Guidance for undertaking a Systematic Review

ABSTRACT – should be no more than around 250 words, and should be done following completion of the project as it has to include an overview of the topic, what you want to find out, the method, results and conclusion.

  1. INTRODUCTION  

This needs to be condensed in to no more than 1000 words. It should ‘set the scene’ and provide a rationale of the project or present the problem. This should be written in such a way that it leads to the aim of the project; what the research question is; and how you are going to answer this i.e. your objectives, which would be a review of the literature; a systematic review of the primary research; a discussion of the results – As this is a nursing programme results need to be linked to nursing.

  • LITERATURE REVIEW (Background) (Literature Review is a better title and more accurate)

This should be about 3500-4000 words.  This is an in depth exploration of the topic and associated issues. It will include theoretical work and a critical debate with key pieces of research, supported by the current literature and should be linked to the evidence that made you think of the question. Relate this to nursing practice.

Within this section you continue to analyse and critique the literature, especially the research. When you have done this think about what you have read. Does it answer your original question? If so why? If not, do you have another one? What are the key issues which stand out for you? Do any of these relate to your question? If so why? What are you overall thoughts about the literature and research about the subject matter? Does more research need to be done? If so, what areas and what type of research? These questions do not need to be asked in any particular order but you need to structure your response to them in a logical way which informs the reader of your thought processes.

  • METHODOLOGY

This needs to be around 1000 words. It should start with a brief summary of the literature review and the key findings with support from the pertinent current literature and a reminder of your question and why you are answering it.

You should have a critical debate, supported by the current literature which will include why you are doing a Systematic Review. What does the literature say about Systematic Reviews? What are the benefits of a systematic review compared to a literature review?  What search terms are you going to use? These should be informed by your literature review – you could use several more than you did originally.

Remember the material you are looking for will be primary research such as RCTs, quantitative and qualitative.

Say which data bases you used. State your inclusion and exclusion criteria. You will need to decide on the type of data i.e. ‘qualitative’ or ‘quantitative’; and is this only RCTs or a wider remit? This will be informed by the literature review and your reflections about the literature. The criteria will form your ‘filtering’ process. You need to state the number of results you have had (numbers of articles revealed after a search) after each stage of the filter process – See PRISM Flow Diagram and PRISM Table. Ideally you will probably go from having 2000 pieces of research to about 6-10. For example, list the number of total hits in the identification box using broad general key words from the respective search engine – could be only one if using Discover.  Then after filtering/narrowing your search using key words for example; depending on your question: gender, age, RCT (Treatment) Qualitative methodology (patient experience) language, country or countries and year, should allow you to end up with approximately 6- 10 good quality papers that you can then critique in your results section. Include your PRISM flow diagram in your methodology section and the PRISM table should be an appendix.

Please note a systematic review should not be included in your review of the literature. PICO can be used to help you to think about the key words –

P = Patient, Problem, Population (How would you describe a group of patients similar to you? What are the most important characteristics of the patient?)I = Intervention, Prognostic Factor, Exposure (What main intervention are you considering? What do you want to do with this patient? What is the main alternative being considered?) C = Comparison (Can be None or placebo.) (What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests?) O= Outcome (What are you trying to accomplish, measure, improve or affect? Outcomes may be disease-

Many clinical or research questions can be divided into these four components, which we call ‘P I C O’. Try to use all four parts of the question, if possible.

   P      Population/patient

   I      Intervention/indicator

   C      Comparator/control

   O      Outcome

Different types of questions

The most common type of clinical question is about how to treat a disease or condition. In Evidence Based Medicine (EBM), treatments and therapies are called ‘interventions’ and such questions are questions of INTERVENTION.

Not all research questions are about interventions. Other types of questions may arise:

1. What causes the problem? AETIOLOGY, RISK FACTORS

2. What is the frequency of the problem? FREQUENCY

3. Does this person have the problem? DIAGNOSIS

4. Who will get the problem? PROGNOSIS, PREDICTION

In each case the P I C O method can be used to formulate the question, as shown in the following examples. You can use the same approach to research qualitative questions about health issues of a more general nature (i.e. PHENOMENA). In this case, the question will consist of ‘P’ and ‘O’ only oriented or patient-oriented (Cochrane, 2015)

  • RESULTS – around 1500 words

You should summarise your final articles in a table, and use a tool like PRISMA to apply your criteria to help you narrow down the results, to around 6 -10 pieces of research.

Each piece of research that you have identified needs to be critiqued and analysed. Use of a methodological framework will help you to critique your chosen literature – this can be downloaded from the Module Space on Sunspace. You may wish to do this in Chronological order or within headings of the emerging themes. After doing a couple of these you should start to make some connections, observations or reflections. These need to be woven in to your discussion –

When you have done this for each of the articles individually, conclude the section with your response to some questions like, what does all this information tell me? Where there any particular themes emerging? Does this answer my original question?

  • DISCUSSION  – around 1000 words

Start with a summary of what you have done so far and where you are up to.

Reflect on the findings of your analysis of the research. How does this fit/relate to some of the material in the literature review? What are your overall thoughts about the body of evidence? So what does this mean? How does this all fit with the main subject matter? What does it Mean to nursing? Critically debate your findings with use of the literature; you may have identified additional points from your literature review that   can be added here – remember there needs to be a rationale for any literature mentioned here – i.e  it must have been stated earlier in the literature review section.

  • LIMITATIONS – around 500 words

What would you do differently in you had to carry this research out again? Why? Was there anything in particular that influenced the process of this research?

  • CONCLUSION AND RECOMMENDATIONS

This is a summary of the project, your final reflections and recommendations. What do you think needs to happen next in terms of research in this area?

It is important to get the process right when doing a project, and you need to demonstrate transparency in your thought processes. Sometimes when you have written something you need to ask yourself ‘would this stand up in court?’ If not, then you need to support your discussion more with literature and research, but you need to demonstrate this is credible and this is done through critique and analysis.

This process is not dissimilar to how you might recommend a novel about a particular character to a friend…you briefly describe what it is about, what the good/bad bits are, and why. You might say it is similar to another story about the same type of character which had the same ending or might be similar to some extent (about the same type of character for example) but has a different ending. You might want to comment on why you think that is, perhaps relating it to another story.