Evidence-Based Practice in Social Work and Nursing

Course content

This self-study course is companion material for your studies: for catching up, revising and preparing through self-study, without support or evaluation by teaching staff. It does not replace any lecture or seminar, any university examination or any practical placement and does not confer any official recognition; what counts is your university's requirements and the laws as currently in force. It does not replace legal advice in an individual case.

PART 1 – Knowledge that holds up: introduction and key terms

A situation you know

Imagine you are sitting in a team meeting at your placement. Someone suggests an approach, and when you ask why, you hear something like “That is just how we do it here” or “There are studies on that”. Both sentences sound confident, yet they say very different things about the foundation of a decision. This is exactly where the idea of evidence-based practice comes in: it asks what we rely on when we act professionally, and how clear this basis is to others – including the people we work with.

For your studies this is more than a buzzword. When you write a term paper, prepare a presentation or have to explain in your practical placement why a service makes sense, you need exactly these terms: evidence, evidence-based medicine, evidence-based nursing, evidence-based social work. This first module lays the foundation. In Module 2 you turn practice questions into search questions, in Module 3 you get to know study designs, and in the following modules you search, read studies critically and place guidelines in context.

One more note on the role of this course: it is a self-study course and companion material for your studies. It does not replace any lecture or seminar, any university examination or any practical placement. You can work through all tasks at your own pace and reflect on them yourself using the expandable hints; there is no submission of work and no feedback from teaching staff.

What “evidence” means – and what it does not

The German word “Evidenz” can easily be misleading. In everyday German it sounds like “obvious” or “proven”. In English usage, evidence means rather a piece of proof or an indication that can carry more or less weight. In the technical language of this course, evidence therefore means findings that come from research, were obtained in a transparent way, and whose strength varies depending on the type and quality of the study. Evidence is thus not a seal of truth but an offer of justification that you have to put in context.

The Institute for Quality and Efficiency in Health Care (IQWiG), a legally commissioned and professionally independent institute, describes this in its General Methods as follows: anyone who invokes evidence-based medicine for health questions relies not on opinions alone but on findings obtained with scientific methods that are as objective as possible. Evidence-based medicine rests on a collection of scientific tools and strategies (IQWiG, 2025). The difference between opinion and methodically obtained knowledge is the core – not an opposition between “study” and “gut feeling”.

Figure 1 gives you an overview of the core concept before we take it apart step by step. The mind map shows five branches: the definition, the building blocks of a decision, the nursing-science view of evidence-based nursing, the debate in social work, and the anchoring in the profession. You can later use the figure as a map when you get lost in the literature.

The classic definition by Sackett et al. (1996)

The classic definition goes back to Sackett et al. (1996). According to it, evidence-based medicine is the conscientious, explicit and judicious use of current best external evidence in making decisions about the care of individual patients. Practising evidence-based medicine means integrating individual clinical expertise with the best available external evidence (Sackett et al., 1996). A German-language rendering of this definition can be found in the IQWiG methods paper (IQWiG, 2025), which you can use well as a German-language source in term papers.

Because definitions are often taken apart word by word in timed written papers, a reading aid is worthwhile. Conscientious means: careful and not casual. Explicit means: the basis of a decision is named rather than merely working in the background. Judicious refers to weighing up the individual case. Current best is a reminder that the state of knowledge changes, and external means findings from outside the specific situation, i.e. not your own experience on the spot. This reading aid is a didactic explanation of the terms, not an additional statement by the authors.

Particularly important: the definition has two halves. It names not only the best available evidence but equally the individual expertise of the professional. Anyone who shortens evidence-based practice to the sentence “We follow study results” therefore already misses the original definition. That the definition comes from medicine and refers to individual patients is at the same time the starting point for the question of how well the idea can be transferred to nursing and social work – more on this in Part 3 and Part 5.

PART 2 – Foundations: the building blocks of an evidence-based decision

Four building blocks instead of “study equals answer”

IQWiG describes evidence-based decisions as a combination of three elements: the evidence, the clinical condition and circumstances of a person, and their preferences and attitudes. Clinical expertise brings these elements together (IQWiG, 2025; Section 1.3.1 of the General Methods). Figure 2 shows this as overlapping circles: professional expertise does not stand beside the building blocks but in their middle, because it weighs them up and justifies the decision.

IQWiG writes about health decisions; the term “clinical condition” therefore comes from medicine. For social work and everyday nursing practice you can sensibly translate it as the situation of the person and their environment: state of health, housing situation, social relationships, resources. You make this transfer yourself and should flag it as such in a piece of work.

The building blocks one by one

Evidence. This means findings from research, for example from studies or from reviews that bring several studies together. How robust they are is a question in its own right. IQWiG names three aspects on which the certainty of results of clinical studies primarily depends: internal validity, external validity and statistical precision (IQWiG, 2025). In everyday terms: first, whether an observed difference really goes back to the intervention studied and not to something else (internal validity). Second, whether the results can be transferred to other people and situations (external validity). Third, how precisely the effect was estimated, that is, how much chance may still play a part (statistical precision). IQWiG also reports that random allocation of participants to comparison groups, randomisation, increasingly became an internationally accepted standard from the beginning of the 1960s (IQWiG, 2025). You will learn more about which study design suits which question in Module 3, and how to recognise bias in Module 5.

Condition and circumstances. The same intervention can mean something quite different for two people, because health, housing situation, support network and everyday life differ. This building block prevents general findings from turning into a template that overlooks the individual case.

Preferences and attitudes. What matters to the person, what do they reject, what experiences do they bring? That IQWiG names preferences as an element in their own right is remarkable: according to this understanding they are not a disturbing factor to be considered after the “actual” professional decision, but an equal building block of the decision.

Professional expertise. It brings the elements together. This includes knowledge and experience, but also the ability to put evidence in context: does the group studied match the person sitting in front of me? Are there indications of side effects or burdens? Where are the gaps? Expertise therefore does not mean replacing evidence but using it responsibly.

Evidence-based nursing: external and internal evidence

In nursing, the idea is taken up as evidence-based nursing. It bases nursing decisions on two sources of knowledge (general professional knowledge in nursing science). External evidence is systematically gained, scientifically secured experience of others. Internal evidence is the individual needs and experiences of the people who need care and of the nurses themselves. This raises the perspective of those affected to the rank of a source of knowledge – an idea that fits the building block “preferences”.

The approach sees itself as a process. The steps range from shared decision-making and the formulation of the problem, through searching and critically appraising the literature found, to changing practice and evaluating it. We pick up exactly this sequence of steps in Module 2, when it comes to the cycle and the search question.

Three terms compared

The table and comparison cards (Figure 3) set side by side the three terms that often blur into one another in your reading: evidence-based medicine, evidence-based nursing, and evidence-based or evidence-informed social work.

PART 3 – Social work and nursing: debate, professional ethics and code of conduct

Evidence-based social work – a debated concept

Unlike in medicine, “evidence-based practice” is not a self-evident term in German-language social work but the subject of a controversial professional debate. The main lines of this debate are presented here as general professional knowledge. For your own work it is important to present them fairly and without attributing them to individual people.

Supporting positions stress the importance of randomised outcome studies: if professionals want to show that a service achieves something, methodically controlled knowledge is needed. Critical positions point to a technology deficit of social interaction – meaning that social processes cannot be reliably steered according to the pattern “right cause, certain effect”. They also see the transferability of causal models to social practice as limited and voice concerns about professional autonomy if evidence is understood as a requirement. Mediating positions lie in between. A productive way of handling the debate begins with taking the arguments of both sides seriously: even those who stress the technology deficit need good reasons for their actions; and those who favour outcome studies must explain how results fit individual cases.

Important for term papers and presentations: the arguments of the debate are described here as main lines, not as positions of individual authors. If you want to attribute an argument to a person, you have to read the respective primary text and cite it precisely.

“Evidence-based” or “evidence-informed”?

Besides “evidence-based”, you will come across the expression “evidence-informed” in social work. Linguistically, it stresses that evidence flows into a decision and informs it, but does not settle it on its own. This fits the building blocks from Part 2, because the definition by Sackett et al. (1996) also requires expertise in addition. How sharply the two expressions are distinguished from each other can vary from text to text; the term “evidence-informed” cannot be attributed here to any particular person. My tip for your work: briefly explain how you use the terms, and support your usage with the sources you have actually read.

Anchoring in professional ethics: DBSH

The professional association for social work also comments on the relationship between ethics and knowledge. The professional ethics of the German Professional Association for Social Work (DBSH) has been available in a second edition since December 2024; the first version dates from 2014. It names respect for people’s autonomy as well as justice and solidarity as basic principles, links ethics and professional competence, and assumes that the practical competence of social work rests on scientifically secured knowledge (DBSH, 2024).

Why do knowledge and ethics belong together here? One answer is: scientifically secured knowledge makes professional decisions justifiable and comprehensible to service users. Respect for autonomy at the same time requires that people are involved in decisions and are not merely recipients of the “best knowledge”. Both ideas stand side by side in the professional ethics – this is an interpretation that you should flag as such in your work. It is also important that the professional ethics is the position of a professional association and not a law. It does not create a legal obligation but a professional self-understanding.

Anchoring in the code of conduct: NRW Chamber of Nursing

In nursing, the code of conduct of the Chamber of Nursing of North Rhine-Westphalia (Pflegekammer Nordrhein-Westfalen) is a statute that explicitly takes up the idea. This is a special feature that you need to place precisely, because it is easily overestimated.

Two reading tips will help you. First, section 19(1) is worded as a “should” provision; what legal consequences follow from it in an individual case is not a topic of this module. Second, taking sections 3, 15 and 19 together shows that the code of conduct can be read as a combination of the scientific state of knowledge and self-determination – a double idea similar to the definition by Sackett et al. (1996) and the building block “preferences”. This code of conduct does not apply to registered nurses (Pflegefachpersonen) in other federal states; whether and how similar rules exist there is not covered here. The same applies to professional groups outside the chamber: for social workers, the DBSH professional ethics is an important statement of position, but likewise not a law.

Current developments at a glance

On the nursing degree, the Federal Statistical Office gives the following official figures (Destatis, 2026b):

These figures merely describe orders of magnitude of the nursing degree under the Nursing Professions Act. They say nothing about how evidence-based work is done in practice or how good care is; such conclusions would not be supported. Figure 4 places the developments mentioned in time: from randomisation as an accepted standard in the 1960s, via the EBM definition in 1996 and the debate in social work, to the changes of 2024 and 2025.

PART 4 – In practice: breaking down decisions, classifying statements, applying

Worked example: “Which support suits Ms K.?”

Theory becomes tangible when you work through it with an example. We break down a typical everyday decision step by step into the building blocks from Part 2. The starting situation is fictional: Ms K. lives alone in her flat and is supported by a community-based team. The team asks itself: which support suits Ms K.? From the team’s point of view there are two forms to choose from – a regular visiting service and a group activity outside the home. Important: the example deliberately makes no statement about which of the two forms “works better”; it is about the steps of thinking, not about an effect. Figure 5 shows the sequence.

Step 1 – Clarify the question. “What suits?” is too vague. The team first clarifies together with Ms K. what should improve – for example more contact with other people or more security in everyday life. Only with this goal can you judge whether an option fits at all. This corresponds to the beginning of the process in evidence-based nursing: shared decision-making and formulation of the problem.

Step 2 – Determine the evidence. Here you first record what kind of knowledge is needed: findings from studies or reviews on which groups of people, and under which conditions, such forms of support achieve something. In the example we use no finding. This is itself a lesson: sometimes a team finds that suitable evidence is missing or still has to be searched for. This too explicitly belongs in the justification – “we did not find a suitable study” is an honest and professionally legitimate statement.

Step 3 – Condition and circumstances. The team gathers what matters for the specific situation: how mobile is Ms K.? How accessible is her flat? Which people belong to her environment? This information is not “extra”, but a building block in its own right. Anyone who overlooks the housing situation might suggest an option that cannot be put into practice in everyday life at all.

Step 4 – Ask about preferences. Ms K. says (fictional) that she dislikes sitting in large groups, but likes having conversations and values fixed times. This is internal evidence in the sense of evidence-based nursing: her needs and experiences. What matters is not to guess what she might want but to ask her and record her answer.

Step 5 – Bring together. Now the team’s professional expertise brings the building blocks together. It is possible that the team chooses the option that best fits Ms K.’s preferences and circumstances – even if more studies should exist for the other option. The justification is what counts: what was known, what was missing, what tipped the balance? The result is documented, and the team agrees when it will review, together with Ms K., whether the decision holds up. In this way the circle closes with evaluation.

What the example shows: evidence is a building block, not a verdict. The same body of evidence can lead to different, equally well-justified decisions for two people.

Two case studies from practice

Classifying statements: the matrix

In everyday work you come across statements of very different origins. Figure 6 helps you classify them. The matrix is our own didactic arrangement and not a model from the literature: the columns ask whether a statement applies to many cases or to this person, the rows whether it is traceably backed up or asked about, or merely customary or experienced. This gives four fields – evidence, preferences and circumstances, tradition and single experience. In the middle stands professional expertise again, mediating between the fields. Single experience is not “worthless” here: it can be a reason to ask questions that you then compare with evidence.

PART 5 – Critical perspective: limits, tensions and open questions

Evidence alone settles nothing

A common misunderstanding is: if there is evidence, the decision is made. The definition by Sackett et al. (1996) and the description by IQWiG (2025) say something different: evidence is a building block that expertise brings together with condition, circumstances and preferences. Two people with similar starting points can therefore decide differently after careful weighing without anyone “ignoring” the evidence. Conversely, arbitrariness is no solution either: the decision should be explicit and justified.

Limits: context, values and gaps

Context and transferability. Studies describe particular groups under particular conditions. Whether the findings fit your service users and your field of work in Germany is a question of external validity (IQWiG, 2025). It cannot be answered across the board but requires judgement.

Values and questions of power. What counts as an important result is not neutral. Who decides whether a service is “successful” – the organisation, the funding body, the researchers or the people who use the service? The professional ethics of the DBSH stresses autonomy, justice and solidarity (DBSH, 2024); this means that such questions of value have to be kept in mind. The technology-deficit argument and the concern about professional autonomy from the debate can also be read this way: as a reminder that evidence does not relieve anyone of responsibility and participation. This is an interpretation; what is supported is only that these arguments occur in the debate.

Gaps in research. For some questions there is no suitable study. This does not mean that nothing may be done – it means that the justification honestly rests on experience, professional knowledge and preferences and names the uncertainty. In Module 3 you see why a study design has to fit the question, and in Module 7 we look at the limits in the lifeworld of service users in more depth.

Open questions for your thinking and writing

• How much standardisation can social work bear without losing the particularity of the individual person?
• Who should have a say in which results (outcomes) count in research and practice?
• How much evidence is “enough” to justify an approach – and how does a team deal with gaps?
• How can the perspective of service users be included so that it is more than a duty to be ticked off?

