evidence-based decision
evidenced-based medicine
paradigm shift
information
health caregiver
randomizes control trial
systematic review
meta-analysis
Sackett,
Rosenberg, Gray, Haynes, & Richardson, 1996
1 02 23123456 8428
evidenced-based nursing
Zoccali
1999
clinical practice
caring
clinical expertise
research of evidence
understanding of patients'
prefer-ences
sources
McSherry, Simmons, & Pearce, 2002; Stetler et al.,
1998
true
context
insights
non-positivis-tic
1994
Leininger, 1994; Sandelowski, 1993
Dicenso,
Cullum, Ciliska, & Marks, 2000; French, 1999; Marks,
2000; Mulhall, 1998
(Clinical expertise) (Aknowledge of research evidence) (Access to adequate resources) (Evidence-based nursing) (An understanding of patients' preference)clinical decision
knowledge
ethics
guidelines
Mulrow, Cook, & Davidoff, 1998
evidence
randomized trials
evidence
evidence-based
appro-ach
critical appraisal
generalizability
transferability
2
3
evidence-based practice
(primary studies)
(crit-ical appraisal )
bias
reliable
summa-ries
effective-ness
Stone, 2002
comprehensive search strategy
appraisal
synthesis
Holmes, 1996
secondary research studies
Bradley & Field, 1995
sea of papers
Smyth
2002
objectives
hypotheses
eligibility criteria
Pubmed
Medline
publication bias
inclusion
and exclusion criteria
eligibil-ity
extract data
“no evidence of effect”
“evidence of no
effect”
“no evidence of effect”
“evidence of no
effect”
effect
protocol
meta-analysis
effect size
materials
Mulrow, 1994;
Siwek, Gourlay, Slawson, & Shaughnessy, 2002
narrative review
systematic review
question
focus
comprehensive sources
criterion-based
selec-tion
appraisal
synthesis
variable
critical appraisal
qua-ntitative summary
Cook, Mulrow, & Haynes, 1998
beneficial or harmful
the size of that effect
tradi-tional journal
evidence-based journal
Libraries-text books
Cochrane
Library
http://hiru.mcmaster.ca/
cochrane/revab-str/mainindex.htm/
MEDLINE
http://
www.ncbi.nlm.nih.gov.com/
CINHAL
http://www.cinahl.com
Harrison's textbook
http://www.harrisonsonline.com/
internet
Clinical Evidence
http://www.clinicalevidenceonline.org/
Up to
Date
http://www. utdlibrary.com
Scientific
American Medicine
http://www.samed.com
Pub Med (
http://www.ncbi.nlm.nih.gov./ PudMed.
com/ )
Evidence-based Medicine Review
EBMR
http://www.ovid.com
200
Beaven, 2002; French, 2002; King,
2001; Morris, Scott-Findlay, & Estabrooks, 2001
1998
Dicenso
2000
1998
1999
Journal Advance Nursing
Cancer Nursing
bibliographic databases
CD-ROM
world wide web/internet
field
TI
title
AU
author
AB
abstract
Beaven, 2002
index
thesaurus
key components
research question
population
“
”
interventions
“
”
outcomes
word list
“s”
“
s”
(population)
fear of needles
fear of syringes
fear of injection(s)
phobia of
nee-dles
phobia of syringes
phobia of injection(s)
interventions
behavior
behavio(u)r
behavior(al)
coping skills
counsell-ing
psychological
psycotherapy
AND
OR
NOT
trunca-tion
wildcard
truncation
*
$
child*
child
children
child-hood
an
emia
McKibbon, 1997
Cochrane Library
DARE
randomized controlled trials
Cochrane
MEDLINE
Embase
CINAHL
Cumulative Index of Nursing and Allied Health
Literature,
BNI
British Nursing Index
A I D S L I N E
C A N C R L I T
ACBHealth
AMED
PsycINFO
HealthSTAR
keyword
Mesh term
text-word
websites
National Electronic Library for Health
Nursing
organi-zations
Evidence-based practice organization
Endnote
Reference manager
appraising research
Long, 2002
systematic review
( narrative review )
