Nursing: 6S/Foreground Info

Foreground Information and the 6S Pyramid

Foreground questions are best answered by evidence found at different levels of the 6S Pyramid.

The different levels of the pyramid are outlined and colour-coded to the right.

Learn more about the 6S Pyramid:

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(4), 99-101. https://doi.org/10.1136/ebn.12.4.99-b [View record in Omni]

Use the concepts identified in your PICO Question to come up with approriate search terms, remembering that:

• A piece of evidence's ability to guide clinical action increases as you move up the pyramid.
• Topics become more specific as you move down the pyramid.

HSL's Database Fundamentals Tutorial will explain the process of building an effective and efficient search.

The small lock icon  beside a link indicates this is an online library resource.  When you click on the resource link from off-campus you'll be redirected to a login page. Login using your MacID and password to access the content.

Meta-Searches (aka "federated" search engines) search for evidence across multiple resources. These tools return information from all levels of the pyramid. They can be especially useful when you're unsure which database is best suited to answer a clinical question.

Purdue Online Writing Lab (Purdue OWL):

Evidence-based texts:

Systems, i.e., Clinical Decision Support Systems (CDSS), integrate information from the lower levels of the hierarchy with individual patient records. They represent the most sophisticated form of evidence for clinical decision-making because they combine various layers of synthesized information with patient-specific recommendations.

Summaries are regularly updated clinical guidelines or textbooks that integrate evidence-based information about specific clinical problems.

Clinical Practice Guidelines

Note: Some guidelines are also published in journals. To search for these:

• Build your search in a journal database and apply publication type limits for practice guidelines.
• Add 'practice guideline' or 'clinical practice guideline' to your search terms.
• The TRIP database, also located under the 'Meta-Searches' heading on the left side of this page, is another good resource for locating clinical practice guidelines.

Evidence-Based Texts

Synopses of syntheses summarize the information found in systematic reviews and meta-analyses.  By drawing conclusions from evidence at lower levels of the pyramid, these synopses often provide sufficient information to support clinical action.

Evidence-Based Abstract Journals

Commonly referred to as systematic reviews and meta-analyses, a synthesis is a comprehensive summary of all the evidence surrounding a specific research question.    

Journal Databases - Systematic Reviews and other forms of knowledge synthesis can be found using the limits by publication type and by adding terms into your search e.g. "systematic review".

Synopses of single studies summarize evidence from high-quality studies.   The following evidence-based abstract journals are the best place to find this type of information:

Studies represent unique research conducted to answer specific clinical questions.

Article Databases

Clinical Queries

The CINAHL, OVID (Medline, EMBASE, PsycINFO, and more), and Pubmed databases can be searched using the Clinical Queries filter, limiting your results to specific clinical research areas: Therapy, Prognosis, Review, Qualitative, and Causation (Etiology)

For further information and tips on using the Clinical Queries filter, please visit the following links: