A systematic and critical appraisal

Chapter 3

Gathering and

Appraising the Literature

Literature Review

A systematic and critical appraisal

Provides the development and foundation of a research study

Provides the development and foundation of the theoretical framework

ESSENTIAL to evidence-based nursing practice

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Literature Review

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Theoretical or Conceptual Framework

The basis for the development of research questions or hypotheses

Can be viewed as a map for understanding the relationships between or among the variables in quantitative studies

Presents the context for studying the problem

Often illustrated using a diagram

Integral to practice and research

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Sources for Literature Review

Primary: Research articles and books by the original author

Secondary: Published articles or books that are written by persons other than the individual who conducted the research study or developed the theory

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Literature Review: Components of Research Process

Research question and hypothesis

Design and method

Outcome of the analysis

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Outcome of the Analysis

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Goal of the Literature Review

Researcher

Develop the knowledge foundation necessary to design a sound study

Generate research questions and hypotheses

Consumer

Answer a clinical question or solve a problem to improve patient outcomes

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Literature Review: Researcher’s Perspective

Facilitates understanding of the problem by identifying a theoretical or conceptual framework to provide a context

Discover what is known and not known to refine the research question and hypothesis

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Literature Review: Researcher’s Perspective

Assists in the design and methods to be used

Allows interpretation and discussion of the outcome of the analysis by comparison with previous studies

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Literature Review: Consumer’s Perspective

Answer a clinical question or solve a problem to improve patient outcomes by:

Identifying and gathering evidence

Critically appraising and synthesizing evidence

Assessing the usefulness of the evidence in changing practice

Changing practice to improve outcomes or justify current interventions

Developing evidence-based practice projects

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Literature Review: Consumer’s Perspective

First three steps of evidence-based practice process:

Asking clinical questions

Identifying and gathering evidence

Critically appraising and synthesizing the evidence or literature

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PICO Format

P  Problem/patient population; specifically defined group

I  Intervention; what intervention or event will be studied?

C  Comparison of intervention; with what will the intervention be compared?

O  Outcome; what is the effect of the intervention?

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Hierarchy of Preappraised Evidence

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Computerized Decision Support System

Integrates evidence-based clinical information into an electronic medical record. In these systems, specific patient data can be entered and then matched against a knowledge base to generate patient-specific recommendations or assessments.

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Summaries

Clinical practice guidelines and electronic evidence-based textbooks

Evidence-based guidelines that provide recommendations based on high-quality evidence

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Synopsis of Synthesis

Provides a preappraised summary of systematic review

Synopses provide a synthesis of the review; some include a commentary related to strength of the evidence and applicability to a patient population

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Synthesis

Systematic reviews (e.g., a Cochrane review) are a synthesis of research on a clinical topic conducted by multiple experts.

They include quantitative summaries, meta-analysis.

Synopsis of single studies: Keep in mind that a synopsis of a single study, while critically preappraised, still remains a single study. Most often, significant practice changes are not based on the results of a single study.

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Studies

“Synopsis of a Single Study” appraisal conducted by a single expert

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Types of Resources

Print and electronic books, journals, indexes

Refereed or peer-reviewed journal articles are the best choice because they contain the latest information.

Books take longer to publish than journals.

Print indexes are needed for sources not available in online databases.

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What Is a Refereed or
Peer-Reviewed Journal?

A panel of scholars who are experts review submitted manuscripts.

Usually the reviews are “blind” to promote objectivity; that is, the manuscript to be reviewed does not include the name of the authors.

The reviewers use a set of scholarly criteria to judge whether a manuscript meets the publication standards of the journal.

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Types of Resources

Electronic databases

Used to find journals, publications of professional organizations, and publications of government agencies

CINAHL: Cumulative Index to Nursing and Allied Health Literature

MEDLINE

PubMed

Cochrane Library

Search engines

Electronic databases

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How Far Back?

A general timeline for most academic or evidence-based practice papers/projects is to go back in the literature at least 3 years, and preferably 5 years.

Some research projects may warrant going back 10 or more years.

Extensive literature reviews on particular topics or a concept clarification methodology study helps limit the length of the search.

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Using Electronic Databases

Find right terms to “plug in”

Controlled vocabulary

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CINAHL in the EBSCO Interface

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Venn Diagram

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Boolean Operators

Boolean operators define the relationships between words or groups of words in a literature search.

Boolean operators dictate the relationship between words and concepts:

“AND” requires both concepts to be located within the results that are returned.

“OR” allows the grouping together of like terms or synonyms.

“NOT” eliminates terms from the search.

