination of 
evidence was: 
    (  ) not helpful   (  ) partially helpful  (  ) helpful  (  ) very helpful 
 
7. In relation to going through the phases of an evidence-based 
practice project, the material offered during the workshop was: 
   (  ) not helpful   (  ) partially helpful  (  ) helpful  (  ) very helpful 

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8. Additional comments: __________________________________________ 
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Appendix 5: 
COMPLIANCE VERIFICATION QUESTIONNAIRE IN THE EXERCISE OF 
PREPARING a PBE PROJECT, FROM THE RESEARCHER’S PERSPECTIVE 
 
Researcher's name: _______________________________________________ 
Participant’s name: _____________________________________________________ 
(     ) Group A             (     ) Group B 
1. Was the participant able to elaborate a clinical question?  
                        (     ) Yes                                (      ) No 
2. The survey of bibliographic articles was  
          (     ) Sufficient  (     ) Partially sufficient  (     ) Insufficient 
3. Regarding the classification of evidence according to the level of 
quality, was the participant able to carry out this classification? 
    (     ) Yes          (     ) Partially        (      ) No 
4. Was the participant able to elaborate a synthesis of the findings 
relating to the levels of evidence?  
    (     ) Yes          (     ) Partially        (      ) No 
5. 5. Was the participant able to develop a dissemination plan for 
implementing the PBE project?  
    (     ) Yes          (     ) Partially        (      ) No 
 
 
 
 

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Appendix 6: 
Program content: 
Lesson Plan - THEORETICAL-PRACTICAL WORKSHOP 
Model: Presencial 
Hours: 6 hours 
Menu: The workshop proposes a review of all stages of EBP which includes 
approaches to clinical care based on science and the quality of evidence, with 
the ultimate goal of promoting safe and quality care. 
Program content: 
 
Teaching strategies (methodologies): Lecture / Mini-lecture / Kahoot: 
 
- Introduction to PBE 
- Identification of a problem and elaboration of a clinical question 
- Video lesson on searching for evidence and using a scientific database 
- Classification of evidence levels / summary of evidence 
- Elaboration of an action plan for the implementation of evidence-based clinical 
practice 
- Dissemination and sharing of the project. 
Practical Lesson (case exercise):       
Case 1 group description:       
        Structuring a PBE project based on the knowledge acquired in the initial 
topics of the Workshop 
       To base this exercise, we will use a finalized and consolidated project, 
which will be used as a template for the exercise. 
        The participant will receive the description of a problem as a basis for 
elaborating their clinical question and thus go on to the following phases. 
        From that point on, the participant will be free to go through the following 
phases based on the previous content received the previous day, no sequence 
will be provided to follow the project. 

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      To search for scientific evidence, access to a computer room will be offered 
to conduct research in the databases: PUBMED and CINAHL. 
      For the evaluation of evidence, we will not use articles from the results of 
each participant. 2 articles previously classified in the final PBE project will be 
delivered so that the participant can carry out their classification of level and 
quality of evidence of these articles. The form of classification of the participant 
will be compared with the previous classification and used to assess this 
requirement in the questionnaire to verify compliance in the exercise of 
preparing a PBE project from the researcher's perspective. 
      In continuation of the workshop and based on these 2 articles, the 
participant must prepare a summary of the findings relating to the levels of 
evidence found and recommendations. 
The finalization will be with the elaboration of a plan for the dissemination of 
these results, which should involve the interested parties in the PBE project in 
question. 
Group 2 case description: 
It will follow the same molds as the case of group 1 plus the Johns Hopkins 
Nursing Evidence-based Practice forms since the beginning of this practical 
class, when the participant will receive a description of a problem as a basis for 
elaborating their clinical question and thus go to the stage following. 
The following forms will be offered in the case of this group: question 
development, evidence level and quality guide, research evidence assessment 
tool, individual evidence tool, evidence synthesis and recommendation tool, 
action planning tool and tool dissemination.