Lisa Hopp

Risk of bias reporting in Cochrane systematic reviews.

Risk of bias is an inherent quality of primary research and therefore of systematic reviews. This column addresses the Cochrane Collaborations approach to assessing, risks of bias, the meaning of each, indicators of low, high and uncertain, and ways that risk of bias can be represented in a Cochrane systematic review report. The sources of risk of bias that reviewers evaluate include selection, performance, detection, attrition and reporting bias. Each poses threat to the internal validity of the primary studies and requires the reviewer to judge the level of risk as high, low or unclear. Reviewers need to address how studies of higher risk of bias might impact the pooled effect.

Science on a Shoestring: Building Nursing Knowledge With Limited Funding

Building the science for nursing practice has never been more important. However, shrunken federal and state research budgets mean that investigators must find alternative sources of financial support and develop projects that are less costly to carry out. New investigators often build beginning programs of research with limited funding. This article provides an overview of some cost-effective research approaches and gives suggestions for finding other sources of funding. Examples of more cost-effective research approaches include adding complementary questions to existing funded research projects; conducting primary analysis of electronic patient records and social media content; conducting secondary analysis of data from completed studies; reviewing and synthesizing previously completed research; implementing community-based participatory research; participating in collaborative research efforts such as inter-campus team research, practice-based research networks (PBRNs), and involving undergraduate and doctoral students in research efforts. Instead of relying on funding from the National Institutes of Health (NIH) and other government agencies, nurse researchers may be able to find support for research from local sources such as businesses, organizations, or clinical agencies. Investigators will increasingly have to rely on these and other creative approaches to fund and implement their research programs if granting agency budgets do not significantly expand.

Strengthening Clinical Nurse Specialist Role Socialization

In my many years as coordinator of a Master of Science in Nursing program that has 3 optionsVclinical nurse specialist (CNS), family nurse practitioner (FNP), and nurse anesthetist (NA)Vit has become increasingly evident to me that advanced practice nursing students have difficulty articulating their role, including explaining their role to each other. Perhaps because of the numerous options for CNS specialty practice, CNS students have difficulty trying to explain their unique advanced practice nurse (APN) role and how that role is different from and similar to other APNs. In helping the CNS student to be more articulate about the role, the process should facilitate camaraderie and collegiality as well as a clear understanding of each APN role. Before addressing how to strengthen CNS role socialization, it is important to examine APN role socialization.

Review and Synthesize Completed Research Through Systematic Review

The evidence-based health care movement has generated new opportunity for scholars to generate synthesized sources of evidence. Systematic reviews are rigorous forms of synthesized evidence that scholars can conduct if they have requisite skills, time, and access to excellent library resources. Systematic reviews play an important role in synthesizing what is known and unknown about a particular health issue. Thus, they have a synergistic relationship with primary research. They can both inform clinical decisions when the evidence is adequate and identify gaps in knowledge to inform research priorities. Systematic reviews can be conducted of quantitative and qualitative evidence to answer many types of questions. They all share characteristics of rigor that arise from a priori protocol development, transparency, exhaustive searching, dual independent reviewers who critically appraise studies using standardized tools, rigor in synthesis, and peer review at multiple stages in the conduct and reporting of the systematic review.

Designing podcasts for clinical nurse specialist education.

This is the first in a series of occasional articles in this column related to using educational technology in clinical nurse specialist education. In 2005, the New Oxford American Dictionary nominated several words for its Word of the Year including persistent vegetative state, Sudoku, bird flu, and trans fat. But ‘‘podcast’’ won. The editor-in-chief of the dictionary wrote that the word was considered in 2004, but they found that not enough people were using the word or familiar with it to recognize it as Word of the Year. In 1 short year, podcasts became so common that the editors selected the word over all of these other additions to Americans’ everyday language. Now, podcasting is becoming a common instructional delivery method in higher education. In the New Oxford American Dictionary, podcast is defined as ‘‘a digital recording of a radio broadcast or similar program, made available on the Internet for downloading to a personal audio player.’’ Thus, there are 3 elements to podcastingVthe audio/video content, publication through Web syndication, and a mobile device for playback. When students choose to use a handheld digital device for playback, they can be mobile while listening or even watching, depending on their environment and activity. By December 2009, Apple sold more than 228 million iPods. These sales figures excluded the iPhone, which also plays podcasts. Of course, Apple is not the only company that makes handheld digital players, but it is certainly the largest, accounting for more than 73% of the market share in the United States. Coupled with other types of handheld digital players, it is safe to say that portable devices are ubiquitous and prevalent among graduate students. Podcasting is just emerging in the higher education literature, andmost publications are opinion, anecdotal experiences, or ‘‘how-to’’ articles. In 2009, Hew conducted a structured, 3-stage search of education databases and proceedings, netting 153 articles. However, he retained only 30 articles that met his inclusion criteria of being an empirical and original study of podcasting in K-12 and higher education. Hew did not search the healthcare databases, but a January 2010 search of CINAHL using the keyword ‘‘podcast*’’ and no year restriction led to 126 articles, but only 7 were classified as research. Similarly, in Medline OVID, Current

Socializing clinical nurse specialist students for practice.

