Lit review, Lit appraisal,  Evidence (Evaluation) Table/Matrix  

Developing a Clinical Question and Selecting a Framework

          Nursing research and evidence-based practice are generated from clinical problems identified in practice, often in search of a solution to the problem. Once a problem is selected, practice in asking and writing the right question about the problem is needed. Distinguishing between a background and a foreground question is the first step in this process.  In general, nurses with less experience begin with a background question, but as experience increases, foreground questions become prominent.  A focused foreground question in a Population, Intervention, Comparison, Outcome and Time (PICOT) framework provides the components of an answerable, searchable question.  The language used in the question represents the purpose of the question.  For example, research questions generally have a directional outcome. (i.e., to reduce or improve); clinical questions gather the evidence related to an outcome (i.e., who, what, and where); and quality improvement questions are focused on processes influencing the outcomes (i.e., why) (Fineout-Overholt & Stillwell, 2019).  Once a clinical question is drafted, a literature search is conducted using key search terms, and a framework or model from which to develop a method for answering the question should follow.

          As a doctorally prepared nurse, the ability to understand how to ask the clinical question, search the literature, appraise the information obtained, and organize it is imperative. The purpose of this course module is to practice building the skill for these critical features. This module is an exercise in asking an answerable, searchable question for study, performing a scholarly literature search, appraising the publications selected and creating an organized evidence (evaluation) table for easy reference when drafting the introduction and literature review for a clinical scholarship project.  An evidence-based framework or model will also be selected to guide the draft of the clinical scholarship project.

 Module Objectives

 At the end of this learning module, the student will be able to:

· Identify a clinical problem of interest.

· Create a study question about the clinical problem.

· Perform a literature search to answer the study question.

· Appraise the factors impeding and facilitating the adoption of the evidence.

· Develop an evidence (evaluation) table or matrix highlighting the attributes and limitations of the literature selected from a scholarly literature search.

· Select an evidence-based practice framework or model from which to build a clinical scholarship project.

Assignments


Literature Search (25 points)

Directions:  Identify a clinical issue or problem.  Develop a study question to answer the question.  Perform a


Evidence Table/Matrix
(100 points)

Directions: The evidence table/matrix should include all studies which will be included in the draft of the introduction and literature review for the clinical scholarship project due at the end of the semester. At least 10 studies should be included and in alphabetical order according to author. Complete the following items on the word document (.docx) provided in the module (download the document, complete it, then upload into the assignment area). Or, copy and paste the assignment (below) into your own word document (.docx), then upload it into the assignment area. (adapted from Melnyk & Fineout-Overholt, 2019, p. 724). Each section is worth 10 points (10 sections x 10 points = 100 points). DO NOT ALTER THIS DOCUMENT (a 5-point deduction will occur)

Name (-1 point if missing):

Academic Program & Population of Focus (-1 point if missing; e.g., BSN-DNP, Pediatric Primary Care):

Citation (in APA)

Purpose of the Study

Framework/

Theory

Design/

Method

Setting/

Sample

Major Variables

Outcome Measures

Statistical Analysis

Findings

Strengths/Limitations/

Recommendations

<


Literature Search

(25 points)

Directions: Identify a clinical issue or problem. Develop a study question to answer the question. Perform a literature search (consider working with a librarian on this). Complete the following items on the word document (.docx) provided in the module (download the document, complete it, then upload into the assignment area). Or, copy and paste the assignment (below) into your own word document (.docx), then upload it into the assignment area. DO NOT ALTER THIS DOCUMENT (a 5-point deduction will occur)

Name (-1 point if missing):

Academic Program & Population of Focus (-1 point if missing; e.g., BSN-DNP, Pediatric Primary Care):

Clinical Issue or Problem (3 points) (e.g., there is a high number of pediatric needlesticks in an Emergency Department)

Problem Statement (3 points) (e.g., the average number of needlesticks for children in an Emergency Department is 2.2 needlesticks per visit

)

Study Question (5 points)

· PICO(T) format (e.g., Melnyk & Fineout-Overholt, 2019, Appendix A, pp. 706-7)

Key Search Terms (5 points) (include Boolean operators)

Search Engines Used (5 points) (e.g., PubMed, CINAHL, etc.)

