first step in implementing EBP and identifying practice
Barriers to the implementation of best practice in the clinical setting
Lack of research experienceUnsure about how to locate research Unfamiliar with the critical appraisal process. Unsure of the process to apply research to practice
Purpose of a review
Identification of a research problemGenerates new research questions or hypothesesClarifies and provides evidence of the importance of a problemIdentifies what is knownIdentifies gaps or inconsistencies in knowledgeProvides examplesNew or better practice interventions, protocols, or policiesIdentifies theoretical frameworks and conceptual modelsIdentifies experts in the fieldIdentifies research design and methodologiesProvides a context for analysisIdentifies possible research instruments
The review in Quantitative research
Major reviewAt the beginning of a studyHelps to direct planning & execution of studyLimited reviewAt the conclusion of studyTo isolate new studies published since last review
The review in Qualitative research
Brief reviewBefore beginning of a studyLimited to avoid biasMajor reviewAt the conclusion of studyCompare literature to participants responses in current study.
Components to a research article
Introduction-Significance-Problem-Purpose, aim-Research questions/hypotheses-Literature reviewMethodology-Design-Procedures-Population/sample-InstrumentsResultsDiscussion-Highlights major findings, gaps-Limitations-Recommendations
all written sources relevant to the topic you have selected, including articles published, theses, dissertations, clinical journals, textbooks, and other books.
what is included?
Translation literature-Article – Periodical vs. Monograph (peer reviewed)-Theoretical vs. Empirical literature-Clinical practice guidelines, critical pathways, protocols etc.Evidence summaries-Systematic reviews, meta-analysis, integrative reviews etc.
-Cochrane Database of Systematic -Reviews (Cochrane Library)Primary evidence-Data collected from direct patient contact (clinical trials, hospital data)Conference proceeding-Appropriate professional organizationThesis/dissertationWebsites-limit to government agencies & professional organizations
-Structured comprehensive synthesis of research to determine best research evidence to address a healthcare question-Rigorous synthesis by expert researchers
To combine results of previously published quantitative studies into a single statistical analysis. High level of evidence per hierarchy
Synthesis of qualitative and / or quantitative research on a topic
Systematic compilation of qualitative study results to expand the understanding of a particular phenomena
the act of quoting a source, paraphrasing content from a source, using it as an example, or presenting it as support for a position taken.
documentation of the origin of the cited quote
a paper about a specific topic and may be published together with other articles on similar themes in journals (periodicals), encyclopedia, or edited books.
such as a journal is published overtime and is number sequentially for the years published
such as a book on a specific subject, record od conference proceedings, or a pamphlet, usually is a one-time publication.
authoritative compilation of information on alphabetized topics that may provide background information.
Major professional organizations may publish papers selected by a review process that were presented at their conference.
a report of a research project completed by a postgraduate student as part of the requirements for a masters degree.
periodicals that include research reports and non-research articles about practice problems and professional issues.
an easy accessible source of information.
includes concepts analyses, models, theories, and conceptual frameworks that support a selected research problem and purpose.
the knowledge derived from research. Data from research (data-based)
The actual report written by researcher who conducted the study
Summaries of studies by someone other than the researcherLiterature reviewsSystematic reviews
the author of the research report, clinical description, or theoretical explanation has submitted a manuscript to a journal editor, who identified scholars familiar with the topic to review the manuscript.
“Classical studies”The 1st study on a topicFrequently referenced in current research
Significant research projects that generated knowledge that influences the nursing profession.Frequently replicated or serve as a foundation to additional studies.
Steps of the Literature Review
Prepare to review the literatureConduct the searchProcess the literatureWrite the review
1: prepare to review the literature
Identify the purpose of the reviewCourse assignment?To determine the strength of the evidence?To identify solutions to a practice problem?Select databases & search termsNot recommended to use general search engines (Google)Computerized bibliographic databases should be usedRequire subscription
1a: Key Databases for Nurse Researchers
CINAHL (Cumulative Index to Nursing and Allied Health Literature)Nursing and Allied Health1982 to presentSubject headingsMEDLINE (Medical Literature Analysis & Retrieval System Online)1946 – National Library of Medicine journal citation databaseMeSH (Medical Subject Headings)PubMed 1996Includes MEDLINEMeSHCochrane LibrarySystematic ReviewsSearchable in CINAHL & MEDLINE
1b: Identify Keywords
-Identify concepts from the research question to focus the search-Determine synonyms for identified concepts (keywords/search terms)-Keywords do not always have to be the same as the subject heading in the database because most search programs have mapping capabilitiesFor quantitative studies-Keywords are typically the independent and dependent variables and often the populationFor qualitative studies-Keywords are the central phenomenon of interest and the population
1c: Other Free Online Resources
US Preventative Task Force (USPSTF)-http://www.uspreventiveservicestaskforce.org/ Joanna Briggs Institute (JBI)-www.
