Comprehensive Systematic Review for Advanced Practice Nursing by 
Statistics for Evidence-Based Practice in Nursing by 
The Pharmacist's Guide to Evidence-Based Medicine for Clinical Decision Making by 
Making Sense of Evidence-Based Practice for Nursing: An Introduction to Quantitative and Qualitative Research and Systematic Reviews by 
How to read a paper : the basics of evidence-based medicine and healthcare by 
Evidence-Based Practice for Health Professionals by 
Evidence-Based Practice for Nurses and Healthcare Professionals by 
Evidence-Based Practice in Nursing and Healthcare: a guide to best practice by 
Evidence-Based Practice for Nurses, Third Edition by The second step in EBP is to acquire the best evidence.
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The evidence pyramid is a visual representation of grades of evidence.
A systematic review of randomized controlled trials that show consistent results provides the highest quality evidence (i.e., the “gold standard”) and is at the top of the pyramid. Towards the base we find literature such as case reports or case series which are less likely to reliably predict outcomes.
When making evidence-based decisions for patient care, it is essential to select the highest level research design available for the specific question of interest. You should recognize that as you move up the pyramid, fewer studies are available; that is, high levels of evidence many not exist for all your clinical questions. You may need to move down in the pyramid to other types of literature.
These are a few of the study types associated with evidence-based practice taken from the Glossary of EBM Terms from the Centre for Evidence-Based Medicine Toronto:
Meta-analysis: A systematic review that uses quantitative methods to synthesize and summarize results of studies.
Systematic Review: A summary of the medical literature that uses explicit methods to perform a comprehensive literature search and critical appraisal of individual studies and that uses appropriate statistical techniques to combine these valid studies.
Randomized Controlled Trial: A study in which participants are randomly allocated into an experimental group or control group and followed over time for the variables/outcomes of interest.
Cohort Studies: Involves identification of two groups (cohorts) of patients, one which received the exposure and one which did not, and following these cohorts forward for the outcome of interest. These studies can be Prospective or Retrospective.
Case Controlled Studies: A study which involves identifying patients who have the outcome of interest (cases) and patients without the same outcome (controls), and looking back to see if they had the exposure of interest.
Case Series: A report on a series of patients with an outcome of interest. No control group is involved.
Depending of the clinical question, a certain study type can often provide the best answer. Keep in mind that randomized controlled trials (RCTs) are not always available or even possible for every therapy/intervention, and that certain questions are appropriately answered by studies that are lower on the EBP pyramid. Systematic reviews (SRs) provide higher-level evidence than single RCTs and other types of studies, so you should select SRs when they are available.
| Question | Study Type |
|---|---|
| Diagnosis | prospective, blind comparison to a gold standard |
| Therapy | SR > RCT > cohort > case control |
| Prognosis | cohort > case control > case series |
| Harm/Etiology | SR > RCT > cohort > case control |
What are journal articles?Visit the Evaluate Sources tab for more information on how to identify scholarly journals.
Visit the Research Metrics Guide for more information on how articles, journals and authors are rated.
Full-text scholarly articles for the areas of nursing and allied health, including occupational therapy, physiotherapy, radiologic technology, laboratories, and social sciences. CINAHL Ultimate is an expanded version of CINAHL Complete that includes fewer embargos and more full text content.
In Find@Farley and EBSCOhost databases such as CINAHL Ultimate, full text articles can be easily accessed by clicking on the "Access Now" button in the search results.
Sometimes there will be a drop-down menu with different access options.
If an article is listed as available in full text but does not give you access, contact a librarian.
If Wilkes does not have access to the article, try looking for the article in Google Scholar. Occasionally, the authors of the article will post a copy of their paper in ResearchGate or similar website. These sources will likely not appear in a Wilkes database search.
If you still cannot access the article, you can click on the "Request via InterLibrary Loan" link and we can try to obtain the article from another library. Visit the InterLibrary Loan page for more information on how to register for an account.
How do books differ from journal articles?Visit the Evaluate Sources tab for more information on scholarly book sources.
Primary sources (unfiltered information) are publications that report the results of original research may be in the form of conference papers, journal articles, technical reports, theses and dissertations or journal articles. The information is present in its original form (that is, it has not been interpreted or condensed or otherwise "repackaged" by other writers). The works present new thinking/discoveries/results and unite them with the existing knowledge base.
Secondary sources (filtered information) are those which are published about the primary literature, that generalize, analyze, interpret, evaluate or otherwise "add value" to the original information, OR which simplify the process of finding and evaluating the primary literature. Some examples of secondary sources are "review" articles, and indexes such as PubMed or the Cochrane Library.
Tertiary Sources (filtered information) compile or digest information from primary or secondary sources that has become widely accepted. They aim to provide a broad overview of a topic, or data, already proven facts and definitions, often presented in a convenient form. They provide no new information. These include "reference" types of works such as textbooks, encyclopedias, factbooks, guides and handbooks, and drug databases such as Micromedex and Facts & Comparisons.
Resources like DynaMed are often considered both secondary and tertiary sources.
| Primary | Secondary | Tertiary | |
|---|---|---|---|
| Title | Very specific, sometimes states a position | Very general title | Very general title |
| Definition | An article where researchers have conducted original research and/or a study. Presented in its original form. | An article that summarizes or reviews work of a primary source on a particular topic. | An article that compiles or digests information from either (or both) primary and secondary sources. |
| Includes | Methods, Results, Tables, Figures | Methods may include a literature review, tables can list other articles | History, Diagnosis, Evaluation, Management |
| Example Words | Clinical trial, Controlled trial, Study | Review, Meta-analysis, Systematic Review | Overview, General Information |
| Example Title | Prospective Study on Food Fortification with Vitamin D Among Adolescent Females in Finland: Minor Effects | Malnutrition: Supplements and Food Fortification in the Older Population | Vitamin D Deficiency in Adults (DynaMed) |
| Example Publications | journal articles, technical reports, conference papers, theses and dissertations, patents, field notes, interviews, lab notebooks, specimens | books, science magazine articles, review articles, | almanacs, encyclopedias. handbooks, bibliographies, clinical point-of-care databases |
|
Quantitative Studies: |
Qualitative Studies: |
| Have results that can be counted numerically, quantifiable | Have results that cannot be counted numerically |
| Focus on measurements rather than descriptions | Focus on descriptions of qualities rather than measurements |
| Often take place in a controlled environment or study | Often take place in naturalistic environments |
| Use statistical analysis | Often don't use statistical analysis |
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What to look for:
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What to look for:
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You can specify the type of study in the CINAHL Ultimate database. You can find this option in advanced search in the right column.
Unfortunately, many other databases lack the ability to limit results to quantitative or qualitative research. However, adding "quantitative" or "quantitative" to your keyword searches will often give you these studies in your results, as many researchers often use these terms in their abstracts or article text.
Here is an example using Summon search:
Note that "All Fields" is another term for a keyword search.
Make sure to verify the methods are quantitative or qualitative by reviewing the article itself. Most articles will have a "Methods" or "Methodology" section that explains how the researchers conducted their study.