Read two of the articles, then discuss [in detail] at least four (4) things learned about searching and appraising evidence.

Read two of the articles, then discuss [in detail] at least four (4) things learned about searching and appraising evidence.

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Discussion Post
Practical Tips for Literature Synthesis Cheryl Westlake, PhD, RN, ACNS-BC

The clinical nurse specialist (CNS), as an advancedpractice nurse, has the primary goal of continuousimprovement in patient outcomes and nursing care by creating clinical practice environments that reflect evidence-based practices and interventions.1 A synthesis of the literature may be needed to answer a clinical ques- tion for implementation in practice, serve as an indepen- dent paper for publication as a review, or be part of a larger project such as a research proposal, dissertation, or data-based publication. In order to achieve this goal, the CNS needs to be able to systematically review the lit- erature and synthesize the findings on issues related to patient outcomes and nursing care.

The synthesis of the literature is intended to do more than just document or summarize the relevant literature. Rather, the synthesis of the literature is intended to pro- vide a detailed analysis and yield conclusions about the current state of the science and the knowledge gaps about the topic of interest. An example of such a review created by Dumoulin and Hay-Smith2 on pelvic floor muscle training for urinary incontinence in women was published as a synopsis in the journal Clinical Nurse Specialist by McLoughlin and McAuley.3 The review serves as the example cited throughout this article.

While creating and writing a synthesis of the literature may seem like a daunting task to the CNS who has many demanding responsibilities and literature sources with which to maintain currency, the goal of this article is to provide a simple guide for the process that may be used easily by the CNS. Specifically, the purpose of this article is to provide a step-by-step process of how one might approach the literature synthesis. The specific topics covered in this article are the steps involved in a synthe- sis of the literature including recommendations about

how to analyze each individual paper for potential inclu- sion in the analysis and synthesis, specific processes for analyzing the collective papers, and suggestions for writ- ing the final product. Tools one might use to facilitate the process with examples using the Dumoulin and Hay- Smith’s2 article are provided to smooth the process and soothe the mind of the ambitious CNS.

A literature synthesis is a focused review, in-depth eval- uation, critical analysis, and creative compilation of infor- mation based on patterns, alternatives, or relationships gleaned from the process that allow one to come to a higher level of understanding or knowledge about a spe- cific topic. ‘‘It works very much like a jigsaw puzzle. The individual pieces (arguments) must be put together in or- der to reveal the whole (state of knowledge).’’4

CONSIDER AND REFINE THE QUESTION The first step in the synthesis of the literature is to care- fully consider and refine the question the CNS wishes to ask of the literature. Particular attention to the proposed concepts, research design, sample selection criteria and process, measures, and statistical analyses is warranted and recommended to ease the process. Refinement of the topic and clarity about the question are critical at the onset and is enhanced by the expert knowledge base of the CNS. The eventual quality of the synthesis of the literature is dependent, in part, on this important first step. Issues for consideration are provided in Figure 1.

Using the example of urinary incontinence, the posed question may have been: What is the difference in wom- en’s outcomes for different interventions for urinary in- continence including to pelvic floor muscle training?

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