Newman & Roberts, 2002
randomization
ran-domization
randomized controlled
trials
random assignment
experimental
control
hier-archy
Newman
Roberts
2002
I
systemic review of multiple
well-designed randomized controlled trial
II
randomized controlled trial
III
without
randomization
IV
non-experimental studies
V
risk
Agency for Health Care Policy and Research;
AHCPR
Jacox et al., 1994
applica-bility
r
t
F
95%
1999
Jadad et al., 1998; Lau, Ioannidis,
John, & Schmid, 1998
number needed to
treat, NNT
EER
experi-mental event rate
CER
control event rate
ARR
absolute risk reduction
effect size
95%
confidence intervals
p
sensi-tivity
specificity
positive and negative
relative risk, RR
odds
ratio, OR
number needed to
harm, NNH
RR
ARI
absolute
risk increase
McQuay & Morre, 1998
checklist
synthesize
Dixon-Woods, Fitzpatrick, &
Roberts, 2001
human-to-human
interviewing
participant or non-participant
focus groups
Lincoln
Cuba (1985)
Sandelowski
1993
Leininger
1994
credibility
true value
transferability
applicability
fittingness
dependability
consistency
auditability
prolonged
engage-ment
persistent observation
triangulation
peer
brief-ing
negative case analysis
referential adequacy
mem-ber check
thick description
audit process
2000
Lincoln & Cuba, 1985
Dixon-Woods, Fitzpatrick, 2001; Leininger,
1994
2000
Sandelowski,
1993
Leininger, 1994; Litva
& Jacoby, 2002
Dicenso et al., 2000
1999 7 2 183 191 1994 2000 pp. 21 51Beaven, O. (2002). Searching the literature. In J. V. Craig, R. L. Smyth, & S. Mullally (Eds.), The Evidence-based practice manual for nurses (pp. 45 _ 85). New York: Churchill Livingstone. Bradley, A. L., & Field, J. (1995). Evidence-based medicine. Lancet, 346, 838 _ 839.
Cook, D. J., Mulrow, C. D., & Haynes, B. (1998). Synthesis of best evidence for clinical decisions. In C. D. Mulrow, & D. J. Cook (Eds.), Systematic reviews-Synthesis of best evidence for health care decisions (pp. 5 _ 12). Philadelphia: Pennsylvania.
Dicenso, A., Cullum, N., Ciliska, D., & Marks, S. (2000). Based Nursing: Past, present, and future. Evidence-Based Nursing, 3(1), 7 _ 8.
Dixon-Woods, M., Fitzpatrick, R., & Roberts, K. (2001). Including qualitative research in systematic reviews: Opportuni-ties and problems. Journal of Evaluation in Clinical Practice, 7(2), 125 _ 133.
Dixon-Woods, M., & Fitzpatrick, R. (2001). Qualitative research in systematic reviews. Has established a place for itself. British Medical Journal, 323(7316), 765 _ 766.
French, P. (1999). The development of evidence-based nurs-ing. Journal of Advanced Nursing, 29(1), 72 _ 78.
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Holmes, S. (1996). Systematic search offers a sound evi-dence base. Nursing Times, 92(4), 37 _ 39.
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Leininger, M. M. (1994). Evaluation criteria and critique issues of qualitative research studies. In J. M. More (Ed.), Critical issues in qualitative research methods (pp. 95 _ 115). Thousand Oaks, CA: Sage.
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Litva, A., & Jacoby, A. (2002). Qualitative methods and evidence-based practice. In J. V. Craig, R. L. Smyth, & S. Mullally (Eds.), The evidence-based practice manual for nurses (pp. 136 _ 163). New York: Churchill Livingstone.
Long, A. F. (2002). Critically appraising research studies. In R. McSherry, M. Simmons, & P. Abbott (Eds.), Evidence-informed nursing-Aguide for clinical nurses (pp. 41 _ 64). London: Routledge.
