- Look at the literature Matrix (John Hopkins University Appendix G) and use the sources found in Discussion 6.
- Use the Literature Review Synthesis Matrix Download Literature Review Synthesis Matrixto compare and contrast findings found in appendix G.
- Title the discussion with the PICOT question.
- Initial post: Your post should be within a range of 200-240 words.
- By looking at the Matrix, carefully look at similarities and differences between the studies.
- Do any themes arise from comparing and contrasting are there any similarities or differences.
- Write a paragraph synthesizing the information. Remember, this is in preparation for writing the literature review.
Cite your references APA 7th ed.
The Literature Review Summary Table: Synthesizing Information
Use the "Literature Review Synthesis Matrix Template" as a guideline to help you sort through your thoughts, note important points and think through the similarities and differences:
Pico Question:________________________________________________________________
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Synthesize the findings by identifying the themes (themes or findings are subject to your literature review question.
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The Impact of Using Nursing Care Bundles in Neonatal Intensive Care Units to Reduce Central Venous Line Infection
Adrian Santiesteban
Miami Dade College
NUR3165
Professor Roxana Orta
2/2/25
The Impact of Using Nursing Care Bundles in Neonatal Intensive Care Units to Reduce Central Venous Line Infection
The article by Ifar et al. (2020) examines how a nursing care bundle helps diminish central venous line infections (CLVIs) among neonates in NICUs. Research explores the essential concern of CLVIs because they endanger at-risk populations of newborns.
The study belongs to the category of experimental research with a specific type being quasi-experimental. The research sought to establish if a structured nursing care bundle would lower the rate of CLVIs among patients in NICUs.
The research included 100 neonates who received care at one NICU through convenience sampling. The research took place at Mansoura University Hospital in Egypt for several months.
Observational data collection focused on infection rates of neonates before and after nurses put the developed care bundle into practice. The bundle implementation led to an important decrease in CLVI rates which demonstrated how the bundle supported improved patient safety outcomes.
The study had two significant drawbacks: its limited sample size and sampling biases due to convenience sampling methods. The research received funding from the hospital, which could affect the observed outcomes due to funding source bias.
References
Ifar, N. M., EL-Sheikh, O. Y., Hassan, R. E., & Selim, M. A. E. (2020). The Effect Of Applying Nursing Care Bundle On Controlling Central Venous Line Infection In Neonatal Intensive Care Units. Mansoura Nursing Journal, 7(1), 56-74. DOI: 10.21608/mnj.2021.175762
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Adrian Santiesteban
Miami Dade College
NUR3165
Professor Roxana Orta
2/2/25
Key Points:
· Evidence synthesis is best done through group discussion. All team members share their perspectives, and the team uses critical thinking to arrive at a judgment based on consensus during the synthesis process. The synthesis process involves both subjective and objective reasoning by the full EBP team.
Through reasoning, the team:
· Reviews the quality appraisal of the individual pieces of evidence
· Assesses and assimilates consistencies in findings
· Evaluates the meaning and relevance of the findings
· Merges findings that may either enhance the team’s knowledge or generate new insights, perspectives, and understandings
· Highlights inconsistencies in findings
· Makes recommendations based on the synthesis process
· When evidence includes multiple studies of Level I and Level II evidence, there is a similar population or setting of interest, and there is consistency across findings, EBP teams can have greater confidence in recommending a practice change. However, with a majority of Level II and Level III evidence, the team should proceed cautiously in making practice changes. In this instance, recommendation(s) typically include completing a pilot before deciding to implement a full-scale change.
· Generally, practice changes are not made on Level IV or Level V evidence alone. Nonetheless, teams have a variety of options for actions that include, but are not limited to: creating awareness campaigns, conducting informational and educational updates, monitoring evidence sources for new information, and designing research studies.
· The quality rating (see Appendix D) is used to appraise both individual quality of evidence and overall quality of evidence.
