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Designing the architecture of an
undergraduate or master’s evidence based
practice health care dissertation.
A road map to success!
Edward Alan Glasper, Diane Carpenter, Michelle Cowen
Jenny Jepson
Abstract
This paper details the steps that need to be taken for the successful completion of an evidence based practice healthcare
dissertation. The individual architectural landscapes of the chapters making up a dissertation are fully discussed with
appropriate examples to illuminate the process
Introduction
Health care dissertations come in many
formants but all follow a similar format
with undergraduate dissertations
of up to 10,000 words and masters
20,000, words plus. Irrespective of the
word count it is the architecture of the
dissertation which is of prime importance
when it is submitted for assessment by
markers. Most evidence based practice
dissertations (EBP) are configured
as critical reviews of the literature.
When dissertations are assessed the
dissertation architecture is of great
significance in allowing the markers
to see the big picture of the student‘s
dissertation journey. Dissertations are
rarely written like a novel commencing
with chapter 1 but should still read like
a novel! I.e. with a plotline that takes the
reader through the student journey in a
way that allows full comprehension of
the subject being studied. This will vary
immensely and might range for example,
from a critical review of the literature
Correspondence author on the optimum methods of pain
management in patients recovering from
Alan Glasper , Professor; Faculty of Health Sciences, University of knee replacement surgery through to an
Southampton. E-mail (E.A.Glasper@soton.ac.uk) evaluation of larvae therapy for varicose
ulcer wound healing. Although the
Authors subject matter might change the basic
architecture of how the dissertation is
Diane Carpenter, Lecturer in Nursing: University of Southampton presented will not. While this paper is
designed to help undergraduates and
Michelle Cowen, Principal Teaching Fellow in Nursing: University of master’s degree students write an EBP
Southampton dissertation some doctoral students
writing a thesis will find it useful for
Jenny Jepson, Lecturer in Nursing: University of Southampton building the architecture of their early
chapters. Full details of how to write
Working Papers in Health Sciences 1:2 ISSN 2051-6266 / 20120000 1
an EBP health care dissertation can be • The dissertation must be word files/2012/08/NPSA-Annual-Report-
sourced from Glasper and Rees (2013 processed using a standard font (e.g. and-Accounts-2011-12-020812.pdf)
Arial) in point size 12 with black ink
What is expected in a EBP only, on one side only with double An example of using the decimal
dissertation spacing throughout and 1” margin notation system in a sample dissertation
on each side (A4 white paper). introductory chapter
Dissertation writers are advised
Undoubtedly the most important not to use exotic fonts or any other 1.1 Introduction to the topic (e.g.
function of an EBP dissertation is to ink colour apart from black. Major writer’s disease)
demonstrate that the writer has been headings should use 16 point in bold
able to demonstrate the ability to with subheadings in 14 point bold. 1.2 What is writer’s disease?
systematically search and critically Each should be consecutively centrally
appraise evidence including literature/ numbered at the foot of each page 1.3 What is the prevalence of writer’s
primary research /systematic reviews / beginning with the Abstract page. disease (in your clinical area)?
clinical guidelines using an appropriate
critical appraisal framework(s).To do • The dissertation must be printed 1.4 The management of writer’s
this the student needs to critically preferably using a laser printer (make disease in contemporary healthcare
analyse practice and normally identify a sure it has sufficient ink and do not be
clinically related issue for exploration. In tempted to use an older dot-matrix 1.5 The role of health policy in the
interrogating published research about printer). Any figures, tables or management of writer’s disease
a particular subject it is important that illustrations need to be carefully
the student is able to demonstrate a printed to protect their integrity 1.6 The role of evidence based
critical awareness and knowledge of the (hot tip: laser printers use heat and practice in the management of
research methodology adopted by the this distorts the paper. To avoid a writer’s disease
researchers. This enables a reflection on ripple effect when later bound, laser
the breadth of evidence that underpins print the 1st copy ensuring that all
a particular field of practice. Importantly the pages have been printed and Dissertations are normally configured
in reviewing literature the student is able then photocopy. This will facilitate a as follows (but readers are advised to
to show that they have developed the perfectly flat dissertation; keep the check with their own university):-
confidence to understand, manipulate, laser copy as a loose bound master.)