McQuay, H. J., & Morre, A. R. (1998). Using numerical results from systematic reviews in clinical practice. In C. Mulrow, & D. Cook (Eds.), Systematic reviews-Synthesis of best evidence for health care decisions (pp. 23_36). Philadelphia: Pennsylvania. McSherry, R., Simmons M., & Pearce, P. (2002). An intro-duction to evidence-informed nursing. In R. McSherry, M. Simmons, & P. Abbott (Eds.), Evidence-informed nursing: A guide for clinical nurses (pp. 1 _ 13). New York: Routledge.
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Mulrow, C. D., Cook, D. J., & Davidoff, F. (1998). Systematic review: Critical links in the great chain of evidence. In C. D. Mulrow, D. J. Cook, & F. Davidoff (Eds.), Systematic reviews-Synthesis of best evidence for health care decisions (pp. 1 _ 4). Philadelphia: Pennsylvania.
Newman, M., & Roberts, T. (2002). Critical appraisal 1: Is the quality of the study good enough for you to use the finding? In J. V. Craig, R. L. Smyth, & S. Mullally (Eds.), The evidence-based practice manual for nurses (pp. 86 _ 113). New York: Churchill Livingstone.
Newman, M., & Roberts, T. (2002). Critical appraisal 2: Can the evidence be applied in your context? In J. V. Craig, R. L. Smyth, & S. Mullally (Eds.), The evidence-based practice manual for nurses (pp. 114 _ 135). New York: Churchill Living-stone.
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Systematic Review in Evidence-Based Nursing
Wen-Yu Hu
ABSTRACT:
In practicing evidence-based nursing, a nurse has to decide whether the evidence is relevant for the particu-lar patient. The incorporation of clinical expertise should be balanced with the risks and benefits of alternative treatments for each patient and should take into account the patient's unique clinical circumstances including preferences. Systematic review of literature is an important element of evidence-based nursing. There are nine explicit steps in the procedure of systematic review. Systematic review differs from the traditional nar-rative review in that systematic, explicit methods are used to identify, assess and synthesize the information obtained. Systematic reviews use rigorous methods to reduce bias and can provide reliable summaries of relevant research evidence. The hierarchy of evidence used has five levels and emphasizes the evidence about the effectiveness of interventions. Therefore, it is better that evidence-based nursing should be based on systematic reviews of randomized controlled trials, as well as meta-analysis.Critical appraisal is necessary in systematic reviews to ensure that they are conducted to rigorous stan-dards. The purpose of critical appraisal for evidence-based practice is to decide whether the quality of a research study is good enough for the results it provides to be used to answer a question posed by a health care practitioner or patient. Critical appraisal can be broken down into three distinct but related parts which: (1) Whether the quality of the study is good enough; (2) The application of the study result in my setting; (3) What the results mean for my patients.
The paradigms of nursing research are qualitative and quantitative research. Meta-analysis is a statisti-cal technique used in systematic reviews and it must be a rigorous process in quantitative research. It can answer two main questions about an intervention: “ Does this intervention have a beneficial (or harmful) effect?” and if so, “ What is the size of that effect?” No algorithmic criteria can be produced that can unpro-blematically judge the quality of qualitative research. It is necessary to avoid a checklist approach to evalu-ating qualitative research. The quality of qualitative research is assessed based upon a critical assessment of how well the issues of credibility, transferability, dependability and confirmability are addressed. Therefore, by combining qualitative and quantitative approaches, the ability to produce applicable clinical evidence is greatly increased in future.
Key words:
evidenced-based nursing, systematic review, critical appraisal.RN, MSN, Assistant Professor, School of Nursing, College of Medicine, National Taiwan University.
Address correspondence to: Wen-Yu Hu, No. 1, Jen-Ai Rd. Sec. 1, Taipei 100, Taiwan, ROC. Tel: 886(2)2312-3456 ext. 8428; E-mail: weyuhu@ha.mc.ntu.edu.tw