In a previous issue, this column discussed beginning the socialization of the clinical nurse specialist (CNS) students by suggesting that the faculty should develop strategies to foster knowledge, understanding, and collegiality among advanced practice nurses. In this issue, the discussion shifts to socializing CNS students to the unique CNS role. Strategies for role socialization are multifaceted, beginning with clinical and didactic experiences that involve identifying with and internalizing the role. This article explores ideas to create a rich socialization process for the CNS student.

Developing a Robust Evidence Base for Nursing

Systematic reviews provide robust evidence for nursing practice because of the exhaustiveness of search, the critical appraisal methods to determine the risks of bias, and synthesis methods that pool evidence to increase the power of statistical estimates or credibility of aggregated metasynthesis of qualitative findings. More consistency in publication standards will enhance the rigor of available evidence and allow nursing to live up to the promise of best available evidence.

Talk to me about evidence-based practice!

Answer The emergence of evidence-based nursing represents a significant shift in the profession and the opportunity to improve care. Countries with nationalized healthcare services, such as Canada, the United Kingdom, and Australia were among the first to establish centers to study and lead evidence-based healthcare. Teams are rapidly evolving in American clinical facilities in response to this global movement and the inherent promise to improve healthcare delivery and patient outcomes. These teams are often charged with meeting quality improvement goals and accreditation standards while using an evidence-based practice (EBP) approach. Although many authors have defined evidence-based practice, most have included the integration of the best available evidence from research with clinical expertise and patient preferences in order to inform decision making for positive patient outcomes.12 Though the definition seems straightforward enough, each element of the definition has generated controversy. That is, questions have arisen as to what constitutes legitimate sources of evidence, what “best available” means, and what roles should patient preferences and clinical expertise play in evidence-based practice. The answers and focus of these conversations will likely evolve and change, as it is the disposition of those who use the EBP to embrace uncertainty. Kitson wrote: “The ongoing tension between certainty and uncertainty is the driving force of the evidence-based practice movement. Its central philosophy is one of never taking for granted one’s own practice, and by using a structured, problem-based approach each practitioner can logically manoeuvre [sic] their way through the obstacle race of clinical decision making.” Particularly in America, EBP arose from the traditions of research utilization. Most authors differentiate EBP as a more expansive process that is informed not only by research, but also by both clinical expertise and patient preferences. Furthermore, best evidence sources are meta-analyses or meta-syntheses based on exhaustive searches of all available sources rather than a single report of research.45

PODCAST TRANSCRIPTS: CNCN Podcast Transcript: The aims and strategies for the Cochrane Nursing Care Network Node Nursing Care Clinical Trials Database

The main aim of this node is to identify primary studies of nursing care by searching databases and hand-searching relevant journals and conference proceedings especially those published in languages other than English. This is a very important endeavour to support systematic reviewers in their search and discovery of trials related to nursing care. In other words, we hope to develop a one-stop shop for any reviewer who wants to comprehensively find all the literature in all languages from any country related to the effect of an intervention. For example, if I was interested in the effect of open vs. closed visiting hours in a critical or intensive care nursing unit, I would expect many countries have conducted trials like this to assess the effect of these approaches to visiting. If our Node is successful, I would be able to find studies in both indexed English language and non-indexed non-English languages in Cochrane’s central database of trials. Our task of uncovering all clinical trials of nursing will be a daunting task if only a few individuals become involved. It will be a very reasonable task if we can recruit a global army of volunteers willing to search and find randomized and clinical controlled trials in their native languages and journals. We hope to develop a network of networks in order to scale this task into a manageable size. We are looking for people willing to volunteer in small and larger ways. We need regional directors willing to recruit and coordinate a group of searchers, we need searchers who would be willing to monitor a journal or two to identify randomized controlled trials and clinical trials related to nursing care. In addition to journals, we need searchers who will monitor conference proceedings to uncover trials that exist as abstracts. Then the citation and the English abstracts will be uploaded to the central database. Now, this is a very important endeavour that will widen the catch of all trials related to nursing care. In addition, we will increase the availability and regard for trials of nursing care that might currently go unnoticed by Cochrane reviewers. Currently, only 35 nursing journals are hand-searched by other Cochrane entities. We are absolutely certain there are more journals that publish trials relevant to nursing care. We welcome anyone who is willing to hand-search to participate, we are particularly interested in those of you who speak other languages besides English. To volunteer, visit the Cochrane nursing care website for an online form to participate.

SCHOLARLY PAPER: Cochrane nursing care field nursing care clinical trial database node

Hopp L. International Journal of Nursing Practice 2010; 16: 647–648 Cochrane nursing care field nursing care clinical trial database node