Showcasing the range of literature reviews in nursing: 'Broad Brush' and 'Deep Dive' approaches.

Abstract

Literature reviews are a popular method of research and are useful because they bring together all the research in a particular area; reducing the need for an individual to read every paper on a topic—as these are carefully selected and summarised within a review. We are delighted to introduce this Journal of Clinical Nursing special issue, which has a focus on literature reviews for the advancement of nursing practice. We were overwhelmed by the number of submissions and as a result made the decision to include as many of these as we could in this edition. We think this demonstrates the range and breadth of submissions for doing a literature review and how these advance nursing practice. There are many different types of literature reviews that have distinct (although sometimes very similar) methods and purposes (Aveyard & Bradbury-Jones, 2019). However, the hallmark of all literature reviews is that they are undertaken in a systematic way. This was a specific consideration for each of the papers submitted for this special issue. The term ‘systematic’ is frequently prefixed to the title of many reviews, but it is important to identify whether the method was undertaken in a systematic manner, rather than to assume that a review which is entitled ‘systematic’ is in fact any different and/or better than another. Whilst there are many different methods, most reviews follow a structure which includes a clearly defined question, a clearly defined search strategy, critical appraisal and analysis of the papers followed by an appropriate method of synthesis. We have identified a range of methods and topics, drawn from wide geographical areas. Almost without exception, all included reviews provide a clear rationale for the review, both in terms of its purpose and method. We start this special issue with what we could call the ‘broad brush’ reviews. These are reviews which intend to give an overview of research in the area rather than a deep dive into the findings. These types of reviews do not provide an in-depth analysis of the evidence on a particular topic. Instead, they provide a mapping of the available research that has been undertaken in an area. They are useful for those who need to identify the scope and range of studies that have been undertaken, to identify, in broad terms, the gaps in the literature. There are clear methods for doing a scoping review and we have identified papers that adhere to a particular method. Overall, nine scoping reviews were accepted into this special issue (Garcia-Exposito et al, Woo et al, Otter et al, Zhang et al, Doody et al, Dzakirin et al, Nickerson et al, Schmudderich et al, Smallwood et al). Here, we pick out just three for discussion. The first, by Otter and colleagues is co-authored by a team with affiliations from the Netherlands and UK. We like the fact that, like many articles published in JCN, the first author is a PhD student. The review follows the methods developed by the Joanna Briggs Institute but also incorporates the methods of Arksey and O'Malley (2005). The focus of the review is to identify literature that focuses on the ways in which nurses support self-management in hospitalised patients. Clearly this is a big topic, and it is expected that much will be published in this area: Hence, the need for a scoping review. A positive feature of this review is the description and justification of a scoping review as the review choice. Consistent with most scoping reviews, the optional sixth stage of consultation with stakeholders, was not conducted. Another scoping review by Doody et al. explores the care of people with intellectual disability. Again, this is a broad area that is likely to have many associated publications. The review is mentioned because the authors provide a clear justification of review choice. Like the review by Otter et al, these authors follow five steps. What we really like, is the description of an interactive approach, whereby each step was returned to and advanced during the review. It is unusual to see this iterative process captured in reviews and it is helpful to emphasise that the review process is not linear. A third review by Smallwood (another PhD candidate) and colleagues has a very different feel to the preceding two. It is described as an Indigenist scoping review, that de-problematising Aboriginal young peoples' health. A real strength of this scoping review is the novel methodology and the inclusion of a community, non-academic member of the team; a Spiritual Elder of the Gamilaroi Nation. The authors sensitively lay out the reasons for adopting the Indigenous and decolonising approach, as one that adopts an Indigenous-led worldview. Crucially, they are clear about what this means for their methodology. For example, the non-application of a Westernised process of quality appraisal, because it risks de-valuing Aboriginal ways of knowing, being and doing. The review is a fine example of a decolonising approach to literature review processes. An approach which is similar, but not identical to a scoping review is a focused mapping review and synthesis (FMRS). This type of review also provides a mapping of research undertaken in a particular area, but the focus is on context and ‘what is happening’ in a certain field, rather than evidence. Researchers undertaking a FMRS, define the parameters of interest that they wish to locate in a topic—often to identify trends in publications. The FMRS by Palese et al explores the time limits set by researchers when they undertake searches for their reviews. This review is quite typical of an FMRS, in that it focuses on trends in methodological issues, as opposed to health conditions. Whereas a scoping review and FMRS provide a map of the research undertaken in a certain area, typically, other types of review provide a more in-depth exploration of a narrower topic. Unlike the ‘broad brush’, this is more of a ‘deep dive’ into the literature. To put this in context, for those undertaking an empirical study, for a doctorate or a larger funded study, a scoping review is unlikely to provide the necessary depth and context to identify the gap in knowledge: A more detailed review is likely to be required. There are various method for doing this deeper type of analysis. If all the papers identified are qualitative, then a review method that synthesises qualitative papers might be appropriate. It is important to note that the review method reflects the papers therein; qualitative research is a process of in-depth synthesis and analysis and the review methods for bringing together qualitative papers reflects this. We have included seven papers in this special edition that synthesise qualitative research (Walker et al, Burke et al, Ryan et al, Lillekroken et al, Compton et al, Molloy et al, Vo). Again, we only have space to discuss a few. Lillekroken et al bring together qualitative research that explores the experiences and challenges of providing care for people with dementia who are from different ethnic groups. The tight focus of this review is evident from the title, and it is easy to see how qualitative papers are likely to have