Original Article

A Guide to Writing a Qualitative Systematic

Review Protocol to Enhance Evidence-Based
Practice in Nursing and Health Care
Ashleigh Butler, MNurs, BNurs, RN • Helen Hall, PhD, MMid, RN, ND •
Beverley Copnell, PhD, RN

ABSTRACT
Keywords Background: The qualitative systematic review is a rapidly developing area of nursing research.
systematic review In order to present trustworthy, high-quality recommendations, such reviews should be based on
protocol, a review protocol to minimize bias and enhance transparency and reproducibility. Although there
qualitative, are a number of resources available to guide researchers in developing a quantitative review
meta synthesis, protocol, very few resources exist for qualitative reviews.
guidelines Aims: To guide researchers through the process of developing a qualitative systematic review
protocol, using an example review question.
Methodology: The key elements required in a systematic review protocol are discussed, with
a focus on application to qualitative reviews: Development of a research question; formulation
of key search terms and strategies; designing a multistage review process; critical appraisal
of qualitative literature; development of data extraction techniques; and data synthesis. The
paper highlights important considerations during the protocol development process, and uses a
previously developed review question as a working example.
Implications for Research: This paper will assist novice researchers in developing a qualitative
systematic review protocol. By providing a worked example of a protocol, the paper encourages
the development of review protocols, enhancing the trustworthiness and value of the completed
qualitative systematic review findings.
Linking Evidence to Action: Qualitative systematic reviews should be based on well planned,
peer reviewed protocols to enhance the trustworthiness of results and thus their usefulness in
clinical practice. Protocols should outline, in detail, the processes which will be used to undertake
the review, including key search terms, inclusion and exclusion criteria, and the methods used for
critical appraisal, data extraction and data analysis to facilitate transparency of the review process.
Additionally, journals should encourage and support the publication of review protocols, and
should require reference to a protocol prior to publication of the review results.

INTRODUCTION Developing the protocol before undertaking the review en-

The qualitative systematic review is a newly emerging area of sures that all methodological decisions, from identifying search
health care research. Qualitative reviews differ from their quan- terms to data extraction and synthesis processes, are carefully
titative counterparts in that they aim to present a comprehen- considered and justified, enhancing the integrity and trustwor-
sive understanding of participant experiences and perceptions, thiness of the results (Moher et al., 2015; Risenberg & Jus-
rather than assess the effectiveness of an intervention (Stern, tice, 2014a). Additionally, it encourages consistency between
Jordan, & McArthur, 2014). However, their goal remains the reviewers, reduces the ambiguity of what constitutes “data,ˮ
same: to produce high-quality recommendations for patient and ensures the data extraction and synthesis processes are
care based on a scrupulous review of the best available evi- not arbitrary (Moher et al., 2015).
dence at the time (Aromataris & Pearson, 2014; Risenberg & Although the processes used in quantitative systematic re-
Justice, 2014a). In order to achieve this, the review process views are well developed, with many guidelines available to
must be well developed and preplanned to reduce researcher assist novice researchers, there are very few examples of a qual-
bias and eliminate irrelevant or low quality studies. Typically, itative systematic review protocol available. This paper aims to
a systematic review is planned by developing a protocol, which guide readers through the process of developing a qualitative
forms the foundation of the entire process. systematic review protocol, using a meta synthesis protocol

Worldviews on Evidence-Based Nursing, 2016; 13:3, 241–249. 241


C 2016 Sigma Theta Tau International
The Qualitative Systematic Review Protocol

Table 1. Example SR: Modified PICO identifying keywords and appropriate databases, and develop-
ing a robust search strategy.

Population Parents, family, siblings (deceased child)

