Nursing Research

Recommended resources to support research in nursing.

PICO Framework

A common framework used for developing research questions is the PICO framework. 

P-Patient/Population -- could include age, gender, persons with certain conditions

 I-Intervention C-Comparison -- an alternative to the intervention O-Outcomes
Example: Elderly Adults Walking, Exercise Sedentary, No Comparison Lower blood pressure
Adults over 65, Older Adults Running, Treadmill, Bicycle Normal routine Cardiovascular health
Adults with high blood pressure   Drug therapy, medication  

There are variations to the PICO framework, including PICOT (T being for time-the time it may take to demonstrate the outcome)

Other frameworks include (P)opulation (E)xposure (O)utcome; SPIDER (Simple, Phenomenon of Interest, Design, Evaluation, Research Types

PRISMA Flow Diagram

The PRISMA Flow diagram is used to show how a researcher moves through the process of searching for information in databases.

More information on using the PRISMA flow diagram can be found here: Creating a PRISMA flow diagram: PRISMA 2020

Evidence Synthesis and Levels of Evidence

According to Evidence Synthesis International, "Evidence synthesis is the interpretation of individual studies within the context of global knowledge for a given topic. These syntheses provide a rigorous and transparent knowledge base for translating research in decisions. As such, evidence syntheses can be thought of as the basic unit of knowledge used in tools such a policy brief or clinical practice guideline.

In other words, evidence syntheses are the “evidence-base” in evidence-based policy, or evidence-based medicine etc. Essential to all evidence syntheses is the use of explicit and transparent methodology in the formation of the questions they address. The transparent methodology encompasses how studies are identified, selected, appraised, analyzed, and the strength of the evidence assessed to answer the questioned posed."

Evidence Synthesis International. (2019, October 1). About evidence synthesis. – bringing together organizations from around the world to advance methods and teaching of evidence synthesis. https://evidencesynthesis.org/about/about-evidence-synthesis/

the evidence pyramid is an hierarchy of evidence that as you rise up it, the risk of bias lowers. At the lowest tier is expert opinion, then case series and case reports, then observational studies with comparison groups, then non-randomized controlled trials, then randomized controlled trials, and finally at the top is systematic reviews and meta-analyses.

The levels of evidence rise in hierarchy based on quality of the research design and as it increases, the risk of bias on each tier decreases.

Golden, Sherita & Bass, Eric. (2013). Validity of meta-analysis in diabetes: Meta-analysis is an indispensable tool in evidence synthesis. Diabetes Care, 36(10), 3368-3373. https://doi.org/10.2337/dc13-1196

Evidence-based practice (EBP) involves using the most up-to-date, accurate evidence available from high quality research and expert experience. In addition, "integrating individual clinical expertise with the best available external clinical evidence from systematic research."

Sackett, D. L., Rosenberg, W. M., Gray, J. A., & Haynes, R. B. (1996). Evidence based medicine: What it is and what is isn't. BMJ, 312(7023). 71-72. https://doi.org/10.1136/bmj.312.7023.71

Here is a visualization of Evidence-Based Practice (EBP) and using Assess, Ask, Acquire, Appraise, Apply:

Visualization of evidence=based practice (EBP). Assess (assess situaiton), Ask (what is the problem?), acquire (search for evidence), appraise (synthesize evidence), and apply (apply the evidence). The EBP framework uses expert experience along with client/patient values and research evidence to inform decision-making.

This graphic was created by Megan York, Education Librarian at the University of Arkansas.

Subjects: Nursing