addressed the review question. Likewise, Walker et al explore the perceptions of the patient and family to interprofessional teamwork; a topic that might be hard to quantify. Names used to describe the review of qualitative research are not always consistent: Systematic review of qualitative evidence is one example but there are others such as a meta-ethnography and thematic synthesis. The methods differ slightly and the key point, which Lillekroken and Walker's reviews illustrate, is that the review follows a specific and named method. When the focus of a literature review is not solely qualitative research, a review that incorporates different types of research might be needed. Twelve such papers were accepted into this special edition (Ramos et al, Delva et al, Montano et al, Remm et al, Zeung et al, Zhao et al, Lim et al, Corley et al, Edgar etal, Sigmon et al, Goransson et al, Jestico et al). To illustrate this approach, we have mentioned Jestico et al's integrative review. An integrative review incorporates different types of literature, including but not restricted to both qualitative and quantitative research. We have identified this review as it illustrates why such an approach might be needed. Jestico's review focuses on the decision making of parents when their child is seriously ill. Such a complex (though still a focused question) is likely to be answered by different types of literature and hence an approach that enables this is warranted. Often, the requirements of a literature review demand a quantitative approach. The first literature reviews undertaken by the Cochrane Collaboration, founded in 1993, focused specifically on ‘does it work’ questions that brought together the results of randomised controlled trials into a review. These methods are clearly described by Higgins et al. (2019). These ‘quantitative’ reviews largely follow the same systematic method as mixed method and qualitative reviews, but have a clearly defined quantitative method of analysis, often referred to as a meta-analysis: A process in which the results of the individual trials that make up the review are reanalysed using a specific statistical method. Meta-analysis can generate robust results to help researchers better understand the magnitude of an effect, providing the basis for important conclusions and frequently in healthcare, clinical decision making. It is important to note that doing a meta-analysis is not always possible and can only be done when the included studies are sufficiently similar to each other. In this special issue, we have included 15 systematic reviews (Lovegrove et al, Saragih et al, Jin et al, Kerimaa et al, Li et al, Xu et al, Kim et al, Lin et al, Chung et al, Nollen et al, Zhou et al, Li et al, Choung et al, Li et al. Shao et al. Most, but not all of these include a meta-analysis. We will comment on just four systematic reviews which provide good examples of explicit and transparent a priori review methods. Firstly, in an international review, Saragih et al leading a team from Taiwan, examine the use of telehealth approaches in stroke survivors, reporting that in the performance of activities of daily living that telehealth interventions have a positive effect on stroke survivors. Secondly, Jin et al, explore the relationship between resilience and self-care in people with chronic conditions. This study was undertaken in America. The multidisciplinary nature of their review was one of its main strengths, pulling together evidence from nursing, medicine, sociology and psychology. In another systematic review and meta-analysis, Chung et al validate the main purpose of using the Braden scale. Importantly, the findings of their meta-analysis may provide a source of motivation for more nursing staff to use the Braden scale. Despite similarities between studies included within this review, Chung et al raises important points about comparing similar studies in meta-analytic studies, where the studies might not be similar enough to compare. Finally, Xu et al's review from China, examining psychological interventions for sexual function and satisfaction in women with breast cancer. Xu et al used several different outcome measurements to evaluate the effectiveness of psychological interventions on the sexual health of women with breast cancer. This meta-analysis of 1307 participants highlights another important aspect of performing this type of review, identifying the quality of the studies included within a review and determining the methodological quality and levels of bias in these studies. There are two umbrella review included in the special issue (Bellon et al, Connolly et al). Umbrella reviews are a relatively new method of review. They are undertaken when there are several existing literature reviews, and there is a need for these to be collated. They are sometimes referred to as a ‘review of reviews’. For example, an umbrella review included in this special issue is co-authored by Connolly and Cotter, who are a Registered Advanced Nurse Practitioner and Lecturer in Advanced Nursing Practice, respectively. The review is on the effectiveness of nurse-led clinics on healthcare delivery, a topic on which there are already several existing reviews. The authors provide a useful description of an umbrella review, as its ability to synthesise the highest level of available evidence (that is, existing reviews) on the topic; this form of review integrates evidence from numerous systematic reviews (as opposed to reports from primary studies) into a single ‘meta review’. One reason why we included the article was the authors' use of Rayyan. Rayyan - Intelligent Systematic Review - Rayyan. This online system is ideal for organising and managing systematic reviews and is one that we recommend for most forms of review. We have found it particularly useful when undertaking reviews with post-graduate students and/or colleagues who are new to reviews. We hope the reviews within this special issue are useful not only for their findings but also to illustrate the variety of robust methods that are available. There are many different approaches, and each has its own specific purpose. It is not uncommon for authors to mix up methods and to use an inappropriate method for their review. Unfortunately, for many authors, this is unlikely to lead to publication; therefore, clarity in the methods used is vital in any literature review submission. Publication guidelines and checklists such as those available through the EQUATOR network are useful and should accompany all submissions. The appropriate use of methods for doing a literature review indicate that a robust and systematic approach has been undertaken—regardless of whether the term ‘systematic’ is included in the title. A robust method ensures that we can be confident in the findings that the papers have not been ‘cherry picked’ but have been identified and appraised in a transparent and systematic manner. In short, authors need to identify an appropriate and named method for doing their review, whether it sits within a broad brush or deep dive approach. We look forward to receiving many more high-quality reviews submitted to the Journal of Clinical Nursing, such as those included in this special issue.