Stage One: Developing a Search Strategy
Keywords and search terms. The next step in writing a
Context Death of a child in PICU
qualitative systematic review protocol is developing the key-
Outcome Family experiences words and search terms. The PICO framework can be used
to identify the keywords in the review question. The example
from Table 1 outlines five main keywords: Population-Family,
Context-Death, Context-Child, Context-PICU, and Outcome-
Experiences. Once the keywords are ascertained, a table listing
all of the synonyms can be developed to guide the search, such
entitled “The family experience of the death of a child in the as in Table 2. This table of synonyms will then form the ba-
Pediatric Intensive Care Unit (PICU)” as an example. sis of the search strategy. Examining some of the key studies
on the topic can help to uncover commonly used synonyms
Where to Start: Choose a Topic and Aim and keywords in the literature and help to focus the search
Systematic reviews aim to answer a specific question, rather terms. Familiarity with the truncation or wildcard operators for
than provide a simple overview of the evidence (Aromataris each database will enable searching for all alternative spellings
& Pearson, 2014). It is important to have a well-developed or endings to a word, ensuring all possibilities are captured.
question from the outset, as it will form the basis for the entire Plans to use relevant MeSH headings or similar should also be
review protocol, guiding the formation of the search strategy, documented.
inclusion criteria, and data extraction (Bettany-Saltikov, 2012).
However, developing a focused, answerable question for a Determining inclusion and exclusion criteria. The inclusion
review can be challenging for novice researchers. There are criteria provide boundaries for the review, defining which stud-
numerous frameworks to aid in designing a question for quali- ies will be potentially included, and which ones are irrelevant
tative studies: Population, Exposure, Outcomes (PEO); Sample, to the topic (Stern et al., 2014). Additionally, inclusion criteria
Phenomena of Interest, Design, Evaluation, Research type help to mitigate any personal bias of the reviewer; they ensure
(SPIDER); and Setting, Perspective, Intervention, Comparison, that studies are selected only on the basis of predefined, jus-
Evaluation (SPICE). The acronym PICO, (Population, Interven- tified criteria, rather than because they are of interest to the
tion, Comparison, Outcome) developed for quantitative review reviewer, fit into a preconceived framework, or match emerg-
questions, (Bettany-Saltikov, 2012; Risenberg & Justice, 2014a; ing findings (Aromataris & Pearson, 2014). The researcher
Stern et al., 2014) can also be modified to Population, Context, must negotiate the fine balance between having too narrow
Outcome (PCO) or Population, Interest, Context (PICo), to or specific inclusion criteria, where there is a risk of eliminat-
more appropriately suit a qualitative methodology (Risenberg ing relevant papers, and having too few or too broad criteria,
& Justice, 2014a; Stern et al., 2014). For example, the question capturing a large number of irrelevant papers. Commonly, in-
“What is the experience of the family when a child dies in the clusion criteria consist of aspects such as type of study, type
PICU?ˮ was designed using the modified PCO framework (see of data (qualitative or quantitative), phenomena under study,
Table 1). date of study and age or sex of participants (Stern et al., 2014).
The review question is used to design the overall study aim. Excluding papers based on language may introduce a language
The aim should be a clear statement of the intention of the bias into the review, limiting the transferability of the results;
review, and is typically phrased as a statement. For the above however, this may be difficult to avoid as translating papers
example, the aim would be stated as follows: “The aim of this is often not possible. Whatever the inclusion criteria, they
review is to synthesize the best available evidence exploring should be justifiable based on the requirements of the review,
the experiences of the death of a child in the PICU, from the and clearly documented in the protocol. The inclusion criteria
perspective of the child’s family.ˮ used for the example question are outlined in Table 3, and pro-
vide an illustration of the typical types of justifications used in
Locating the Literature a qualitative systematic review protocol.
Once a focused question has been developed and the aim writ- Designing the search strategy. A systematic review requires
ten, the search strategy must be designed. This is one of the a comprehensive search of multiple databases, using the
most important parts of the systematic review protocol, because same search strategy for each database. It is important that
it outlines a priori the strategies reviewers will use to find, se- the protocol clearly outlines the planned search strategy; it
lect, appraise and utilize the data. It is advisable to conduct ensures the search is undertaken in exactly the same way
a brief search of the literature before planning the review, to each time, and also allows the search to be replicated by other
ensure it has not previously been done. Consulting an expert researchers in the future with the same results (Aromataris &
librarian at this stage may also provide valuable assistance in Riitano, 2014). Ideally, the search will contain three parts: the

242 Worldviews on Evidence-Based Nursing, 2016; 13:3, 241–249.


C 2016 Sigma Theta Tau International
 Original Article
Table 2. Example SR PICO Search Terms

Population Context-death Context-child Context-PICU Outcome

*
Mother Death Child PICU Experience
Father Die Daughter P*ediatric ICU Perception
Grandparent Dead Son P*ediatric Intensive Care Perspective
Grandmother Deceased P*ediatric P*ediatric critical care View
Grandfather Dying P*ediatric Intensive therapy unit Need
Sibling Loss
Brother ‘Passed away’
Sister Bereav*
Famil* ‘End of life’
*
Parent

Note. The * is used as a truncation indicator.

Table 3. Example SR Question: Inclusion Criteria

Criteria Justification

Conducted between 1990 and 2014 The development of a formal definition of family centred care in 1987 (Shelton, Jeppson, &
Johnson, 1987) led to a change in the way pediatric departments recognize and incorporate
parents and family members into a child’s care delivery. Studies published before 1990 will be
excluded, to ensure the review examines current practice and philosophical standpoints.
Examines family member Family experiences and needs surrounding child death in PICU must be a primary aim of each
experiences, perspectives or study. Studies examining family experiences of organ donation, bereavement follow up or
needs as a primary aim family presence during resuscitation will be excluded, owing to the expansive number of
reviews on each topic.
Relates to the death of a child aged The child’s death must have occurred in a PICU setting. Any studies which focus on the death of a
less than 18 years in a PICU setting child in the neonatal ICU (NICU) will be excluded, due to the difference in the philosophy of
care delivery. Studies which examine data from both NICU and PICU settings will be included if
the data from PICU parents is reported separately.
Original qualitative data The review will focus on the experiences, needs or perspectives of family members, which is most
appropriately answered through qualitative research. Any study which utilizes survey data or
statistical reporting of results will be excluded, as will commentaries or discussions on the
subject. Qualitative data from a mixed methods study will be included.
Published in the English Language Due to limited resources, studies published in languages other than English are unable to be
translated and included into the review.

