Not recommended for practice
• No objective evidence or only anecdotal evidence available;
or the supportive evidence is from poorly controlled
or uncontrolled studies
• Other indications for not recommending evidence for
practice may include:
○ Conflicting evidence
○ Harmfulness has been demonstrated
○ Cost or burden necessary for intervention exceeds
anticipated benefit
○ Does not have relevance or applicability to emergency
nursing practice
• There are certain circumstances in which the recommendations
stemming from a body of evidence should
not be rated as highly as the individual studies on which
they are based. For example:
○ Heterogeneity of results
○ Uncertainty about effect magnitude and consequences,
○ Strength of prior beliefs
○ Publication bias