Advanced practice nurses must be equipped to critique scholarly literature and discern its value for application to practice. Select one current clinical practice guideline (CPG) related to your PICOT question. If a relevant CPG does not exist, choose a CPG related to another topic. Appraise the CPG using the Rapid Critical Appraisal Questions to Ask of Evidence-Based Guidelines (Melnyk & Fineout-Overholt, 2023, Box 8.4). Summarize your appraisal of the CPG in your own words.
Include the following sections:
Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
Credibility
Who developed the CPG?
Who funded the CPG?
Has the CPG been peer-reviewed?
Comprehensiveness
What method was used to identify, select, or combine evidence?
Was a current, comprehensive literature review included?
Were all important options considered?
Is the strength of evidence noted for each recommendation?
Applicability and generalizability:
Is the intent of use provided?
Are the recommendations clinically relevant?
Are the recommendations relevant to the reader’s population?
Are the recommendations practical and feasible?
Are the recommendations significantly different from current practice?
Are the outcomes measurable using standard care practices?
Include a complete APA reference for the selected CPG.
Has the CPG been peer-reviewed? Yes, the CPG undergoes a rigorous internal and external peer-review process. The draft is reviewed by the ADA’s Executive Committee and external subject matter experts before being published in the journal Diabetes Care.
Comprehensiveness
What method was used to identify, select, or combine evidence? The ADA’s guidelines are based on a systematic review of the literature. Researchers conduct comprehensive searches for randomized controlled trials (RCTs), systematic reviews, and meta-analyses to identify the highest level of evidence. This systematic approach ensures all relevant research is considered.
Was a current, comprehensive literature review included? Yes, the ADA’s Standards of Medical Care in Diabetes are updated annually. The publication includes a comprehensive bibliography and clear citations for all studies supporting each recommendation, ensuring the information is current and evidence-based.
Were all important options considered? The CPG is highly comprehensive, considering a broad range of options for diabetes management, including lifestyle interventions, various oral medications, injectable therapies, and modern technologies like insulin pumps and continuous glucose monitoring.
Is the strength of evidence noted for each recommendation? Yes, the ADA uses a clear grading system to classify the strength of evidence for each recommendation. Recommendations are graded A, B, C, or E, with "A" representing the strongest evidence (based on well-conducted clinical trials). This allows the clinician to easily discern the level of scientific support for each guideline.
Applicability and Generalizability
Is the intent of use provided? Yes, the CPG explicitly states its intent is to provide clinicians with the most up-to-date and evidence-based guidance to improve the care of people with diabetes.
Are the recommendations clinically relevant? The recommendations are highly relevant to clinical practice, as they address common challenges like achieving glycemic control, preventing complications, and using technology to improve patient outcomes.
Are the recommendations relevant to the reader’s population? As an APN, the recommendations are directly relevant to my adult patient population with Type 2 diabetes. The guidelines are designed to be broadly applicable to diverse patient groups.
Are the recommendations practical and feasible? The recommendations are generally practical. While some technologies like CGM may have cost barriers, increasing insurance coverage is making them more feasible for a wider patient population. The guidelines offer a tiered approach, making them adaptable to different practice settings and resource levels.
Sample Answer
As an advanced practice nurse, I've selected a Clinical Practice Guideline (CPG) related to the management of Type 2 diabetes, a topic directly relevant to my PICOT question regarding the use of Continuous Glucose Monitoring (CGM) versus standard self-monitoring of blood glucose (SMBG). For this appraisal, I will use a CPG from the American Diabetes Association (ADA), as it is a highly credible and widely accepted source in clinical practice.
Application of Course Knowledge: CPG Appraisal
Credibility
Who developed the CPG? The guideline was developed by the American Diabetes Association’s (ADA) Professional Practice Committee, a multidisciplinary panel of experts in diabetes care, including physicians, nurses, dietitians, and other healthcare professionals.
Who funded the CPG? The CPG is funded by the American Diabetes Association itself, a non-profit organization. This source of funding minimizes the potential for commercial bias from pharmaceutical or device companies, which enhances its trustworthiness.