For your studies

• ☐ Term paper: I can define the terms evidence-based medicine, evidence-based nursing and evidence-based or evidence-informed social work with a source and justify my own usage.
• ☐ Timed written paper: I can name the building blocks of an evidence-based decision and explain why evidence alone settles nothing.
• ☐ Presentation: I can present the pro and critical lines of the debate without attributing them to individuals, and correctly state the reach of professional ethics and code of conduct.
• ☐ Practical placement: I can classify statements in the team as evidence, experience, preference, circumstance or tradition and ask in a friendly way for the reason.
• ☐ All written work: I mark professional standards as positions, not as law, and mark interpretations as interpretations.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you judge your own understanding.

PART 1 – Introduction: Why every piece of evidence work starts with a good question

From gut feeling to question

Imagine a team meeting in a residential group. Someone says: “We should try life-story work.” Everyone nods. But what exactly is meant by that? Who would it be for? What would you compare it with? And how would you know later that it had done the young people any good? As long as these points remain open, you can neither research sensibly nor decide on good grounds. This is exactly where this module comes in: it is about the step that carries everything else, namely a question that can be answered.

You already know from Module 1 the definition of evidence-based practice by Sackett et al. (1996) and the building blocks of an evidence-based decision. Here we pick up at a practical point: before evidence can be appraised, weighed up or applied, it must be clear what it is meant to refer to. A good question is therefore not an optional extra but the steering wheel of the whole process.

Practice question, search question, research question – sorting out three terms

In your studies you will come across several terms that are easily mixed up. In this course we use them as working definitions. A practice question arises in the everyday language of a situation: “Does this actually help?” or “Is there anything better than bed rails?”. A search question is a question framed so precisely that search terms can be derived from it; Module 4 explains how to do this. The research question of a term paper, finally, is the guiding question of your argument. It can arise from a search question, but it is not automatically the same thing: in a term paper you also have to place the question in the professional debate and explain why it is relevant.

The idea behind evidence-based work explains why the route from an everyday question to a search question is worthwhile. The Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) describes it as follows: for questions about health, you do not rely on opinions alone but on findings obtained with scientific methods that are as objective as possible (IQWiG, 2025). Opinions and routines certainly have their place in a team, but they do not replace a targeted question. A vague question almost inevitably leads to vague results: too many hits that have nothing to do with your situation, or studies that answer a different question from the one you asked.

The overview: mind map of the module

Figure 1 shows how the contents of this module fit together. The EBP cycle is at the centre. Five branches lead away from it: the question itself, the PICO mnemonic, the steps of the cycle, the preferences of service users and the limits of the approach. Later you can use the mind map as a memory aid to recall the structure of the module.

PART 2 – Foundations: The EBP cycle in five steps

The model at a glance

In evidence-based nursing, nursing decisions rest on two sources of knowledge: external and internal evidence (general professional knowledge in nursing science). The steps there run from shared decision-making and formulating the problem, through searching and critical appraisal, to changing practice and evaluation. In this course we summarise this sequence in five steps: ask the question, acquire evidence, appraise it critically, apply it together with service users, and assess the result.

Figure 2 shows the five steps as a cycle. The arrow from the fifth step back to the first expresses that the work is never “finished”: what you learn during the evaluation becomes the basis for the next question.

The five steps in detail

Step 1 – Ask. You translate a situation from practice into a question that can be answered. This step is the topic of the present module. Service users should already be kept in mind here, because evidence-based practice in nursing begins with shared decision-making and formulating the problem.

Step 2 – Acquire. With your question in hand, you search in a targeted way for studies, reviews or guidelines. How to derive search terms and document a search is covered in Module 4.

Step 3 – Appraise. Sources you find are not automatically good or suitable. You judge how robust the findings are and whether they can be transferred to your situation. This includes study design (Module 3) and risks of bias (Module 5).

Step 4 – Apply. The findings meet a concrete life situation. Professional knowledge, evidence and the wishes of those involved are brought together; Module 7 looks in more depth at how this succeeds and where it becomes difficult.

Step 5 – Assess. After implementation you review what has happened in the concrete situation. A measure may look beneficial in a study and work differently in your field. Only the review on site shows whether the approach holds up.

External and internal evidence: two sources of knowledge in one question

The distinction between external and internal evidence is especially helpful for formulating the question. In evidence-based nursing, external evidence means scientifically tested experience of others, that is, what studies and reviews provide. Internal evidence covers the individual needs and experiences of people in need of care and of those who care for them. Applied to social work, this means that the views of service users and the experience of practitioners in the situation also belong to the knowledge that feeds into the decision. This transfer is an application of an idea from nursing; as you saw in Module 1, it is itself a subject of debate in social work.

For the question, this means: a good search question draws on both sources. It asks about external evidence (“What does research say about this?”) but is guided by internal evidence (“What matters to the people involved here?”). If you only consider the first half, you risk questions that miss the lifeworld.

Elaboration: Why a cycle and not a one-way street?

Ask yourself the following question and answer it briefly for yourself before reading on: why is the evaluation a step of its own and not simply the end? One possible line of thought: studies describe results under particular conditions. Whether these conditions apply to your service users is something you only learn by observing it in your own practice. At the same time, situations change, and an answer often gives rise to new questions. The cycle therefore keeps the work flexible and protects against the assumption that a decision, once made, holds for ever.

PART 3 – Method: Building the search question with PICO

Distinguishing two question types: background and foreground

Not every question needs a study search. Some questions call for basic knowledge; others call for a decision between options. We call the first group background questions (“What is …? How does … work?”) and the second foreground questions (“Does A help, compared with B, for C?”). The distinction is a teaching aid in this course; it is not attributed to any particular person here. You usually clarify a background question in textbooks or review articles. Only when you want to weigh up options for action does the foreground question become relevant, and PICO is intended for it.

There is also a third case that you should not overlook: questions that ask not about effectiveness but about experience or meaning, for example “How do young people experience moving into a residential group?”. These too are legitimate and important questions. However, they need different types of study from comparison studies; Module 3 explains which ones. Figure 3 helps you match your practice question to the right type, and Figure 4 sets the three types side by side with examples from child and youth services and from nursing.

PICO: four elements for a clear foreground question

The acronym PICO stands for population, interventions, comparators, outcomes, in German roughly Population, Interventionen, Vergleiche and Endpunkte. In the Cochrane Handbook it serves as a mnemonic for defining the question and the inclusion criteria of a systematic review (Higgins et al., 2024). The handbook is aimed at review authors. If you transfer the pattern to a practice question, this is an application of the idea and not something the handbook prescribes for practice questions. It does help you break the question down so that nothing important stays vague. For getting started, PICO is enough as a basic framework.

The table shows the four elements, each with a guiding question and an example from child and youth services and from nursing. The examples are question elements. They say nothing about whether the services mentioned actually help.

Narrowing down population and intervention

The population decides which studies are relevant to you at all. “Young people” is too broad, because a residential group, a school setting and outpatient counselling are different life situations. “Young people in a residential group home” is much better. The population should not be too narrow either: if you fix age, gender, background and diagnosis all at once, you may find nothing. What is needed is a well-reasoned balance. The same applies to the intervention: describe so precisely what is meant that another team would understand the same thing by it. A word like “life-story work” can mean very different things, and this vagueness carries over into every search.

Comparison and outcome: the often forgotten part

Many practice questions contain not a word about the comparison. “Does it help?” sounds like a complete question but is incomplete: does it help compared with what? With the usual support? With another method? With nothing additional? Only the comparison intervention makes a statement about a difference possible. The answer can also simply be “what we have done so far”, as long as it is said out loud.

The outcome is the result by which you recognise whether there is a difference. Good outcomes are clearly named and can be observed, asked about or measured. They should also be something that matters to service users. This brings us to preferences: IQWiG describes evidence-based decisions as a combination of evidence, the condition and circumstances of a person, and their preferences and attitudes, with professional expertise bringing these elements together (IQWiG, 2025). If you already think about what matters to those involved when you formulate the question, you avoid the classic mistake of measuring something that plays no role for them. Which studies later evaluate your outcomes and how effects are presented is something you learn in Module 5.

Worked example: from the team’s question to a PICO question

Before you practise yourself, we go through one fictional example in full. Mira Winter works in a residential group home. In the team, the question comes up: “Does life-story work help young people in the residential group?” Mira wants to turn this into a search question. Figure 5 shows the five working steps that we go through one after another.

Step 1: Mira first clarifies the question type. The team’s question wants to set two options side by side, namely with and without life-story work. So it is a foreground question; PICO is the right tool. Step 2: She narrows down the population. The team does not mean all young people, but young people who live in the residential group. Step 3: She clarifies the intervention. In conversation it becomes clear that the team means a planned, structured service and not every conversation about the past. Step 4: She names the comparison: the usual support in everyday group life without such a service. Step 5: Together with the team, she defines a few outcomes, for example the young people’s self-reported wellbeing and self-esteem. Ideally the team first asks what would matter to the young people themselves.

The result reads: “Compared with the usual support without this service, does structured life-story work improve self-reported wellbeing and self-esteem in young people in a residential group home?” Note what deliberately stays open in this example: whether life-story work helps is not something this course states. The example shows only how a question comes about. In Module 4 you will derive search terms and synonyms from the four elements, so it is worth formulating them precisely now.

PART 4 – Application: Data as context, cases and an exercise

A practice question has a context: residential care and full-time foster care

Questions do not arise in a vacuum. Anyone working in child and youth services moves in a field in which many young people are looked after outside their family of origin. For 2024, the Federal Statistical Office (Statistisches Bundesamt, Destatis) reports that across Germany around 134,000 young people were looked after in a residential home and just under 87,500 in a foster family; in total, around 221,500 young people grew up, at least temporarily, outside their family of origin, around 7,000 or 3% more than in 2023 (Destatis, 2026a). Figure 6 places the two larger figures side by side.

In summary: in 2024, around 134,000 young people were looked after in a residential home and just under 87,500 in a foster family. These figures should be read soberly. They describe an order of magnitude and so give an indication of how many people are affected by decisions in the field. But they say nothing about why the number has risen, nor about which form of support works better or worse. Anyone who draws a statement about effectiveness from the statistics is answering a foreground question with data that were not meant for it.

Two case studies

The following cases are fictional. In both, the focus is expressly only on formulating the question and not on an answer from studies.

Exercise with step-by-step hints

Now it is your turn. The exercise is built on the worked example: you apply the same five working steps to three new, deliberately vague questions.

PART 5 – Critical perspective: Limits, tensions and consequences

Not every good question is an effectiveness question

PICO is a strong tool, but a one-sided one: it thinks in terms of interventions, comparisons and measurable outcomes, that is, in questions about effectiveness. Many questions in social work and nursing are of a different kind. How do people experience a situation? What does a move or a service mean to them? Such questions are hard to capture with a comparison pattern, and it would be a mistake to discard them because they do not fit the pattern. The choice of question determines which form of knowledge comes into view at all. If you ask only foreground questions in PICO format, you systematically screen out whatever cannot be expressed in outcomes. This is why Module 3 takes up the question of which type of study suits which question.

The choice of outcomes is not neutral either. What counts as success is a value judgement: is it the behaviour that practitioners see as progress, or the wellbeing that those affected report? Involving service users in formulating the question does not solve the problem, but it makes it visible. It may also be that there is simply no suitable study for your precise question. That is not a failure of the question but a result that you can name in a term paper as a research gap.

The debate in social work

You already learned in Module 1 that this approach is the subject of controversial debate in German-language social work: supportive, critical and mediating positions face each other. For this module, the critical arguments matter most: the technology deficit of social interaction and the limited transferability of causal models.

For formulating the question, this gives rise to an interpretation that is flagged as such: anyone who approaches practice only with the question “Which method works?” tacitly adopts a technical understanding of social work, as if help could be called up at the push of a button. Anyone who instead uses PICO as one of several questioning techniques and involves service users in the question stays closer to what the critics call for. In a term paper you do not have to take sides, but you should be able to explain why you choose a particular form of question.

Typical stumbling blocks

• Several questions in one: “Does it help, and how do those involved experience it, and what does it cost?” – separate the questions and work on them one after another.
• Unclear intervention: a term like “counselling” or “support” can mean many things; describe what exactly is supposed to happen.
• Missing comparison: without a comparison, “helps” remains an empty word.
• Outcomes that nobody wanted: measurable is not automatically meaningful; clarify with those involved what counts.
• Bending the question afterwards: if you only phrase the question to fit after reading the results, you merely justify what was already settled.

Consequences for term paper, presentation, timed written paper and practical placement

In the term paper a clean question helps you limit the scope and justify your choice of literature. Whether PICO is required or useful there depends on the task and on the requirements of your degree programme; there is no rule that every term paper must contain a PICO question. In the presentation the practice question works well as a common thread: you first present the question, then your search path and finally what you draw from it. In the timed written paper you can name the five steps of the cycle, explain the PICO elements and reformulate a vague question as a precise one. In the practical placement you can raise questions in the team as search questions without attacking routines: asking a question is not criticism but an invitation to think together. This course does not replace any lecture or any practical placement; it helps you organise and practise what you have learned.

Consolidation: Flashcards for the module

The flashcards help you with retrieval. For each card, first think of an answer of your own and only then open it. Retrieving from memory consolidates more than reading again.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and nobody evaluates them. Click an answer; the explanation helps you judge your own understanding.

PART 1 – Introduction: understanding study design and levels of evidence

Activating prior knowledge: ‘There is a study on that’

Imagine a team meeting. Someone says: ‘There is a study on that.’ Surprisingly little has been said for a decision. What question did the study ask? Whom did it investigate? Was a comparison made between two ways of working, were people followed over several years, was a count made on a single day – or did researchers listen and analyse what was said? Depending on the answer, the same statement (‘Studies show …’) can mean something completely different.

In Module 1 you saw that an evidence-based decision brings together several elements: evidence, the person's situation, their preferences and professional expertise. In Module 2 you translated practice questions into search questions and noticed that some questions ask about effect, while others ask about experience or meaning. This module picks up exactly there. It is about the fit between the question and the study that can answer it.

The key terms

A study design is the plan of an investigation: Who is included? Is a comparison made, and if so, with what? Are people followed over a longer period? Are the results numbers or texts? The design determines what kind of question a study can answer at all. A primary study collects its own data. A synthesis – such as a systematic review or a guideline – evaluates existing studies and brings them together.

You already met the term evidence in Module 1; here a reminder of one point that matters for this module is enough: The Institute for Quality and Efficiency in Health Care (IQWiG) describes evidence-based practice as the attempt not to rely on opinions alone when answering questions, but on findings gained with methods that are as objective and scientific as possible (IQWiG, 2025). Evidence is therefore not a synonym for ‘numbers’ or ‘experiment’, but an umbrella term for knowledge gained in a methodologically controlled way. Which method fits which question is the guiding question of this module.

