literature review in evidence based practice

Evidence-Based Practice (EBP)

• The EBP Process
• Forming a Clinical Question
• Inclusion & Exclusion Criteria
• Acquiring Evidence
• Appraising the Quality of the Evidence
• Writing a Literature Review
• Finding Psychological Tests & Assessment Instruments

What Is a Literature Review?

A literature review is an integrated analysis of scholarly writings that are related directly to your research question. Put simply, it's  a critical evaluation of what's already been written on a particular topic . It represents the literature that provides background information on your topic and shows a connection between those writings and your research question.

A literature review may be a stand-alone work or the introduction to a larger research paper, depending on the assignment. Rely heavily on the guidelines your instructor has given you.

What a Literature Review Is Not:

• A list or summary of sources
• An annotated bibliography
• A grouping of broad, unrelated sources
• A compilation of everything that has been written on a particular topic
• Literary criticism (think English) or a book review

Why Literature Reviews Are Important

• They explain the background of research on a topic
• They demonstrate why a topic is significant to a subject area
• They discover relationships between research studies/ideas
• They identify major themes, concepts, and researchers on a topic
• They identify critical gaps and points of disagreement
• They discuss further research questions that logically come out of the previous studies

To Learn More about Conducting and Writing a Lit Review . . .

Monash University (in Australia) has created several extremely helpful, interactive tutorials. 

• The Stand-Alone Literature Review, https://www.monash.edu/rlo/assignment-samples/science/stand-alone-literature-review
• Researching for Your Literature Review,  https://guides.lib.monash.edu/researching-for-your-literature-review/home
• Writing a Literature Review,  https://www.monash.edu/rlo/graduate-research-writing/write-the-thesis/writing-a-literature-review

Keep Track of Your Sources!

A citation manager can be helpful way to work with large numbers of citations. See UMSL Libraries' Citing Sources guide for more information. Personally, I highly recommend Zotero —it's free, easy to use, and versatile. If you need help getting started with Zotero or one of the other citation managers, please contact a librarian.

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• Volume 21, Issue 2
• Reviewing the literature: choosing a review design
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• Helen Noble 1 ,
• Joanna Smith 2
• 1 School of Nursing and Midwifery , Queen’s University Belfast , Belfast , UK
• 2 School of Healthcare , University of Leeds , Leeds , UK
• Correspondence to Dr Helen Noble, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; helen.noble{at}qub.ac.uk

https://doi.org/10.1136/eb-2018-102895

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Many health professionals, students and academics including health researchers will have grappled with the challenges of undertaking a review of the literature and choosing a suitable design or framework to structure the review. For many undergraduate and master’s healthcare students their final year dissertation involves undertaking a review of the literature as a way of assessing their understanding and ability to critique and apply research findings to practice. For PhD and Master’s by Research students, a rigorous summary of research is usually expected to identify the state of knowledge and gaps in the evidence related to their topic focus and to provide justification for the empirical work they subsequently undertake. From discussions with students and colleagues, there appears to be much confusion about review designs and in particular the use and perhaps misuse of the term ‘systematic review’. For example, some quantitatively focused researchers subscribe to a ‘Cochrane’ approach as the only method to undertake a ‘systematic review’, with other researchers having a more pragmatic view, recognising the different purposes of a review and ways of applying systematic methods to undertake a review of the literature. Traditionally, systematic reviews have included only quantitative, experimental studies, usually randomised controlled trials. 1 More recently, systematic reviews of qualitative studies have emerged, 2 and integrative reviews which include both quantitative and qualitative studies. 3

In this article, we will build on a previous Research Made Simple article that outlined the key principles of undertaking a review of the literature in a structured and systemic way 4 by further exploring review designs and their key features to assist you in choosing an appropriate design. A reference to an example of each review outlined will be provided.

What is the purpose of undertaking a review of the evidence?

The purpose of a review of healthcare literature is primarily to summarise the knowledge around a specific question or topic, or to make recommendations that can support health professionals and organisations make decisions about a specific intervention or care issue. 5 In addition, reviews can highlight gaps in knowledge to guide future research. The most common approach to summarising, interpreting and making recommendations from synthesising the evidence in healthcare is a traditional systematic review of the literature to answer a specific clinical question. These reviews follow explicit, prespecified and reproducible methods in order to identify, evaluate and summarise the findings of all relevant individual studies. 6 Systematic reviews are typically associated with evaluating interventions, and therefore where appropriate, combine the results of several empirical studies to give a more reliable estimate of an intervention’s effectiveness than a single study. 6 However, over the past decade the range of approaches to reviewing the literature has expanded to reflect broader types of evidence/research designs and questions reflecting the increased complexity of healthcare. While this should be welcomed, this adds to the challenges in choosing the best review approach/design that meets the purpose of the review.

What approaches can be adopted to review the evidence?

• View inline

Key features of the common types of healthcare review

In summary, we have identified and described a variety of review designs and offered reasons for choosing a specific approach. Reviews are vital research methodology and help make sense of a body of research. They offer a succinct analysis which avoids the need for accessing individual research reports included in the review, increasingly vital for health professionals in light of the increasing vast amount of literature available. The field of reviews of the literature continues to change and while new approaches are emerging, ensuring methods are robust and remain paramount. This paper offers guidance to help direct choices when deciding on a review and provides an example of each approach.

• 5. ↵ Canadian Institutes of Health Research . Knowledge translation. Canadian Institutes of Health Research . 2008 . http://www.cihr.ca/e/29418.html ( accessed Jan 2018 ).
• 6. ↵ Centre for Reviews and Dissemination . Guidance for undertaking reviews in heathcare . 3rd ed . York University, York : CRD , 2009 .
• Buchwald H ,
• Braunwald E , et al
• Horvath M ,
• Massey K , et al
• Sheehan KJ ,
• Sobolev B ,
• Villán Villán YF , et al
• Christmals CD ,
• Whittemore R ,
• McInnes S ,
• Bonney A , et al
• Greenhalgh T ,
• Harvey G , et al
• Rycroft-Malone J ,
• McCormack B ,
• DeCorby K , et al
• Mitchison D ,
• 19. Joanna Briggs Institute Umbrella reviews . 2014 . http://joannabriggs.org/assets/docs/sumari/ReviewersManual-Methodology-JBI_Umbrella_Reviews-2014.pdf ( accessed Jan 2018 )
• van der Linde R , et al

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

Read the full text or download the PDF:

JAY SIWEK, M.D., MARGARET L. GOURLAY, M.D., DAVID C. SLAWSON, M.D., AND ALLEN F. SHAUGHNESSY, PHARM.D.

Am Fam Physician. 2002;65(2):251-258

Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Updates selectively review the medical literature while discussing a topic broadly. Nonquantitative systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses (quantitative systematic reviews) seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. This article presents guidelines for writing an evidence-based clinical review article for American Family Physician . First, the topic should be of common interest and relevance to family practice. Include a table of the continuing medical education objectives of the review. State how the literature search was done and include several sources of evidence-based reviews, such as the Cochrane Collaboration, BMJ's Clinical Evidence , or the InfoRetriever Web site. Where possible, use evidence based on clinical outcomes relating to morbidity, mortality, or quality of life, and studies of primary care populations. In articles submitted to American Family Physician , rate the level of evidence for key recommendations according to the following scale: level A (randomized controlled trial [RCT], meta-analysis); level B (other evidence); level C (consensus/expert opinion). Finally, provide a table of key summary points.

American Family Physician is particularly interested in receiving clinical review articles that follow an evidence-based format. Clinical review articles, also known as updates, differ from systematic reviews and meta-analyses in important ways. 1 Updates selectively review the medical literature while discussing a topic broadly. An example of such a topic is, “The diagnosis and treatment of myocardial ischemia.” Systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Examples are many of the systematic reviews of the Cochrane Collaboration or BMJ's Clinical Evidence compendium. Meta-analyses are a special type of systematic review. They use quantitative methods to analyze the literature and seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. An example is, “Do beta blockers reduce mortality following myocardial infarction?”

The best clinical review articles base the discussion on existing systematic reviews and meta-analyses, and incorporate all relevant research findings about the management of a given disorder. Such evidence-based updates provide readers with powerful summaries and sound clinical guidance.

In this article, we present guidelines for writing an evidence-based clinical review article, especially one designed for continuing medical education (CME) and incorporating CME objectives into its format. This article may be read as a companion piece to a previous article and accompanying editorial about reading and evaluating clinical review articles. 1 , 2 Some articles may not be appropriate for an evidence-based format because of the nature of the topic, the slant of the article, a lack of sufficient supporting evidence, or other factors. We encourage authors to review the literature and, wherever possible, rate key points of evidence. This process will help emphasize the summary points of the article and strengthen its teaching value.

Topic Selection

Choose a common clinical problem and avoid topics that are rarities or unusual manifestations of disease or that have curiosity value only. Whenever possible, choose common problems for which there is new information about diagnosis or treatment. Emphasize new information that, if valid, should prompt a change in clinical practice, such as the recent evidence that spironolactone therapy improves survival in patients who have severe congestive heart failure. 3 Similarly, new evidence showing that a standard treatment is no longer helpful, but may be harmful, would also be important to report. For example, patching most traumatic corneal abrasions may actually cause more symptoms and delay healing compared with no patching. 4

Searching the Literature

When searching the literature on your topic, please consult several sources of evidence-based reviews ( Table 1 ) . Look for pertinent guidelines on the diagnosis, treatment, or prevention of the disorder being discussed. Incorporate all high-quality recommendations that are relevant to the topic. When reviewing the first draft, look for all key recommendations about diagnosis and, especially, treatment. Try to ensure that all recommendations are based on the highest level of evidence available. If you are not sure about the source or strength of the recommendation, return to the literature, seeking out the basis for the recommendation.

In particular, try to find the answer in an authoritative compendium of evidence-based reviews, or at least try to find a meta-analysis or well-designed randomized controlled trial (RCT) to support it. If none appears to be available, try to cite an authoritative consensus statement or clinical guideline, such as a National Institutes of Health Consensus Development Conference statement or a clinical guideline published by a major medical organization. If no strong evidence exists to support the conventional approach to managing a given clinical situation, point this out in the text, especially for key recommendations. Keep in mind that much of traditional medical practice has not yet undergone rigorous scientific study, and high-quality evidence may not exist to support conventional knowledge or practice.

Patient-Oriented vs. Disease-Oriented Evidence

With regard to types of evidence, Shaughnessy and Slawson 5 – 7 developed the concept of Patient-Oriented Evidence that Matters (POEM), in distinction to Disease-Oriented Evidence (DOE). POEM deals with outcomes of importance to patients, such as changes in morbidity, mortality, or quality of life. DOE deals with surrogate end points, such as changes in laboratory values or other measures of response. Although the results of DOE sometimes parallel the results of POEM, they do not always correspond ( Table 2 ) . 2 When possible, use POEM-type evidence rather than DOE. When DOE is the only guidance available, indicate that key clinical recommendations lack the support of outcomes evidence. Here is an example of how the latter situation might appear in the text: “Although prostate-specific antigen (PSA) testing identifies prostate cancer at an early stage, it has not yet been proved that PSA screening improves patient survival.” (Note: PSA testing is an example of DOE, a surrogate marker for the true outcomes of importance—improved survival, decreased morbidity, and improved quality of life.)

Evaluating the Literature

Evaluate the strength and validity of the literature that supports the discussion (see the following section, Levels of Evidence). Look for meta-analyses, high-quality, randomized clinical trials with important outcomes (POEM), or well-designed, nonrandomized clinical trials, clinical cohort studies, or case-controlled studies with consistent findings. In some cases, high-quality, historical, uncontrolled studies are appropriate (e.g., the evidence supporting the efficacy of Papanicolaou smear screening). Avoid anecdotal reports or repeating the hearsay of conventional wisdom, which may not stand up to the scrutiny of scientific study (e.g., prescribing prolonged bed rest for low back pain).

Look for studies that describe patient populations that are likely to be seen in primary care rather than subspecialty referral populations. Shaughnessy and Slawson's guide for writers of clinical review articles includes a section on information and validity traps to avoid. 2

Levels of Evidence

Readers need to know the strength of the evidence supporting the key clinical recommendations on diagnosis and treatment. Many different rating systems of varying complexity and clinical relevance are described in the medical literature. Recently, the third U.S. Preventive Services Task Force (USPSTF) emphasized the importance of rating not only the study type (RCT, cohort study, case-control study, etc.), but also the study quality as measured by internal validity and the quality of the entire body of evidence on a topic. 8

While it is important to appreciate these evolving concepts, we find that a simplified grading system is more useful in AFP . We have adopted the following convention, using an ABC rating scale. Criteria for high-quality studies are discussed in several sources. 8 , 9 See the AFP Web site ( www.aafp.org/afp/authors ) for additional information about levels of evidence and see the accompanying editorial in this issue discussing the potential pitfalls and limitations of any rating system.

Level A (randomized controlled trial/meta-analysis): High-quality randomized controlled trial (RCT) that considers all important outcomes. High-quality meta-analysis (quantitative systematic review) using comprehensive search strategies.

Level B (other evidence): A well-designed, nonrandomized clinical trial. A nonquantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower quality RCTs, clinical cohort studies, and case-controlled studies with non-biased selection of study participants and consistent findings. Other evidence, such as high-quality, historical, uncontrolled studies, or well-designed epidemiologic studies with compelling findings, is also included.

Level C (consensus/expert opinion): Consensus viewpoint or expert opinion.

Each rating is applied to a single reference in the article, not to the entire body of evidence that exists on a topic. Each label should include the letter rating (A, B, C), followed by the specific type of study for that reference. For example, following a level B rating, include one of these descriptors: (1) nonrandomized clinical trial; (2) nonquantitative systematic review; (3) lower quality RCT; (4) clinical cohort study; (5) case-controlled study; (6) historical uncontrolled study; (7) epidemiologic study.