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Appraising the Evidence

Organized

Strong knowledge base

Quantitative (meta-analyses) and qualitative (meta-syntheses) systematic reviews

“Does the literature search seem adequate?”

“Does the report demonstrate scholarly writing?”

The key to a strong literature review is a careful search of published and unpublished literature.

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Clinical Guidelines

www.guidelines.gov

www.cochrane.org

Websites of national organizations, for example:

www.ons.org

www.americanheart.org

www.strokeassociation.org

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WARNING

Searching with Google, Ask.com, Lycos, or other search engines is an inefficient use of time. It can be very difficult, especially for beginners, to judge the scholarly merit of information obtained this way.

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Librarian: Your New Best Friend

Visit your university or institution’s library and ask a librarian for help accessing electronic databases. Librarians are experts and usually are glad to help.

Learn to use at least two databases.

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How Far Back Should a Search Go?

Usually 5 years is good, but some advanced projects may require searches that go back 10+ years.

Although systematic reviews contain secondary sources, they can give a scholarly overview of a topic and are helpful in deciding how far back to search.

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Critiquing the Literature Review

Are all the relevant concepts and variables included in the literature review?

Does the search strategy include an appropriate and adequate number of databases and other resources to identify key published and unpublished research and theoretical sources?

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Critiquing the Literature Review

Are both theoretical and research literature included?

Is there an appropriate theoretical or conceptual framework that guides the development of the research study?

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Critiquing the Literature Review

Are primary sources mainly used?

What gaps or inconsistencies in knowledge does the literature review uncover?

Does the literature review build on earlier studies?

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Critiquing the Literature Review

Does the summary of each reviewed study reflect the essential components of the study design?

Type and size of sample

Reliability and validity of instruments

Consistency of data collection procedures

Appropriate data analysis

Identification of limitations

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Critiquing the Literature Review

The critique of each reviewed study should include

Strengths

Weaknesses

Limitations of the design

Conflicts

Gaps in information

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Critiquing the Literature Review

Does the synthesis summary follow a logical sequence that presents the overall strengths and weaknesses of the reviewed studies and arrive at a logical conclusion?

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Critiquing the Literature Review

Is the literature review presented in an organized format that flows logically?

The literature review should clearly outline the need for the particular research study or evidence-based practice project.

Does the literature review follow the proposed purpose of the research study or evidence-based practice project?

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Critiquing the Literature Review

Does the literature review generate research questions or hypotheses or answer a clinical question?

HELPFUL HINT:

Making a table using critical appraisal criteria is a helpful way to organize information.

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Which source provides the most information on evidence-based practice?

CINAHL

MEDLINE

PsycINFO

Cochrane Systematic Review

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ANSWER: D

RATIONALE: Cochrane Systematic Review according to the Search for Evidence critical thinking decision path. CINAHL is great for nursing research, MEDLINE is great for medical research, and PsycINFO is used for research on human behavior. But the systematic review, even though it is a secondary source, is a higher-level information resource. Evidence-based nursing would be a higher and better selection. Although systematic reviews are considered to be examples of secondary sources because they represent a body of completed research studies that have been critically appraised and synthesized by a team other than the original researchers, they often represent the best available evidence on a particular clinical issue.

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A nurse researcher finds four useful resources. What is an appropriate next action?

Decide whether the four resources provide a strong enough base for the topic.

Review the resources in the articles.

Talk to the librarian.

Expand the topic.

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ANSWER: B

RATIONALE: Review references in the resources. Although a few articles may be comprehensive, it is not likely. Before talking to the librarian, review the references in the resources. They often lead to another path of resources. And if all else fails, you may need to expand your topic.

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The author of the nursing theory on which you are basing a review is in attendance at a social function. What might you do next?

Introduce yourself and ask a few questions about your topic.

Introduce yourself and ask for an appointment at a later date.

Listen on the fringe of the discussion.

Realize that this is a social function and do not talk “business.”

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ANSWER: B

RATIONALE: Introduce yourself and ask for an appointment at a later date. This would be most appropriate after you explain your intention. The theorist may prefer to discuss your project at the function, but asking for an appointment allows the theorist some flexibility. Never underestimate yourself by not introducing yourself. Also, a nursing function is an opportunity to meet other nurses and to discuss pertinent topics.

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Reply 1 And 2 ,150 Words Each One By 06/03/2021 At 6:00 Pm ,Please Add References And Citations

Qualitative researchers study people in their natural settings, attempting to make sense of phenomena in terms of the meanings people bring to them.

A systematic and critical appraisal