Literature Synthesis Paper Instructions

Literature Synthesis Paper Purpose

The purpose of the Literature Synthesis is to allow the Student to demonstrate their ability to search recent health literature in order to recommend an intervention to improve an outcome with sufficient evidence.  This will require proficiency in search methodology, inclusion/exclusion criteria, statistical data analysis, and critical thinking.

Here is a video guide that will walk you through the Literature Synthesis process:

• Literature Synthesis Video Guide

Overview of the Literature Synthesis Process

1. Perform 4 literature searches based on your approved PICO

   • You must complete at least 4 searches including:

     • MEDLINE via PubMed
       

     • CINAHL via EBSCO

     • Nursing & Allied Health Source (ProQuest)

     • Another search of your choice from https://guides.augusta.edu/nursing/databases

       • ex: Ovid, Science Direct, Cochrane, etc.

   • See “Research Guide and Resources” for instructions on how to search each of these engines.

2. Keep a record of your searches and results (How many results for each term and combined terms in each search.)

3. Develop inclusion/exclusion criteria for your results to narrow down the list to a group of articles you will analyze.

4. Analyze the data of how your selected intervention (I) compares with the current strategy of your microsystem (C)

5. Develop your recommendation based on the evidence with a focus on the goals/issues from the  NAM’s Vital Directions
   

6. Write up your findings in a formal Literature Synthesis Paper with the instructions and headings below

• • DO NOT WRITE THE NAME OF YOUR AGENCY.

  • Instead, use a description: In this agency, in this microsystem, etc.

  • Download and use the Literature Synthesis Template

    • This template includes inline instructions

    • Please delete the instructions content and add your own content 😉

Problem Context & Project Need

This will be your introduction to the reader concerning the outcome you have chosen. 

• Outcome Significance

  • Provide some compelling statistics and/or figures that show this outcome’s significance.

    • Describe the Population (P) this project will focus on (adult ICU patients, Pediatric Oncology patients…)

    • What is the overall significance of this Outcome (O) for the patient/population?

    • This offers a “big picture” view of the outcome’s impact.

• Outcome Benchmarks

  • Discuss the Outcome benchmarks at the regional, state, and/or national level

    • This gives the reader an understanding of how this Outcome exists on a larger scale. 

    • It gives context and a realistic expectation as to where a hospital should be compared to others.

    • Usually, there are different benchmarks for the size, region, or specialty of a hospital, so try to get data that represents your hospital’s characteristics as this will improve the validity.

• Microsystem Outcome Context

  • Describe the Outcome and its context within your specific Population and microsystem.

    • What is the significance of this for the microsystem/agency?

    • This will take the outcome and bring it down to a local or “small picture” level.

    • Sum up this section by impressing upon the reader the need to improve this outcome on this level. 

      • Why does it need to be improved here? 

      • Why should the hospital spend money and effort on this issue?

• Strategies for Outcome Improvement

  • Discuss the interventions you will present in this paper to give the reader context for the data to follow.

    • Briefly describe the current microsystem intervention (C)

      • What they are doing currently to improve this outcome?

      • Sometimes they do not have a specific current intervention (C) – so in this case you would just say “standard care”

    • Briefly describe your research intervention (I) of the study

      • What intervention will you study as an alternative option for your microsystem to improve this outcome?

    • Do not go into detail…just a brief overview of each.

Search Methodology

This will ensure Process transparency and should allow others to duplicate your search with similar results.
Discuss the full strategy of your literature search, including:

• PICO and Key Terms

  • Write out the full PICO question and list the “main concept” key terms you used in your search

    • Key Terms are usually straight from your PICO question.

    • You don’t have to use EVERY term from your searches here…just the main concept keywords

      • Ex: You may search for the concept of ICU with:

        • (“Intensive Care Units”[MeSH]) OR (ICU) OR (Critical Care) OR (Intensive Care Unit) OR (Acute Care) OR….

        • For this section, just write ICU as your term and then include the full term list in the appendixes.

• • Microsystem Scenarios

    • Some of your Microsystems will be using an intervention already, and some will not be doing anything specific (yet!)

      1. Your Microsystem is using a specific current intervention

         • In this case, your Literature search will include terms for both your I and C

         • You will need to use BOTH terms in your search methodology and appendix charts.

      2. Your Microsystem is NOT using a specific current intervention

         • This actually happens often…no need to worry! 

         • If this is the case, you will discuss the comparison intervention as “standard care”

         • You won’t actually use the term “standard care” as a search term…it’s just the academic way of saying they aren’t doing anything!
           