Here are some examples of the way evidence ratings should appear in the text:

“To improve morbidity and mortality, most patients in congestive heart failure should be treated with an angiotensin-converting enzyme inhibitor. [Evidence level A, RCT]”

“The USPSTF recommends that clinicians routinely screen asymptomatic pregnant women 25 years and younger for chlamydial infection. [Evidence level B, non-randomized clinical trial]”

“The American Diabetes Association recommends screening for diabetes every three years in all patients at high risk of the disease, including all adults 45 years and older. [Evidence level C, expert opinion]”

When scientifically strong evidence does not exist to support a given clinical recommendation, you can point this out in the following way:

“Physical therapy is traditionally prescribed for the treatment of adhesive capsulitis (frozen shoulder), although there are no randomized outcomes studies of this approach.”

Format of the Review

Introduction.

The introduction should define the topic and purpose of the review and describe its relevance to family practice. The traditional way of doing this is to discuss the epidemiology of the condition, stating how many people have it at one point in time (prevalence) or what percentage of the population is expected to develop it over a given period of time (incidence). A more engaging way of doing this is to indicate how often a typical family physician is likely to encounter this problem during a week, month, year, or career. Emphasize the key CME objectives of the review and summarize them in a separate table entitled “CME Objectives.”

The methods section should briefly indicate how the literature search was conducted and what major sources of evidence were used. Ideally, indicate what predetermined criteria were used to include or exclude studies (e.g., studies had to be independently rated as being high quality by an established evaluation process, such as the Cochrane Collaboration). Be comprehensive in trying to identify all major relevant research. Critically evaluate the quality of research reviewed. Avoid selective referencing of only information that supports your conclusions. If there is controversy on a topic, address the full scope of the controversy.

The discussion can then follow the typical format of a clinical review article. It should touch on one or more of the following subtopics: etiology, pathophysiology, clinical presentation (signs and symptoms), diagnostic evaluation (history, physical examination, laboratory evaluation, and diagnostic imaging), differential diagnosis, treatment (goals, medical/surgical therapy, laboratory testing, patient education, and follow-up), prognosis, prevention, and future directions.

The review will be comprehensive and balanced if it acknowledges controversies, unresolved questions, recent developments, other viewpoints, and any apparent conflicts of interest or instances of bias that might affect the strength of the evidence presented. Emphasize an evidence-supported approach or, where little evidence exists, a consensus viewpoint. In the absence of a consensus viewpoint, you may describe generally accepted practices or discuss one or more reasoned approaches, but acknowledge that solid support for these recommendations is lacking.

In some cases, cost-effectiveness analyses may be important in deciding how to implement health care services, especially preventive services. 10 When relevant, mention high-quality cost-effectiveness analyses to help clarify the costs and health benefits associated with alternative interventions to achieve a given health outcome. Highlight key points about diagnosis and treatment in the discussion and include a summary table of the key take-home points. These points are not necessarily the same as the key recommendations, whose level of evidence is rated, although some of them will be.

Use tables, figures, and illustrations to highlight key points, and present a step-wise, algorithmic approach to diagnosis or treatment when possible.

Rate the evidence for key statements, especially treatment recommendations. We expect that most articles will have at most two to four key statements; some will have none. Rate only those statements that have corresponding references and base the rating on the quality and level of evidence presented in the supporting citations. Use primary sources (original research, RCTs, meta-analyses, and systematic reviews) as the basis for determining the level of evidence. In other words, the supporting citation should be a primary research source of the information, not a secondary source (such as a nonsystematic review article or a textbook) that simply cites the original source. Systematic reviews that analyze multiple RCTs are good sources for determining ratings of evidence.

The references should include the most current and important sources of support for key statements (i.e., studies referred to, new information, controversial material, specific quantitative data, and information that would not usually be found in most general reference textbooks). Generally, these references will be key evidence-based recommendations, meta-analyses, or landmark articles. Although some journals publish exhaustive lists of reference citations, AFP prefers to include a succinct list of key references. (We will make more extensive reference lists available on our Web site or provide links to your personal reference list.)

You may use the following checklist to ensure the completeness of your evidence-based review article; use the source list of reviews to identify important sources of evidence-based medicine materials.

Checklist for an Evidence-Based Clinical Review Article

The topic is common in family practice, especially topics in which there is new, important information about diagnosis or treatment.

The introduction defines the topic and the purpose of the review, and describes its relevance to family practice.

A table of CME objectives for the review is included.

The review states how you did your literature search and indicates what sources you checked to ensure a comprehensive assessment of relevant studies (e.g., MEDLINE, the Cochrane Collaboration Database, the Center for Research Support, TRIP Database).

Several sources of evidence-based reviews on the topic are evaluated ( Table 1 ) .

Where possible, POEM (dealing with changes in morbidity, mortality, or quality of life) rather than DOE (dealing with mechanistic explanations or surrogate end points, such as changes in laboratory tests) is used to support key clinical recommendations ( Table 2 ) .

Studies of patients likely to be representative of those in primary care practices, rather than subspecialty referral centers, are emphasized.

Studies that are not only statistically significant but also clinically significant are emphasized; e.g., interventions with meaningful changes in absolute risk reduction and low numbers needed to treat. (See http://www.cebm.net/index.aspx?o=1116 .) 11

The level of evidence for key clinical recommendations is labeled using the following rating scale: level A (RCT/meta-analysis), level B (other evidence), and level C (consensus/expert opinion).

Acknowledge controversies, recent developments, other viewpoints, and any apparent conflicts of interest or instances of bias that might affect the strength of the evidence presented.

Highlight key points about diagnosis and treatment in the discussion and include a summary table of key take-home points.

Use tables, figures, and illustrations to highlight key points and present a step-wise, algorithmic approach to diagnosis or treatment when possible.

Emphasize evidence-based guidelines and primary research studies, rather than other review articles, unless they are systematic reviews.

The essential elements of this checklist are summarized in Table 3 .

Siwek J. Reading and evaluating clinical review articles. Am Fam Physician. 1997;55:2064-2069.

Shaughnessy AF, Slawson DC. Getting the most from review articles: a guide for readers and writers. Am Fam Physician. 1997;55:2155-60.

Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709-17.

Flynn CA, D'Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998;47:264-70.

Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: feeling good about not knowing everything. J Fam Pract. 1994;38:505-13.

Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39:489-99.

Slawson DC, Shaughnessy AF. Becoming an information master: using POEMs to change practice with confidence. Patient-oriented evidence that matters. J Fam Pract. 2000;49:63-7.

Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Methods Work Group, Third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force. A review of the process. Am J Prev Med. 2001;20(3 suppl):21-35.

CATbank topics: levels of evidence and grades of recommendations. Retrieved November 2001, from: http://www.cebm.net/ .

Saha S, Hoerger TJ, Pignone MP, Teutsch SM, Helfand M, Mandelblatt JS. for the Cost Work Group of the Third U.S. Preventive Services Task Force. The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. Am J Prev Med. 2001;20(3 suppl):36-43.

Evidence-based medicine glossary. Retrieved November 2001, from: http://www.cebm.net/index.aspx?o=1116 .

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What is a literature review?