joannabriggs.org National Guidelines Clearinghouse-www.guideline.gov NIH RePORTER: Research Portfolio Online Reporting Tool-http://report.nih.gov/ Registry for Nursing Research: Virginia Henderson International Nursing Library-www.nursinglibrary.
org Turning Research into Practice (TRIP) Database: For Evidence-based Medicine-www.tripdatabase.com/index.html
2: Conducting the Literature review
Search the selected databases-Be sure to search within different disciples -Search beyond single research studies-Systematic reviews or clinical practice guidelines for exampleOrganize the search – table-Refine your search as needed -See Table 6-3 page 179 for an exampleReview abstracts-Do the variables in the study match your PICOT question?-Are the settings similar? Obtain full-text copies of relevant articles
2a: Tools of Searching
Wildcard characters-Can extend a search to multiple words with the same root by adding the database’s wildcard character to a truncated wordDifferent databases / software packages use different wildcards, such as * or $Example: nurs* would search for nurse, nurses, nursingBoolean operators: used to combine, restrict, or broaden searchesAND: retrieves references in which two or more terms are present (e.g. obesity AND diabetes) OR: retrieves references containing any of 2+ terms separated by “OR” (e.
g., obesity or diabetes) Quotation marksThe use of quotation marks around a phrase can change the search resultsExample: a search for “high blood pressure” would yield overlapping but non-identical results to high blood pressure
3: Processing the Literature
Read each full-text article-Use analytical skills as basis for evaluation-Determine if the study supports the question identifiedAppraise, Analyze, & SynthesizeDevelop a Literature Summary TableSee Table 6-4, 6-5, & 6-6 on pages 181-182 in textbook
3a: Parts to Review
Author’s credentialsCitation informationPurpose of the studySample size and selectionStudy designData collection proceduresData analysis Major findingsConclusion
3b: Critical Appraisal Criteria
Are all relevant concepts & variables included?Is the search organized & include appropriate databases?Is theoretical & research literature included?Consists of mainly primary sources?Are gaps & inconsistencies uncovered & discussed?Do the review build on earlier studies?Does the summary of each source include essential components?Does the synthesis follow a logical sequence?Is it presented in an organized format? Does the review follow the proposed purpose of the study?Does the review generate new questions or answer hypotheses
3c: Overall Evaluation
The reader should be able to identify:The review is directed toward an identified topic of interestIt should provide what is known and what continues to be unknown about a topicControversial perceptions within the literature need to be delineated for considerationSummarization should facilitate the development of future research
4: A Well Written Review of Literature
Each reviewed source is relevant to the study or projectIdentifies research questions & hypothesesConsists mainly of primary sourcesOrganized using a systematic approachUses established critical appraisal criteria Provides a synthesis of the strengths & weaknesses of studies reviewedSummarizes each study or article succinctlyConcludes with a summary statement & provides recommendations
summarizes the major elements of a study and identifies the contributions of that study to nursing knowledge.
Major Sections of a Research Report
Presents a starting point for deciding whether or not the article is relevant to the clinical question.
The best ones include: what was done, to whom it was done, and how it was done.”Randomized Control Trial of a Family-led Mutual Support Programmed for People with Dementia” (Wang & Chien, 2011)
Located after the title and author sectionUsually graphically set apart by use of a box, shading, or italicsA good abstract should contain:The study’s purposeMethodResultsConclusionsClinical relevance** EBP team members should not rely on the abstract alone – the entire article must be read **
The first section the reader sees after the abstractIncludes:-Statement of the problem-Purpose-Background (brief review of literature)-Framework (if used)-Any research objectives, questions, or hypotheses
Describes how the study was conducted (study procedures) in sufficient detail so that the reader can replicate the study, if desired.This section should include:The designTreatmentSampleSettingMeasurement methodsData collection processHow data will be analyzed
Presents the outcomes of the statistical tests used to analyze the study data and the significance of these outcomes.Presentation of demographic characteristics firstPay particular attention to figures and tables as this is often where important results presented.Look for statistical and clinically significant results.
Ties together other sections of the research report and gives meaning to the results.
-Each part should be interconnected-It should provide sufficient information so the reader can make an informed judgment about the relevance to the clinical question.
Reading the report:
Skimming – enables the reader to make a preliminary judgment about the value of the study. Comprehending – the reader must understand all terms & major concepts. Analyzing – determining the value of the content of the report