         • So your C will basically not be in the search methodology/Appendix charts…just the PIO terms with an explanation.

• Search Locations and Results

  • PLEASE USE YOUR LIBRARY RESOURCES TO SEARCH EFFECTIVELY…this is not Google.

  • List the search engines and databases for each of your 4 searches and what you found.

    • This is where you will describe the 4 searches you initiated…PubMed, EBSCOhost, ProQuest, and another of your choice.

    • The results from your searches:

      • Total number of articles you found with your search parameters (for all searches)

      • Total number of articles you ended up using in your analysis (for all searches)

      • Overview of the included articles’ evidence levels based on Stetler’s Evidence Hierarchy

    • You will also direct them to Tables 1-5 in the appendix for full search results.

    • You will have many other article and/or resource references…this section is ONLY for the ones that contain the data/evidence for your intervention/outcome.

• Selection Criteria

  • This is telling the reader how you went from so many articles to the ones you decided to analyze.

    • Inclusion Criteria – Articles have to meet some type of standard to even be considered
      

      • Ex: Meets PICO search terms, English language, published within 5 years, etc.

    • Exclusion Criteria – considered articles met inclusion criteria – but did not offer valid data or content to your study

      • Ex: Studied another intervention at the same time, studied a very specific geographical location, level of evidence too low, commentary/opinion review, Poor quality study design, duplicate articles, etc.

      • Sometimes if you have a meta-analysis, you may find RCTs that were included in the meta-analysis.  In this case, you would not include those RCTs as they are already within the meta-analysis data.  This is another example of a common exclusion criteria.

  • Remember that inclusion and exclusion are not opposites

    • Ex: If you have articles written in English as an inclusion criterion, you can’t have non-English articles as an exclusion criterion.

Literature Synthesis 

This is a discussion of what your literature search found specifically on how your intervention affected the outcome compared to current strategies on your microsystem.

• General instructions and guidance

  • This is a synthesis, not just a list of every article’s results. 

    • Do not just list what each article found, but rather present an overview of the current literature.

    • Once you discuss an overview you may discuss individual articles if relevant.

    • You will include actual data in your discussion – ex: RR 1.08 (95% CI 0.81 to 1.45, p=0.690)

  • DO NOT USE direct quotes

    • Put the concepts into your own words. #paraphrase

  • Keep the discussion focused only on the Outcome in your PICO question. 

    • Your intervention may affect other outcomes…but you are only focusing on this specific Outcome.

    • You can mention other benefits in the recommendation section as part of your decision, but not here.

    • The evidence you find will determine how you write the synthesis part.

  • Evidence Scenarios

    • Sometimes the evidence you find will be from articles that study either:

      1. Your project intervention VS. The current intervention on your unit

         • This is the most ideal as the comparative data has already been studied for both your PICO…but also rare!!!
           

         • These studies will include direct comparison data of your I and C.

         • In this case, you will discuss how the 2 compared to each other in regard to the outcome impact.

      2. Your project intervention VS. No intervention being done (aka “standard care”)

         • Sometimes a study will just compare the intervention to nothing specific being done.

         • In this case, you will write up the evidence of your intervention data on its own.

         • In this case, you will discuss the impact on the outcome on its own as there is not real comparison.
           

      3. Your project intervention VS. Some other intervention(s)

         • This is the more complex scenario, but also the most common.

           • This is where you find an article that compares your intervention to 1 or more interventions not used by your microsystem.
             

           •  It may be more difficult to write up, but it still works…just be sure your search methodology was good and you didn’t miss other articles.

         • Here you would just discuss your intervention’s data and how it compared to the other intervention(s)’ data in the study.

           • You will include in your discussion that these interventions are NOT currently being used.

           • This is still a way to show that the research intervention has an impact on the outcome.

           • It will just have less external validity as it does not relate directly to your microsystem.

             • Then you will just need to research the unit’s intervention on its own and write about that data.
               

             • This way you have some representation on how the current intervention affects the outcome.

             • If your unit does not have a specific intervention, then no other data search is necessary

             • Then you will compare both sets of data (yours vs units) in a conclusion and then the recommendation

      4. Combination – Usually you will have all 3 types of studies.

         • Just be sure to discuss each type when presenting the data

         • This will help focus on the external validity of these data in relation to your microsystem

    • Despite which evidence scenarios you have, you MUST include data on your current microsystem’s intervention

      • You may need to research the unit’s intervention on its own and write about that data.
        

