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What is the 6S pyramid?

The 6S evidence pyramid above is designed to help health practitioners prioritize evidence. The higher up the pyramid your evidence falls, the more weight you should give it in your clinical decision making process. Not every topic will have evidence at all levels – use the highest level that is available. 

Currently, we do not have access to Systems level evidence at Mount Royal. The resources listed below will help you look for evidence at each of the remaining levels.

The image above is based on levels discussed in the following article:

DiCenso, A., Bayley, L., & Haynes, R. B. (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Evidence Based Nursing, 12. 99-101.

Define and search - Key steps in research process

Practice Scenarios

Scenario A

Your friend is pregnant and has come to you for some advice. They have been thinking about getting a flu shot, but someone shared an article on Facebook that said it might increase the risk of miscarriage. What does the scientific literature say on this issue?

Scenario B

Your friend is a new parent, and has recently read a blog post that too much screen time could negatively impact their child's language skills. You are interested in finding out what research is out there on this subject.

Scenario C

Recently, you came across a news article talking cannabis use during pregnancy. You are interested in learning more about what pregnant  people understand about the implications of this choice.

STEP 1 - Defining your question/problem - Using PICO or PS to Identify Main Search Concepts

1. Read your search scenario.

2. What type of research will best answer this question - quantitative or qualitative?

  • If quantitative, complete the PICO worksheet.
  • If qualitative, complete the PS worksheet.

STEP 2 - Identifying Appropriate Keywords and Subject Headings (MeSH & CINAHL Headings)

Identify the key concepts you will use in your search. Brainstorm possible synonyms, and check to see if there are relevant subject headings (MESH in Medline/PubMed and CINAHL Headings in CINAHL).

Tips for Building A Thorough Search in Medline or CINAHL

You can combine searches by clicking on the Search History tab

Our usual database tricks still apply

  • An asterisk (*) means I don't care how it ends  e.g. nurs*
  • AND (if you want all the words to appear in your search results) e.g. nurs* AND role*
  • OR (if you don't care which word shows up) e.g. patient* OR client*
  • Use quotation marks "" to search for a particular phrase  e.g. "nurse researcher"
  • New trick! Search for words near each other by using N - nicotine N3 (patch* or gum) looks for nicotine within 3 words of patch or gum.
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Cari Merkley

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