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Chapter 4

NURS 2031H Chapter Notes - Chapter 4: Meta-Analysis, Statistical Hypothesis Testing, Confidence Interval

Course Code
NURS 2031H
Ellen Buck McFaden

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Chapter 4
You’ve Been Asked to Conduct a Systematic Review: What You Need to Know
Clinical Scenario:
-You are a third year nursing student who is placed at a local public health department and
the school health program for your clinical placement. For your first day you go to a
school with your preceptor and discuss School bullying as it is a priority issue at the
school. A recent survey indicated that more 50% of students reported being bullied in the
past year, 30% of parents expressed concerns over their child being bullied at school.
Several strategies are identified during the meeting to reduce bullying in the school.
There is no relevant research about these strategies. The meeting is adjourned with the
plan to reconvene in two months upon which time the results of the literature reviews
would be presented.
Systematic Review:
-You decide to conduct a search on the term systematic review. according to Google the
definition of a systematic review is a “literature review focused on a research question
that tries to identify, appraise, select, and synthesize all high-quality research
evidence relevant to that question.”
-According to a reliable source a systematic review “attempts to organize all empirical
evidence that fits tree specified eligibility criteria in order to answer a specific
research question. It uses explicit systematic methods that are selected with a view
to minimize bias thus providing more reliable findings from which conclusions can
be drawn and decisions made.”
Purpose of Research
-Research generally it is about testing theories often generated by previous studies and
applying them to real-world situations, to determine definitive and comprehensive
-The end goal of this inquiry is to apply the knowledge gained from this study to the
whole population. However, is not feasible or ethical to include the entire sample, in this
case, school attending children. Therefore, a sample of children Will be selected with the
intent of generalizing what we learn from the sample of children to all children.
-However, choosing a sample of children will instantly introduce bias into our study.
-The results of single studies help healthcare practitioners stay aware of new emerging
knowledge in particular topic areas.
-Systematic reviews therefore use explicit methods aimed at minimizing bias in order
to produce more reliable findings that can be used to inform decision-making.
Steps in Conducting a Systematic Review
-What distinguishes a systematic review from other types of reviews is that the process of
conducting the review is clearly articulated, that this process is decided priori (before the
review is started) and the process does not change throughout the course of conducting
the review.
-There are many steps in conducting a systematic review including:
odefining the research question
oidentify inclusion and exclusion criteria
osearching for studies
oselecting studies
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oassessing methodological quality of the included studies
oextracting relevant data from each included study
oanalyzing the data
ointerpreting the results
odrawing conclusions
Defining the Research Question
-A well done systematic review can only be conducted when the research question review
is intended to answer is focused and clearly articulated.
-A focused and clearly to hear that research question addresses the following components
as specifically as possible:
opopulation of interest
ointervention you want to know the effectiveness of
othe intervention is being compared to
oit outcomes you want to learn about
-A clearly articulated it research question using P ICO as a template is advantages for at
least two reasons: (1) is helps to review authors focused on exactly what the question is
and (2) it helps readers of the review identified very quickly in the review is relevant for
their practice question.
oP – population
oI – Intervention
oC – comparison
oO – outcome
-the population of interest is school attending children, Therefore, children aged 5 to 12.
-next we need to identify the intervention we are interested in.
-we will limit our search two interventions that occurred in the school setting and are
focused on reducing bullying behaviors.
-for our scenario, we could compare school based anti-bullying interventions to standard
-finally, you Need to identify what outcomes we want to know about. For our scenario the
outcome of greatest interest can be the number of reported bullying episodes during a
given school year.
Inclusion and Exclusion Criteria
-Inclusion and exclusion criteria is important because it allows for reviewers to follow in
order to make consistent decisions about which studies to include or not.
- inclusion criteria identifies what the study needs to address in order to be included in the
review. inclusion criteria can also decide the type of research design that will be included
as well as the timeframe of when the study was published
-Exclusion criteria identify situations and circumstances in which a study will not be
-Inclusion and exclusion criteria are essential to conducting systematic review because
they reduce bias in the selection of studies.
Searching for Studies
-inclusion criteria stipulate the only randomized controlled trials will be included
interview and as such does identify two killer databases and which randomized controlled
trials are likely to be found.
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