Levels of evidence or hierarchies of evidence are rankings that sort study designs by how well they protect against bias for a particular kind of question. In your studies you will mostly meet pyramids. An important point in advance: These diagrams are thinking models. They differ in the number and naming of the levels, and there is no single official or generally binding pyramid. In Part 5 we look at what such models achieve and where they mislead.

The overview as a mind map

Figure 1 shows the five branches of the module as a mind map: effect, observation, experience and meaning, syntheses, and quality and limits. You can use it as a map and come back to it later when you need to classify a design in a term paper.

PART 2 – Foundations: how to recognise reliable results

Certainty of results: three aspects according to IQWiG

Before we turn to individual designs, you need yardsticks. In its General Methods, IQWiG names three aspects on which the certainty of results of clinical studies depends primarily: internal validity, external validity and statistical precision (IQWiG, 2025). Although these methods come from health research, the three terms also help with studies from social work, childhood education, curative education and nursing, because they pose questions that make sense for any investigation.

• Internal validity: Can an observed difference really be traced back to what was investigated – or could systematic distortions, so-called biases, have shaped the result? This is about the internal logic of the study.
• External validity: Does the result hold beyond the study – for other people, other services, a different everyday setting? This is about transferability.
• Statistical precision: How exact is the estimate? A study with few participants usually gives less precise results than a larger one. How to read this imprecision is covered in Module 5.

The three aspects do not always go together. A study that works under tightly controlled conditions can be very convincing internally and still reveal little about everyday life in a residential group or a care home. Conversely, a study close to everyday practice can be easily transferable but leave more room for bias. For you this means: With every study, ask not only ‘Is this true?’ but also ‘For whom and under what circumstances?’.

Randomisation: why chance helps

Randomisation means that chance decides who ends up in which comparison group – for example by drawing lots or by computer. IQWiG notes that random allocation to comparison groups increasingly became an internationally accepted standard from the beginning of the 1960s (IQWiG, 2025). The reason is simple: People differ in many things that can influence the outcome – in age, motivation, prior experience or life situation. If chance decides the allocation, known and unknown differences are, on average, spread evenly across both groups. A difference at the end can then more plausibly be traced back to the measure being compared.

Two misunderstandings are worth avoiding. First: Randomisation is the random allocation to groups, not the random selection of participants. Second: It protects against certain kinds of bias, but not all. The Cochrane tool RoB 2, which appears in detail in Module 5, looks at five domains in randomised studies in which bias can arise – starting with the randomisation process itself (Higgins et al., 2024). A study can therefore be called ‘randomised’ and still have weaknesses.

Quality criteria: quantitative and qualitative studies

When studies collect numbers, methodology usually draws on three quality criteria: objectivity, reliability and validity. Qualitative research works with different quality standards because it aims to understand, not to measure. Two frequently mentioned ones are the traceability (Nachvollziehbarkeit) of the procedure and the appropriateness of the method to its subject (Gegenstandsangemessenheit) . How exactly such lists are put together and named differs depending on the methods literature; for your term paper this means: Use the terms and sources used in your methods literature, and cite them there.

PART 3 – The most important study designs at a glance

Now you will get to know the designs you meet most often in specialist texts on social work, curative education and nursing. The point is not rankings, but the question: What can this design answer – and what can it not? You will remember the foreground question from Module 2 (‘Does A help compared with B for C?’): It is the classic question that comparative designs answer. Other questions need other designs.

Randomised controlled trial (RCT)

In a randomised controlled trial chance allocates the participants to an intervention group and a comparison group. Both groups are followed in the same way, and at the end outcomes defined in advance are compared. This is where your PICO from Module 2 pays off: population, intervention, comparison and outcome (Higgins et al., 2024) must be clear before the start. The strength of this design lies in the fair comparison and therefore in high internal validity for questions about effect.

The limitations are just as important. Randomised studies are demanding, and random allocation is not always practically possible or ethically acceptable – for example when people urgently need help or when services cannot be freely assigned. In social work settings there is the additional point that those involved usually know which service they receive. And because conditions in a study are often more orderly than in everyday practice, the question of transferability (external validity) remains open.

Cohort study

A cohort study follows a group of people – the cohort – over a longer period and observes what happens. Typically it compares how people with different experiences or characteristics develop later on. It is therefore suited to questions about course over time, prognosis and risk factors. A cohort study could, for example, observe how the job satisfaction of newly qualified nurses develops over several years.

The decisive point: The researchers do not assign the experiences, they only observe them. This is why confounders (confounding factors) can distort the picture – these are factors that are related both to the experience under investigation and to the later outcome. An association therefore does not automatically imply a cause. You will need this principle – correlation is not causation – once more in Part 5.

Case-control study

The case-control study reverses the direction of view. It starts from the outcome: People in whom an event has occurred (cases) are compared with people who are as similar as possible but without this event (controls). Looking back, the question is how the two groups differed earlier. The design is particularly useful when an event is rare and a cohort would have to be very large and followed for a very long time. Limitations lie in the memory of those asked and in the choice of controls: Do they really match the cases?

Cross-sectional study

A cross-sectional study is a snapshot: At one point in time or over a short period, characteristics are collected, for example by a survey. It answers questions about frequency and prevalence (‘How widespread is …?’) and can show associations. Because everything is recorded at the same time, it remains open what came first. The design is therefore not sufficient for statements about course over time or cause.

Qualitative studies

Qualitative studies work with interviews, group discussions, observations or documents. They aim to understand how people experience, interpret and evaluate something – and why a service is accepted or rejected. Their strength is depth: They make visible what does not appear at all in questionnaires with preset answers. Their results are not statements about frequency; instead they need other quality standards such as traceability and appropriateness to the subject. Important for your judgement: Qualitative studies answer different questions, not the same questions less well. Anyone who dismisses them across the board as ‘weaker’ is comparing apples with oranges. Some studies combine both approaches by combining qualitative and quantitative data collection.

Systematic review and meta-analysis

A systematic review searches for, selects, appraises and summarises studies on a clearly defined question according to criteria set in advance. The Cochrane Handbook describes how the question and the inclusion criteria of a review are defined using PICO (Higgins et al., 2024). A meta-analysis is one possible building block: It statistically combines the numerical results of several studies, as far as the studies are comparable enough. Not every review contains a meta-analysis. The PRISMA 2020 checklist with 27 items in seven sections sets out what a review should report transparently; however, it is a reporting guideline, not instructions for carrying out a review and not an instrument for assessing quality (Page et al., 2021). For randomised studies there is a corresponding reporting guideline in CONSORT 2025 (Hopewell et al., 2025). You will get to know both as reading aids in Module 5.

Guidelines as a synthesis

Guidelines are not studies but syntheses: They combine evidence and expertise into recommendations for practice. How systematically they were developed is shown by the classification in the AWMF rulebook (version 2.2 of 22 May 2025). The ‘S’ there stands for the degree of systematic development; a distinction is made between S1 recommendations for action, S2k, S2e and S3 (AWMF, 2025). An S2e guideline requires, for example, a systematic search, selection and appraisal of the evidence, while an S3 guideline combines all elements of systematic development. How to classify guidelines you will learn in Module 6; here it is enough to note that they, too, as a synthesis build on the primary studies described in this part. (AWMF = Association of the Scientific Medical Societies in Germany.)

The designs compared

The following table summarises the designs. Figure 2 then places three families side by side: designs that investigate an effect, designs that observe, and designs that aim to understand.

PART 4 – Choosing the right design: from question to study

Principle: the question determines the design

Beginners often ask: ‘Which design is the best?’ The better question is: ‘Which design fits my question?’ If you want to know whether one service changes something compared with another, you need a comparison. If you want to know how young people experience a conversation, you need to listen. Neither design is better; they answer different questions. Figure 3 shows a decision tree with five typical questions, the designs that fit them and one limitation each that you should always keep in mind.

Read the tree from top to bottom. The level with the question comes first, the design follows from it, and the dashed boxes at the bottom remind you that every design has a limitation. For questions about effect, the randomised study is often the first choice; if it is not possible, comparison studies without random allocation can be an alternative, although they call for more caution when it comes to statements about causes.

Worked example: four questions, four routes

Before you practise yourself, here is a fully worked example. The questions are explicitly meant only as research questions; they say nothing about the effectiveness of any service. Figure 4 shows the four steps you go through with every question.

Practice example: how the DNQP searches hierarchically

What does an orderly approach look like in the practice of a professional standard? The German Network for Quality Development in Nursing (DNQP) searches hierarchically for its national expert standards (Expertenstandards): first for systematic reviews, then for primary studies. The search covers MEDLINE, CINAHL and the Cochrane Library, among others, and the search is documented with a PRISMA flow diagram. For appraisal, the DNQP uses instruments such as AMSTAR-2, RoB 2 and AGREE II and presents the certainty of the evidence using GRADE. Where the body of evidence is weak, the judgement of the expert group carries particular weight (DNQP, 2025b).

The logic behind it: A good review brings together many studies and is therefore usually the most efficient source; only when it is missing or leaves gaps is it worth looking at individual primary studies. This ‘top-down’ searching is a working strategy that fits questions about effect and the body of evidence. It does not mean that reviews would be the right source for every kind of question – questions about experience, for example, call for other studies. You will find more details on expert standards in Module 6.

PART 5 – Critical appraisal: hierarchies of evidence, the debate and limits

The pyramid as a thinking model

In many teaching texts you will find a pyramid: At the top are syntheses and randomised studies, below them observational studies, and at the very bottom individual observations and expert opinions. The idea behind it is understandable. For a question about effect, a design with random allocation protects better against bias, and this is why, from the beginning of the 1960s, randomisation increasingly became the internationally accepted standard for testing the effectiveness and safety of medical interventions (IQWiG, 2025). For learning, the pyramid is helpful because it creates a first order.

The weaknesses show as soon as you read it as a ranking for all questions. For the pyramid silently answers only one kind of question: the one about effect. For questions about experience, meaning or prevalence it has no suitable place. In addition, representations differ in the number and naming of the levels; there is no single official or generally binding pyramid. Anyone who speaks of ‘the’ pyramid of evidence in a term paper should therefore state which representation they mean and which source it comes from.

A question-based model reverses the order: The question comes first, then the suitable design, and only after that is the quality of implementation within that design considered. Figure 5 contrasts both views as a matrix.

The debate in social work

The dispute about evidence-based practice is lively in German-language social work, and it concerns precisely the question of study designs. Broadly, three lines can be distinguished:

• Supportive positions stress the value of randomised studies of effect: Anyone who wants to know whether support changes anything needs robust comparisons.
• Critical positions point to a so-called technology deficit of social interaction (Technologiedefizit) – meaning that social action does not work like a technique in which the same causes reliably produce the same effects. Further objections are the limited transferability of causal models and concern for professional autonomy.
• Mediating positions lie in between: They recognise the usefulness of studies but do not want them to be understood as the sole basis for decisions.

These lines are deliberately not attributed here to individual people; for your work it is worth reading primary texts of the debate yourself and documenting the position of the respective authors. Evidence-based nursing stresses that, besides external evidence, internal evidence – the needs and experiences of those involved – also feeds into decisions. This, too, is an answer to the limits of pure effectiveness research. What role this perspective plays in practice you will explore in Module 7.

Avoiding typical fallacies

• Correlation is not causation. An observed association does not imply a cause as long as confounders have not been ruled out.
• ‘No study found’ does not mean ‘does not work’. Missing studies are a gap in knowledge, not proof that something has no effect. In many areas of social pedagogy, studies on numerous questions are simply lacking.
• One study is not yet a body of evidence. Individual results can be due to chance or shaped by peculiarities of the sample; reviews bring together several studies.
• Qualitative studies are not weaker, but different. They answer other questions and are judged by other quality criteria.

Consequences for term papers, presentations, timed written papers and practical placements

For your term paper this means: Justify why you draw on a particular design for a question or how you classify a study result. State the limitation right away – this shows critical thinking. Wording such as ‘The study suggests …’ or ‘The association does not allow any statement about the cause’ is more precise than ‘The study proves …’. In a presentation, a short statement on the design and its limits helps as a frame for every finding. In a timed written paper, it pays off if you can describe designs with question, strength and limitation. And in a practical placement, when someone asks ‘Is there a study on that?’, you can ask what kind of question it is actually meant to answer.

How to find such studies in a targeted way you will practise in Module 4. How to read them critically afterwards and spot bias follows in Module 5.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and nobody evaluates them. Click an answer; the explanation helps you assess your own understanding.

PART 1 – Searching as a craft: terms and context

Where searching sits in the cycle

In Module 2 you built a PICO question from a vague practice question. Now comes the step at which many students notice for the first time how much craft there is in academic work: finding. Evidence-based practice in nursing is described as a sequence of steps that runs from shared decision-making and problem formulation through searching and critical appraisal to a change in practice and evaluation. Searching therefore sits between the question and the critical appraisal: it supplies the material that you read critically in Module 5.

Keep the framework from Module 1 in mind. According to the Institute for Quality and Efficiency in Health Care (IQWiG, 2025), an evidence-based decision consists not only of evidence, but also of a person’s condition and circumstances and of their preferences. Searching therefore answers only part of the decision. It can show what research reports on a question; whether it fits this person, their life situation and their wishes is something you clarify later, in the team and with those involved (more on this in Module 7).

Key terms, clearly defined

Technical terms quickly seem arbitrary in term papers if they are not defined. So here are the basic terms of this module first. By literature search we mean here the planned and traceable search for publications on a clearly formulated question. A literature database is a searchable directory of such publications. A citation is the bibliographic reference to a text, an abstract is its short summary. According to the National Library of Medicine (National Library of Medicine [NLM], n.d.), PubMed, for example, contains more than 40 million citations and abstracts of biomedical literature (retrieved October 2026).

The search line (often also called a search string) is the combination of search terms and operators that you enter into a database. The search log records what you searched, where, when and with which line. The results list is what the database then returns. You also need a distinction that already played a role in Module 3: primary studies report on their own data collection, syntheses summarise several studies. Syntheses include systematic reviews, guidelines and expert standards. According to Cochrane Germany (n.d.), Cochrane, for example, is an international network that has been producing systematic reviews for more than 30 years. This module clarifies where you find such syntheses.

Searching broadly or narrowly: a trade-off

Every search sits between two wishes. A broad search finds a lot that is relevant, but also a lot that is not. A narrow search gives you a manageable list, but risks gaps. There is no setting that is always right. For a short presentation you may search more narrowly and look at overview articles first. If, on the other hand, you want to justify a practice question in the team, a broader search across several sources is worthwhile. What matters is that you know your choice and can justify it.

