| Principal Investigator: | Kathleen R. Stevens, RN, EdD, FAAN |
| Co-Principal Investigator/Collaborator: | Matita W. Charlton |
| Organization: | University of Texas Health Science Center at San Antonio |
Abstract
Problem
In evidence-based practice, effective nursing care depends upon high quality systematic reviews (SRs). SRs published in nursing literature must be rigorous so as not to misinform clinical decisions. The question remains: What is the quality of SRs published in nursing literature?
Evidence
SRs have been called the heart of evidence-based practice (EBP) because of the vital function they fulfill in synthesizing research knowledge into a useable form (Stevens, 2001). While methods of research synthesis clearly specify rigorous research design for conducting SRs (e.g., Cochrane Handbook), reviews in leading medical journals do not use rigorous scientific methods (Mulrow, 1987; Delaney et al., 2005). Rigor of SRs published in nursing literature has not been evaluated, as evidenced from lack of such evaluations in the nursing literature.
Strategy
A bibliometric study was conducted to determine scientific quality of SRs in nursing literature. We developed and used expert CINAHL searches to locate SRs, randomly sampled the population of SRs to obtain 10 reviews, and two reviewers critically appraised the SRs using the Overview Quality Assessment Questionnaire (OQAQ).
Practice Change
Closer scrutiny of quality of SRs.
Evaluation
Critical appraisals of selected SRs were accomplished by two reviewers using well-established critical appraisal tools — the OQAQ.
Results
- The 39 SRs (CINAHL classification) in 1998 grew to 250 in 2005
- The number of SRs classified by authors remains static
- “Reviews” were over-classified into the publication type, “systematic review” as compared to articles author-classified as SRs
- Author-classified SRs scored > median quality score
- The OQAQ has multifaceted questions and was demanding to use when evaluating reviews with scant rigor
- Interpretive statements must be used with the OQAQ
- Critical appraisal is time-intensive and requires advanced skills.
Recommendations
The preponderance of nursing publications in the sample lacked the necessary rigor to develop the science base for evidence-based practice. Therefore, clinicians must use SRs in the nursing literature with caution in establishing best practice. A larger study is proposed.
Bibliography
- Bero, L. A., Grilli, R., Grimshaw, J. M., Harvey, E., Oxman, A. D., & Thomson, M. A. (1998). Getting research findings into practice: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. British Medical Journal, 317(7156), 465–468.
- Delaney, A., Bagshaw, S., Ferland, A., Manns, B., Laupland, K., & Doig, C. (2005, A systematic evaluation of the quality of meta-analyses in the critical care literature. Critical Care, 9(5), R575–R582.
- Mulrow, C. D. (1987). The medical review article: state of the science. Annals of Internal Medicine, 106(3), 485–488.
- Mulrow, C. D. (1994). Systematic reviews: Rationale for systematic reviews. British Medical Journal, 309(6954), 597–599.
- Oxman, A. D., & Guyatt, G. H. (1991). Validation of an index of the quality of review articles. Journal of Clinical Epidemiology, 44(11), 1271–1278.
- Oxman, A. D., & Guyatt, G. H. (1993). The science of reviewing research. Annals of the New York Academy of Sciences. 703, 125–133.
- Oxman, A.D., Guyatt, G. H., Singer, J., Goldsmith, C. H., Hutchison, B. G., Milner, R. A., & Streiner, D. L. (1991). Agreement among reviewers of review articles. Journal of Clinical Epidemiology, 44(1), 91–98.
- Stevens, KR. (2001). Systematic Reviews: The Heart of Evidence-based practice. AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 12(4), 529–538.
Partially funded by Sigma Theta Tau Delta Alpha Research Committee, 2005-2006.