One of the marks of a professional and qualified nurse is that their practice is evidence based. There are many armchair and social media health commentators who peddle their opinions as though they were proven facts, propagating misinformation and, at times, harmful practices. Nurse education, at pre-registration level, helps students develop an understanding of how to assess the evidence on which practice is developed, and at postregistration level, education helps advanced practice nurses develop and build practice based on the best evidence available. When undertaking pre-registration degrees and postregistration Masters and PhDs, nurses need to demonstrate this evaluative ability by the depth of writing in their various assignments; one of the ways this is achieved is by the evaluation of evidence and comparative analysis of the published literature.
Evaluation of the evidence: Over the years I have marked many thousands of essays at all levels of pre- and postregistration study and the following sentence typifies a way in which many students present information from the literature: ‘Smith (2015) identifies preoperative information as an important factor in reducing pain’. They seem to think that simply quoting an author gives authority to the point they are making. Sadly, that sort of sentence has little more authority that someone on social media saying ‘Jo Brown says that pink crystals cure cancer’. The reason that both of those sentences cannot be ‘trusted’ to form the basis of any clinical practice, is that they simply repeat a statement; neither has evaluated the evidence on which the statement is based. Consider a sentence that begins to demonstrate an evaluation of the evidence: ‘Smith (2015) in a controlled study of 2000 patients found that those patients who were given written information about the type of discomfort and pain they might experience after planned abdominal surgery required less postoperative analgesia, than those patients not receiving that information’. This type of writing begins to demonstrate that the student is evaluating what they are reading; they are highlighting the type of research study, its size and its specific population and specific findings. The writer is not suggesting that ‘information’ is some sort of panacea for the reduction of all pain, as could be inferred from reading the first sentence. Evaluation of individual pieces of literature can be developed further by the student commenting on the reliability of the research method used, the sampling method and size and transferability of any results to other types of populations, eg gender, age, culture, illness or different healthcare settings.
Comparative analysis: Evaluative comments on one piece of published literature, as discussed above, demonstrate the student's ability to understand the strengths and weaknesses of individual pieces of evidence; however, in the realities of clinical practice there are very few sound and robust single studies that demonstrate unequivocally that practice should be built on or changed, based on that one study. Single studies must be compared with other similar studies and an evaluation of their combined worth needs to be undertaken; this is termed ‘comparative analysis’. Consider the following sentence that might appear in a student's assignment: ‘Smith (2015) in a controlled study of 2000 patients and Brown (2016) in a qualitative study interviewing 15 postoperative patients, both identified written information as an important factor in their conclusion that preoperative information reduces the experience of pain postoperatively. Interestingly both of these studies focused on women, whereas a similar, smaller controlled study by Taylor (2016) focusing on male surgical patients found little significant effect on pain reduction. Smith's, Brown's and Taylor's studies were all carried out in the UK. A controlled study by Patel (2015) in India showed no significant difference in results between genders, but did indicate a small difference relating to age of the patients, which was not identified in the UK studies.’ In this example you can see that the student is not just accepting the results of a single study, they are exploring how the results of one study compare with those of another and giving possible indications of how summative conclusions may or may not be made.
A written assignment that combines an evaluation of single pieces of literature, together with a comparative analysis of other literature relating to one area of practice, written in a way indicated above, will show the student's depth of ability. Written in that way they demonstrate to the person marking the assignment that they have read the literature, understood the strengths and weaknesses of various forms of research styles and extracted core information and compared it with other findings. If their literature review is written in this way, they can then logically progress to the discussion section of the assignment, posing ideas as to why there may be similarities or differences between different literature. This will then lead logically to any implications for clinical practice and the conclusions of the assignment.
This sort of academic writing, although important for the communication of thought and ideas to a university lecturer and successful completion of an assignment, is not just an academic exercise. Such evaluative thinking and comparative analysis translates into evidence-based clinical practice. It is the mark of a health professional and the foundation for practice development.