Figure 1 summarises the search routes of this module as a mind map: databases, evidence portals and syntheses tell you where to search; search strategy and documentation tell you how to search and how to make it traceable. The five branches also form the outline of the next parts.

PART 2 – Where to search: databases, evidence portals and syntheses

There is no single search engine for evidence-based practice. A different place is worthwhile depending on the question. Figure 2 sorts three types of access points; Table 1 compares them by content, access and suitability.

PubMed: a records database for biomedical literature

PubMed is run by the National Center for Biotechnology Information at the U.S. National Library of Medicine (National Library of Medicine [NLM], n.d.). Its focus is biomedical literature. That suits questions from health and nursing; for purely social-pedagogical questions you should also draw on other sources. A second point is often overlooked: PubMed itself does not contain full texts, but often links to them. So first you find the record, and then you have to obtain the text. Many full texts are only accessible via the university library (Hochschulbibliothek); others are freely available because they were published as open access. Allow time for obtaining them when you write term papers.

Cochrane and Cochrane Germany: reviews with plain-language summaries

Cochrane is an international network that has been producing systematic reviews for more than 30 years. Cochrane Germany has existed since 1998; since 2017 it has been a non-profit foundation funded by the Federal Ministry of Health and the University Medical Centre Freiburg (Cochrane Deutschland, n.d.). What is particularly useful for you as a student is that the reviews have plain-language summaries. They make it easier to get started, but they do not replace reading the review itself if you want to support a statement in a piece of work. The Cochrane Handbook (Higgins et al., 2024) is also the methodological reference to which the PICO mnemonic from Module 2 relates. The DNQP, too, names the Cochrane Library as one of its search sources (DNQP, 2025b).

Campbell Collaboration: evidence for social policy questions

For social work, the Campbell Collaboration is an important counterpart to the sources with a medical orientation. According to Welch (2021), it sees itself as a member-supported open-access organisation that provides systematic reviews and evidence and gap maps for social policy decisions. An Evidence and Gap Map is an overview that shows where studies exist on a topic area and where there are gaps. This helps you with the question of whether it is worth searching for effectiveness studies at all. In 2021 a new Coordinating Group “Child Welfare” was set up; alongside it there is, among others, the group “Social Welfare”. For questions from child and youth welfare this is an obvious starting point.

Finding guidelines and expert standards as syntheses

Sometimes you do not need individual studies, but guidance for practice. Then it is worth looking at guidelines and expert standards. The AWMF rules and regulations for guidelines (AWMF-Regelwerk Leitlinien) are available in version 2.2 of 22 May 2025. There, the “S” of the classification stands for the degree of systematic approach in the development process (AWMF, 2025). An S1 recommendation for action arises from the informal consensus of an expert group. S2k requires a representative guideline group and structured consensus-building under neutral facilitation, S2e a systematic search, selection and appraisal of the evidence. An S3 guideline combines all elements of systematic development. You practise how to classify guidelines in more depth in Module 6; for now it is enough to know this: do not search only for the topic, but read the class and the date as well.

According to the methods paper, expert standards of the German Network for Quality Development in Nursing (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege, DNQP) are evidence-based, single-discipline instruments that describe nursing’s contribution to key quality risks (DNQP, 2025b). So they are not studies, but syntheses with a defined development procedure. The content of individual guidelines and standards is not the subject of this module; you learn how to find and classify them.

PART 3 – From the PICO question to the search line: building a search strategy

The route at a glance

According to the Cochrane Handbook, PICO is a mnemonic for populations, interventions, comparisons and outcomes, used to define the question and the inclusion criteria (Higgins et al., 2024). You know it from Module 2. Figure 3 shows the path from this question to the log in six steps.

Deriving search terms from PICO

You turn each building block of your question into a list of search terms. People do not all use the same words: what you call a “Wohngruppe” (residential group) is called “stationäre Jugendhilfe” (residential youth welfare) in other texts, or “residential care” in English. For each building block, therefore, collect synonyms, spelling variants (singular and plural, British and American spelling) and English technical terms. The latter are important because the large databases are indexed mainly in English. A good source of terms is the titles and abstracts of the first relevant hits: there you see how authors actually name the topic.

Not every PICO building block belongs in the search line. You often start with population, setting and intervention. Comparison and outcomes are often named differently or not at all in titles and abstracts; if you put them into the line too early, you lose relevant studies. They help you instead when screening: you can use them to recognise whether a hit fits your question.

Boolean operators: AND, OR, NOT

Boolean operators link search terms logically. Many interfaces expect them in capital letters; the exact spelling differs from database to database. The rule for everyday use: OR within a building block, AND between the building blocks, NOT only with great care. Table 2 compares the three operators.

Why is NOT risky? If you exclude a term, you also remove every hit in which it appears only in passing, for example in a list in the abstract. You do not notice what you lose as a result. For beginners the rule is: narrow the search with AND and filters instead, and sort out hits during screening.

Wildcards, phrases and filters

With a wildcard (truncation, often written as an asterisk) you search for all word forms with the same beginning: adolescent* finds adolescent, adolescents and adolescence. This saves typing, but it can also pick up unusable words if the word stem is too short. With quotation marks you mark a phrase, that is, words that are to be searched for together, for example "residential care". How wildcards and phrases work together differs slightly in each database. The help page tells you.

Filters limit the results list by properties such as period of publication, language or study type. They are practical, but never neutral: if you allow only the last few years, you give up older foundational work; if you allow only one language, you overlook studies from other countries. Note every filter in the log and justify it. Figure 4 shows how a complete search line results from synonym blocks: within the blocks OR widens, between the blocks AND narrows.

PART 4 – Working traceably: search log, screening and PRISMA flow diagram

The search log: your memory for the search

Without a log, in four weeks you will no longer know which line you entered where. More important still: nobody can trace your search. A log does not have to be elaborate, but it should record each search so that someone else could repeat it. Table 3 lists the fields that are enough to begin with.

Screening: from the results list to the included studies

The results list is only the raw material. When screening you proceed in stages. First you read the title and abstract and sort out what is clearly unsuitable. Then you obtain the full texts of the remaining candidates and appraise them more closely. What is left is included. It makes sense to derive inclusion and exclusion criteria from your PICO question in advance: Does the population fit? Is the intervention studied? Is there a comparison? Is a relevant outcome reported? For each exclusion at full-text stage, briefly note the reason. This costs little time and saves you later from the question of why a known study is missing.

PRISMA 2020: what the guideline does – and what it does not

PRISMA 2020 is a reporting guideline for systematic reviews. According to Page et al. (2021), it comprises a checklist of 27 items in seven sections and shows what should be reported transparently in a review. It is expressly not a guide to conducting a review and not an instrument for quality appraisal. This needs to be kept clearly apart: PRISMA says how a search is reported, not how good the studies found are. You learn how to appraise studies in Module 5. A core element is the flow diagram, which shows how many hits dropped out at which stage. Figure 5 shows our own, deliberately simplified version with the stages hits, screening and inclusion. The placeholders stand for the numbers that you determine in your own search.

PRISMA 2020 and the simplification shown here are not a compulsory programme for term papers or bachelor’s theses. They are reporting guidelines for publications. Even so, it is worth adopting their logic: if you know how many hits your own search produced, what was sorted out and why, you can justify your work better. Whether and to what extent you present the search path in your work depends on the requirements of your university and of the person supervising your work.

CLEANING Without duplicates SCREENING Title and abstract read FULL-TEXT REVIEW Full texts read INCLUSION Included studies Removed Duplicate records Excluded Does not fit the question Excluded Reasons noted

Figure 5: Simplified flow diagram “Hits – screening – inclusion”. Source: own illustration (AI-assisted), based on Page et al. (2021).

How a professional organisation searches: the DNQP example

The DNQP methods paper shows what this can look like in practice. It describes a hierarchical search: first systematic reviews, then primary studies, including in MEDLINE, CINAHL and the Cochrane Library. Documentation is by a PRISMA flow diagram; appraisal uses instruments such as AMSTAR-2, RoB 2 and AGREE II, and the trustworthiness of the evidence is presented using GRADE (DNQP, 2025b). You do not need to know these instruments now. For searching, the logic is what matters: first look for syntheses, then go into the individual studies, and document every step. That is the same order that you used in the worked example. In Module 3 you also saw that study designs and syntheses have different tasks; searching connects the two.

PART 5 – Limits, tensions and consequences

Good technique does not make a good search. Finally, it is about what even the most careful search cannot do.

No hits does not mean: no answer

If you find hardly any studies on a social-pedagogical question, this is first of all a finding about the data situation, not about the effect of a method. It can mean that there are none, that you searched the wrong source, that your terms do not match the literature, or that the question is studied in a form you did not expect. Biomedical databases such as PubMed cover social work questions only in part; that is why sources such as the Campbell Collaboration, with its evidence and gap maps, are so valuable. Missing studies imply neither that a measure works nor that it does not work. A “nothing found” belongs in the log together with the search path, not in a claim about effectiveness.

Whoever searches also decides: bias in the search process

A search is never completely objective. You decide which databases you use, which terms you choose, which filters you set and which hits you sort out. Someone who uses only English terms sees different texts from someone who also searches in German. Someone who searches only for randomised studies will hardly find qualitative studies on experience and meaning, even though in Module 3 these were classed as valuable in their own right. The log does not remove these distortions, but it makes them visible and so open to discussion. This fits with the following point: a search for a term paper is not a systematic review. Systematic reviews are produced with a fixed procedure and, as a rule, in a team; PRISMA describes how they are reported, not how to carry them out (Page et al., 2021). This module does not make you a review author, but a careful user of search routes. Module 8 shows you how a literature report differs from a systematic review.

Access, language and fairness

Anyone with access to a university library gets full texts more easily than professionals without that access. This is a fairness problem of science that reaches into practice: teams in small organisations sometimes have to manage without access to paid databases. Open-access offerings such as those of the Campbell Collaboration (Welch, 2021) and freely available methods papers such as the DNQP’s (2025b) ease this, but do not solve it. Language is a further issue: a large part of research is in English, while practice is in German. Translation errors and differences in context are a source of misunderstandings that you should watch for when reading.

Searching in the debate on evidence-based social work

The question of what counts as robust knowledge is contested in German-language social work; you know the supportive, critical and mediating positions of the professional debate from Module 1. For searching this means: what you search for reflects what you consider worth knowing. Anyone who searches only for effectiveness studies takes a position, even if this remains unspoken. A reflective search names this decision and asks whether the question might also need other types of study.

Consequences for study and practice

For your studies this means: describe your search so exactly that others can repeat it, and state its limits openly. For practice: do not search alone, but in the team and with a view to the people concerned. A good search supplies material for a decision. You make the decision itself with your professional knowledge and the preferences of those involved, following the procedures of your organisation. This module is not legal advice and replaces neither a lecture nor a practical placement.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and nobody analyses them. Click an answer; the explanation helps you to judge your own understanding.

PART 1 – Reading studies with a method: terms, structure and reading routine

From finding to appraising: critical reading in the EBP cycle

Once you have built a search strategy in Module 4 and screened the hits, the real thinking begins: what does this study say, and how sure can you be of it? In the cycle of evidence-based practice this is the step of critical appraisal, which sits between searching and changing practice. “Critical” here does not mean distrustful or smug, but asking systematically how the robustness of a statement can be recognised. The Institute for Quality and Efficiency in Health Care (IQWiG) stresses that evidence-based decisions should not rest on opinions alone, but on knowledge gained with scientific methods that are as objective as possible (IQWiG, 2025).

A word on scope: “study” here means an empirical investigation that discloses its procedure – from an interview study to the randomised controlled trial that you classified in Module 3. This module concentrates on comparative studies on questions of effectiveness and on systematic reviews, because tools for assessing bias, effect measures and reporting guidelines are most fully developed for them. You know from Module 3 how to classify qualitative work: there, traceability and appropriateness to the subject are the guiding questions, not effect measures.

Figure 1 gives you the map of this module: critical reading is in the centre, and the building blocks you will get to know one after another hang on the five branches. You can come back to this overview at any time to find your bearings.

The structure of a study: five sections, five ways of looking

Most empirical journal articles follow a similar pattern, even if the names and the order vary by discipline and journal. The abstract is the short version: it tells you what the study is about and what came out of it, but it is necessarily condensed and often worded optimistically. The introduction explains why the question matters and leads to the research question. The methods section states who was studied, how the groups were formed, what was measured and how the data are analysed. The results report what came out – ideally without interpretation. In the discussion the authors interpret their findings, compare them with other studies and name limitations.

Each of these sections answers a different question, and each calls for a different reading attitude. The following table brings together guiding questions you can use to work through the sections critically. It is a reading aid and not a complete appraisal method; for systematic judgements you need the tools in the following parts.

The reading routine: methods first, then results

Why the methods first? If you read the abstract and the discussion first, you unwittingly adopt the authors’ interpretation and then read the results through those glasses. If you first know how the groups were formed and the outcomes measured, you can place the results in context before interpretation colours them. This is a working habit, not a law; what matters is that you choose your order deliberately and stick to it. Figure 2 shows a routine in five steps that you can use for term papers, presentations and the journal club (Module 8).

PART 2 – Recognising bias: systematic errors and the RoB 2 tool

What does bias mean?

Bias (German: Verzerrung) is a systematic error that shifts results in a particular direction. It must be distinguished from random fluctuation: this evens out on average and can be narrowed down with more participants. Systematic distortion, by contrast, does not disappear just because a study is large. Imagine kitchen scales that always show a little too much: if you weigh a hundred times, the average becomes more stable, but it stays wrong.

IQWiG bases the certainty of results of clinical studies on three aspects: internal validity, external validity and statistical precision (IQWiG, 2025). Bias mainly affects internal validity, that is, the question of whether a difference that has been found can be due to the intervention under study at all. You know the two validity concepts from Module 3 and do not need to learn them anew here; you will turn to statistical precision in Part 3.

RoB 2: five domains, three judgements

For randomised trials, Cochrane has developed the tool RoB 2 (Risk of Bias 2). It breaks the question “How susceptible is this result to bias?” down into five areas, which are called domains (Higgins et al., 2024). Each domain comes with guiding questions that you use to go through the study. In your own words and applied to everyday life, they read as follows:

• Randomisation process: Was the allocation to the groups really generated at random, and could nobody predict or steer it in advance? Groups that already differ clearly at the start are a warning sign.
• Deviations from the intended interventions: Did both groups receive what was planned? It becomes problematic, for example, if the comparison group also uses a similar service or if professionals change their behaviour because they know who belongs to which group.
• Missing outcome data: For how many people are there no measurements at the end, and is dropping out related to the intervention or the outcome? If people with an unfavourable course are more likely to leave the study, the result looks better than it is.
• Measurement of the outcome: Was the outcome measured in the same way in both groups, and did the assessors know who belonged to which group? People who know the group allocation sometimes judge more favourably without realising it.
• Selection of the reported result: Was what had been planned in advance reported, or only the favourable results from many possible analyses?