databases, the reference lists and hand searching, and the grey and EMBASE, were proposed in the example review protocol,
literature sources. due to their relevance to the review question.
Identifying the most appropriate databases for the review Once the databases are identified, the search strategy should
topic is crucial. Searching inappropriate databases leads to be developed. The protocol should document who will under-
inappropriate results, which may impact on the overall review take the search, how the search terms will be combined and
findings. Librarians are often well positioned to identify used, and whether any limits will be applied.
the most useful databases for the area under study. Typical The search strategy used to answer the example question is
nursing databases include CINAHL Plus, PubMed, OVID outlined in Figure 1, and was based on the recommendations
Medline, and Scopus. These databases, alongside PsychINFO given by Bettany-Saltikov (2012) and Aromataris and Riitano

Worldviews on Evidence-Based Nursing, 2016; 13:3, 241–249. 243


C 2016 Sigma Theta Tau International
The Qualitative Systematic Review Protocol

Each database will be searched by the research student, in consultaon with an expert librarian,
based on the following strategy. Each column in Table 2 contains a set of synonyms for the key
search terms. Each term in the column will be entered into the database and will be truncated
where appropriate. All individual searches for that column will be combined using the “OR” Boolean
operator into a single group. Each overall group will then be combined using the “AND” funcon to
produce a final list of citaons, which will be saved into Endnote, and screened for duplicates.
Records of all searches in each database will be maintained.

Figure 1. Example SR question: search strategy.

(2014). It provides a systematic way to search each database, the trustworthiness of the review findings by removing per-
minimizing the impact of the researcher on the outcome of the sonal bias from the review process, and minimizing the poten-
search. tial for error. The protocol should clearly stipulate what each
It is important that thorough records of all searches are reviewer’s role will be in each stage of the review, such as in
maintained for future reference, as this provides an audit trail Figure 2.
and enhances trustworthiness of the review findings. Addition-
How many stages? Typically, the review process is under-
ally, use of a PRISMA flowchart is recommended as a pictorial
taken in a series of stages, with articles moving through
representation of the search process (Moher, Liberati, Tetzlaff,
screening based on title and abstract, and then full text review.
& Altman, 2009).
Only those with titles and abstracts that meet inclusion criteria
Another common search strategy is examination of refer-
are retrieved and included for full text review (Aromataris &
ence lists, or hand searching key journals in the area of interest.
Pearson, 2014; Porritt et al., 2014). The protocol should outline
The reference lists of relevant papers, especially other literature
how many review stages each article will undergo, what each
reviews on the topic, may identify citations which did not ap-
stage involves, and how many reviewers will be included at
pear during a database search. The protocol should outline
each stage. The protocol should also clearly document what
whether this type of search will be undertaken, and if key jour-
will occur if reviewers disagree. Generally, most reviewers tend
nals will be manually searched for potentially relevant articles,
to err on the side of caution and include any citations that are
these should be identified as well.
unclear when screening based on title and abstract, and then
Lastly, the protocol should also outline whether or not
utilize a third reviewer if reviewers disagree during full text
grey literature will be sourced, and which databases will be
review (Porritt et al., 2014). The protocol should also discuss
searched. Grey literature is the term given to unpublished
what will occur if there is insufficient or unclear information
studies, theses, conference proceedings, presentations, gov-
in an article. Many reviewers will attempt to contact the author
ernment documents, or any other relevant documents that are
for clarification; however, the protocol should stipulate a
not published in journals and will not appear in a database
timeframe for reply before the article is excluded on the basis
search (Aromataris & Riitano, 2014; Bellefontaine & Lee,
of insufficient information. An outline of the review process
2014). The inclusion of grey literature helps to reduce publi-
for the example SR question can be viewed in Figure 3.
cation bias—the notion that studies with limited, negative, or
neutral outcomes are less likely to be published (Aromataris
The Critical Appraisal
& Riitano, 2014; Pappas & Williams, 2011). Grey literature
The aim of critical appraisal in a systematic review is to as-
can be obtained from government websites, Google scholar,
sess the potential studies for rigour, and ensure they are
these databases (such as trove.nla.gov.au; worldcat.org), or
free from significant methodological issues which may impact
grey literature data bases (such as opengrey.eu; greylit.org).
on the quality of the review findings (Bettany-Saltikov, 2012;
Stage Two: Reviewing the Literature Korhonen, Hakulinen-Viitanen, Jylha, & Holopainen, 2013).
Whilst the more traditional qualitative literature provides am-
In order to uncover the studies most relevant to the review, a
ple guidance on what constitutes rigor in the various qualita-
multistage process for reviewing and selecting citations must
tive methodologies (Charmaz, 2006, 2014; Corbin & Stauss,
be developed. The protocol should stipulate how many review-
2008; Holloway & Wheeler, 2010; Lincoln & Guba, 1985; Polit
ers will undertake the review, how many stages there are, and
& Beck, 2010; Sandelowski, 1986; Thomas & Magilvy, 2011;
what each stage will encompass.
Whittemore, Chase, & Mandle, 2001), very few of these guide-
How many reviewers? A systematic review requires at least lines have been incorporated into critical appraisal tools. Thus,
two independent reviewers (Aromataris & Pearson, 2014; critical appraisal of qualitative studies remains a contentious is-
Porritt, Gomersall, & Lockwood, 2014; Risenberg & Justice, sue, with little consensus on what makes a good study, whether
2014b). Having more than one reviewer at each stage increases critical appraisal should be undertaken at all, and if so, what