Part of your final project is to conduct a literature review that shows a progressive development of ideas and explains the current state of the research surrounding your PICO question and rationale for the project. Use the resources below to learn more about how to approach the literature review and best practices.

An Introduction to Literature Reviews

• Article: Literature Review in Encyclopedia of Evaluation A literature review is both process and product. The literature review process entails a systematic examination of prior research, evaluation studies, and scholarship to answer questions of theory, policy, and practice. Read this short article entry from the Encyclopedia of Evaluation to learn about literature reviews and how an integrative review is a specific type.
• eBook Chapter: Literature Review in Nursing Research and Statistics Chapter 5 of Nursing Research and Statistics, detailing the concept of the literature review, its importance, purpose, the different types etc.
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Evidence-Based Practice PT

• Evidence-Based Practice
• Literature Review
• Developing a Topic
• Question Development
• Background questions
• Citation Management
• Critical Appraisal

What is a Literature Review

A literature review is a  systematic review of the published literature on a specific topic or research question designed to analyze-- not just summarize-- scholarly writings that are related directly to your research question .  That is, it represents the literature that provides background information on your topic and shows a correspondence between those writings and your research question.  This guide is designed to be a general resource for those completing a literature review in their field. 

Why a Literature Review is Important

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Helps focus your own research questions or problems
• Discovers relationships between research studies/ideas.
• Suggests unexplored ideas or populations
• Identifies major themes, concepts, and researchers on a topic.
• Tests assumptions; may help counter preconceived ideas and remove unconscious bias.
• Identifies critical gaps, points of disagreement, or potentially flawed methodology or theoretical approaches.
• Indicates potential directions for future research.

A Literature Review Must:

A literature review must do these things

• be organized around and related directly to the thesis or research question you are developing
• synthesize results into a summary of what is and is not known
• identify areas of controversy in the literature
• formulate questions that need further research

A Literature Review is NOT

Keep in mind that a literature review defines and sets the stage for your later research.  While you may take the same steps in researching your literature review, your literature review is NOT:

• Not an annotated bibliography i n which you summarize each article that you have reviewed.  A lit review goes beyond basic summarizing to focus on the critical analysis of the reviewed works and their relationship to your research question.
• Not a research paper  where you select resources to support one side of an issue versus another.  A lit review should explain and consider all sides of an argument in order to avoid bias, and areas of agreement and disagreement should be highlighted.

Types of Literature Reviews

D ifferent projects involve different  kinds  of literature reviews with different  kinds  and  amounts  of work. And, of course, the "end products" vary.

• Honors paper
• Capstone project
• Research Study
• Senior thesis
• Masters thesis
• Doctoral dissertation
• Research article
• Grant proposal
• Evidence based practice
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• Next: Developing a Topic >>

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5. Conducting an Evidence-Based Literature Review

Learning Objectives

By the end of this chapter, you will be able to:

• Explain the purpose of a literature search.
• Develop a literature search strategy based on the PICO framework.
• Describe and Apply the PICOT approach to specific research question development for capstone projects.
• Identify at least two databases that can be used for a literature search.
• Explain the relationship between evidence-based practice and levels of evidence.
• Implement an information management system to facilitate critical appraisal of identified literature.

This chapter discusses the importance of the PICO framework when developing a literature search strategy.  Common databases for literature scoping are shown.  Strategies for critically appraising the literature are presented and examples of information management systems for effective literature reviews are included.  This chapter ends with some examples of information management systems that can be used or modified to facilitate a succinct and relevant literature review.

Introduction

Once Phase 1 of literature scoping has been completed and a topic has been identified, and a PICO/PIO question developed it is time to begin Phase 2 of literature scoping.  The second phase of a literature review is to help you delve deeper into what evidence is available on your topic or program of interest (Burke & Dempsey, 2022).  Although literature reviews can be time consuming it is an extremely important component of a capstone project.  Literature reviews are used to describe the population or community using supporting data.  Literature reviews also begin to introduce the population or community needs or problem to substantiate a program or intervention.  Literature reviews are also used with grant proposals and Institutional Review Board (IRB applications) as a means of supporting evidence-based practice.  Once you have selected a topic and created a PIO/PICO question, literature should be reviewed for similar programs.  Exploring other programs can help you understand challenges, successes, and potential funding streams associated with program development.  Furthermore, students should be knowledgeable about what similar programs exist so as not to reinvent the wheel (Doll, 2010).

The purpose of the literature search is to identify existing published research or information in a particular area of interest.  This will assist you in clarifying your guiding question(s), and to identify whether your guiding question has been answered.  A literature review must be strategic and systematic and informed by documented strategies.  Search strategies have two major considerations: search terms and databases (Considine et al., 2017).

Developing a Search Strategy

The PIO/PICO framework (Chapter 3) should be used to develop search terms that are informed by the PIO/PICO question, Medical Subject Headings (MeSH), and any other terms deemed relevant.  Alternative terms and spellings must also be considered (see Table 5.1:  Examples of Alternative Terms)

Table 5.1:  Examples of Alternative Terms

Performing the literature search (literature sourcing).

With a solid PICO/PIO question, selection of databases begins.  Conducting a literature search involves the use of web-based search engines along with electronic research databases.  Electronic bibliographic databases collect and index publications in a focus area.   To find the correct database(s), explore what material it covers and develop knowledge of the search features within the database.  This is also a great time for you to meet with their school’s librarian,  who can help you determine the most suitable databases available (Burke & Dempsey, 2022; DeIuliis, Bednarski, Bell, & DeAngelis,  2020).

To carry out a good literature review, you need to draw it from the latest research and information.  While some books are good for providing you with a helicopter view of a topic, before the average book is written and published at least a year has passed.  Consequently, books that have been published two or three years ago more than likely contain research that is over five years old (Burke & Dempsey, 2022).  Yet each year, there are at least one million new academic articles published in peer-reviewed journals.  For this reason, the most effective way of sourcing literature is by reading and reviewing peer-reviewed journal articles.  Many peer-reviewed journal articles are accessible via open access.  Literature sourcing can be done via Google Scholar, Touro Scholar, and other open access platforms; however, they are not exhaustive.  That’s why it is useful for you to draw from some of the databases available through the library of your educational institution  (Burke & Dempsey, 2022).  (Refer to Table 5.2:  Common Databases for Literature Scoping).

Table 5.2:  Common Databases for Literature Scoping

Source:  DeIuliis, E. D., Bednarski, J. A., Bell, A., & DeAngelis, T. (2020). 3. In The entry level Occupational Therapy Doctorate Capstone: A Framework for the experience and project (pp. 41–55). essay, SLACK Incorporated.

To find the right database(s), explore what material it covers, and become familiarized with the search features within the database.  It is best practice to search multiple databases that are relevant to your topic because different databases can yield different search results.  Furthermore, all databases will allow you to truncate terms to find different word endings and expand your results.  Note that the truncation symbol is usually the asterisk (*).  For example, nurs* will find nurses, nurse, and nursing.  The wildcard is usually a question mark symbol (?) that can be used to replace a single character in a word to find different spellings.  For example, wom?n will show results for both woman and women.  It is important to save your search strategy as this information is considered an important component of your capstone project (Considine et al., 2017).