For each domain, RoB 2 gives one of three judgements: low risk, some concerns or high risk. The overall judgement for a study is at least as unfavourable as the most unfavourable domain; some concerns in several domains can also lead to an overall “high risk” if they substantially lower confidence in the result (Higgins et al., 2024). That sounds strict, but it is logical: a chain is only as strong as its weakest link, and a serious flaw in one place cannot be made up for by care in four others. Figure 3 shows the five domains with an invented example judgement. Note that the judgement levels are distinguished not only by colour, but also by shape and text.

You should avoid two misunderstandings. First, “high risk” does not mean that a study is worthless; it means that its result has to be read with particular caution and should carry little weight on its own. Second, RoB 2 is intended for randomised trials. It cannot simply be transferred to studies without random allocation; for those you need other tools; you saw in Module 3 which designs exist and how to classify them. And one more thing: two assessors may reach different judgements on individual domains. RoB 2 structures your thinking, it does not replace judgement.

Blinding and closeness to practice: a tension

In social work and nursing, RoB 2 reaches a practical limit. People who take part in a group programme generally know that they are taking part, and professionals who deliver a programme know who is in which group. Completely concealing group membership, as one imagines it from everyday medicine, is often not possible here. This is not a failing of the researchers but lies in the nature of the subject. It must nevertheless be reported openly and taken into account when weighing the results, for example through the domains on deviations from the intended interventions and on measurement of the outcome.

At the same time, a tension appears that plays a role in the German-language debate on evidence-based social work: positions in favour stress the strength of randomised effectiveness studies, while critical positions point to the technology deficit of social interaction and to the limited transferability of causal models. For your critical reading this means: bias tools are valuable, and they also show how hard it is to translate practice conditions into strict study designs. You can keep both in view at the same time.

PART 3 – Effects in words: risk, difference, NNT and precision

Which effect measures exist and what they are for

An effect measure is a number that describes how large the difference between two groups is. Which number makes sense depends on the type of outcome. For outcomes with two possible values (“event yes/no”, so-called dichotomous outcomes), the Cochrane Handbook names the risk ratio, the odds ratio and the risk difference; for continuous outcomes (for example scores on a scale) it names the mean difference and the standardised mean difference (Higgins et al., 2024). Added to these is the number needed to treat (NNT), which is derived from the risk difference. The following table translates all the measures into questions that you could also explain to a team.

A warning in advance: there are deliberately no fixed thresholds here for when an effect would be “small”, “medium” or “large”. How important a difference is depends on the professional question, on the outcome and on the consequences for the people affected, and such rules of thumb easily suggest a clarity that does not exist.

Worked example: from “20 out of 100” to an everyday sentence

Now we work through an example step by step before you try a task yourself. The figures are entirely invented: this is an invented study of an invented group programme, and it says nothing about the effectiveness of real programmes. The event that is to be avoided we simply call an “adverse event”. The intervention group (with the group programme) contains 100 people, of whom 20 have an adverse event. The control group (without the programme) also contains 100 people, of whom 30 do. Figure 4 records these details in a two-by-two table: two groups times two outcomes.

What the calculation does not achieve is at least as important as what it shows. It does not tell you whether the groups were formed fairly (that is the bias question from Part 2), nor how certain the estimate is given the sample (that is the precision question further below), nor whether the difference reaches a particular person. The NNT is also an average across groups and not a prediction for individuals. The same applies to the question of causation: whether a difference may be attributed to the intervention is decided by the design of the study (Module 3) and not by the type of calculation.

Relative or absolute? Why “risk halved” alone says little

The Cochrane Handbook states that relative measures can only be interpreted with the baseline risk in view, whereas absolute measures such as the risk difference are particularly suitable for weighing up options (Higgins et al., 2024). The example above shows it: “a third fewer” sounds like a lot, yet behind it are 10 percentage points. For a very rare event, the same relative reduction can stand behind a tiny absolute difference; for a common event, it stands behind a large one. Without the starting values you cannot tell the two apart. So whenever you read statements such as “risk halved” or “twice as common”, always ask: starting from what value?

The confidence interval: how precise is the estimate?

Every study examines only a sample, never all people. Every effect measure is therefore an estimate with uncertainty. The confidence interval (CI) makes this uncertainty visible: it gives a range of values that is well compatible with the observed data. A narrow interval means a precise estimate, a wide one an imprecise estimate. IQWiG lists statistical precision as a separate aspect of the certainty of results (IQWiG, 2025). Small studies tend to have wide intervals, large ones narrow intervals; a narrow interval, however, says nothing about whether the study is free of bias. Precision and freedom from bias are two different properties.

Figure 5 shows the principle schematically. The dashed line marks “no difference between the groups” (for differences this is the value 0, for ratio measures such as the relative risk the value 1). Study A has a narrow interval that lies entirely on one side of the line: the study separates a difference fairly clearly from “no difference”. Study B has a wide interval that includes the line: with these data, both a benefit and no difference are compatible. Both studies are invented, and the graphic deliberately contains no numbers.

PART 4 – Reporting guidelines as a reading aid: CONSORT 2025 and PRISMA 2020

Reporting guidelines are not a quality verdict

In journal articles you keep coming across notes such as “reported in line with CONSORT” or “according to PRISMA”. What is meant are reporting guidelines: checklists that set out what authors should transparently state in a publication. They therefore say what should be reported, not how well a study was carried out. For you as a reader this is helpful all the same: if you know what a complete report should contain, you notice more quickly when something is missing. Figure 6 places three tools side by side that are easily confused but have different tasks.

The difference between the columns is fundamental: CONSORT and PRISMA are aimed at authors who report, RoB 2 at readers and review teams who appraise. A study can be carefully reported and still have methodological weaknesses; conversely, a well-conducted study may have been reported incompletely. If an item is missing, however, you do not know what happened, and it is precisely this uncertainty that you should make visible in your judgement.

CONSORT 2025: checklist for randomised trials

CONSORT 2025 is the reporting guideline for randomised trials and has replaced CONSORT 2010 (Hopewell et al., 2025). The current checklist has 30 items. For your reading it is worth looking at some of the new features, because they touch on questions you already know from judging bias: there is an item on the handling of missing data, which refers to the area of missing outcome data from Part 2, and one on recording harms, that is, adverse effects alongside the benefit. Added to these are, among others, items on data sharing, on conflicts of interest and on the involvement of patients and the public.

PRISMA 2020: reporting guideline for systematic reviews

PRISMA 2020 applies to systematic reviews. The guideline consists of a checklist with 27 items in seven sections; it sets out what a review should report transparently, and it is expressly not a guide to conducting a review and not a tool for quality appraisal (Page et al., 2021). The flow diagram you know from Module 4 belongs in this context: it shows how many hits were screened and how many were included. When you read a review, you can use four questions as a guide: is the search documented in a traceable way? Is it clear by which criteria studies were included or excluded? Was the quality of the individual studies appraised, for example with RoB 2? And does this appraisal feed into the conclusions?

That the link between appraisal and reporting guideline is also put into practice is shown by a look ahead to Module 6: the DNQP (German Network for Quality Development in Nursing) documents its literature search with a PRISMA flow diagram and appraises the literature it finds with instruments such as AMSTAR-2, RoB 2 and AGREE II (DNQP, 2025b). Here you can see how the building blocks of this module work together, without having to master the individual instruments in detail yet.

Putting it together: a reading pass in four questions

The previous parts can be turned into a short routine that you can apply to any comparative study. First: does the question of the study fit my practice question (PICO from Module 2)? Second: how were the groups formed, who dropped out, who knew what, what was planned in advance (bias from Part 2)? Third: how large is the effect in words, absolute and relative, and how precise is the estimate (Part 3)? Fourth: is the report complete enough that I could answer the first three questions at all (Part 4)? If you cannot answer one of these questions, that is a finding in itself, which you should record in your judgement.

PART 5 – Applying and placing in context: practice, limits and outlook

Practice: reading a fictional abstract critically

You have followed the worked example, now it is your turn. The following abstract is entirely invented and does not reproduce a real study. It is only meant to make typical gaps visible.

Limits of critical reading

Part of dealing with studies scientifically is knowing the limits of your own tools. You should keep five restrictions in mind.

First, bias tools are aids to thinking, not calculating machines. Two readers can reach slightly different judgements on the same study, and the reasons should be documented. Second, the best-developed instruments are tailored to randomised trials. Many questions in social work cannot, or only with difficulty, be investigated in this way, and often no such studies exist for them; this is part of the debate on evidence-based social work, in which supporters and critics weigh their positions differently. The absence of randomised trials does not mean that there is no robust knowledge; it means that you have to classify other designs differently (Module 3).

Third, effect measures show average differences between groups. They say nothing about whether an intervention fits the values, wishes and life circumstances of a particular person; Module 7 is devoted to this question. Fourth, the quality of a report is not the quality of a study: careful reporting according to CONSORT or PRISMA makes a study transparent, but not automatically good. Fifth, criticising can become an end in itself. If you dismiss every study as useless, you have gained nothing. The aim is a reasoned judgement with reservations that is usable for decisions in the team.

Behind this lies a professional-ethical stance: the professional ethics of the German Professional Association for Social Work (DBSH) assume that the practice competence of social work rests on scientifically secured knowledge (DBSH, 2024). Anyone who reads studies critically takes this claim seriously: it prevents statements from being believed simply because they appear in a journal or because they sound good. It is also a matter of responsibility towards the service users whose living situation is affected by decisions.

Outlook: what comes next

In Module 6 you classify guidelines, expert standards and professional standards, which summarise many studies as syntheses and whose structure you read step by step there. In Module 7 you ask how evidence comes together with the preferences and the lifeworld of the people concerned, and in Module 8 you bring everything together in the journal club and the literature report. The reading routine from this module accompanies you through all three.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and not analysed by anyone. Click an answer; the explanation helps you assess your own understanding.

PART 1 – From the single study to orientation: an overview of syntheses

Why not everyone reads all the studies themselves

In the earlier modules you learned to turn a practice question into a search question (Module 2), to classify study designs (Module 3), to search in a targeted way (Module 4) and to read a single study critically (Module 5). That is demanding and takes time. In everyday work nobody can start their own literature search for every decision, appraise studies and weigh the findings against each other. That is why there are documents that bundle knowledge and condense it into orientation. In this module we call them syntheses for practice: texts in which a group of experts collects and weighs findings according to a described procedure and turns them into recommendations, requirements or principles.

The decisive point is never just the question “What does it say?”, but: Who produced it, by what procedure, for whom and when? If you can read these four details, you can also classify a document you have never seen before. That is exactly what we practise here. The framework from Module 1 still applies: a synthesis is one building block of evidence – it replaces neither the expertise of the professional nor the question of what the person concerned wants and what their situation is.

The overview: five branches around classifying

Figure 1 shows the map of this module. At the top left are the AWMF guidelines, at the top right the DNQP national expert standards, at the bottom left the professional standards of social work, at the bottom right the law, and in the bottom centre the critical classification that links all the other branches. If you lose the thread later in the text, it is worth looking back at this figure.

Four terms you must keep apart

In everyday study life, “guideline”, “standard” and “directive” are often used as if they meant the same. For term papers and timed written papers that is a risk, because the documents differ in origin, procedure and binding force. We therefore work with four clearly separated terms.

Guideline (Leitlinie): an aid to orientation for decisions in a field of care, developed by a described procedure. In Germany the Association of the Scientific Medical Societies in Germany (AWMF) classifies guidelines by the degree of systematic method in the development process and distinguishes several classes for this purpose (AWMF, 2025). A guideline is a decision aid, not a law.

National expert standard (Expertenstandard): The German Network for Quality Development in Nursing (DNQP) describes national expert standards as evidence-based, monodisciplinary instruments that set out the contribution of nursing to key quality risks (DNQP, 2025b). “Monodisciplinary” means that the standard speaks from the perspective of one professional group, here nursing. Other professional groups in the team are not automatically included.

Professional standard (Fachstandard): In this course we use the term as a collective label for positions of professional and specialist associations that describe attitudes and professional requirements. These include the professional ethics of the German Professional Association for Social Work (DBSH, 2024) and the international definition of social work (IFSW, 2014). Both are positions of professional associations and are not law.

Law or statutes: binding legal rules. An example from nursing that you know from Module 1 is the professional code of the Nursing Chamber of North Rhine-Westphalia (Pflegekammer NRW, 2025), which, however, applies only to chamber members in NRW. You will find more in the legal basis box further down.

Figure 2 places the three professional document types side by side. Pay attention to the “Perspective” row: it often decides whether a document is intended for your field of work at all.

The following table adds law as a fourth type and makes the differences in binding force visible. The limit of your statement matters here: whether a professional document plays a role in a specific legal dispute, contract or administrative procedure is a legal question. This module does not answer it, and professionals do not give legal advice in individual cases.

A decision tree for everyday use

When you come across a document, four questions help, answered in order. Figure 3 shows the decision tree: first you check whether it has been officially published (then it is law), then whether it carries an AWMF class (then it is a guideline), then whether it comes from the DNQP (then it is a national expert standard), and finally whether it is the position of a professional association (then it is a professional standard). If a question stays open, you clarify publisher, procedure and version date and start again.

PART 2 – Guidelines: what the “S” tells you and how to read a guideline

The S in the AWMF classification

The AWMF rulebook for guidelines (AWMF-Regelwerk Leitlinien) is available in version 2.2 of 22 May 2025 (AWMF, 2025). It sets out how guidelines are developed and classified. The “S” stands for the degree of systematic method in the development process (AWMF, 2025). So it is a statement about the procedure – not about the correctness or importance of an individual recommendation. This is an obvious misunderstanding, and one sentence avoids it: the class describes how a guideline came about, not whether it fits your case.

Four classes, four procedures

According to AWMF (2025), the classes can be distinguished as follows. An S1 recommendation for action comes about through the informal consensus of a group of experts. An S2k guideline requires a representative guideline group and structured consensus-building under neutral moderation. An S2e guideline requires a systematic search for, selection and appraisal of the evidence. An S3 guideline combines all elements of systematic development. Figure 4 lays these descriptions over each other as a matrix: you can see at a glance which elements are required in which class and where there is only a “–”, meaning that no corresponding requirement is stated.

Two reading tips help you understand the matrix. First: S2k and S2e are not preliminary stages of each other, but set different emphases – here the breadth of participation and the structure of voting, there the systematic work with the body of studies. Second: the classes do not form an evidence pyramid in the sense of Module 3. There you saw that evidence hierarchies are a way of thinking and that the suitable study design depends on the question. The S-classes say something about the development procedure of the guideline, not about the type of study behind individual sources.

