Systematic Review, Meta-analysis, Clinical Practice Guidelines and Protocols

How to write the Literature Review

How to write an Evidence Based Practice Literature Review Paper

Objectives After the presentation the student will be able to:

Understand the purpose and basic requirements of an effective literature review. Critically assess research materials. Develop strategies for inventing, organizing, and drafting a literature review. Cite sources appropriately.

What is a Literature Review? Unlike research, EBP isn't about developing new knowledge or validating existing knowledge. It's about translating the evidence and applying it to clinical decision-making. The purpose of EBP is to use the best evidence available to make patient-care decisions. However, we need to communicate and disseminate best practices. The following presentation will explain the steps in developing an EBP paper. There is a pressing need for nurses to participate and, in many circumstances, take the lead in managing change in clinical practice to improve the quality of care. A Literature review It is not a discussion of creative literature like that from Shakespeare, Poe, and J.K. Rowling. Simply put: A Literature Review surveys, summarizes, and links together research (a.k.a., literature) in a given field.

Annotated Bibliography Please note that a Literature Review is NOT an annotated bibliography.

An annotated bibliography is the following:

The full References/Bibliography/Works Cited citation for a source; A brief summation of the major points of the work; A brief indication of how this research is helpful to your project; And at times, any indications of weaknesses that are in the source that could compromise using it.

Why a Lierature Review is Important? Literature Reviews are considered important for numerous reasons:

They allow you to know just WHAT is out there; They allow you to demonstrate mastery over a subject; They allow you to locate your area of research within the literature, such as "how does this fit in with everything else that has been written on this subject?"

Getting Started

APA format APA Style Presentation

Please review the following presentation

Writing an Outline Using headings to provide visual "cues" for readers:

Sections are well delineated with descriptive headings and subheadings.

IMRD structure (Example)

Introduction What question was studied? Methods How was the question studied? ResultsWhat was found? Discussion What do the results mean?

Abstract Should I read the article?

What is the essence of this EBP review—the "take home" message? Clinical Problem – in one sentence if possible Purpose of the project Summary of evidence and strength of evidence supporting practice change Proposed practice change Implementation strategies Evaluation methods Outcomes Conclusions/Nursing Implications It should not exceed 250-350 words

*The abstract for your proposal includes all the above elements except the outcomes and conclusions/nursing implications.

Title What is paper about?

Max info in least words <12 words <100 characters The title is a label Introduces the work Should almost never contain abbreviations Might… Be provocative or controversial Ask a question Make statement of conclusion Question: easier to understand, more impact State results

*One trick professional writers use to unify a work is extracting a title from an essential piece in the paper's final summary/conclusion or a main section. Look for a phrase in these areas that really captures the paper's main idea or argument (thesis) and turn it into a title.

Introduction In the introduction, explain why the topic is important and give the reader an idea of where you are going in your paper.

The introduction should answer ?

What is the Problem/issue?

Brief background of problem (stats) Why was this an important question? What is the Approach? It should also determine if the proposed evidence based improvement is actually needed. It should be 2-3 paragraphs, <450 words

First paragraph

Introduce broad area but don't be too global (for example, discussing the pain when the topic is on phantom pain) The introductory paragraph should engage the reader's interest by setting out clearly the question that the paper is attempting to address, how you plan to address it, and why it is worth addressing in the first place; You may use common knowledge for example Hand washing has demonstrated to reduce germs and bacteria contamination

Second paragraph

Narrowing: As you narrow down the research, the major categories you identify will probably end up being the section headers for your paper.

Discuss the general importance of your topic for those in your field Problem Statement: The problem statement needs to include the general area of concern, a brief background about the concern, and the significance of the concern. A justification of the need is also included. The justification may indicate that there is a gap in the knowledge, conflicting findings, or omission of a group. You may see one of these phrases at the end of the problem statement:

1. Little is known about.… 2. Findings of previous studies are conflicting…. 3. Few studies of this have been done….

Why is it important?

Does it fill a needed gap in knowledge base?

1. What is context? 2. Who is affected? 3. Where is ocurring 4. When is Ocurring? 5. How serious is this issue

Last paragraph

Purpose: (how it will help resolve problem or contribute to knowledge base)

Sets complete roadmap for paper Slavishly followed in order and with same words for rest of paper.

PICO/PICOT Statement: It is stated as a clinical practice problem format, such as PICO (Population, Intervention, Comparison, Outcome) or PICOT (Population, Intervention, Comparison, Outcome, Timeline).

Methods Section Enough information for:

How literature was searched? Should I believe this review? Inclusion/exclusion criteria?What criteria led you to include or exclude sources? (Credibility, Validity and Reliability). What databases did you search? What search terms did you use? (keywords) How many total articles on the subject did you find?

*Pay attention to domain name extensions (.edu, .gov, .org) as these tend to be more reliable. Be selective of .com sites. Learn how to evaluate sites critically

Background and Significance Basic material about the subject, to provide context for the reader.

Very often, you will encounter the same concept defined in different ways by different writers.

Brief paragraph introducing sections to come

1. Brief history of the problem 2. Population who is affected? 3. Where is concentrated ( Areas of concentration) 4. Definitions of terms

Review of the Evidence Section

The real "meat" of your paper will be the actual points of discussion.

Objectively present your findings, and explain what was found These will be a series of paragraphs that support your purpose , with each point occupying one or two paragraphs, depending on the issue. Some people take notes and come back to articles. However, it is recommended that you paraphrasing AS YOU GO. CITE AS YOU GO! You will not have to go back to examine a source.

