Section Two: Review of the Literature

1. Clinical practice problem statement

The Clinical Practice Problem is to be formulated and stated using the PICO(T) format of Population, Intervention, Comparison, Outcome, Timeline.

2. Evaluation/Summary of the evidence from the literature

  1. Develop and implement an exhaustive search process
  2. Describe in a narrative format the following items:
    1.  Literature search method.
    2. Selection criteria.
    3. Publication years included in search.
  3. Synthesize the evidence that supports the project utilizing appropriate synthesis table(s) followed by a narrative synthesis including the following items; strength of the body of evidence, quality of the body of evidence, generalizability of the body of evidence to answer your inquiry, feasibility of implementing the evidence in the proposed setting.
    1. Review current research and other related literature.
    2. Complete an Evaluation/Summary Table to summarize the literature.
    3. If guidelines exist, rate the guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) Instrument
  4. Review each article using Critical Appraisal Tools.
  5. There must be adequate evidence to support the proposed problem and the subsequent proposed recommendation for practice change.
  6. If applicable evaluation/summary of any internal (Organizational) evidence. Examples may include:
      1. QI Data;
      2. Quality Metrics (HCAPS, core measures, NDNQI).

3. Critical appraisal of the evidence

This is an essential step of the evidence-based practice project that moves the analysis beyond a mere review of evidence; you are appraising the quality and the strength of the evidence to answer your clinical question.

  1. Synthesize the evidence that supports the project utilizing appropriate synthesis table(s) followed by a narrative synthesis including the following items; strength of the body of evidence, quality of the body of evidence, generalizability of the body of evidence to answer your inquiry, feasibility of implementing the evidence in the proposed
  2. Interventions should then be evaluated for Effectiveness as related to Scholarly Examinationples of rating systems are provided in Evaluation of the Level of Effectiveness. Record on Summary of Effectiveness Table.
  3. Utilize a Synthesis Table followed by a narrative Synthesis would include steps such as:
    1. Synthesize the body of evidence assembled to answer the clinical question including a synthesis of;
    2. the strength of the body of evidence;
    3. the body of evidence related to outcomes of interest;
    4. the body of evidence related to practice change recommendations;
    5. the body of evidence related to implementation strategies, etc.

4. Presentation of theoretical basis

Theoretical base for investigation of the clinical problem or implementation of the intervention is provided. This may include a conceptual framework; mid-range theory to guide the formulation of the intervention; theoretical framework for implementation (i.e., change theory, EBP models).

  1. Presentation would include:
    1. Providing theoretical basis for the investigation of the problem (conceptual framework, etc.).
    2. Providing an EBP model that will guide the project (Iowa, Rosswurm and Larabee, etc.).
    3. Providing a description of how the project fits the organizational nursing department’s theory of practice, or the organizational strategic plan or mission statement.

5. Utility/Feasibility

  1. Complete a critique of applicability of your proposed intervention/implementation.
  2. Determine the clinical feasibility and usefulness of your proposed intervention/implementation.
    1. Feasibility goes beyond cost. Other considerations are time involvement, adequate resources; training needs if applicable, space needs, institutional interest and commitment, etc.
  3. Analyze the benefits and risks of use of intervention/implementation.
  4. Complete a cost analysis and resources needed to implement change including:
    1. A budget.
    2. Education plan if applicable.
    3. Timeline.
    4. Including but not limited to i.e. personnel, operational, equipment.

6. Recommendations summary

  1. Statement of the recommendations
  2. Reference(s) in support of the recommendations
  3. Identification of key stakeholders
  4. Strategies to engage
  5. Identification of potential barriers
  6. Strategies to address