This is an evidence-based document, meaning the committee searched the published literature and carefully evaluated all evidence. As indicated in the rating scale found on page S10 of the document, there is a hierarchy of these studies based on the study design. There are several ways to evaluate this found evidence. Multiple studies with good research design and study processes that produced consistent results received a high rating, usually a grade of I or II. These statements are the ones that begin with the strong action verbs.
As you would imagine, this high level of evidence was not always found. Sometimes, the study design and process was good, but the outcome of several studies may be inconclusive or conflicting. This indicated the need for a lower rating. These practice criteria statements begin with “consider” and require a closer examination for your practice. These statements go on to provide specific criteria that should be contemplated. You may be using these statements to make decisions about a specific patient situation or to write facility policies and procedures. These “consider” statements will require more critical thinking on your part. You may need to think about all aspects of care for a specific patient or the needs of a larger patient population. The expertise or skill level of your staff, and the staffing mix such as RN versus LPN/LVN versus unlicensed assistants may need to be deliberated. Additionally, you may reach a different practice decision based on the venue of care, considering the differences between hospitals, skilled nursing facilities, an ambulatory clinic, or the home.
The bottom line is that there continues to be many aspects of practice without concrete answers to every question. You may need to look up the references provided to obtain more details to guide your decision. This process requires a high level of critical thinking skills and good nursing judgment. The body of evidence is improving, however we will never have all the needed answers, so critical thinking is a necessary skill to develop. Pay attention to the action verbs and the rankings of evidence to reach the most appropriate decisions.