Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals Hierarchy of Evidence Guide Appendix D

Note: Refer to the appropriate Evidence Appraisal Tool (Research [Appendix E] or Nonresearch [Appendix F]) to determine quality ratings.

Evidence Level Types of Evidence

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Level I • Experimental study, randomized controlled trial (RCT) • Explanatory mixed methods design that includes only a Level I quaNtitative study • Systematic review of RCTs, with or without meta-analysis

Level II • Quasi-experimental study • Explanatory mixed methods design that includes only a Level II quaNtitative study • Systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

Level III

• Nonexperimental study • Systematic review of a combination of RCTs, quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta-analysis. • Exploratory, convergent, or multiphasic mixed methods studies • Explanatory mixed methods design that includes only a Level III quaNtitative study • QuaLitative study • Systematic review of quaLitative studies with or without meta-synthesis

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Level IV Opinion of respected authorities and/or nationally recognized expert committees or consensus panels based on scientific evidence. Includes:

• Clinical practice guidelines • Consensus panels/position statements

Level V

Based on experiential and non-research evidence. Includes: • Scoping reviews • Integrative reviews • Literature reviews • Quality improvement, program or financial evaluation • Case reports • Opinion of nationally recognized expert(s) based on experiential evidence

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

Step-by-Step Guide to Understanding and Using the Johns Hopkins Hierarchy of Evidence

Step 1: Understand the Purpose of the Hierarchy

The Johns Hopkins Hierarchy of Evidence helps you:

Rank research and nonresearch evidence by strength and reliability
Support evidence-based clinical decisions
Select appropriate sources for nursing assignments and practice

Higher levels generally provide stronger evidence for practice decisions.

Step 2: Identify Whether Your Source Is Research or Nonresearch

Before assigning a level, determine:

Research evidence → involves systematic investigation and data analysis
Nonresearch evidence → based on expert opinion, reviews, or experiential knowledge

This step ensures you use the correct appraisal tool (Appendix E or F).

Step 3: Classify Research Evidence (Levels I–III)

Level I (Strongest Evidence)
Use this when your source is an RCT or a systematic review of RCTs. These studies minimize bias and provide high confidence in outcomes.
Level II
Choose this level for quasi-experimental studies where randomization is not used but an intervention is still tested.
Level III
Apply this level to nonexperimental, qualitative, or mixed-methods studies that explore relationships, experiences, or perceptions.

💡 Tutor tip: Qualitative studies are valuable for understanding patient experiences, even though they are not experimental.

Step 4: Classify Nonresearch Evidence (Levels IV–V)

Level IV
Includes evidence from expert panels, clinical guidelines, and consensus statements grounded in scientific literature.
Level V (Lowest Level)
Includes experiential knowledge such as case reports, quality improvement projects, and narrative reviews.

💡 These levels are still useful, especially when higher-level evidence is unavailable.

Step 5: Apply the Hierarchy to Assignments

When writing papers or care plans:

Clearly state the level of evidence
Justify why the source fits that level
Prioritize Level I–III when possible

Step 6: Avoid Common Student Errors

❌ Confusing literature reviews with systematic reviews
❌ Assuming guidelines are Level I evidence
❌ Ignoring qualitative research value

Always evaluate study design, not just the topic.

Helpful Academic Resources

Use these links to strengthen understanding and citation accuracy:

Johns Hopkins Evidence-Based Practice Model Overview:
https://www.hopkinsmedicine.org/evidence-based-practice
Johns Hopkins Nursing EBP Tools & Appendices:
https://nursing.jhu.edu/evidence-based-practice
Melnyk & Fineout-Overholt – Evidence-Based Practice in Nursing:
https://www.ncbi.nlm.nih.gov/books/NBK2659/

Johns Hopkins Hierarchy of Evidence Explained for Nursing Practice