International Journal of Nursing Studies
Volume 47, Issue 7 , Pages 795-797, July 2010

Are Cochrane Collaboration systematic reviews relevant resources for evidence-based nursing internationally?

  • Colleen M. Davison

      Affiliations

    • Corresponding Author InformationCorresponding author. Tel.: +1 613 376 1031; fax: +1 613 376 6196.
  • Anne Sochan

      Affiliations

    • Tel.: +1 613 562 5473; fax: +1 613 562 5443.

Institute of Population Health, University of Ottawa, 451 Smyth Avenue, Room 1118B, Ottawa, ON, Canada K1H 8M5

School of Nursing, University of Ottawa, 451 Smyth Avenue, Ottawa, ON, Canada K1H 8M5

School of Nursing Science, North-West University, Private Bag X 6001, Potchefstroom 2520, South Africa

Received 30 March 2010

Article Outline

Keywords: Evidence-based practice, Cochrane Collaboration, Decision-making, Knowledge translation, Knowledge synthesis, Nursing practice, Systematic review

 

Nursing is a diverse and challenging endeavor worldwide. While nurses make up the largest group of health care professionals within most of the world's health care systems, they face many constraints that interfere with their ability to provide professional services (Holmes et al., 2008). Nurses work within weakening health systems with limited infrastructures to support nursing education and development (WHO, 2007a, WHO, 2007b, ICN, 2004, ICN, 2009), are discriminated against in their quest to advance their professional practice internationally (Thompson, 1987, Singh and Sochan, 2010) and are also experiencing a workforce crisis resulting from decreasing numbers of practitioners—both entering and staying within the profession worldwide (WHO, 2007a, WHO, 2007b, WHO, 2008, Massey et al., 2009). Evidence-based practice enjoys considerable support within nursing, although we do recognize recent debate about its utility (Porter and O’Halloran, 2009). In light of the evolving complexity of nursing practice and the growing challenges faced by those working in the profession, we believe there is an ever-present need for good quality research, and the synthesis of research, to inform decision-making and best nursing practice internationally.

A systematic review is a way of reviewing and assessing research literature. Using a variety of methods, scholars pool, or synthesize, the results of a number of research studies to provide meaningful, overall conclusions (Petticrew and Roberts, 2007, Cochrane Collaboration, 2009a). Systematic reviews can be powerful tools, as they are often considered superior to reports of single studies, for informing health care practice and health services delivery. Coster and Norman (2009) have pointed out that the use of systematic reviews as the highest standard of evidence might prove beneficial to clinical nursing practice because these reviews collect, assimilate and summarize evidence from the highest quality research.

There are various organizations that have put forth recommendations for best practice in the conduct and reporting of systematic reviews, see for example, the University of York's Centre for Reviews and Dissemination Guidance for Undertaking Reviews in Health Care (http://www.york.ac.uk/inst/crd/systematic_reviews_book.htm) and the Prisma Statement (http://www.prisma-statement.org). Another well-known organization providing guidance and promoting the conduct and use of systematic reviews in health care is the Cochrane Collaboration. “Cochrane” is a not-for-profit organization established in 1993, following a British medical researcher's call for systematic, up-to-date reviews of all relevant randomized control trials (Cochrane Collaboration, 2009b). Cochrane Collaboration reviews adhere to a very consistent, critically established method that has been established with the hopes of ensuring the quality, transparency and replicability of each review. There are many high quality reviews that are not registered with the Collaboration (including some of those recently published in this journal, see for example Crowe et al., 2010, Goethals et al., 2010, Salter et al., 2010, Kottner et al., 2009, West et al., 2009, Bee et al., 2008) and there is significant debate surrounding the utility of registering a review with the Collaboration (Tricco et al., 2008, Tricco et al., 2009). Cochrane Collaboration systematic reviews however, are still recognized by many as a ‘gold standard’ for evidence to improve the translation of knowledge to practice (Tetzlaff et al., 2009). Against this backdrop, we questioned whether Cochrane Collaboration systematic reviews were relevant as resources to inform evidence-based nursing internationally.

The Cochrane Collaboration is divided into 52 review groups. “Review groups are composed of persons from around the world who share an interest in developing and maintaining systematic reviews relevant to a particular health area” (Cochrane Collaboration, 2009c, p. 1). Currently, there is no review group, within the Collaboration, specifically focused on nursing practice, nurses or nursing specific issues. Indeed, the great majority of review groups center on specific diseases (e.g. epilepsy, gynecological cancer and acute respiratory infections) or body parts (e.g. bones, joints and muscles, eyes, and heart). While there is obvious relevance of the content areas of some of these review groups to the work of nurses (i.e. such as syntheses of outcomes from specific treatment regimes where nurses have a role in treatment or care), there still appears to be a gap with respect to scholarship pertaining to nursing practice and to the nursing workforce itself.