The process that you use to search for and select literature should be organized and systematic, Although the majority of capstone projects will undergo the process of a rapid review of the literature, systematic reviews can also be completed. Rapid reviews have narrow search criteria to answer a policy or practice issue and systematic reviews have more expansive search criteria needed to answer a broader question (DeIuliis et al., 2020).

Getting and Reporting Your Search Results

Once search results are completed, the next step is for you to review all titles and abstracts and to remove duplicates.  The remaining titles and abstracts are critiqued against the PIO/PICO question and the articles can then be labeled as included, excluded, or possibility .  The full-text articles are then retrieved and read in detail for appraisal against the PIO/PICO question (Considine et al., 2017).  One system to consider using to guide the critical reading of results obtained from the literature search is the Preview, Question, Read, and Summarize (PQRS) Model (Refer to Table 5.3:  PQRS Model for Critical Reading).  At this point, additional literature scoping can be done by hand searching the reference lists of the full-text papers for secondary sources.  At the end of this process, it is imperative to have documented the literature search in a systematic fashion (Considine et al., 2017).  This will be covered in the Information Management section of this chapter.

Table 5.3:  PQRS Model for Critical Reading

Evaluating the Literature

Once the inclusion/exclusion process of the literature is complete, the resultant articles are re-reviewed and the level, quality, relevance and strength of the evidence is critically appraised (Refer to Table 5.4:  Level, Quality, Relevance, and Strength of Evidence Checklist)

Table 5.4:  Level, Quality, Relevance, and Strength of Evidence Checklist

Source:  Considine, J., Shaban, R. Z., Fry, M., & Curtis, K. (2017). Evidence based emergency nursing: designing a research question and searching the literature.  International emergency nursing ,  32 , 78-82.

Levels of Evidence:  Quantitative Studies

Levels of evidence are based on the principle that certain study types have more rigor and these higher quality study designs provide more confidence to associated clinical decision-making (Tomlin & Borgetto, 2011).  It is important to note that in many areas of health, it is difficult to attain high-level evidence.  Consequently, the focus should be on determining the highest available level of evidence (Refer to Table 5.5:  Levels of Evidence)

Table 5.5:  Levels of Evidence

The levels of evidence are an important component of evidence-based practice (EBP) .  Understanding the levels and why they are assigned to publications can help you prioritize information.  With that being said, not all Level IV or V evidence should be ignored nor all Level I be accepted as fact.  The levels of evidence table within this chapter (Table 5.5) can be used as a guide; however, you will still need to be cautious when interpreting results (Burns, Rohrich, & Chung, 2011).

Information Management (CAPs Matrix, COREQ)

Developing an effective strategy for managing information before you begin to engage with the literature is vital.  Using reference manager software or developing an information management system will help to enable efficient saving and sorting of references.  There are several techniques that can be used for information management that we will review; however, it is important to discuss information management with your capstone course instructors and mentors to ensure you are meeting specific course and program requirements.  It should also be noted that any information management system used can be modified to meet your and/or individual program needs and requirements.

Microsoft Excel Note-Taking Spreadsheet

A simple technique for managing information is to create a Microsoft Excel spreadsheet comprised of information you require for your literature review (Refer to Table 5.6:  Example of Note-Taking Spreadsheet for Literature Review).

Table 5.6:  Example of Note-Taking Spreadsheet for Literature Review

Critically Appraised Paper (CAP)

A CAP is an at-a-glance summary of the method, findings, study limitations, and clinical implications of a selective quantitative or qualitative- based article. Critically Appraised Papers are used to provide a detailed appraisal of an individual study to determine its value and relevance to a capstone project.   Each article would have its own CAP and each CAP would be numbered (Refer to Appendix 5.A:  Sample Critically Appraised Paper (CAP).

Matrix Tables

Using a review matrix enables you to quickly compare and contrast articles in order to determine the scope of research across time. A review matrix can be used for quantitative or qualitative studies and can help you easily spot differences and similarities between journal articles about a given research topic. Review matrixes are especially helpful for health sciences literature reviews covering the complete scope of a research topic over time. Matrix tables expand both horizontally and vertically, with the number of rows and columns being determined by the number of unique values in the specific fields (Refer to Appendix 5.B:  Sample Matrix Table).

Consolidated Criteria for Reporting Qualitative Studies (COREQ) Checklist

For qualitative research, you can also use the Consolidated Criteria for Reporting Qualitative Studies Checklist (COREQ) for reporting purposes.  The COREQ is a 32-item checklist developed to promote explicit and comprehensive reporting of interviews and focus groups   It is important that you include sufficient detail on the methods of data analysis and the relationship between the analysis and their findings in this research report so reviewers can assess the rigor of the research analysis and the credibility of research findings (Booth, Hannes, Harden, Noyes, Harris & Tong, 2014).  (Refer to Appendix 5.C:  Sample COREQ (Consolidated Criteria for Reporting Qualitative Research Checklist).

Citing Sources

Once you have consulted the literature and are ready to synthesize your information, be sure to adequately give credit to original authors by citing appropriately.  You must cite the source every time you incorporate research, words, ideas, data, or information that is not your own.  Typically, citations consist of standard elements and contain the information necessary to identify and track down publications.  Citations may look different, depending on what is being cited and which style is used to create them.  Plagiarism occurs when you borrow another’s words or ideas and do not acknowledge that you have done so.  The best way to avoid plagiarism is to cite your sources, both within the body of your paper and also within the bibliography of sources, or reference page.  It is important for you to discuss citation style and requirements with your program and capstone instructors to ensure you are citing your sources according to program and course policies (Boston University School of Public Health, 2021).  It should also be noted that there are a number of citation management tools that can help you organize your references such as RefWorks and Zotero.  Your educational institution’s library can provide you with more guidance with citation management tools available to students.

To understand the importance and relevance of available literature, you must locate, identify, and analyze available literature that supports your topic.  Using a systematic process for literature scoping and information management is essential to the literature review process.  Level of evidence interpretation can also help you effectively critically appraise the evidence and report on your findings.

Case Study:  Conducting a Literature Review

Glynn began the second phase of their literature review, a systematic and thorough literature search to locate the most current research supporting their capstone project.  Glynn met with her school’s librarians via Zoom meetings and subsequently used the databases subscribed to by their educational institution and Google Scholar.  Science Direct, CABI, The Embase, The Cochrane Library, and ERIC were included to investigate articles published in any country and written in English over a ten-year lookback.  Keywords and phrases that were used to perform effective database searches included health literacy, functional health literacy, low health literacy, health literacy and chronic disease, health literacy curricula for health care professionals, occupational therapy and low health literature patients, health literacy education, health literacy universal precautions, low health literacy and older adults in rehabilitation settings, and health literacy and community-dwelling adults.   

  A systematic database review by title and keywords resulted in 57 articles that were further reviewed and scrutinized in their entirety to determine their relevance to the capstone project.  After a thorough analysis of these articles, 21 studies were chosen for Glynn’s Critically Appraised Topic (CAT) portfolio.

