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Advanced Nursing: Critical Appraisal

Introduction to Critical Appraisal

Once you have asked the clinical question and searched for evidence, the next step of EBP is to critically appraise the evidence you have found. This is a really important process because it ensures that studies with scientific flaws are disregarded, and the ones you include are relevant to your question.

In the Evidence-Based Practice process, and especially in the process of evaluating primary research (which hasn't be pre-appraised or filtered by others), we need to go beyond the usual general information evaluation and make sure the evidence we are using is scientifically rigorous. The main questions to address are:

  • Is the study relevant to our clinical question?
  • How well (scientifically) was the study done, especially taking care to eliminate bias?
  • What do the results mean and are they statistically valid (and not just due to chance)?

For a more detailed look at Critical Appraisal, head to the Systematic Review Guide - Critical Appraisal and the Evidence-Based Practic Guide - Appraise.

Critical Appraisal Tools

Fortunately, there have been some great checklist tools developed for different types of studies. Here are some examples:

  • The Joanna Briggs Institute (JBI) provides access to critical appraisal tools, a collection of checklists that you can use to help you appraise or evaluate research.
  • Critical Appraisal Skills Programme (CASP) is part of Better Value Healthcare based in Oxford, UK. It includes a series of checklists, suitable for different types of studies and designed to be used when reading research.
  • The Equator Network is devoted to Enhancing the QUAlity and Transparency Of health Research. Among other functions, they include a Toolkit for Peer Reviewing Health Research which is very useful as a guide for critically appraising studies.
  • Critical Appraisal Tools (CEBM) - This site from the Centre of Evidence Based Medicine includes tools and worksheets for the critical appraisal of different types of medical evidence.
  • Critical Appraisal Tools (iCAHE) - This site from the International Centre of Allied Health Evidence (at the University of South Australia) has a range of tools for various types of studies.
  • Understanding Health Research - is from the Medical Research Council in the UK. It's a very handy all-purpose tool which takes you through a series of questions about a particular article, highlighting the good points and possible problem areas. You can print off a summary at the end of your checklist
  • Critical appraisal tools from the NHS in Scotland links interactively to all sorts of resources on how to identify the study type and build your critical appraisal skills, as well as to tools themselves.

Critical reading and understanding research

A useful series of articles for nurses about critiquing and understanding types of research has been published in the Australian Journal of Advanced Nursing by Rebecca Ingham-Broomfield, from the University of New South Wales:

Ingham-Broomfield, R. (2014). A nurses' guide to the critical reading of research. Australian Journal of Advanced Nursing, 32(1), 37-44.
[Updated from 2008.]

Ingham-Broomfield, R. (2014). A nurses' guide to quantitative research. Australian Journal of Advanced Nursing, 32(2), 32-38. 

Ingham-Broomfield, R. (2015). A nurses' guide to qualitative research. Australian Journal of Advanced Nursing, 32(3), 34-40. 

Ingham-Broomfield, R. (2016). A nurses' guide to mixed methods research. Australian Journal of Advanced Nursing, 33(4), 46-52. 

Ingham-Broomfield, R. (2016). A nurses' guide to the hierarchy of research designs and evidence. The Australian Journal of Advanced Nursing, 33(3), 38-43. 

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