There is one review group within the Cochrane Collaboration which pertains to effective health care practice and the organization of health care. This review group was originally established as the Cochrane Collaboration on Effective Professional Practice (CCEPP) in 1994, and was later changed to Effective Practice and Organization of Care (EPOC) in 1998 (Cochrane Collaboration, 2009d). Currently, the EPOC review group focuses on reviews of interventions to improve professional practice and the delivery of effective health services. The types of interventions listed within their scope include continuing education and quality assurance, patient mediated interventions, financial interventions, organizational and management interventions and, professional and regulatory interventions (EPOC, 2009). By this description, it appeared possible that EPOC reviews may have a place in informing decisions related to nursing practice and nursing workforce, but it was not entirely clear that this is the case. Nor was it clear whether EPOC would be the appropriate place to undertake these kinds of reviews.

To examine this more closely, we accessed the Cochrane Collaboration's database of systematic reviews from the EPOC review group. In total, this group has overseen, or is currently overseeing, the completion of 117 systematic reviews. We went to these reviews with four questions in mind: (1) Was there explicit mention, for reason of inclusion, of nurses or nursing in the title or the text of the protocol? (2) Were nurses members of samples included in the studies reviewed? (3) Was the topic relevant to the work of nurses or nursing in Canada or other high income countries? (4) Was the review specifically relevant to nurses or nursing in low- or middle-income countries (LMICs)?

The result of our review was somewhat reassuring. Of the 117 titles, protocols or completed reviews, 32 (27%) had explicit mention, for reason of inclusion, of nurses or nursing practice in the title or protocol. Nurses were confirmed members of the samples in the included studies in 39 (33%) of the reviews with a further 28 (24%) reviews having possible inclusion of nurses in the samples.

There was a broad range of topics among the 117 reviews including reviews of specific programs and health care practices, pharmaceutical and prescribing policies, health economics and financial interventions in health systems, health system structuring and processes, health professional educational reviews, as well as reviews of health human resource and knowledge translation topics. 98 review topics (i.e. 84%) were obviously relevant to nurses or nursing. Another nine (i.e. 8%) were possibly related. We were unsure in only 2 cases whether a topic would be relevant to nursing or not.

Nine reviews (i.e. 8%) were specifically focused upon issues related to nursing in low- and middle-income countries. These reviews included such titles as: the integrated management of childhood illness programmes in low- or middle-income countries; interventions for controlling emigration of health professionals from LMICs; strategies for integrating primary health services in middle or low-income countries at the point of delivery; supervision outreach visits to improve the quality of primary health care in LMICs; and, the effectiveness of policies promoting facility-based deliveries in reducing maternal and infant morbidity and mortality in LMICs. In addition to these, two reviews focused on rural and underserviced areas, in LMICs and elsewhere. There were no reviews focused on nursing practice in high income countries specifically, however most were relevant to these areas. There were a number of reviews that looked at technological and human resource interventions, it was unclear as to whether these would be accessible in low- or middle-income settings.

So, what does this mean if we are examining the relevance of Cochrane Collaboration systematic reviews for informing decisions about nursing and the nursing workforce internationally? More than 84% of the reviews of the EPOC review group were found to be relevant to nurses or nursing practice. Over 25% of the reviews explicitly include nurses or nursing in the review title or protocol with more than half including nurses in the study samples. Nine of the reviews focused specifically on issues in low- and middle-income countries. While there is always room for some improvement, we believe these are positive findings, and that the Cochrane Collaboration, and specifically the reviews of the EPOC review group, can be an important access point for practicing nurses, managers, educators, and researchers to useful evidence to inform health care decision-making in the profession.

As mentioned at the outset, currently beyond EPOC, there is no specific review group focused on nursing, although there has been some discussion in the past about its establishment. In March 2009, the Cochrane Collaboration officially registered the Cochrane Nursing Care Network. This is a group of scholars that “support the conduct, dissemination and utilization of the systematic reviews relevant to the field of nursing.” (Cochrane Nursing Care Network, 2009, p. 1). The six core functions of the Cochrane Nursing Care Network are to:

1.Identify priority topics or questions related to nursing care that are not covered by existing Cochrane reviews.

2.Identify primary studies in nursing care by searching databases and hand-searching relevant journals and conference proceedings, especially those published in languages other than English.

3.Promote the Network's perspectives and priorities across the Cochrane Collaboration.

4.Raise awareness in the role of the Cochrane Collaboration and its resources that are available to support practitioners of nursing care.

5.Disseminate the findings of relevant Cochrane reviews to the nursing care community.

6.Identify sources of funding to undertake or complete Cochrane reviews of interest to the Network.

The Cochrane Nursing Care Network states that it will work with review groups like EPOC to further strengthen the relevance of Cochrane systematic reviews to nursing. We are encouraged by this development and by the current direction of the Cochrane Collaboration in relation to nursing. We hope the Cochrane Nursing Care Network, as well as the EPOC Review group will continue to support, and advance, the conduct, dissemination and utilization of high quality systematic reviews relevant to the field of nursing internationally into the future.

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Conflicts of interest 

None.

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PII: S0020-7489(10)00142-2

doi:10.1016/j.ijnurstu.2010.04.001

International Journal of Nursing Studies
Volume 47, Issue 7 , Pages 795-797, July 2010

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