Inclusion criteria for Glynn’s CAT portfolio included topics that:

• Clearly described a health literacy intervention that was developed or adapted for health care professionals or students enrolled in an accredited health care program
• Utilized a validated measure of health literacy for patients, such as the Rapid Estimate of Adult Literacy in Medicine (REALM)
• Included measurements of participants; self-perceived ability to identify, assess, and provide client-centered interventions for patients identified as low health literature using questionnaires, pre-post workshop surveys, or pre-post workshop quizzes regarding knowledge of health literacy
• Provided a description of effective, evidence-based educational tools and strategies that can be included in health literacy curricula for health care professionals
• Addressed the importance of health literacy and integrating health literacy initiatives into health care practice
• Described the impact of low health literacy and patient outcomes for older adults

Exclusion criteria for Glynn’s CAT portfolio included:

• Literacy plans not related to functional health literacy initiatives for health care professionals
• Literature lacking in an evidence-based practice approach

According to Glynn’s educational program and capstone course policies and procedures, these 21 articles became part of their Critically Appraised Topic Portfolio and a critically appraised resource template, provided by her educational institution and capstone instructors.  A critically appraised resource template was completed for each article.  Each critically appraised resource was numbered, and levels of evidence were reported according to the Oxford Centre for Evidence-Based Medicine Standard Levels of Evidence (Refer to Appendix 5.D:  Glynn’s Critically Appraised Resource #1).

Glynn further reviewed these 21- articles and the following common themes were identified:

• Defining health literacy
• Health literacy universal precautions
• Health literacy curriculum for health care professionals
• Identifying and assessing low-health literate patients
• Strategies to develop patient-friendly reading materials and forms
• Strategies to improve provider/low-health literate patient communication

Glynn consulted with her capstone instructors and will be using APA Style, 6th edition to cite sources within their capstone project.

Refer to Appendix 5.D:  Glynn’s Critically Appraised Resource #1

CRITICALLY APPRAISED PAPER #1 (you will number each resource)

List PIO/PICO Question Here or your health promotion program idea (on everyone)

Name of Article and source:

Put APA Formatted Citation Here-don’t forget hanging indent and double spacing

The information in the boxes to the RIGHT in the table has been provided for explanation purposes.  You should delete this information and use this template for each resource.

Source:  Tong, A., Sainsbury, P & Craig J. (2007). Consolidated criteria for reporting qualitative research (COREQ):  a 32-item checklist for interviews and focus groups.  International Journal for Quality in Health Care, 19 (6), 349-357.

Optimizing Your Capstone Experience: A Guidebook for Allied Health Professionals Copyright © 2023 by Virginia E. Koenig is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Original research

Evidence-based practice models and frameworks in the healthcare setting: a scoping review, jarrod dusin.

1 Department of Evidence Based Practice, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA

2 Therapeutic Science, The University of Kansas Medical Center, Kansas City, Kansas, USA

Andrea Melanson

Lisa mische-lawson, associated data.

bmjopen-2022-071188supp001.pdf

bmjopen-2022-071188supp002.pdf

No data are available.

The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change, along with patient values and preferences and clinical skills.

A Scoping review.

Included sources and articles

Published articles were identified through searches within electronic databases (MEDLINE, EMBASE, Scopus) from January 1990 to April 2022. The English language EBP models and frameworks included in the review all included the five main steps of EBP. Excluded were models and frameworks focused on one domain or strategy (eg, frameworks focused on applying findings).

Of the 20 097 articles found by our search, 19 models and frameworks met our inclusion criteria. The results showed a diverse collection of models and frameworks. Many models and frameworks were well developed and widely used, with supporting validation and updates. Some models and frameworks provided many tools and contextual instruction, while others provided only general process instruction. The models and frameworks reviewed demonstrated that the user must possess EBP expertise and knowledge for the step of assessing evidence. The models and frameworks varied greatly in the level of instruction to assess the evidence. Only seven models and frameworks integrated patient values and preferences into their processes.

Many EBP models and frameworks currently exist that provide diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models and frameworks. Also, the issues of EBP expertise and knowledge to assess evidence must be considered when choosing a model or framework.

STRENGTHS AND LIMITATIONS OF THIS STUDY

• Currently, no comprehensive review exists of evidence-based practice (EBP) models and frameworks.
• Well-developed models and frameworks may have been excluded for not including all five steps of original model for EBP.
• This review did not measure the quality of the models and frameworks based on validated studies.

Introduction

Evidence-based practice (EBP) grew from evidence-based medicine (EBM) to provide a process to review, translate and implement research with practice to improve patient care, treatment and outcomes. Guyatt 1 coined the term EBM in the early 1990s. Over the last 25 years, the field of EBM has continued to evolve and is now a cornerstone of healthcare and a core competency for all medical professionals. 2 3 At first, the term EBM was used only in medicine. However, the term EBP now applies to the principles of other health professions. This expansion of the concept of EBM increases its complexity. 4 The term EBP is used for this paper because it is universal across professions.

Early in the development of EBP, Sackett 5 created an innovative five-step model. This foundational medical model provided a concise overview of the process of EBP. The five steps are (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change. Other critical components of Sackett’s model are considering patient value and preferences and clinical skills with the best available evidence. 5 The influence of this model has led to its integration and adaption into every field of healthcare. Historically, the foundation of EBP has focused on asking the question, acquiring the literature and appraising the evidence but has had difficulty integrating evidence into practice. 6 Although the five steps appear simple, each area includes a vast number of ways to review the literature (eg, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Newcastle-Ottawa Scale) and entire fields of study, such as implementation science, a field dedicated to implementing EBP. 7 8 Implementation science can be traced to the 1960s with Everett Rogers’ Diffusion of Innovation Theory and has grown alongside EBP over the last 25 years. 7 9

One way to manage the complexity of EBP in healthcare is by developing EBP models and frameworks that establish strategies to determine resource needs, identify barriers and facilitators, and guide processes. 10 EBP models and frameworks provide insight into the complexity of transforming evidence into clinical practice. 11 They also allow organisations to determine readiness, willingness and potential outcomes for a hospital system. 12 EBP can differ from implementation science, as EBP models include all five of Sackett’s steps of EBP, while the non-process models of implementation science typically focus on the final two steps. 5 10 There are published scoping reviews of implementation science, 13 however, no comprehensive review of EBP models and frameworks currently exists. Although there is overlap of EBP, implementation science and knowledge translation models and frameworks 10 14 the purpose of the scoping review was to explore how EBP models and frameworks used in healthcare settings align with the original EBP five-step model.

A scoping review synthesises findings across various study types and provides a broad overview of the selected topic. 15 The Arksey and O’Malley method and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) procedures guided this review (see online supplemental PRISMA-ScR checklist ). 15 16 The primary author established the research question and inclusion and exclusion criteria before conducting the review. An a priori protocol was not pre-registered. One research question guided the review: Which EBP models and frameworks align with Sackett’s original model?

Supplementary data

Eligibility criteria.

