Systematic Reviews in Nursing: Healthy Diversity or Complete Confusion?

Thursday, 25 July 2019: 4:50 PM

Quanlei Li, MPH, MSN, RN
Johns Hopkins University School of Nursing, Baltimore, MD, USA
Helen Aveyard, PhD, MA, BSc (Hons), PDCE, RGN
School of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
Caroline Bradbury-Jones, PhD, RN
School of Nursing, University of Birmingham, Birmingham, United Kingdom
Diana Lyn Baptiste, DNP, MSN, RN
Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA

Purpose: Over the past twenty years in nursing, literature reviews have become an increasingly popular form of synthesising evidence and information relevant to the profession. The foundation of the Cochrane Collaboration in 1993 was the first organisation to pioneer the design and delivery of comprehensive, systematically undertaken literature reviews and widely held to be the most robust form of evidence synthesis; indeed the term systematic review is often closely associated with Cochrane reviews.

The establishment of the Cochrane Collaboration triggered interest in the development of other types of literature reviews; not just those concerned with the effectiveness of interventions. The main alternative at the time, the ‘narrative style’ review, was a collective term for summaries of evidence where the methods for undertaking the review was not articulated. These narrative reviews have been criticised for a lack of systematic approach and consequently significant limitations as regards the findings. As a result, methods that increased rigour in the undertaking of these ‘narrative type’ reviews were developed. These include Noblet and Hare’s ‘Meta-ethnography’ in the late 1990s, followed slightly later by the meta-synthesis of Walsh and Downe (2005) and the thematic synthesis of Thomas and Harden (2008). Also, to overcome the dichotomy of the quantitative/qualitative reviews, the integrative review was described according to Whitemore and Knafl (2005) which has been widely used by academics over the last decade.

However, our observations concur with others such as Booth et al (2016) and indicate that many different methods for doing a literature review have emerged in recent years, with a corresponding increase in use of terms used to describe them. This confirms the increasing interest in doing a literature review but also suggests a diversity in methods that may or may not be helpful.

Methods: We were interested in diversity of terms used to describe a literature review and undertook a ‘Focused Mapping Review and Synthesis’ (FMRS) (Bradbury-Jones et al 2017). The FMRS is concerned with ‘what is happening in this field?’ and is hence an ideal method to investigate current practices in literature reviews in nursing.

Using the international Scopus SCImago Journal and Country Rank, we identified the highest ranked journals with ‘nursing’ in the title. The following journals were included: International Journal of Nursing Studies, Nurse Education Today, Nursing Ethics, Journal of Advanced Nursing, and Journal of Nursing Management. We surveyed the titles of each paper included in each journal between 2017-2018 and any paper with the word ‘review’ or ‘synthesis’ in the title was included in the review.

Articles meeting the inclusion criteria, papers were read in full and the following details were recorded: journal reference, type of review, search strategy, use of critical appraisal, approach to data analysis, apparent alignment between type of review and methods undertaken in the review.

Results: We identified more than 35 terms used to describe a literature review out of a total of 223 papers, which had either ‘review’ or ‘synthesis’ in the title. Some examples were: qualitative systematic review, qualitative review and meta-synthesis, qualitative meta-synthesis, meta-ethnography, critical literature review, umbrella review, mixed methods review, integrative review, and literature review. It was clear from reading the reviews that many of the different terms were used to describe the same process although often full details of the method were omitted. Literature reviews were sometimes inconsistently indexed in journals such that a review with the same name was listed in different sections of a journal.

Conclusion: A wide variety of terms are used to describe doing a literature review although the extent to which these terms reflect completely different methods is unclear. There is apparent inconsistency in the use of terms by both authors and journal editors. This raises cause for concern and we argue that work needs to be undertaken to achieve a consensus regarding the classification. Since this is the first study of this kind spanning nursing journals, further investigation is warranted to develop expert consensus for use of terms among scientific journal editors, and reviewers.

See more of: C 10
See more of: Research Sessions: Oral Paper & Posters