Systematic reviews of nursing research : development of a conceptual framework

Abstract

Background : - The past two decades has seen an increasing emphasis placed on basing health care on the best available evidence. However, existing research has come under increasing scrutiny, which suggests its quality was often poor. This problem has been exacerbated by the ever increasing volume of health care literature. To address these difficulties systematic reviews have emerged as one of the most important ways by which research is summarised and communicated to its end-users. However, as these reviews have been primarily concerned with effectiveness, they have focused almost exclusively on randomised controlled trials. As a result, systematic reviews have excluded much of the research of nurses. Purpose : - The purpose of this study was to develop a process to systematically collect, appraise, summarise and synthesise the findings of a range of different types of research. Conceptual Framework : - To aid in the development of these expanded review methods, a conceptual framework was developed that addressed effectiveness, appropriateness and feasibility. Method : - A search of the literature was undertaken to identify published reviews of different types of research, and discussions in the health care literature related to the conduct of research reviews. These reviews and discussion papers served as the basis for developing the expanded review methods. Evaluation : - To evaluate the expanded review methods, two systematic reviews were conducted. The protocol and results of the first review on the use of music in hospitals are presented to demonstrate how the conceptual framework and expanded review methods enabled a broader evaluation of the topic. Selected results from the second review on the use of physical restraint are presented to demonstrate how the findings from a number of methodologically different types of research were incorporated into a systematic review. Conclusion : - The conduct of the two systematic reviews clearly demonstrated that the proposed expanded review process was able to rigorously collect and summarise a range of different types of research. Additionally, the conceptual framework underpinning these reviews enabled each of the studies to be located logically and coherently during the synthesis of data.