To be included in the review, English language published EBP models and frameworks needed to include the five main steps of EBP (asking the question, acquiring the best evidence, appraising the evidence, applying the findings to clinical practice and assessing the outcomes of change) based on Sackett’s model. 5 If the models or frameworks involved identifying problems or measured readiness for change, the criteria of ‘asking the question’ was met. Exclusions included models or frameworks focused on one domain or strategy (eg, frameworks focused on applying findings). Also, non-peer-reviewed abstracts, letters, editorials, opinion articles, and dissertations were excluded.

Search and selection

To identify potential studies, a medical librarian searched the databases from January 1990 to April 2022 in MEDLINE, EMBASE and Scopus in collaboration with the primary author. The search was limited to 1990 because the term EBP was coined in the early 90s. The search strategy employed the following keywords: ‘Evidence-Based Practice’ OR ‘evidence based medicine’ OR ‘evidence-based medicine’ OR ‘evidence based nursing’ OR ‘evidence-based nursing’ OR ‘evidence based practice’ OR ‘evidence-based practice’ OR ‘evidence based medicine’ OR ‘evidence-based medicine’ OR ‘evidence based nursing’ OR ‘evidence-based nursing’ OR ‘evidence based practice’ OR ‘evidence-based practice’ AND ‘Hospitals’ OR ‘Hospital Medicine’ OR ‘Nursing’ OR ‘Advanced Practice Nursing’ OR ‘Academic Medical Centers’ OR ‘healthcare’ OR ‘hospital’ OR ‘healthcare’ OR ‘hospital’ AND ‘Models, Organizational’ OR ‘Models, Nursing’ OR ‘framework’ OR ‘theory’ OR ‘theories’ OR ‘model’ OR ‘framework’ OR ‘theory’ OR ‘theories’ OR ‘model’. Additionally, reference lists in publications included for full-text review were screened to identify eligible models and frameworks (see online supplemental appendix A for searches).

Selection of sources of evidence

Two authors (JD and AM) independently screened titles and abstracts and selected studies for potential inclusion in the study, applying the predefined inclusion and exclusion criteria. Both authors then read the full texts of these articles to assess eligibility for final inclusion. Disagreement between the authors regarding eligibility was resolved by consensus between the three authors (JD, AM and LM-L). During the selection process, many models and frameworks were found more than once. Once a model or framework article was identified, the seminal article was reviewed for inclusion. If models or frameworks had been changed or updated since the publication of their seminal article, the most current iteration published was reviewed for inclusion. Once a model or framework was identified and verified for inclusion, all other articles listing the model or framework were excluded. This scoping review intended to identify model or framework aligned with Sackett’s model; therefore, analysing every article that used the included model or framework was unnecessary (see online supplemental appendix B for tracking form).

Data extraction and analysis

Data were collected on the following study characteristics: (1) authors, (2) publication year, (3) model or framework and (4) area(s) of focus in reference to Sackett’s five-step model. After initial selection, models and frameworks were analysed for key features and alignment to the five-step EBP process. A data analysis form was developed to map detailed information (see online supplemental appendix C for full data capture form). Data analysis focused on identifying (1) the general themes of the model or frameworks, and (2) any knowledge gaps. Data extraction and analysis were done by the primary author (JD) and verified by one other author (AM). 15

Patient and public involvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

The search identified 6523 potentially relevant references (see figure 1 ). Following a review of the titles and abstracts, the primary author completed a more detailed screening of 37 full papers. From these, 19 models and frameworks were included. Table 1 summarises the 19 models and frameworks. Of the 19 models and frameworks assessed and mapped, 15 had broad target audiences, including healthcare or public health organisations or health systems. Only five models and frameworks included a target audience of individual clinicians (eg, physicians and nurses). 17–22

Retrieval and selection process.

Models and frameworks organised by integration of patient preferences and values

EBP, evidence-based practice.

Asking the question

All 19 models and frameworks included a process for asking questions. Most focused on identifying problems that needed to be addressed on an organisational or hospital level. Five used the PICO (population, intervention, comparator, outcome) format to ask specific questions related to patient care. 19–25

Acquiring the evidence

The models and frameworks gave basic instructions on acquiring literature, such as ‘conduct systematic search’ or ‘acquire resource’. 20 Four recommended sources from previously generated evidence, such as guidelines and systematic reviews. 6 21 22 26 Although most models and frameworks did not provide specifics, others suggested this work be done through EBP mentors/experts. 20 21 25 27 Seven models included qualitative evidence in the use of evidence, 6 19 21 24 27–29 while only four models considered the use of patient preference and values as evidence. 21 22 24 27 Six models recommended internal data be used in acquiring information. 17 20–22 24 27

Assessing the evidence

The models and frameworks varied greatly in the level of instruction provided in assessing the best evidence. All provided a general overview in assessing and grading the evidence. Four recommended this work be done by EBP mentors and experts. 20 25 27 30 Seven models developed specific tools to be used to assess the levels of evidence. 6 17 21 22 24 25 27

Applying the evidence

The application of evidence also varied greatly for the different models and frameworks. Seven models recommended pilot programmes to implement change. 6 21–25 31 Five recommended the use of EBP mentors and experts to assist in the implementation of evidence and quality improvement as a strategy of the models and frameworks. 20 24 25 27 Thirteen models and frameworks discussed patient values and preferences, 6 17–19 21–27 31 32 but only seven incorporated this topic into the model or framework, 21–27 and only five included tools and instructions. 21–25 Twelve of the 20 models discussed using clinical skill, but specifics of how this was incorporated was lacking in models and frameworks. 6 17–19 21–27 31

Evaluating the outcomes of change

Evaluation varied among the models and frameworks, but most involved using implementation outcome measures to determine the project’s success. Five models and frameworks provide tools and in-depth instruction for evaluation. 21 22 24–26 Monash Partners Learning Health Systems provided detailed instruction on using internal institutional data to determine success of application. 26 This framework uses internal and external data along with evidence in decision making as a benchmark for successful implementation.

EBP models and frameworks provide a process for transforming evidence into clinical practice and allow organisations to determine readiness and willingness for change in a complex hospital system. 12 The large number of models and frameworks complicates the process by confusing what the best tool is for healthcare organisations. This review examined many models and frameworks and assessed the characteristics and gaps that can better assist healthcare organisations to determine the right tool for themselves. This review identified 19 EBP models and frameworks that included the five main steps of EBP as described by Sackett. 5 The results showed that the themes of the models and frameworks are as diverse as the models and frameworks themselves. Some are well developed and widely used, with supporting validation and updates. 21 22 24 27 One such model, the Iowa EBP model, has received over 3900 requests for permission to use it and has been updated from its initial development and publication. 24 Other models provided tools and contextual instruction such as the Johns Hopkin’s model which includes a large number of supporting tools for developing PICOs, instructions for grading literature and project implementation. 17 21 22 24 27 By contrast, the ACE Star model and the An Evidence Implementation Model for Public Health Systems only provide high level overview and general instructions compared with other models and frameworks. 19 29 33

Gaps in the evidence

A consistent finding in research of clinician experience with EBP is the lack of expertise that is needed to assess the literature. 24 34 35 The models and frameworks reviewed demonstrated that the user must possess the knowledge and related skills for this step in the process. The models and frameworks varied greatly in the level of instruction to assess the evidence. Most provided a general overview in assessing and grading the evidence, though a few recommended that this work be done by EBP mentors and experts. 20 25 27 ARCC, JBI and Johns Hopkins provided robust tools and resources that would require administrative time and financial support. 21 22 27 Some models and frameworks offered vital resources or pointed to other resources for assessing evidence, 24 but most did not. While a few used mentors and experts to assist with assessing the literature, a majority did not address this persistent issue.