Johns Hopkins Nursing Evidence-Based Practice
Appendix H: Synthesis Process and Recommendations Tool
Johns Hopkins
Appendix H
Synthesis Process and Recommendations Tool
NUR3165
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EBP Question: Among neonates in the NICU, does the implementation of evidence-based sepsis prevention bundles, compared to usual care practices, decrease the incidence of neonatal sepsis within six months of implementation? |
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Category (Level Type) |
Total Number of Sources/Level |
Overall Quality Rating |
Synthesis of Findings Evidence That Answers the EBP Question |
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Level I · Experimental study · Randomized controlled trial (RCT) · Systematic review of RCTs with or without meta-analysis · Explanatory mixed method design that includes only a Level I quaNtitative study |
3 |
A |
Systematic reviews and RCTs demonstrate consistent evidence that sepsis prevention bundles significantly reduce neonatal sepsis rates by up to 30%. Evidence highlights effective strategies such as hand hygiene protocols, central line infection prevention, and antibiotic stewardship. |
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Level II · Quasi-experimental studies · Systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis · Explanatory mixed method design that includes only a Level II quaNtitative study |
4 |
B |
Quasi-experimental studies confirm the effectiveness of bundled interventions, with a 20–25% reduction in sepsis cases. Results show moderate variability due to differences in implementation fidelity across hospitals. |
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Level III · Nonexperimental study · Systematic review of a combination of RCTs, quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta- analysis · QuaLitative study or meta- synthesis · Exploratory, convergent, or multiphasic mixed-methods studies · Explanatory mixed method design that includes only a level III QuaNtitative study |
2 |
B |
Observational and cohort studies further support the reduction in sepsis rates, particularly when bundles are used consistently. Some studies report challenges in sustained compliance, which affects outcomes. |
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Category (Level Type) |
Total Number of Sources/Level |
Overall Quality Rating |
Synthesis of Findings Evidence That Answers the EBP Question |
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Level IV · Opinions of respected authorities and/or reports of nationally recognized expert committees or consensus panels based on scientific evidence |
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C |
Expert opinion emphasizes the importance of ongoing education and monitoring for successful implementation. Findings are based on experiential evidence rather than empirical data. |
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Level V · Evidence obtained from literature or integrative reviews, quality improvement, program evaluation, financial evaluation, or case reports · Opinion of nationally recognized expert(s) based on experiential evidence |
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C |
Case studies indicate potential cost savings and improved neonatal outcomes, though findings lack robust empirical validation. |
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Based on your synthesis, which of the following four pathways to translation represents the overall strength of the evidence? |
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· Strong, compelling evidence, consistent results: Solid indication for a practice change is indicated. · Good and consistent evidence: Consider pilot of change or further investigation. · Good but conflicting evidence: No indication for practice change; consider further investigation for new evidence or develop a research study. · Little or no evidence: No indication for practice change; consider further investigation for new evidence, develop a research study, or discontinue project. |
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If you selected either the first option or the second option, continue. If not, STOP, translation is not indicated. |
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Recommendations based on evidence synthesis and selected translation pathway |
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Given the robust evidence, implementing evidence-based sepsis prevention bundles is recommended. To ensure feasibility: · Conduct a pilot study tailored to the NICU's unique context. · Secure resources, administrative approval, and stakeholder engagement. · Provide training to staff on bundle implementation and establish monitoring mechanisms to ensure adherence. · Evaluate outcomes from the pilot before scaling to full implementation. |
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Consider the following as you examine fit: |
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Are the recommendations: · Compatible with the unit/departmental/organizational cultural values or norms? The recommendations align with the organization’s commitment to evidence-based practices and improving patient safety outcomes. · Consistent with unit/departmental/organizational assumptions, structures, attitudes, beliefs, and/or practices? The interventions complement existing infection control measures and support a culture of accountability and quality care in the NICU. · Consistent with the unit/departmental/organizational priorities? The recommendations address organizational goals to reduce neonatal morbidity, improve patient care, and achieve cost-effective health outcomes. |
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Consider the following as you examine feasibility: |
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· Can we do what they did in our work environment? · Are the following supports available? · Resources: The necessary tools and equipment for implementing sepsis prevention bundles, such as central line care kits, are likely available or can be procured. · Funding: The organization should assess available financial resources or grants to support initial training and monitoring. · Approval from administration and clinical leaders: Administrative and clinical leadership must endorse the project to ensure institutional buy-in and sustained support. · Stakeholder support: Engaging NICU staff, including nurses and neonatologists, is critical for ensuring adherence and ownership of the interventions. · Is it likely that the recommendations can be implemented within the unit/department/organization? The recommendations are practical and achievable within the organizational environment, particularly with a phased approach, such as starting with a pilot study. Success is contingent upon effective training, consistent monitoring, and feedback mechanisms to ensure compliance and address barriers during implementation. |
Directions for Use of This Form
Purpose of form
Use this form to compile the results of the individual evidence appraisal to answer the EBP question. The pertinent findings for each level of evidence are synthesized, and a quality rating is assigned to each level.
Total number of sources per level
Record the number of sources of evidence for each level.
Overall quality rating
Summarize the overall quality of evidence for each level. Use Appendix D to rate the quality of evidence.
Synthesis of findings: evidence that answers the EBP question
· Include only findings from evidence of A or B quality.
· Include only statements that directly answer the EBP question.
· Summarize findings within each level of evidence.
· Record article number(s) from individual evidence summary in parentheses next to each statement so that the source of the finding is easy to identify.
Develop recommendations based on evidence synthesis and the selected translation pathway
Review the synthesis of findings and determine which of the following four pathways to translation represents the overall strength of the evidence:
· Strong, compelling evidence, consistent results: Solid indication for a practice change.
· Good and consistent evidence: Consider pilot of change or further investigation.
· Good but conflicting evidence: No indication for practice change; consider further investigation for new evidence or develop a research study.
· Little or no evidence: No indication for practice change; consider further investigation for new evidence, develop a research study, or discontinue the project.
Fit and feasibility
Even when evidence is strong and of high quality, it may not be appropriate to implement a change in practice. It is crucial to examine feasibility that considers the resources available, the readiness for change, and the balance between risk and benefit. Fit refers to the compatibility of the proposed change with the organization’s mission, goals, objectives, and priorities. A change that does not fit within the organizational priorities will be less likely to receive leadership and financial support, making success difficult. Implementing processes with a low likelihood of success wastes valuable time and resources on efforts that produce negligible benefits.