Clinical Practice Guideline Evidence Table

Clinical Practice Guideline Evidence Table

XYZ theory is important to nursing because it addresses the problem of __________that affects x% of the population. Smith (2020) developed this middle range theory to explain xxxx.







(Brief, succinct reason why this theory and these guidelines should be adopted by a health care agency).


Armola, R.R., Bourgault, A. M., Halm, M. A., Board, R.M., Harrington, L., Heafey, C. A., Lee, R., Shellner, P. K., Medina, J. (2009). AACN levels of evidence: What’s new? Critical Care Nurse 29(4), 70-73.

Contact Information and Acknowledgements

Contact information



Course Designer:

A qualitative synthesis of XYZ theory was conducted to ascertain the evidence supporting the use of xyz theory in nursing practice, nursing research, nursing education, and nursing administration.

Synopsis of Proposed Clinical Practice Guidelines Using XYZ Theory

Student name, BSN, RN


Application of xyz Theory

Assumptions of XYZ Theory Major Concepts Propositions

Model showing relationship between the concepts


Reference Discipline Purpose/ Research Question(s)/ Hypotheses Sample & Instruments used Variables Analysis of Data Findings Strengths/ Limitations 1 Level of evidence
Otoo, Lartey & Perez-Escamilla (2009) Nursing Incentives/Barriers to exclusive breastfeeding in periurban Ghanian women n= 35 women with child <4 mo. x age=27.5 _____________ 4 focus groups of 7-10 women; 10 open ended questions, Demographics 4 discussion areas: Knowledge of EBF, reasons, motivation, benefits of EBF, barriers to EBF and consequences EBF easier milk flow barriers= jobs, breast/nipple problems, perceived insuf. milk family pressure Convenience sample; possible bias from social pressure in group C

Include inclusion/exclusion criteria for literature search, search engines used, keyterms used in the search, parameters for dates of publication

Qualifying Statement

These guidelines were developed by the author as a master’s student project for NURSING. They were designed to provide nurses with proposed clinical practice guidelines (CPGs) for the clinical application of this middle range theory based on the best available evidence at the time these were written. They were not developed by an expert panel. This document is not intended to impose a standard of care that prevents a variance in a specific situation. They are proposed guidelines that should only be used according to the nurse’s judgment of their usefulness with each individual patient and situation.

1American Association of Critical Care Nurses’ (2011). Evidence Leveling System  
A Meta-analysis of multiple controlled studies or meta-synthesis of qualitative studies with results that consistently support a specific action, intervention or treatment
B Well designed controlled studies, both randomized and nonrandomized, with results that consistently support a specific action, intervention, or treatment.
C Qualitative studies, descriptive or correlational studies, integrative reviews, systematic reviews, or randomized controlled trials with inconsistent results.
D Peer-reviewed professional standards, with clinical studies to support recommendations.
E Theory-based evidence from expert opinion or multiple case reports.
M Manufacturer’s recommendation

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits


Potential Harms


Strength of Recommendation Rating Scale  
A (High) Recommendation Meta-analysis of high quality well-controlled studies or of qualitative studies that consistently support action, intervention, or treatment; relevant to practice
B (Moderate) Recommendation High quality evidence with minor differences in findings; Based on Level B, C, or D evidence: relevant to practice
C (Weak) Recommendation Limited or low quality evidence; based on consensus of usual practice.
NR Not Recommended Unable to recommend based on current evidence; weak evidence or heterogeneity of findings;
Assessments Assess all women admitted to Labor and Delivery for risk factors (single, minimal support system, hx of depression) for PPD (Smith, 2020 [A]; Jones, 2025 [B]) The [A] or [B] after the author, year is the weight of that evidence from your evidence table. Notice how well the CPG will now be supported with graded evidence. A


Decision options

Clinical Practice Guidelines

Strength of Recommendation




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