Guidelines for social work too? The example of the child protection guideline

The very name of the AWMF shows that it comes from medicine. The child protection guideline (Kinderschutzleitlinie) (AWMF register no. 027-069) shows that guideline work can open up across professional boundaries: its title expressly mentions the involvement of child and youth welfare services and education, and it is aimed at the health system, child and youth welfare and education (Kinderschutzleitlinie, 2022). 82 scientific societies, organisations, federal ministries and federal commissioners were involved in its development (Kinderschutzleitlinie, 2022). This breadth shows how many perspectives were brought together; it is expressly not, however, proof of the effect of individual measures. The content or recommendations of the guideline are not the subject of this module – here we are concerned with classifying.

The statusis also important: the short version was updated on 9 January 2022, because of the Child and Youth Strengthening Act (Kinder- und Jugendstärkungsgesetz). The document carries a note that it has not been updated for more than five years and is currently being revised (Kinderschutzleitlinie, 2022). This applies as of the retrieval date October 2026. We do not know of a date for a new version, and we do not speculate about one. For you this means: a guideline with a revision note is not worthless, but you state the note openly when you cite it.

Worked example: reading a guideline in six steps

Before you practise yourself, we work through an example. We take the child protection guideline and read out only what a profile sheet needs: title and register number, class, version date, validity note, target group and contributors. Figure 5 shows the six steps in the order in which you work through them on the document. Why this order? First the identity of the document, then its procedure, then its currency, then its audience – this stops you from taking over content from an outdated version without noticing.

Result as a profile sheet in three sentences: “The child protection guideline (AWMF register no. 027-069) expressly includes child and youth welfare services and education and was developed with the involvement of 82 scientific societies, organisations, federal ministries and federal commissioners. The short version dates from the update of 9 January 2022; the guideline carries a note that it is currently being revised (as of retrieval in October 2026). In my work I cite the version with its year and state the note.” Note what the profile sheet does not contain: not a single recommendation on content. You read those in the document itself and discuss them in the team or with your practice supervisor.

PART 3 – National expert standards: how the DNQP bundles knowledge in nursing

Definition and structure

National expert standards of the DNQP are, as defined above, evidence-based and monodisciplinary instruments. They consist of a preamble, a commentary and structure, process and outcome criteria for every step of the nursing process (DNQP, 2025b). The nursing process describes how nursing is planned, carried out and evaluated systematically. In a sense the standard lays a grid over this sequence and asks at each point: what is needed as a precondition, what should happen, and how do you recognise the result?

The three types of criteria can be understood like this: Structure criteria describe the preconditions, such as competences, resources and rules in the organisation. Process criteria describe the action itself. Outcome criteria describe what should be achieved. The commentary gives reasons for and explains the criteria; the preamble frames the standard. The following table turns each element into a question you can ask while reading. You find the answers in the standard itself; we deliberately do not reproduce any content of a standard here.

Four phases: from development to updating

A DNQP national expert standard goes through four phases (DNQP, 2025b). In the development phase a systematic literature analysis is carried out; an expert working group that includes at least one representative of those affected drafts the standard. In the consensus phase the draft is discussed at a public consensus conference. The model implementation takes place in around 25 organisations and comprises training, adaptation to local practice, introduction and audit. The audit is a structured review of how well the introduction went. Finally comes the updating: first after five years, then every seven years, with an eight-week online consultation.

Two points matter for you as a student. First, the involvement of a representative of those affected is built into the procedure – a foretaste of Module 7, which deals with participation. Second, a national expert standard is expressly not “finished”: it is revised at fixed intervals, and the year of the version therefore belongs in every source reference.

How evidence gets into the standard – and where the experts’ judgement counts

The DNQP searches hierarchically: first systematic reviews, then primary studies, among others in MEDLINE, CINAHL and the Cochrane Library (DNQP, 2025b). It documents the approach with a PRISMA flow diagram – you know the principle from Module 4. The studies are appraised with instruments such as AMSTAR-2 (for reviews), RoB 2 and AGREE II (for guidelines); the certainty of the evidence is presented with GRADE (DNQP, 2025b). You got to know RoB 2 in Module 5 as a tool for randomised trials. The fact that the DNQP first looks for reviews is an example of a pragmatic hierarchical approach, without this turning into a fixed evidence pyramid: which type of study suits the question remains the guiding question from Module 3.

One detail is particularly revealing for critical classification: where the evidence is weak, the judgement of the expert group carries particular weight (DNQP, 2025b). That is methodologically honest, but it also means that a standard visibly contains elements of professional judgement. That can make sense when studies are lacking; but it is something different from a finding based on several well-conducted studies, and you should make this distinction visible in your presentation and term paper.

The procedure itself is being developed further

It is not only the individual standards that are updated, but also the method by which they are produced. In November 2025 the DNQP published the sixth, revised version of its methods paper; earlier versions date from 2002, 2007, 2011, 2015 and 2019. The new version was developed in line with the GIN-McMaster Guideline Development Checklist (DNQP, 2025b). Figure 6 shows this sequence on a timeline. Look at the gaps: they are to scale, which is why the largest gap lies between the fifth and the sixth version. Do not confuse the timeline with the update intervals of the individual standards (after five years, then after seven): this is about the methods paper, not about a particular standard.

PART 4 – Professional standards of social work and the question of care settings

The professional ethics of the DBSH

The professional ethics of the DBSH have been available in a second edition since December 2024; it is a completely revised and expanded version of the first edition of 2014 (DBSH, 2024). Among its supreme principles are autonomy, solidarity and justice. It links ethics and professional practice and assumes that the practice competence of social work rests on scientifically sound knowledge (DBSH, 2024). For our topic this is an important link: the professional ethics anchor the claim that practice should be knowledge-based and at the same time preserve autonomy – exactly the tension we look at in Module 1 and Module 7.

The international definition of social work

The Global Definition of Social Work was adopted by the general assemblies of the IFSW and the IASSW in July 2014 (IFSW, 2014). Its commentary on knowledge describes social work as inter- and transdisciplinary. Research and theory are regarded in it as application-oriented and emancipatory and are often co-constructed together with service users; in addition, indigenous knowledge is recognised (IFSW, 2014). This understanding of knowledge is broad. A medically oriented guideline is one form of knowledge among several in it, and the voice of service users belongs to the production of knowledge itself. One possible interpretation (the definition itself does not say this): this explains why social work approaches guidelines with interest but also with critical questions.

Several perspectives on standards in social work

You know the debate about evidence-based practice in social work, with its supporting, critical and mediating positions, from Module 1. For standards this means: anyone who understands them as orientation sees in them an aid to justifying decisions. Anyone who understands them as a recipe meets exactly the objections of the critics. A reflective position lies in between: standards structure decisions, they do not take them away. In a term paper you convince not with one side, but with the ability to present both sides fairly.

Why standards matter for all care settings

To close this part, a sober look at figures. In December 2023, almost 5.7 million people in Germany were in need of care within the meaning of Book XI of the German Social Code (SGB XI). Of these, 86% or 4.9 million were cared for at home and 14% or 800,000 in full inpatient care in care homes (Destatis, 2024). Figure 7 shows the two groups as bars. The values: 4.9 million people at home, 0.8 million in full inpatient care, as of December 2023, Germany.

What follows from this for our topic? The great majority of people in need of care live at home. A view of standards that only looks at everyday life in care homes would overlook this majority; the reverse also applies. Social work meets people in need of care and their relatives in many fields of work, for example in counselling or in hospital social services. However, the figures say nothing about how and where an individual standard is used – that would be a different question. The increase of 730,000 (+15%) compared with December 2021 should also not be interpreted too quickly: according to Destatis, it is partly due to the broader definition of the need for care in force since 1 January 2017 (Destatis, 2024). Finding and interpretation stay separate.

PART 5 – Critical classification: limits, areas of tension and consequences

Currency: every synthesis has a date

Guidelines and standards are snapshots. The child protection guideline carries a revision note (Kinderschutzleitlinie, 2022), DNQP standards are updated at fixed intervals (DNQP, 2025b), and even the rulebooks change: the AWMF rulebook is at version 2.2 (AWMF, 2025), the DNQP methods paper in its sixth version. Consequence for your work: always state the version and the year, and point out notes. If you cite a document that is currently being revised, that is not a weakness in your argument but a sign of care.

Procedure is not fit

The class of a guideline and the phases of a national expert standard tell you how thoroughly a document was produced. They do not tell you whether it fits the person sitting in front of you. For that you need the framework from Module 1: evidence, condition and circumstances, preferences, and the professional expertise that brings everything together. Module 7 deepens this with the question of how life situation, wishes and resources feed into a reasoned decision. There are also limits to transferability: a document came about in a particular context; whether it fits your field of work, your organisation and your service users is a separate question. In social work, there is also the fact that for many social-pedagogical questions hardly any robust studies exist – a gap in research that you may name in a term paper without glossing over it.

Monodisciplinary in a multiprofessional team

The national expert standard is expressly designed to be monodisciplinary (DNQP, 2025b). That is a strength because it addresses nursing precisely, and at the same time a limit: other professional groups work in the team, and their tasks it does not describe. The child protection guideline, by contrast, brings the health system, child and youth welfare and education together (Kinderschutzleitlinie, 2022). For social work professionals this means: clarify interfaces in the team, name your own role, and do not assume that a document of another professional group describes your own task.

Open questions: standards and self-determination

One open question is how standards and self-determination fit together. The DBSH professional ethics put people’s autonomy first (DBSH, 2024); the NRW professional code commits chamber members to respecting the right to self-determination (Pflegekammer NRW, 2025). A standard describes what is professionally usual or what to aim for – and a person can decide differently. How such situations are to be resolved in an individual case depends on the case, the team and the procedures of the organisation; Module 7 prepares for this. Here the key sentence is enough: a standard is a starting point for the conversation, not a substitute for it.

How to deal with this in a term paper, presentation and timed written paper

In a term paper you name the document type (guideline, national expert standard, professional standard or law), briefly describe the procedure, state version and year, and discuss limits. In the APA 7 reference you list the issuing organisation as the author. In a presentation, a profile sheet with class or structure, version date, target group and contributors is often enough. In a timed written paper a typical task is the comparison: what distinguishes a guideline from a national expert standard, and what is neither of the two because it is law? With the table and decision tree from this module you can answer this in a structured way. Important: never present guidelines and standards as law.

For your studies

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and nobody analyses them. Click an answer; the explanation helps you to judge your own understanding.

PART 1 – Evidence, professional expertise and preferences: how the concepts work together

The common thread from Module 1 – without repeating it

In Module 1 you saw how Sackett et al. (1996) define the practice of evidence-based medicine and how the Institute for Quality and Efficiency in Health Care (IQWiG) transfers this view into German. For this module, a single idea from the definition is enough: it describes practice as the integration of individual expertise with the best available external evidence. The word “integration” carries the whole weight. A study provides findings about groups under certain conditions; a decision, by contrast, always concerns a specific person in a specific situation. Anyone who reads only the study and overlooks the person has shortened the definition.

IQWiG (2025) makes this integration visible by distinguishing three elements: the evidence, a person’s condition and circumstances, and their preferences and attitudes. The professional’s expertise is the instance that brings these elements together. This module starts exactly at the seam between evidence and person: What does bringing them together look like in practice, what supports it, and where is it not enough? Figure 1 shows a mind map of the five branches along which the module unfolds: external evidence, internal evidence, self-determination, participation and the limits of the whole approach.

Four concepts, kept clearly apart

Term papers are where concepts that sit close together in everyday life often blur. Here are four working definitions. They are formulated for this course and are not literal quotations; where a source carries the concept, it is named.

Preferences are what a person favours when several paths are open: priorities, wishes, dislikes. They relate to a specific decision (“group or one-to-one conversation?”). Attitudes are, by contrast, more stable stances and convictions, for example towards help, medicine, public authorities or independence; IQWiG (2025) names both together – preferences and attitudes – as a separate element of the decision. An attitude can colour preferences without being identical to them.

Circumstances is the term IQWiG (2025) uses alongside a person’s clinical condition. For social pedagogical and nursing fields of work, this can be read as life situation : housing, income, social network, language, time, accessibility of services. This translation is a reading made by this course and not a formulation by IQWiG. By lifeworld we finally mean the everyday context of places, relationships, routines and meanings that a person experiences and lives in. This too is a working concept, not a summary of a particular theoretical approach; in your term paper you should use it only if you define it yourself or link it to the definition used in your field of study.

Internal evidence: taking the knowledge of those involved seriously

The nursing-science concept of evidence-based nursing bases nursing decisions on two kinds of knowledge. External evidence comprises methodologically secured experiences of third parties, that is, research findings. Internal evidence consists of the individual needs and experiences of the people needing care and of the nurses. Two things are noteworthy here. First, internal evidence is not an add-on for “soft” cases but an equal building block of the concept: it answers a different question from a study, namely not “What happened on average?” but “What does the measure mean for this person?”. Second, it explicitly also counts the experiences of the professionals themselves; your own experience in your field of work is therefore not mere opinion but part of the basis for decision – admittedly a part that must be open to critical reflection.

The concept comes from nursing. For social work, the transfer is a separate step of thought: service users, parents, young people, relatives and professionals have experiential knowledge that is not found in any database. Whether and how one wants to call it “evidence” is open in the professional debate; at its core the question is which knowledge is heard at all when a decision is made.

Shared decision-making: an attitude, not a form

In the sequence of steps of evidence-based nursing, shared decision-making comes first, followed by formulating the problem, searching the literature, critically appraising the studies, changing practice and evaluation. You practised how to formulate the question in Module 2; what interests us here is the start of the chain. Shared decision-making is less a document than an attitude: you do not assume that the “right” solution is already settled and only has to be conveyed. Instead, you explain in an understandable way what options there are (including doing nothing for now), ask about wishes and worries, take time for questions and agree together how you will later recognise whether the chosen path is working. These guiding questions are a practical compilation made by this course.

Table 1 summarises the four building blocks that come together in such a decision. Read it as a map: each row has its own strength and its own limit, and none replaces the others.

PART 2 – Foundations: self-determination, co-construction and bindingness

Self-determination in the professional ethics of social work

The German Professional Association for Social Work (DBSH) has presented its professional ethics in a second edition since December 2024; it is a completely revised version of the first edition of 2014. Among its supreme principles, the DBSH (2024) names autonomy, solidarity and justice. At the same time, the professional ethics link ethics and professional competence and assume that the practical competence of social work rests on scientifically secured knowledge. Both therefore stand side by side in one document: the demand to act on a sound professional basis and the demand to respect people’s autonomy.

This is valuable for your argument in a term paper, because it shows that the tension between research knowledge and self-determination is not a marginal problem that you “unfortunately also have to bear in mind”, but lies in the professional ethics’ own self-understanding. Note, however, the type of source: the professional ethics are the position of a professional association. They serve as professional orientation, but they are not a law and do not create a legal obligation.