Sackett’s five-step model included another important consideration when implementing EBP: patient values and preferences. One criticism of EBP is that it ignores patient values and preferences. 36 Over half of the models and frameworks reported the need to include patient values and preferences, but the tools, instruction or resources for including them were limited. The ARCC model integrates patient preferences and values into the model, but it is up to the EBP mentor to accomplish this task. 37 There are many tools for assessing evidence, but few models and frameworks provide this level of guidance for incorporating patient preference and values. The inclusion of patient and family values and preferences can be misunderstood, insincere, and even tokenistic but without it there is reduced chance of success of implementation of EBP. 38 39

Strengths and limitations

Similar to other well-designed scoping reviews, the strengths of this review include a rigorous search conducted by a skilled librarian, literature evaluation by more than one person, and the utilisation of an established methodological framework (PRISMA-ScR). 14 15 Additionally, utilising the EBP five-step models as a point of alignment allows for a more comprehensive breakdown and established reference points for the reviewed models and frameworks. While scoping reviews have been completed on implementation science and knowledge translation models and framework, to our knowledge, this is the first scoping review of EBP models and frameworks. 13 14 Limitations of the study include that well-developed models and frameworks may have been excluded for not including all five steps. 40 For example, the Promoting Action on Research Implementation in Health Services (PARIHS) framework is a well-developed and validated implementation framework but did not include all five steps of an EBP model. 40 Also, some models and frameworks have been studied and validated over many years. It was beyond the scope of the review to measure the quality of the models and frameworks based on these other validated studies.

Implications and future research

Healthcare organisations can support EBP by choosing a model or framework that best suits their environment and providing clear guidance for implementing the best evidence. Some organisations may find the best fit with the ARCC and the Clinical Scholars Model because of the emphasis on mentors or the Johns Hopkins model for its tools for grading the level of evidence. 21 25 27 In contrast, other organisations may find the Iowa model useful with its feedback loops throughout its process. 24

Another implication of this study is the opportunity to better define and develop robust tools for patient and family values and preferences within EBP models and frameworks. Patient experiences are complex and require thorough exploration, so it is not overlooked, which is often the case. 39 41 The utilisation of EBP models and frameworks provide an opportunity to explore this area and provide the resources and understanding that are often lacking. 38 Though varying, models such as the Iowa Model, JBI and Johns Hopkins developed tools to incorporate patient and family values and preferences, but a majority of the models and frameworks did not. 21 22 24 An opportunity exists to create broad tools that can incorporate patient and family values and preferences into EBP to a similar extent as many of the models and frameworks used for developing tools for literature assessment and implementation. 21–25

Future research should consider appraising the quality and use of the different EBP models and frameworks to determine success. Additionally, greater clarification on what is considered patient and family values and preferences and how they can be integrated into the different models and frameworks is needed.

This scoping review of 19 models and frameworks shows considerable variation regarding how the EBP models and frameworks integrate the five steps of EBP. Most of the included models and frameworks provided a narrow description of the steps needed to assess and implement EBP, while a few provided robust instruction and tools. The reviewed models and frameworks provided diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models. Also, the issues of EBP expertise to assess evidence must be considered when selecting a model or framework.

Supplementary Material

Acknowledgments.

We thank Keri Swaggart for completing the database searches and the Medical Writing Center at Children's Mercy Kansas City for editing this manuscript.

Contributors: All authors have read and approved the final manuscript. JD conceptualised the study design, screened the articles for eligibility, extracted data from included studies and contributed to the writing and revision of the manuscript. LM-L conceptualised the study design, provided critical feedback on the manuscript and revised the manuscript. AM screened the articles for eligibility, extracted data from the studies, provided critical feedback on the manuscript and revised the manuscript. JD is the guarantor of this work.

Funding: The article processing charges related to the publication of this article were supported by The University of Kansas (KU) One University Open Access Author Fund sponsored jointly by the KU Provost, KU Vice Chancellor for Research, and KUMC Vice Chancellor for Research and managed jointly by the Libraries at the Medical Center and KU - Lawrence

Disclaimer: No funding agencies had input into the content of this manuscript.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Ethics statements, patient consent for publication.

Not applicable.

Strategies for incorporating evidence-based practice into nurse residency programs: A scoping review

Affiliations.

• 1 Mount Carmel College of Nursing, Columbus, Ohio, USA.
• 2 The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
• 3 The Ohio State University Health Science Library, Columbus, Ohio, USA.
• 4 Ohio Health, Columbus, Ohio, USA.
• 5 Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, Columbus, Ohio, USA.
• PMID: 38549466
• DOI: 10.1111/wvn.12720

Background: The American Nurses Credentialing Center's (ANCC's) Practice Transition Accreditation Program (PTAP) establishes standards for nurse residency programs to elevate and optimize the skills, knowledge, and attitudes of new nurses participating in nurse residency programs. Evidence-based practice (EBP) is foundational to providing safe nursing care. One of the National Academy of Medicine's (NAM's) 2020 goals stated that 90% of clinical decisions would be supported by the best available evidence to attain the best patient outcomes. Nurse residency programs can benefit from evidence-based strategies to develop EBP competencies in new nurses.

Aims: The purpose of this scoping review was to synthesize the literature around strategies for incorporating EBP into nurse residency programs across the United States.

Methods: This scoping review was informed by the JBI (formerly known as the Joanna Briggs Institute) methodology for scoping reviews. Searches were conducted by a health science librarian in PubMed and CINAHL with Full Text. Keywords and their synonyms, Medical Subject Headings (MeSH; PubMed), and Subject Headings (CINAHL with Full Text) were used. Covidence, a literature review management program, was used to organize the literature and manage the review. Title, abstract, and full-text reviews were completed within Covidence using three teams of two independent reviewers.

Results: Four hundred and thirty-eight citations were imported into Covidence. Ten articles were retained for the final review. Three strategies for incorporating EBP into nurse residency programs emerged from the literature: (1) exposure of nurse residents to existing organizational resources, (2) completion of online EBP modules, and (3) completion of an EBP project.

Linking action to evidence: The incorporation of EBP competencies in nurse residency programs aligns with NAM's and ANCC's goals, yet a paucity of evidence exists to guide curriculum development in nurse residency programs. This scoping review corroborates the need for further research to inform best practices for implementing EBP into nurse residency programs.

Keywords: EBP; EBP class; EBP competencies; EBP projects; evidence‐based practice; nurse residency programs; transition to practice programs.

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