a series of questions that can be used to guide systematic review updates. As
the number of guidelines has increased, guideline syntheses are
systematic comparisons of selected guidelines that address similar topic areas.
Key elements of each synthesis include a discussion of areas of agreement
and difference, the major recommendations, the corresponding strength of
evidence and recommendation rating schemes, and a comparison of guideline
methodologies. Also included are the benefits/harms of implementing the
guideline recommendations and any associated contraindications. (AHRQ, 2017)The Third S: Synopses
A synopsis is a brief description of evidence, typically presented in a para-
graph. Abstracts obtained through CINAHL and MEDLINE are essentially
synopses. A variety of evidence-based journals have emerged that provide
synopses of valid and clinically useful studies (DiCenso et al., 2005; Melnyk &
Fineout-Overholt, 2015; Straus, Glasziou, Richardson, & Haynes, 2011). Although
most of these require subscriptions, many websites allow guests access to some
full-text articles.
The Fourth S: Summaries
Integrative summaries are addressed in the fourth level of the pyramid of the
5 Ss (Haynes, 2006). For example, the “Evidence Summaries” and “Recom-
mended Practices” are available at Johanna Briggs Institute (JBI) and fit in
this level. Evidence is presented in a succinct, easy-to-read format in two to
three pages. This format allows nurses to review evidence about best practices
quickly, which can be an advantage when caring for patients. Other source of
summaries can be found at BMJ Clinical Evidence (http://www.clinicalevidence
.com/ceweb/index.jsp), the AHRQ’s National Guideline Clearinghouse (http://
http://www.guideline.gov),,) and Physicians’ Information and Education Resource
(American College of Physicians, 2017; Haynes, 2006).
The Fifth S: Systems
If you deliver nursing care in a healthcare organization that has an integrated
computerized decision support system, such as Epic, you have the system
in place to implement evidence-based care (Haynes, 2006; Epic, 2017). This
system model uses an electronic medical record that has integrated practice
guidelines that provide alerts to healthcare providers. This makes it easier
for healthcare providers to follow guidelines, because it can be challeng-
ing to keep up with the volume of new and revised guidelines (Epic, 2017).
Many healthcare organizations have or are implementing this technology. As
technology advances, the ability to link other types of evidence to electronic
medical records will improve.
12.1 The Pyramid of the 5 Ss 319