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Systematic Review Article Analysis

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by Christina Menardie on 13 January 2013

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Transcript of Systematic Review Article Analysis

Christina Menardie & Kristin Pawliwec
University of Phoenix
NUR 518
Dr. Pat Shannon
December 3, 2012 Systematic Review Article Analysis Problem Problem Search
Strategy Search Strategy Part of larger systematic review



Electronic search
Appropriate and comprehensive
Published in last 20 years
Weakness: grey literature excluded
Publication bias


Leadership AND
Research, Evaluation, Measurement



Manual search
Relevant, specific journals
8 related governmental/organizational websites

Exhaustive search-7 final quantitative articles Quantitative
Data Analysis Sample Quality
Appraisal Data
Extraction (Wong & Cummings, 2007)

What is the relationship between nursing leadership and patient outcomes?



Broad

Will yield meaningful findings for creating safer patient care environments Problem

Evidence-based practice

Create safer patient environments

Generate new knowledge

Little is known about the relationship between nursing leadership and patient outcomes Conclusions Relation to nursing "The relationship between nursing leadership and patient outcomes: A systemic review" Research question Scope
Independent variable: nursing leadership

Dependent variable: patient outcomes

Cause-effect relationship explored




‘Nursing Leadership’ Variables Concept Problem Problem
Meta-analysis

Research question similar (strength)

Research question broad (weakness)

Not much past research conducted (weakness)

Consistent data (strength) Integration Approach Sample

Clearly articulated, #1 -> #5

Strong
Standardized ‘”inclusion/exclusion screening tool”
Narrowed study’s broad scope
Inter-rater reliability established

Weak
Only published reports included
Publication bias Inclusion Criteria Sample
Electronic, manual, published, 20 years, multiple searchers/screener, specific search terms, inclusion/exclusion screening tool

7 quantitative articles



Comprehensive, inter-rater bias addressed, broad to specific, manual AND electronic



Only quantitative, search was limited, English, published, variable settings Search Strategy Strengths Weaknesses Sample References Holopainen, A., Hakulinen-Viitanen, T., & Tossavainen, K. (2008). Systematic review: A method for nursing research. Nurse Researcher, 16(1), 72-83.
Key information contained in inclusion criteria

All 5 criteria needed to be met, otherwise automatic exclusion Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &Wilkins. Original reports that lacked key information Sample Did not meet inclusion criteria
Wrong topic

Not published Rationale for exclusion decision Wong, C. A., & Cummings, G. G. (2007). The relationship between nursing leadership and patient outcomes: A systematic review. Journal of Nursing Management, 15, 508-521. Data Extraction McGowan, L. (2012, August). Systematic reviews: The good, the not so good and the good again. British Journal of Midwifery, 20(8), 588-592.
Methodological quality reviewed twice

Reliable quality-rating tool, domain-based

Instrument validity and reliability

Non-experimental, quantitative designs Method Size
Demographics


Statistical analysis techniques
Outliers
Effects on patients
Significant vs. non-significant results Sample Characteristics Study Findings Data Extraction Data Extraction
Methodological quality reviewed twice

Increased reliability
Increased validity Integrity of the data set Search Strategy
1.) Leadership or leadership aspects (styles, behaviors, practices) measured

2.) Leader defined as a nurse in a formal leadership role at any level within a healthcare organization

3.) Addressed impact of leadership on patients (well-being, patient satisfaction, adverse events)

4.) Only English language research studies (quantitative or qualitative)

5.)A relationship (direct or indirect) between leadership and patient outcomes was reported 5 Reasonable Inclusion Criteria Databases Key Words Supplementary Efforts Quality Appraisal
First author used adapted, domain-based quality rating tool
Second author validated results




Assessed 4 areas and assigned points for:
Research design
Sampling
Measurement
Statistical analysis




Strong (10-14 points)
Moderate (5-9 points)
Weak (0-4 points)




All articles rated strong
6/7 used theoretical/conceptual framework
Validity and reliability



Design issues
Lack of randomization
Outliers in 3 studies unaddressed
Data aggregation issues Articles reviewed TWICE Quality Assessment and Validity Tool Grading System Strengths Weaknesses Data Analysis
Leadership defined in terms of...
Practices
Styles
Behaviors
Competencies

Leadership indirectly related to patient outcomes
Changes in work context
Influencing aspects of nurse behavior Pooling and Integrating Data Data Analysis
Outcome variables categorized into 4 themes related to leadership
1.) Patient satisfaction
2.) Patient mortality and patient safety outcomes
3.) Adverse events
4.) Complications Thorough Meta-Analysis Results Summarized into Tables Variety of Outcome Measures Heterogeneity of Settings Conclusion Conclusion Quality Quantity Consistency 12,042 --> 7
Thoroughly extrated from what was available Strong
6/7 theoretical framework
Acceptable sample sizes
4/7 collected multi-site data
Instruments used were reliable and valid
Construct validity
Weak
Study design
Failure to manage outliers 4/7 alpha coefficient 0.70
Strong internal reliability Limitations Few published studies
Heterogeneous samples/settings
Publication bias
English only Future Nursing Practice Transformational leadership
Safer patient care environments
DECREASED behavior problems, restraint use, complications of immobility, patient falls, medication errors, and complications Longitudinal
Multi-site
Random sampling
Qualitative
Assess leadership differently Furture Nursing Research
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