Think about each Study

Note how each article relates to your topic keep your specific topic in mind all the time and make sure your articles address it. If not, do not include Organize your sources

See the following Matrix

Reference Conceptual Framework Research question The methodology; Analysis & Results Conclusion Implications for future research Implications for practice

Always note if the study was qualitative or quantitative

Quantitative: results presented as stats and numbers

Explicitly stated hypotheses large (100-1500), random sample from particular population objectively scored instruments inferential statistics -- make inferences about pop from sample

Qualitative: results presented as narrative

General, nonspecific problem, with no rigid, specific purposes small, purposive (not random) sample measure with unstructured instruments (interviews) results in words with emphasis on understanding sample

Note if study is experimental or non-experimental

Experimental:

treatments administered to participants for purposes of study effects of treatments assessed almost all are quantitative

Non experimental:

participants' traits measured without attempting to change them quantitative or qualitative do not use the term 'experiment' to describe, use 'study,' 'investigation,' etc.

If an experiment, how were subjects assigned to test conditions?

Guarantees no bias in assignment. More weight given to true experiments (with RA).

Cause-and-effect vs. correlation

Reliability

Validity

Sampling, demographics, statistical significance

Make notes on demographics. Could demographics have played a role in results? (no way you can say for sure, but might raise question How large is difference?... not just significance statistically significant -- greater than chance, not necessarily big.

Major flaws? (do not dissect each article)

Safe to assume that all empirical studies have them.

Leves of evidence

Discussion Section Drawing Connections Discussion is about the implications of the findings This is a key step. Gives meaning to the results, the "why"

When looking at these articles, begin to note connections between studies.

can subgroups be created? consider consistency of results from study to study if discrepant, provide relevant info about research, trying to identify possible explanations for the differences Places results in context of previous research Assesses importance of findings Acknowledges limitations of methods Identifies new areas for exploration and/or 'next steps' Discussion is about what the results mean

Conclusion Plan to present conclusions and implications

conclusion: statement about state of knowledge using degrees of evidence. "it seems safe to conclude that..." "one conclusion might be..." if weight of evidence does not favor one conclusion over the other, say so

implications:

statement of what people or organizations should do in light of existing research. What actions (interventions) seem promising based on review

you are now an expert and can offer conclusions and implications.

Make specific (relevant) suggestions about gaps, can be populations (understudied groups), methodologies, etc

How to review your Paper? Tips on writing :

Style, Mechanics, Language

Avoid complex sentence structure (long convoluted sentences confuse the reader),

Avoid Excessive Wordiness:

do not write "time period," when either "time" or "period" will suffice. do not write "due to the fact that," when a simple "because" will do.

Use simple and clear English.

Every sentence must have a subject and a verb, unless it is part of a direct quote. There are no other exceptions to this rule.

Avoid slang, colloquialisms, and idioms .

Example "bumped off" – to describe a "killing"

Avoid Imprecise Language:

Avoid words like "good" She was a "good" leader. Better to say: She was a "strong" leader; she was an "effective" leader

DO NOT use contractions.

Words like "didn't," "couldn't," and "wouldn't"

Use definitive, specific, concrete, language

Some words and phrases to avoid include good, bad, perfect, ideal, seemingly, would, seem to show, in terms of, based on, in light of. Prefer words and phrases that clearly illustrate your point),

Make the paragraph the unit of composition (avoid one-sentence paragraphs, and ensure paragraphs contain meaningful concepts).

Transitions Writing Transitions

By Purdue University OWL

Transitional Words and Phrases

By The UNiversity of Wisconsin Madison

APA Pitfalls DO NOT use first person.

In scholarly writing, the author is assumed to have "distance" from his or her subject. You should therefore write as an outside observer, not a participant, and you should treat the reader in the same way. This means that pronouns such as "I," "we," or "you" are inappropriate.

ONLY use acronyms AFTER you have defined their meaning; Spell out numbers from 0-9 and use the numerals for all numbers above 9; Make sure that every source you cite in your paper is included in the References page(s); Double-space ALL lines,.

Be consistent with verb tenses. APA recommends past (discussed) or present perfect (have discussed) when presenting results.

Active Voice: "Washington chopped down the cherry tree" Passive Voice: "The cherry tree was chopped down by George Washington." [wordy & clumsy]

Put statements in positive form

For example, 30% of those contacted responded as opposed to 70% did not respond).

Excessive Quotations:

Avoid overusing direct quotations Often writers who have yet to develop their own "voice" have a tendency to use a lot of direct quotes from other authors.

Dumb Mistakes

confusing "its" with "it's," "there" with "they're" or "their," and "who's" with "whose." subjects must agree in number with verbs, and pronouns with their antecedents; Example: " "Each of them had their own ideas" is wrong. "Each of them had his [or her] own ideas" is correct.

Plagiarism

Avoiding plagiarism means citing every single source that you used in writing a paper—and "use" means draw any sort of fact (except those which are common knowledge) or interpretation. Check APA style manual for correct use of citations

Reflect Higher-Order Thinking Baccaulaureate writing must reflect the higher-order thinking skills of analysis, synthesis, and evaluation.

in short, your writing must demonstrate your ability to read and analyze the ideas of other scholars, evaluate them, synthesize or integrate them into a meaningful whole, if necessary, and use them in support of your own arguments

objective evidence, as opposed to subjective opinion, is the coin of scholarly