B71P02 – Foundations in Evidence-Based Practice

1. Appraisal of Literature B71P02 – Foundations in Evidence-Based Practice

2. Task 4 The task requires that you: • Obtain a piece of literature from a journal, book or internet source. The literature should be relevant to an aspect of nursing care you have participated in, or observed, during practice. • Compare and contrast this literature with other sources on the same aspect of care in order to judge the quality of the original piece. • Use an appropriate framework to structure your appraisal. You need not though apply a single literature appraisal framework or checklist but rather it requires that you discuss the literature in a systematic way in order to identify key themes about the chosen aspect of care as well as any implications for practice. This presentation is designed to introduce you to systematic approaches to literature appraisal.

3. The Purpose of Appraising Literature • ‘…to critically appraise and synthesise the current state of knowledge relating to the topic under investigation…’ • ‘..to demonstrate insight into the current state of knowledge in the field and the major questions being investigated, so that gaps pertaining to current knowledge [and practice] can be identified with confidence.’ (Carnwell & Daly, 2001)

4. The Purpose of Appraising Literature A literature appraisal may seek to answer a number of questions: • Is the subject of interest to practitioners? • If the literature is a research paper why and how was it done? • What has been found (research paper) or what new ideas or arguments are presented (non-research paper)? • What are the implications or issues for practice? • Can the findings or ideas be used in practice? Who would benefit and what are the opportunities or constraints? (Adapted from le May, 1999) You are trying to establish what the evidence base is concerning your chosen aspect of nursing care and how it may or should impact on your practice.

5. Phases in the Appraisal of Literature • Define the scope of the appraisal (what it will cover) • Identify sources of relevant information • Appraise the literature • Write up the appraisal (Polit & Hungler, 1991) • Apply the literature to the area of study (Clifford, 1997)

6. Defining the scope of the appraisal • The initial scope will be determined by your chosen topic • You should try to include research based literature • Other theoretical works that focus upon the discourses, conceptual frameworks and models specific to your topic should be included • You may also include ‘grey literature’ (published outside of scholarly journals) e.g. commissioned reports, organisational project papers and clinical guidelines.

7. Identifying the sources of relevant information • Library - books, journals, CD ROMS • IT sources - Electronic journals, databases e.g. Medline, CINAHL, EMBASE, ASSIA, ZETOC. • Internet sources e.g. Cochrane Library, National Electronic Library for Health

8. Availability of Literature • You may be faced with two outcomes at this stage: • Too little literature • broaden your search e.g. use different key words, different journals, look at how the area has been investigated by other disciplines. • Too much literature • Use inclusion and exclusion criteria

9. Inclusion and Exclusion criteria Inclusion criteria: • Time frame, e.g. 1995-2000 • Language or national context • Main focus of paper • Explicit methodology and outcomes Exclusion criteria: • These may be dependent on your focus, field of study, rigour or applicability to practice (generalisability).

10. Appraising the Literature This involves reading. • Initially this may be a skim read of contents to establish: • what has been done, why it has been done and how it was done (research) • the current knowledge in the field and possible gaps in theoretical knowledge • themes that emerge and give structure to a more detailed review of each piece of literature

11. Working with Themes An example might be for the topic area of Handwashing. Themes might emerge from your initial reading that include: • Procedure • Compliance • Hospital Acquired Infections • Washing Agents • Accessibility of resources e.g.sinks • Staff education and training You can then structure more detailed reading around these theme areas or limit your focus to some rather than all.

12. Writing the Literature Appraisal • It will include an introduction, main body and conclusion as with any other academic work • The introduction could include: • an outline of the focus area and the rationale for its choice • the aims and structure of the appraisal • sources of the literature used in the appraisal • where the word limit allows include the key search terms used

13. Writing the Literature Appraisal The main body might: • Divide the literature into content themes (this serves to integrate theoretical and empirical literature) • Question the literature in each theme as follows: • Is the evidence conclusive, or is there theoretical consensus? • Are there counter-arguments or any counter evidence? • If there is no counter-argument or counter-evidence presented, can you think of any? This may be an opportunity to apply your learning to practice, to compare theory with practical realities. • If there are multiple viewpoints or positions regarding the topic, what is your considered view?

14. Writing the Literature Appraisal • Once the literature in each theme has been reviewed and synthesised, a short summary should identify the key arguments and how they relate to the next theme if you have more than one (this ensures a logical flow in the review). • The final section should integrate the theme summaries into a broad final conclusion. Any gaps in theory or practice should now be evident and both learning and future action can be articulated.

15. References Clifford, C. (1997) Nursing and Health Care Research: A skills-based introduction, London, Prentice Hall Carnwell, R. and Daly, W. (2001) ‘Strategies for the construction of a critical review of the literature’, Nurse Education in Practice, Vol.1, pp.57-63 Le May, A. (1999) Evidence based practice – Nursing Times Clinical Monographs No 1, London, NT books/Emap Healthcare Ltd