Number of Initial Publications Generated (1 point) (matching the search terms and phrases)

Refined Search: Inclusion and Exclusion Criteria (2 points)

Number of Publications Generated and Number Selected the Literature Review (1 point)

1


Literature Appraisal
(25 points)

Directions: Select a research publication (not an evidence-based practice guideline) from the literature search to critically appraise. Complete the following items on the word document (.docx) provided in the module (download the document, complete it, then upload into the assignment area). Or, copy and paste the assignment (below) into your own word document (.docx), then upload it into the assignment area. (adapted from Polit & Beck, 2017, p. 100). DO NOT ALTER THIS DOCUMENT (a 5-point deduction will occur).

Name (-1 point if missing)

Academic Program & Population of Focus (-1 point if missing)

APPRAISAL

APA Citation (3 points)

Purpose of the Study (1 point)

Type of Study

(1 point)

Quantitative

Qualitative

Mixed Methods

Meta Analysis

Systematic Review

Other:

Any Specifics?

Cross-sectional

Longitudinal

Phenomenology

Other:

Setting (1 point)

Intervention (1 point)

Variables (1 point)

Independent Variables:

Dependent Variables:

Controlled Variables:

Other:

Framework/Theory

(1 point) (If none, state none)

Design (1 point)

Experimental

Randomized Control Trial

Factorial Design

Quasi-Experimental

Non-Experimental

Descriptive

Survey

Correlational

Other:

Sample (1 point)

Population:

Number in Sample:

Sampling Method:

Generalizable? Yes No

Data Sources

(1 point)

Self-Report/Survey

Observational

Retrospective

Prospective

Other:

Outcome Measures

(1 point)

(what data was collected?)

Statistical Analysis

(1 point)

Bivariate (e.g., t-test, ANOVA, Pearson’s r):

Multivariate (e.g., multiple regression, logistic regression):

Other:

Effect size (if provided) and/or p values (if provided) (1 point)

5/15/22

1

Literature Reviews

Laura L. Kuensting, DNP, APRN,
PCNS-BC, CPNP, CPEN

1

Types of
Literature
Reviews

2

Systematic Review

Meta-Analyses

Qualitative Review

Integrative Review ✓

• Each has a distinct purpose, sampling
frame, definition, and method for analysis

2

Review Methods
Systematic Review

• Com bine evidence from m ultiple studies about
a specific clinical problem

• Clear study question, explicit m ethod, and
com prehensive search for prim ary research

• Includes statistical m ethods of a m eta-
analysis

• M ethod of choice for evidence-based practice
(EBP) initiatives (e.g., Cochrane
Collaboration)

Meta-Analysis Review
• Com bines results of m ultiple prim ary studies

using statistical m ethods
• Enhances objectivity and validity of

findings

• Each study is coded and entered in a
quantitative database

• Effect size is calculated

• Adjustm ents for sam ple size and study quality
can be included

3

3

Review Methods (cont’d)
Qualitative Review

• Meta-synthesis, meta-studies,
formal grounded theory, and
meta-ethnography methods
synthesize findings into a new
theory or framework about a
phenomena

• Differing approaches in
analysis and interpretation

• Potentially broaden the
generalizability of the
qualitative research

Integrative Review ✓
• Broadest type of review
• Many purposes: define concepts, review theories, review

evidence, analyze methods
• Combines theoretical and empirical literature
• Results in a comprehensive portrayal of complex

concepts, theories, or health care problems
• Bias and error can occur

• Examples: literature search may be incomplete or
without primary sources, or data may be inaccurately
interpreted

4

4

5/15/22

2

What is an Integrative review?

• A review method summarizing past
empirical or theoretical literature for a more
comprehensive understanding of a
particular phenomenon or healthcare
problem (W hittem ore & K nafle, 2005)

• Allows for diverse methodologies (i.e.,
experimental and nonexperimental
research)

• Allows for varied perspectives (e.g.,
nursing science, social science, etc.)

5

5

Rigour

Research reviews are
considered research of research

(G a n o n g , 1 9 8 7 ; C o p p e r, 1 9 9 8 a s c ite d in W h itte m o re & K n a fle , 2 0 0 5 )

G E N E R A L P R O C E S S

1. Identify a problem

2. P erform a w ell-defined literature search (prim ary
studies and publications)

3. E valuate/A ppraise the literature

4. A nalyze the data (com pare/contrast the findings)

5. O rgani