interpret and present both quantitative • Title page containing: The full title
and qualitative data. Perhaps the most • Normally 2 copies of the dissertation of the University, followed by the
important aspect of the EBP dissertation are submitted for examination. faculty or school, as appropriate, the
is the opportunity it gives the student The dissertations must have soft full name and number of student,
of considering ways in which styles of binding and this should be preferably followed by the title of course being
leadership and organisational culture undertaken by a university or college studied e.g A dissertation in partial
impact on effective care delivery within bindery or an appropriate shop that fulfilment of the requirements for
a range of practice arenas and be able offers print facilities. Subsequent to BSc (Hons) followed by the title of the
to critically discuss the barriers and the assessment process successfully dissertation
behaviours which may undermine the examined dissertations may be
achievement of excellent practice. In subsequently hard bound for • Contents page
considering the ways in which barriers posterity(something to show the
to evidence- based practice can be grandchildren). • List of tables/figures
reduced the student is afforded the
opportunity through the dissertation to • Many student supervisors suggest • Acknowledgements
critically evaluate the process by which the use of the decimal notation
evidence can be disseminated and to system sometimes known as civil • Abstract
draw reasoned conclusions or to reach service formatting for the writing of
sustainable judgements about how to the dissertation and the individual • Introduction
apply these to practice. chapters. The best way to understand
how the decimal notation system • Literature review
Formatting the dissertation is used is to visit the Department of
Heath website (http://www.dh.gov. • Critique of the identified empirical
Although different universities may uk/en/index.htm) and inspect a papers
have slightly different rules concerning government policy document,
the administrative configuration of many of which use this system • Critique conclusions and
a dissertation, and readers should (e.g The National Patient Safety implications for practice
check with their own academic registry Agency Annual Report and Accounts
department first, the following is typical: 2011/12 available via: (https:// • Implementing evidence in practice
www.wp.dh.gov.uk/publications/
Working Papers in Health Sciences 1:2 ISSN 2051-6266 / 20120000 2
• Appendices where there is a deficiency in knowledge and Langton 2000, Timmins and McCabe
about the subject area as this paves the 2005). It is important that the literature
• References - using the Modified way to the literature search. Using the search follows a highly structured step by
Harvard system (do check your own example from table 1, the dissertational step approach that will identify:
university regulations) architectural milestones might be
configured as follows using the decimal 1. Primary sources of information i.e.
• Glossary of terms or abbreviations notation system. papers containing original research
The steps of building the 1. Writer’s disease (NB indented 2. Systematic reviews by agencies such
dissertation subheadings can be used as as Cochrane (http://www.cochrane.
appropriate) org/cochrane-reviews) and the
The abstract Joanna Briggs Institute (http://www.
1.1. Origin of writer’s disease joannabriggs.edu.au/Systematic%20
Ironically this should be written last but Reviews) which attempt to identify,
it is the first page that marking assessors 1.2. Prevalence of writer’s disease appraise and synthesize all
will look at in the sequential order of the appropriate empirical evidence from
dissertation. It is a very important page 1.3 etc a range of sources to answer a specific
usually with a maximum of 500 word and research question. Such reviews
should give a comprehensive summary 1.2 Management of writer’s disease are important and consider both
or synopsis of the whole dissertation quantitative and qualitative research
journey .The abstract where appropriate 1.3 Complications of writer’s disease to illuminate the quest to base health
should give a brief background to the care on best evidence.
EBP study, the aim or literature search 1.4 Health Care Policy and writer’s
question should be clearly stated and the disease 3. Secondary sources i.e. journal
design of the EBP literature review should papers which draw upon or describe
be clearly articulated as should the 1.5 The role of evidence- based other peoples work as in a literature
method(s) used to critique the sourced practice in the management of review paper.
literature. Furthermore the abstract must writer’s disease
briefly present the results of the literature 4. Theoretical papers which describe
critique and give a concise conclusion 1.6 The formulation of the PICO/SPICE explore or analyse the theoretical or
which details what the implications of literature review question conceptual underpinnings of a given
the findings are for practice. As with the subject.
synopsis on the back cover of a holiday The introductory chapter normally ends
paperback novel, an academic abstract with the posing of the EBP question 5. Grey literature (a euphemism for
should tempt the reader into the main literature not formally published in
body of the dissertation where there The literature search chapter (usually the usual publishing format such as
should be no surprises! chapter 2) text books or journals) can include
government health care policy
The introduction chapter Sourcing the best evidence has to be reports, local hospital protocols or
demonstrated by the student through care pathways, as well as professional
In this chapter the writer (normally the literature search and Boagy et al organisation reports e. g., The Royal
1500-2000 words for an undergraduate (2013) offer a clear and concise method College of Nursing (http://www.rcn.