Self-determination and evidence-based knowledge in the professional code of conduct for nursing

For nursing – unlike for social work – there is, at one point, a legally formal regulation that touches on both topics: the professional code of conduct of the Nursing Chamber of North Rhine-Westphalia of 26 June 2025 (Pflegekammer NRW, 2025). Section 19(1) says: “Nursing practice should be based on evidence-based knowledge” (our translation). In addition, Section 3(1) commits to the generally recognised state of nursing-science, medical and other related-science knowledge, and Section 15(1) to safeguarding the right to self-determination. The statute thus names both in the same set of rules – how the two relate to each other in an individual case is a question of professional weighing-up in the team, not one that could be answered from the wording alone.

IFSW: knowledge in social work is often co-constructed

The Global Definition of Social Work was adopted by the General Meetings of the IFSW and the IASSW in July 2014. The commentary on the keyword knowledge describes social work as inter- and transdisciplinary and its research and theory as application-oriented and emancipatory. According to the commentary (IFSW, 2014), knowledge is often co-constructed together with service users; in addition, indigenous knowledge is expressly recognised. The wording is paraphrased here, because no official German translation was used for this passage.

Co-construction means in this context that knowledge is not only produced by researchers and then “applied”, but arises in the interplay of research, practice and the people concerned. This fits the idea of internal evidence from Part 1: in both cases, the knowledge of those involved counts as an independent source of insight. The recognition of indigenous knowledge additionally reminds us that scientific knowledge is not the only form of knowledge that deserves respect. How this can be spelt out concretely in Germany – for example with regard to the experiential knowledge of communities and self-help groups – is food for thought and not a statement of the commentary. This text too is a position of an international professional association, not law.

PART 3 – From recommendation to decision: a matching procedure for practice

Three questions before you adopt a recommendation

The recommendation of a guideline or a standard is an offer to the team, not an instruction for every individual case. Figure 2 translates this into a decision tree with three successive questions. You read it from top to bottom: Is there reliable evidence? Can it be transferred to the context and target group? Does it fit the person’s life situation, wishes and resources? Anyone who answers all three questions with “yes” arrives at joint implementation. Each “no” leads onto a side path of its own, and each side path has a direction for action – so the result is never “ignore the study” but “adapt the approach with good reasons”.

On the first question: according to IQWiG (2025), how reliable evidence is depends primarily on three aspects – internal validity, external validity and statistical precision. How you place these concepts you know from Module 3; for the tree, external validity is particularly important, because it corresponds to the second question on transferability. How guidelines and expert standards are built and what status they have, you learned in Module 6. On the third question: fit with the person is not the same as agreement. It asks whether the measure suits the life the person leads and whether it could reach the goal that matters to them.

Worked example: matching a recommendation with a life situation

The following example is entirely fictional. The “recommendation” is invented, comes from no real guideline and says nothing about what works in reality. It serves only to make the line of thought visible. Starting point: A fictional example recommendation states that people with a fear of falling should regularly take part in a guided exercise group. Oskar Voigt, aged 78, receives outpatient support. The professional wants to discuss the recommendation with him. Figure 3 shows the six steps; the reasoning for each step follows.

On Step 1: You read not only the recommendation but also its framework: for whom does it apply, how did it come about, is its status up to date? This is the view you practised in Module 6 with class, date and validity note. On Step 2: The life situation is the map on which the recommendation has to arrive. That Mr Voigt lives on the third floor is not a nuisance factor but part of the circumstances in the sense of IQWiG (2025). On Step 3: This is where internal evidence comes into play. The order matters: first you ask openly, then you explain the recommendation – not the other way round. Otherwise he answers a question to which you have already given him an answer.

On Step 4: Resources and obstacles work together. The daily walk is a strength that you can build on; the stairs are an obstacle that cannot be “wished away”. On Step 5: The actual integration. The aim of the recommendation remains; what is negotiated is the way. Whether an alternative does justice to the aim of the recommendation is a professional question that you do not decide alone and do not answer with a guess – which is exactly why specialist advice belongs in this step. The example expressly does not claim that guided exercises at home would be equivalent. On Step 6: Documentation is not a formality. It makes the weighing-up understandable for the team and for later questions, and it records the agreement on when you will evaluate together whether the way is working.

Question to think about: why does it make sense for the aim of the recommendation to remain while the way is adapted? Write down an answer in two sentences before you read on. A hint: think about what would happen if every deviation from the way automatically deleted the aim as well – and conversely, if every aim could be reached by exactly one way.

Documenting with reasons: what belongs in a decision note

A good decision note is short and answers six questions. Which recommendation or knowledge was the basis? Which life situation and which wishes of the person were known? Which alternatives were discussed? How was the weighing-up done, and who was involved? What was agreed? When and by what means will progress be evaluated? The format depends on your organisation; how you document follows its procedures. The logic behind it stays the same and is also useful for term papers: justifiability arises when someone outside the situation can follow how you reached the decision.

PART 4 – Participation: involvement in research, standards and everyday practice

Who has a say when evidence is produced?

So far we have looked at people’s involvement in decisions about them. There is also a second level: involvement in the creation of knowledge itself. The thinking behind it is simple. If the people affected are never asked which results matter to them or what a standard looks like in everyday life, there is a risk that knowledge is produced that misses their lifeworld. Participation can narrow this gap; it will not necessarily close it.

One example is the methods paper of the German Network for Quality Development in Nursing (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege, DNQP, 2025b). According to it, in the development phase of an expert standard (Expertenstandard), an expert working group works with at least one representative of the people affected. The standard is discussed at a public consensus conference, and an eight-week online consultation is planned when it is updated. You know the structure and the four phases of an expert standard from Module 6; only the participation aspect matters here. The DNQP (2025b) also states that where the evidence is weak, the judgement of the expert group carries particular weight. An interpretation can be drawn from this, which is expressly labelled as an interpretation here: the thinner the body of studies, the more it matters who helps decide in the group – and therefore also whether the people affected are represented.

Study reports can also be read for participation. CONSORT 2025 is the reporting guideline for randomised trials; it replaces CONSORT 2010 and contains 30 checklist items. Among the seven new items is one on patient and public involvement (Hopewell et al., 2025). A reporting standard does not prescribe how a study is carried out, but what should be reported transparently. In this way it shows whether and how participation took place. Important for your studies: CONSORT 2025 is a reporting guideline for publications and not a requirement for student work. It is still useful as a reading grid in a journal club, as you saw in Module 5.

Recognising participation: guiding questions for reading

Participation is a word that is quickly claimed and rarely described precisely. Table 2 gives you guiding questions you can use when reading standards, studies and methods papers to see whether and how participation is documented. The note in the third column names one anchor point from the sources of this module in each case.

Participation in everyday practice: small forms that matter

Participation here means: people can take part in decisions that affect their own lives. This ranges from understandable information through being listened to up to joint decision-making – this distinction is a working distinction of this course and not a ladder devised by a particular author. In everyday practice, participation mostly happens in small forms: you offer real choices instead of just asking for agreement. You use plain language and say what will happen next. You plan time for questions. You ask for feedback on what you decided together and pass it back to the team.

Honesty requires a look at the obstacles. Language barriers call for interpreting when information would otherwise not get across. Time pressure in organisations limits conversations. Power imbalances between professional and service user remain even when the atmosphere is friendly; people who depend on a service may be less likely to object. And in contexts of compulsion – for example when the protection of another person is at stake – there is limited room for wishes. Further duties apply there that are not negotiated in conversation; how they are to be understood in an individual case, you clarify in the team and with specialist advice. Participation is therefore not a switch that is “on” or “off”, but a quality that you have to reassess in every situation. If there are serious indications of a risk to the child's wellbeing (Kindeswohlgefährdung), inform your practice supervisor or manager immediately and follow your organisation's child protection procedure: in the youth welfare office (Jugendamt), several professionals assess the risk together (Section 8a(1) of Book VIII of the German Social Code (SGB VIII)); at non-statutory provider organisations (Träger), the assessment is made with advice from an experienced child protection specialist (insoweit erfahrene Fachkraft, InsoFa) (Section 8a(4) SGB VIII); for health professions, Section 4 of the Act on Cooperation and Information in Child Protection (KKG) applies. In acute danger: police 110, ambulance 112.

PART 5 – Critical appraisal: limits, tensions, open questions

Context dependence and transferability

A study is carried out somewhere and with particular people. Whether its results can be transferred to your residential group, your ward or your neighbourhood is the question of external validity that you know from Module 3. In Germany there are additional particularities that should not be underestimated: provider and funding structures, responsibilities, regional services and differences between town and country. A service that was studied abroad in a different structure meets different conditions here. The reporting guideline CONSORT 2025 also takes up the question: the earlier separate item on generalisability was removed, and it is now dealt with under limitations (Hopewell et al., 2025). This shift is a sign that transferability is not settled with a tick in a box.

At the same time, “That is different for us” must not become a blanket excuse for fending off inconvenient evidence. A sound argument says specifically how the setting, target group or conditions differ and why this difference could matter for the result.

Values and questions of power

What counts as a desired outcome is never purely technical. Outcomes such as those you chose in Module 2 when formulating your practice question reflect decisions made by researchers, providers or funders. What does not count as an outcome there does not appear in the studies, even if it matters to those involved. Added to this is the power imbalance: professionals have specialist knowledge, access to services and control over documentation. Even when they take participation seriously, service users may hold back wishes because they fear disadvantages.

Both hold true, without a simple order of priority being possible: preferences do not automatically override professional standards, and professional standards do not automatically override preferences. It is the team’s task to bear this tension and work on it rather than resolve it one-sidedly. Table 3 collects the most important tensions of this module with questions for practice and possible ways of handling them.

When studies are missing

For many social pedagogical questions there are no or only a few reliable studies of effectiveness. This is no surprise when you consider how complex the settings, target groups and forms of help are and how hard some questions are to study. Two false conclusions suggest themselves. The first is: “If there is no study, the measure is ineffective.” That is not true, because missing evidence is not proof of missing effect. The second is: “If there is no study, I can decide however I like.” That is not true either. For expert standards, the DNQP (2025b) shows how this can be handled: where the evidence is weak, the judgement of the expert group carries particular weight – that is, a structured professional judgement, not an arbitrary one. In your own practice this means: state the gap openly, combine professional knowledge with the person’s wishes, proceed carefully and evaluate how things go, so that experience becomes knowledge others can follow.

The debate about evidence-based social work

In German-language social work, evidence-based practice is discussed controversially. Three basic positions can be distinguished, which Figure 4 sets side by side: supportive voices that emphasise randomised studies of effectiveness; critical voices that point to a technology deficit of social interaction, the limited transferability of causal models and concern about professional autonomy; and mediating voices that lie between the two lines. For your work, the rule of this course applies: you assign arguments to positions, not to individual authors, unless you have read the contribution in question yourself and can support it with evidence.

How does this help with the topic of this module? The technology deficit-type argument can be understood in general terms to mean that social interaction cannot be planned like a technical process, because service users take part and the same measure lands differently in different life situations. This is exactly the point where preferences, life situation and participation come into play. The position of the mediating voices is the working basis in this module – not because the criticism is unjustified, but because it helps to use study knowledge without narrowing it. The reference to the position is a reading made by this course and not an attribution to any person. The question of professional autonomy remains: who decides when study knowledge is enough to base a decision on?

Consequences for practice: four constellations

A model for thinking can be derived from the considerations so far, which you can use as a guide. Figure 5 arranges situations by two questions – Is there evidence? Does it fit the person? – and gives four fields. Field A is the ideal case: the evidence is there and fits, you implement the recommendation together and evaluate how things go. In field B there is a tension that has to be worked on: ask for reasons, clarify adjustments or alternatives in the team, record the weighing-up. In field C the evidence is thin but the person is open; here you proceed carefully, state the gap openly and evaluate how things go systematically. In field D both evidence and fit are missing; here it is worth clarifying aims and wishes anew, involving specialist advice and not carrying on out of mere habit. This recalls the sentence “We have always done it this way” from Module 1: habit is not a reason, but not an opponent either – it is an occasion to clarify the reasons.

The four-field matrix is a model for thinking and not a classification of people. It describes how you can place a situation, not what a person “is”. A case can move between fields over time – for example when a conversation changes the fit or when new studies appear. To be clear about the limits: the model says nothing about the effectiveness of specific programmes; it only sorts how to deal with the situation.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you judge your own understanding.

PART 1 – Taking stock: what you bring with you from seven modules

From single tool to whole process

Evidence-based practice is not a single action but a sequence. The concept of evidence-based nursing describes steps for nursing that range from shared decision-making and formulating the problem through searching and critical appraisal to changing practice and evaluation. Exactly this logic is found – in modified form – in many study tasks: a term paper, a presentation or a timed-written-paper task often requires you to clarify a question, draw on referenced sources, classify them and in the end take a reasoned position. In the practical placement this becomes a team question to which you look for a comprehensible answer.

This module is therefore not a new block of content but a link. It shows how the building blocks of Modules 1 to 7 can be combined in three formats that really occur in studies and at the start of your career: the journal club, the literature report (a structured literature overview) and the critical review. Figure 1 gives you the overview: in the centre is evidence-based practice in your studies, around it the five building blocks that we will go through one after another.

Looking back: which module supplies which building block?

So that you do not learn anything twice, here is just the map. The definitions are in the respective modules; the table shows what you need them for now.

A why-question to think about: why is it not enough to know individual studies? Because, according to the understanding of the Institute for Quality and Efficiency in Health Care (IQWiG, 2025), a decision never follows from the evidence alone: it comes about when professional expertise brings the evidence together with a person’s condition, circumstances and preferences. A journal club therefore does not end at “What does the study say?” but at “What follows from it for these people in this situation?”

A working definition for the journal club

There is no uniform standard for the journal club. In this course we understand it as a one-off or regular meeting in which a group reads a chosen specialist text together, appraises it critically and relates it to its own practice. This is a working definition for this module, not a fixed technical term with a single source. In a seminar, in a study group and in a team the format often looks different; what matters is that selection, appraisal and consequence remain comprehensible.

PART 2 – Journal club: reading together, appraising critically, drawing consequences

The sequence in five steps

Figure 2 shows a practicable sequence for study groups and team discussions. It is deliberately kept lean so that it also works alongside lecture time and everyday practice.

Step 1 – Clarify the question: Before anyone looks for a text, it is settled which practice question lies behind it. A PICO formulation from Module 2 helps because it names population, intervention, comparison and outcomes (Higgins et al., 2024). Without this clarification you quickly end up discussing what is interesting rather than what fits.

