Nursing

What is evidence-based practice (EBP)?

"Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions" (Titler 2008). It is associated with other terms including:

• Evidence-Based Health Care (EBHC) -- an umbrella term for all forms of evidence-based approaches to health care.
• Evidence-Based Medicine (EBM) -- a more specific term in EBP and EBHC that applies specifically to medical treatment.

One principle of evidence-based practice is the use of the best available research to inform clinical decision making. The evidence hierarchy demonstrates different levels of research types. The higher in the pyramid the more potentially reliable the results are, but also the less common.

• The bottom of the pyramid contains background information and expert opinion, i.e. non experimental commentary.
• The second section contains Unfiltered Information, including case series / reports, and cohort studies. Many other study designs can fit in this category, but RCTs are the highest form of evidence in this section.
• The final section is filtered information--also called secondary sources. These are sources that combine and/or synthesize the results of unfiltered sources, with Systematic Reviews at the top of the evidence pyramid.

There are a couple forms of literature reviews. You may be asked to find one of these types of literature reviews, or you may be asked or may want to write one of these types.

Narrative reviews

Also called traditional reviews, narrative reviews are articles that seek to provide an overview of a topic or show the authors knowledge of the topic and where their research fits in. In a traditional literature review the author will read widely in the literature around their topic and then select articles to include based on their understanding of what sources are important. Therefore a narrative review does not have a particular methodology, as compared to systematic reviews.

Systematic, Scoping, and Integrative Reviews (aka Evidence Synthesis)

Evidence Synthesis is a methodology for systematically reviewing the literature on a topic to come to either a evidence-based clinical decision (in the case of systematic reviews) or identify opportunities and gaps in the literature (in the case of a scoping review). There are many kinds of evidence synthesis review types, but systematic and scoping reviews are the most common. Evidence Synthesis refers to rigorous, well-documented methods of identifying, selecting, and combining results from multiple studies. Often times Evidence Synthesis projects are undertaken by a team and take a year or more to complete.

Systematized Reviews or Structured literature reviews

These are a newer approach to reviews that are often assigned as a project for a class and do not have the intent to be published. They fall somewhere between narrative reviews and systematic reviews, because they use some systematic search principles but do not follow the rigor of a full evidence synthesis project.

Integrative Review

The integrative review is a form of Evidence Synthesis. It is a methodology for comprehensively reviewing the literature around a topic or research question. The paper by Whittemore and Knaff (2005) breaks down the Integrative review methodology, and the more recent book A Step-by-Step Guide to Conducting an Integrative Review provides guidance as well.

Concept Analysis

Concept analysis is defined as "the dissection of a concept into simpler elements to promote clarity while providing mutual understanding within nursing" (Foley et al.)

It is a common methodology in Nursing, and there are a couple approaches to concept analysis that have been popularized. One popular approach was created by Walker and Avant in their book Strategies for Theory Construction in Nursing. You can explore other methodologies in concept analysis in the article Beyond the classics: A comprehensive look at concept analysis methods in nursing education and research.