but more for a master’s student) of undertaking a comprehensive org.uk/). The largest repository of
should orientate the reader to the full literature search. This chapter is usually grey literature is now the World Wide
parameters of the EBP subject being 2000 words in length and a formulaic Web but caution should be used
studied or investigated. Irrespective of approach is advisable. Huang et al (2006) when obtaining material from the
the subject area which might originate suggest the use of PICO to formulate internet as many sites may not be kite
from a range of fields of practice such clinically related questions in terms of marked i.e. have an official approval
as child health or learning disability the problem/population, intervention, from an accrediting agency. The term
nursing, the introductory chapter should comparison, and outcome. These aspects kite marking derives from the British
draw on a range of historical, seminal make up the PICO framework which many Standards Institution, which uses a
and contemporary literature, health students and researchers find useful for kite shape logo to demonstrate that
policy and grey literature to facilitate an interrogating the literature although a product meets specific standards of
appreciation of the subject matter. It is not other similar models are available. quality and reliability. (http://www.
necessary at this stage of the dissertation Glasper and Rees (2013) believe that bsigroup.com/en-GB/our-services/
to give full details of empirical studies the posing of a PICO question can product-certification/kitemark/)
that might have been conducted in the help in focusing the literature search.
area being studied. The introductory Additionally the student should cite a 6. Anecdotal or professional
chapter should however highlight areas particular literature searching model to opinion evidence. Although lowest
provide structure to this chapter (e.g. Hek in the hierarchy of evidence such
Working Papers in Health Sciences 1:2 ISSN 2051-6266 / 20120000 3
information may be generated by 1. Clinical Trials .gov (http://www.
named individuals from specific clinicaltrials.gov/) 12. Index of Theses (A comprehensive
organisations or clinical experts or key listing of theses with abstracts
informants. Such information is useful 2. Trip (http://www.tripdatabase. accepted for higher degrees by
where no specific evidence base com/) universities in the United Kingdom
exists for example a specific clinical and Ireland) (http://www.theses.
management intervention. 3. AMED (The Allied and com/scripts/dtSearch/dtisapi6.dll)
Complementary Medicine Database)
Navigating the bibliographic data bases (http://www.ovid.com/webapp/wcs/ 13. The Cochrane library of
stores/servlet/ProductDisplay?storeI systematic reviews (http://www.
There are a large number of data bases d=13051&catalogId=13151&langId=- thecochranelibrary.com/view/0/
that can be searched by the student, 1&partNumber=Prod-12) index.html)
and to facilitate effective searching it is
important that the student uses Boolean 4. BNI (British Nursing Index) (http:// 14. The Joanna Briggs Institute.
logic, wild cards and truncations to www.proquest.co.uk/en-UK/ (http://www.joannabriggs.edu.au/)
optimally capture the full spectrum of catalogs/databases/detail/bni.shtml)
publications available. Students studying 15. Google scholar. (http://scholar.
for a doctorate will need to cast their net 5. CINAHL (Cumulative Index to google.co.uk/) This search engine
widely and consider data bases which Nursing and Allied Health Literature) is very useful and freely accessible
might be particular to one country e.g. http://www.ebscohost.com/ .Although Google Scholar will host
Thai data bases. Undergraduates may biomedical-libraries/the-cinahl- papers from many peer reviewed
only be expected to consider English database journal it does not automatically
language data bases or just scholarly allow full text downloads or printing,
papers published in the UK. To help 6. Embase (http://www.embase. especially from publications available
contain the parameters of the search com/) through subscription sites. Students
within manageable boundaries it is must not rely solely on Google
common to use inclusion and exclusion 7. HMIC Health management scholar as a way of bypassing a
criteria. In the literature search chapter information consortia (http://www. full and exhaustive search of the
examiners will expect to see a table with library.nhs.uk/help/resource/hmic) literature using the full array of
a justification for each of the inclusion bibliographical data bases. NB
criteria and exclusion criteria as applied 8. Medline and Pubmed (http://www. examiners will undoubtedly check,
by the student for the literature review. ncbi.nlm.nih.gov/pubmed) using Google scholar that the student
has encompassed the most up to
Examples of data bases available for 9. PsycINFO (http://www.apa.org/ date papers in their critique of the
students to search pubs/databases/psycinfo/index.aspx) literature.
Although not exhaustive some of the 10. Web of Science (http://
following can be useful for health related thomsonreuters.com/products_ It is very important that a literature search
research: N.B. The RCN has an excellent services/science/science_ audit trail is included in this chapter as
on line data base search facility available products/a-z/web_of_science/) this allows examiners and future readers
to members via (http://www.rcn.org. to appreciate the provenance of the
uk/development/library/elibrary/ 11. ASSIA (Applied Social Sciences findings. This should show clearly the
databases_to_search) Index and Abstracts) (http://www. search terms etc. used by the student.
csa.com/factsheets/assia-set-c.php)
Working Papers in Health Sciences 1:2 ISSN 2051-6266 / 20120000 4
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