Step 2 – Choose the text: The choice depends on the question, not on the title that promises the most. A question about effects needs a different design from a question about experience and meaning (Module 3). On access: you can reach many full texts through your university library; databases such as PubMed often supply only citations and abstracts, not full texts themselves (National Library of Medicine [NLM], n.d.).

Step 3 – Present: One person summarises question, method and finding in their own words. The separation matters: first you report what the text says, then you interpret what it means. If you mix the two, you lose the chance to question the interpretation later.

Step 4 – Appraise together: This is where the tools from Module 5 come in: where might systematic errors (bias) have distorted the results? Are effects reported in absolute numbers? How certain are the results, according to IQWiG (2025), with regard to internal validity, external validity and statistical precision? You do not have to answer every question – but you should be able to say which one remains open.

Step 5 – Draw the consequence: In the end there is a statement for practice that expressly takes the lifeworld into account (Module 7). Sometimes it is: “We change something.” Equally legitimate is: “The study does not fit our question” or “We need more information from the service users.” This consequence often gives rise to the next practice question – the dashed arrow in Figure 2.

Which texts are suitable – and what reporting guidelines make easier for you

Four types of text come into question for a journal club, all of which you know from the earlier modules: a primary study, a review, a guideline or a national expert standard. Each type brings its own reading aid.

For randomised trials this is the reporting guideline CONSORT 2025. It replaces CONSORT 2010, comprises 30 checklist items and contains seven new ones, including data sharing, conflicts of interest, patient and public involvement, the recording of harms and the handling of missing data; there is also a new section on “open science” (Hopewell et al., 2025). For systematic reviews PRISMA 2020 takes on this role, a checklist of 27 items in seven sections (Page et al., 2021). Both show what should be reported transparently. They help you when reading because you can look specifically for the information – for example, how missing data were handled. But they are not instructions for carrying out a study, and PRISMA 2020 is expressly not an instrument for quality appraisal (Page et al., 2021).

For guidelines and national expert standards you read other things first: for AWMF guidelines the class (S1, S2k, S2e or S3) and with it the degree of systematic method in the development process (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften [AWMF], 2025); for national expert standards of the German Network for Quality Development in Nursing (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege, DNQP) the structure of preamble, commentary and criteria and the way the standard was developed (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege [DNQP], 2025b). The content of individual recommendations is not the subject of this course; for that you read the original each time.

PART 3 – Literature report: structuring, delimiting, referencing

Literature report and systematic review – two genres with different ambitions

In your studies the term “Literaturbericht” (literature report) is often used for a structured literature overview: a reasoned selection of texts on a question that is summarised, evaluated and classified. A systematic review goes further methodologically: the question and the inclusion criteria are fixed in advance – in the Cochrane Handbook, PICO serves as a memory aid for this (Higgins et al., 2024) –, the search is comprehensive and documented, and the report follows a standard such as PRISMA 2020 (Page et al., 2021). Reviews of this kind are produced, for example, by Cochrane (Cochrane Deutschland, n.d.) and by the Campbell Collaboration, which, according to Welch (2021), provides systematic reviews and evidence and gap maps for social policy decisions.

The last point is more than quibbling over words. If you call your work a “systematic review” without having searched systematically, fixed criteria in advance and documented everything, you raise expectations that you cannot meet. It is more honest to describe it as a literature report with openly stated limits. This course does not qualify you to produce systematic reviews or guidelines; it helps you to find, read and classify them.

Worked example: outlining a literature report step by step

We take the team question from Module 2 and treat it expressly only as a question: does life-story work help young people in a residential group, compared with the usual support, on an outcome fixed in advance? Whether and how it helps, we do not know here – this example makes no statement about effectiveness but only shows the structure. Figure 3 walks through the six steps of the outline.

The most important step for the quality of your text is the fifth. Many drafts are “parades of authors”: study 1 is described, then study 2, then study 3. A synthesis instead organises by questions: what do several texts report in agreement? Where do they contradict each other, and what might the reason be – population, comparison or outcome? The distinction from Part 2 between finding and interpretation helps here: what a text reports, you write down factually; what you derive from it, you mark as your own classification. Figure 3 also shows that the limits come before the conclusion: they determine how far the conclusion may reach.

Referencing in APA 7: transparency in small things

The literature report stands or falls with clean references. In the text, APA 7 works with the author–year system. There are two forms: in the parenthetical form the reference stands in brackets at the end of the sentence, for example “(Page et al., 2021)”; in the narrative form the name is part of the sentence, for example “Page et al. (2021) describe …”, and with two authors, German-language texts use “und” instead of the ampersand, for example “Müller und Schmidt (2020)” (fictional example); in English-language texts this is “Müller and Schmidt (2020)”. In the parenthetical form the ampersand is used for two authors: (Müller & Schmidt, 2020). With longer author lists you shorten with “et al.”.

Three special features come up again and again in the research for this course. First: organisations are authors. The first time, you give the full name with its abbreviation; after that the abbreviation is enough, for example “IQWiG (2025)”. Second: if two texts by the same author appear in the same year, you tell them apart with the suffixes a and b – hence the “b” in DNQP (2025b). Third: if the year is missing, you write “n.d.” (no date), as with NLM (n.d.). Press releases, such as those of the Federal Statistical Office (Destatis), appear in the text with the year, with letters if there are several texts from the same year, here Destatis (2026b), and in the reference list with the date. Everything you cite in the text appears in the reference list; everything in the reference list is used in the text. Paraphrase in your own words and still give the source – ideas too must be referenced.

PART 4 – The framework in October 2026: current standards, professional law and data

Current developments at a glance

Anyone working in a journal club or a literature report should always cite the current version of a standard. Several of the documents you have met in this course were renewed recently. The overview shows what has changed.

Two observations connect these innovations. First, transparency and participation come more into focus: a separate IQWiG chapter on involving those affected, a CONSORT item on patient and public involvement. Second, methods papers are revised regularly; a source without a version is therefore harder to classify. That is a practical reason to always state version, date and retrieval date in your literature report.

Data: nursing training and nursing degree programmes

Figures belong in a critical review when they are reported soberly and not over-interpreted. The Federal Statistical Office (Destatis, 2026b) reports for 2025 around 63,900 new training contracts for registered nurses (Pflegefachfrau/Pflegefachmann), 8% more than in the previous year. Figure 4 shows the development of new training contracts from 2022 to 2025.

Summary of the values: In 2022, 52,100 new training contracts were concluded, in 2023 there were 54,400, in 2024 59,400 and in 2025 around 63,900. The number rose from year to year. In addition, the nursing degree programme under the Nursing Professions Act (Pflegeberufegesetz) has been remunerated and funded since 2024: just under 800 people began it in 2025 (about 8% more than in the previous year), and at the end of 2025 there were 1,800 students on the nursing degree programme (Destatis, 2026b).

What the figures do not say is part of the review too. They concern nursing, not social work. They say nothing about team sizes, quality of care or need, and they do not demonstrate any link between training numbers and quality. An interpretation – expressly as such – would be: where different training routes come together in one team, a shared language about evidence makes cooperation easier. That is a thought for the journal club, not a finding.

PART 5 – Critical review: opportunities, limits and what remains open

Opportunities of evidence-based practice

A critical review begins with what speaks in favour of working in an evidence-based way. First, transparency: if you base your decision on comprehensible sources, you can explain it and answer follow-up questions. This is the basic idea of evidence-based medicine according to Sackett et al. (1996), whose definition you know from Module 1: explicitly using the best available external evidence and combining it with professional expertise. Second, justifiability: IQWiG (2025) describes an evidence-based approach as a distinction from mere opinions, supported by scientific methods that are as objective as possible. Third, protection against routines without a reason: the sentence “We’ve always done it this way” is not an argument, but neither is it taboo – it is an occasion to ask for reasons. The professional ethics of the DBSH (2024) link ethics and professionalism and assume that the practice competence of social work rests on scientifically secured knowledge.

Limits and areas of tension

The debate about evidence-based practice in German-language social work is not closed. Positions in favour emphasise randomised studies of effectiveness. Critical positions point to a technology deficit of social interaction (Technologiedefizit) – meaning, roughly, that help between people cannot be planned like a technical process in which a particular action reliably produces a particular effect. They also name the limited transferability of causal models and concerns about professional autonomy. Mediating positions lie in between. We deliberately do not attribute individual arguments to individual people here. Figure 5 sets the three lines side by side.

There are also limits that you know from the earlier modules: context (a study carried out under other conditions cannot simply be transferred), values (what counts as a good outcome is not only a question of data), participation (the perspective of those affected belongs in the decision – and increasingly in the research itself; the DNQP involves at least one representative of the people affected in developing its national expert standards (DNQP, 2025b)) and research gaps (for many practice questions there are no suitable studies). Naming a gap is itself a result of a literature report – not an admission of failure.

The critical review in four sentences

A helpful structure for the end of a paper or presentation consists of four sentences: (1) finding – what the evaluated sources report, (2) limit – where their informative value ends, (3) weighing up – how you set opportunities and limits against each other, (4) consequence – what follows for practice, research or further enquiry. Watch out for two traps: a correlation in the data does not automatically imply a cause, and a survey such as the one in Figure 4 does not support any statement about quality.

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and nobody analyses them. Click an answer; the explanation helps you to judge your own understanding.

All texts in this course were written independently. Cited are laws and regulations (official works under section 5 of the German Copyright Act, UrhG), freely accessible publications by official bodies and specialist literature (within the right of quotation under section 51 UrhG, without copying text). Citation style: APA 7 (German-language adaptation). All figures and tables: own illustrations (AI-assisted). Legal position: October 2026.

Legal sources

Pflegekammer Nordrhein-Westfalen. (2025). Berufsordnung der Pflegekammer Nordrhein-Westfalen vom 26. Juni 2025 [Professional code of conduct of the Nursing Chamber of North Rhine-Westphalia of 26 June 2025] (MB. NRW. 2025 Nr. 68). https://recht.nrw.de/lrmb/bekanntmachung/19082025-berufsordnung-der-pflegekammer-nordrhein-westfalen/

Literature and publications

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). (2025). AWMF-Regelwerk Leitlinien (Version 2.2 vom 22.05.2025) [AWMF rulebook for guidelines (version 2.2 of 22 May 2025)]. https://www.awmf.org/regelwerk/

Cochrane Deutschland. (n.d.). Über uns [About us]. Retrieved 8 October 2026, from https://www.cochrane.de/ueber-uns

Deutscher Berufsverband für Soziale Arbeit (DBSH). (2024). Berufsethik des DBSH: Ethik und Werte in der Sozialen Arbeit [Professional ethics of the DBSH: Ethics and values in social work] (2nd ed.). https://www.dbsh.de/media/public/dbsh-bund/Profession/2026-02-05_DBSH_Berufsethik_2._Fassung_interaktiv.pdf

Deutsches Netzwerk für Qualitätsentwicklung in der Pflege (DNQP) (Ed.). (2025b). Methodisches Vorgehen zur Entwicklung und Aktualisierung von Expertenstandards in der Pflege [Methodological approach to developing and updating national expert standards in nursing]. DNQP. https://www.dnqp.de/fileadmin/HSOS/Homepages/DNQP/Dateien/Weitere/DNQP-Methodenpapier2025.pdf

Deutsches Netzwerk für Qualitätsentwicklung in der Pflege (DNQP). (2025a, 7 October). 28. Netzwerk-Workshop des DNQP „Pflege von Menschen mit chronischen Wunden“ [28th DNQP network workshop “Care of people with chronic wounds”] [Press release]. https://www.dnqp.de/fileadmin/HSOS/Homepages/DNQP/Dateien/Pressemitteilungen/PM_DNQP25.10.07.pdf

Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2024). Cochrane handbook for systematic reviews of interventions (Version 6.5). Cochrane. https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current

Hopewell, S., Chan, A.-W., Collins, G. S., Hróbjartsson, A., Moher, D., Schulz, K. F., Tunn, R., Aggarwal, R., Berkwits, M., Berlin, J. A., Bhandari, N., Butcher, N. J., Campbell, M. K., Chidebe, R. C. W., Elbourne, D., Farmer, A., Fergusson, D. A., Golub, R. M., Goodman, S. N., … Boutron, I. (2025). CONSORT 2025 statement: Updated guideline for reporting randomised trials. BMJ, 389, e081123. https://doi.org/10.1136/bmj-2024-081123

Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG). (2025). Allgemeine Methoden (Version 8.0 vom 19.12.2025) [General methods (version 8.0 of 19 December 2025)]. https://www.iqwig.de/methoden/allgemeine-methoden_v8-0.pdf

International Federation of Social Workers (IFSW). (2014). Global definition of social work. https://www.ifsw.org/what-is-social-work/global-definition-of-social-work/

Kinderschutzleitlinie: Kindesmisshandlung, -missbrauch, -vernachlässigung unter Einbindung der Jugendhilfe und Pädagogik (AWMF-Register-Nr. 027-069, Kurzfassung, Update vom 09.01.2022) [Child protection guideline: Child maltreatment, abuse and neglect, involving child and youth welfare services and education (AWMF register no. 027-069, short version, update of 9 January 2022)]. (2022). AWMF. Validity expired, guideline under revision (as of retrieval: October 2026). https://register.awmf.org/assets/guidelines/027-069k_S3_Kindesmisshandlung-Missbrauch-Vernachlaessigung-Kinderschutzleitlinie_2022-01-abgelaufen.pdf

National Library of Medicine. (n.d.). About PubMed. Retrieved 8 October 2026, from https://pubmed.ncbi.nlm.nih.gov/about/

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71

Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn't. BMJ, 312(7023), 71–72. https://doi.org/10.1136/bmj.312.7023.71

Statistisches Bundesamt (Destatis). (2024, 18 December). 5,7 Millionen Pflegebedürftige zum Jahresende 2023 [5.7 million people in need of care at the end of 2023] (Press release No. 478). https://www.destatis.de/DE/Presse/Pressemitteilungen/2024/12/PD24_478_224.html

Statistisches Bundesamt (Destatis). (2026a, 23 March). Zahl junger Menschen in Heimen und Pflegefamilien 2024 weiter gestiegen [Number of young people in residential homes and foster families rose further in 2024] (Press release No. 098). https://www.destatis.de/DE/Presse/Pressemitteilungen/2026/03/PD26_098_225.html

Statistisches Bundesamt (Destatis). (2026b, 2 July). Pflegeausbildung 2025: Zahl neuer Auszubildender zum dritten Mal in Folge gestiegen [Nursing training 2025: Number of new trainees rose for the third time in a row] (Press release No. 231). https://www.destatis.de/DE/Presse/Pressemitteilungen/2026/07/PD26_231_212.html

Welch, V. A. (2021). Campbell Collaboration: Reflection on growth and cultivation from 2017 to 2021. Campbell Systematic Reviews, 17(4), e1204. https://doi.org/10.1002/cl2.1204