      • This way you have some representation on how the current intervention affects the Outcome.

      • Then you will compare both sets of data (yours vs units)
        

      • If your unit does not have a specific current intervention, then no other data search is necessary

• Research Intervention Data Synthesis

  • Present an overview of the current data related to how the intervention (I) affects the Outcome (O)
    

    • This will give the reader a sense of the evidence related to this intervention.

    • Does it appear ALL studies have a similar result?

      • Discuss the actual data on the studies.

    • Are there different results from the studies analyzed?

      • Discuss why there are some differences (location, resources, study design)

      • Discuss the ranges of differences in data

    • Discuss the data based on relevant characteristics for each study.

      • Ex: Quality of the evidence, design, sample size & homogeneity, internal/external validity

      • Ex: “The articles with higher qualities of evidence tended to show XYZ (Garder et al., 2016; Jo et al., 2019…).  One non-RCT with a low sample size of 12 had differing results of only XYZ (Bart et al., 2018).”

  • Present an overview of the current data related to how the Current microsystem intervention (C) affects the outcome

    • This will give the reader a sense of the evidence related to what your microsystem is currently doing.

    • Use the same framework as the intervention discussion.

    • Refer to the various “Evidence Scenarios” above.

• Intervention Data Conclusion

  • Discuss the differences between your researched intervention (I) and the microsystem’s current strategy (C)
    

    • This is now combining and comparing the data from each to give the reader a clear comparison.

    • List the overall data and any issues that may impact the quality of the evidence.

  • Discuss the strengths and weaknesses of your study (enough or not enough high-quality studies, validity…)

  • This will set the stage for your recommendation…this is the Evidence in “evidence-based practice”

Recommendation

• Project Recommendation

  • Make a recommendation for your microsystem for which intervention would be most effective for their environment.  

    • Base the rationale on the evidence you presented above, the external validity of the data, and specific microsystem characteristics.
      

    • If you recommend the researched intervention

      • State that the project plan will be based on implementing this new intervention.

    • If you recommend the current intervention.

      • State that the project plan will be based on analyzing the current process to maximize and improve the effectiveness of the intervention.

    • Your recommendation will be what your Project Charter will plan.

• Impact on Vital Directions

  • Discuss how your project will impact at least one of the National Academy of Medicine’s Vital Directions

    • Based on your recommendation, select which Vital Direction’s Issue Areas will be impacted.

Appendix

• Table 1 – Levels of Evidence

  • Create an APA table listing your included articles and their corresponding level of evidence based on Stetler’s Evidence Hierarchy
  • Remember, these are ONLY the articles that had data/evidence related to your intervention…not the other background articles.

• Tables 2-5 – Keyword Searches

  • Create an APA table for each of your 4 literature searches.
  • Be sure to refer to the “Microsystem Scenarios” above in the Search Methodology section.

Professional Writing

• Full APA format including Title Page, level formatting, in-text citations, and Reference Page(s)…No abstract.

• Do not use direct quotes for this assignment…you must paraphrase.

• Be sure to use in-text citations correctly to avoid plagiarism (plagiarism is plagiarism…even when not intentional!)

  • See “Beginners Guide to Scientific Writing” and your APA Manual for guidance… 
  • This document contains the most common Student APA errors

• This is a very concise assignment with a 4-page limit (not including the Title page, Reference Pages, or Appendix).

• No APA, spelling, punctuation, or grammar errors should be included.

• See Chapter 2 of the APA 7th for the required format.  (There is a sample Student Paper at the end of the chapter.)

Submission and Grading

• Students will complete and submit using the Literature Synthesis Paper Template

  • Just delete the instructions and add your content…the paper is already formatted for you!

• Submit assignment to the Literature Synthesis Assignment Folder

  • File name format: AUusername.ProjectFaculty.LSP

  • Faculty Grade Feedback by 11/04 @ 1700
    

• Quality Benchmark

  • Grades will be based on the Literature Synthesis Paper Rubric

  • This assignment must have at least an 85% rubric grade in order to advance to the Project Charter Form. 

  • If you do not meet this, then you must resubmit the assignment with improvements.

  • Resubmissions must be submitted to the LSP – Resubmission Assignment Folder by 11/08 @ 1700

    • Grades will be averaged over the submissions (ex. first 50% and second 100% = final grade of 75%)

    • Please see Assignment Overview for more information

• Point Deductions

  • 5-point deduction for late submissions, then 5 points per day after

  • 5-point deduction for incorrect file name