244 Worldviews on Evidence-Based Nursing, 2016; 13:3, 241–249.


C 2016 Sigma Theta Tau International
 Original Article

The review process will use four reviewers - one research student, and three supervisors. Arcles will
be distributed across the four reviewers in such as way that the research student reviews each citaon,
and the three supervisors independently review one third of the total citaons at each stage.

Figure 2. Example SR question: reviewer roles.

All potenal arcles will undergo a two stage screening process based on the inclusion criteria, and
undertaken by four reviewers, as outlined in Figure 2.

Stage 1: All citaons will be screened based on tle and abstract. Reviewers will meet to discuss
results. All uncertain citaons will be included for full text review.

Stage 2: Full text of each included citaon will be obtained. Each study will be read in full and
assessed for inclusion. Any discrepancies which cannot be resolved through discussion will be sent to
a third reviewer for a decision. Authors will be contacted for missing or incomplete informaon. If
there is no response within 2 weeks, the arcle may be excluded on the basis of missing informaon.

Figure 3. Example SR question: screening and review.

should be done with the findings (Dixon-Woods et al., 2006; The protocol should outline the definition of a low- or
Downe, 2008; Porritt et al., 2014; Thomas & Harden, 2008; high-quality article, and discuss whether any studies
Toye et al., 2014). To further complicate the issue, there are will be excluded and why. It is wise to trial the tool
a number of different tools available to aid in the critical ap- and scoring system on a small sample of papers from
praisal of qualitative research, with ongoing debate over which the initial scoping literature review during this stage
is most suitable for use in systematic reviews (Dixon-Woods of protocol design, to examine the scores provided
et al., 2006; Downe, 2008; Toye et al., 2014). and inform development of an appropriate ranking
In light of these issues, there are a number of aspects system and cut-off point.
the protocol must consider and discuss in relation to critical
appraisal:
For the example systematic review, the researchers took
the view that the use of critical appraisal was necessary to
r Whether critical appraisal will be carried out, and by assess the extent to which the authors’ findings represent the
participants’ experiences or views, and decided that studies
whom. The protocol should provide justification if no
would be excluded based on quality. The Critical Appraisal
appraisal will occur.
Skills Programme (CASP; CASP International Network, 2013)
r Which appraisal tool will be used, and why. The pro- qualitative checklist was used for critical appraisal, which had
tocol should also outline any information or instruc- been widely used in recent similar reviews. The tool allows for
tions for reviewers when using the tool. appraisal of all types of qualitative data, and the tool contains
r Whether the papers will be scored or ranked, and how only 10 questions, facilitating rapid evaluation; however, it does
not provide a scoring system. Based on previous experience, the
this will occur. Generally, most critical appraisal tools
scoring system outlined in Table 4 was designed, and was used
provide a checklist for reviewers, but do not provide
without issue.
any guidance as to what constitutes a high or low
quality study. The protocol should therefore clearly Data Extraction
document any scoring system which will be imple-
The next step in developing a systematic review protocol is data
mented, and what will happen if reviewers disagree
extraction. Designing this stage of a qualitative review is often
during this process.
more difficult than for a quantitative review, because what con-
r How the results of the appraisal will be used. This stitutes data is often unclear. The protocol should clearly outline
decision will depend largely on the purpose of the what “dataˮ is before outlining how it will be extracted. Com-
review: those which aim to present an overview of monly, qualitative reviews define data as first order constructs
findings may opt to include all studies, whilst those (participants’ quotes), or second order constructs (researcher
reviews which aim to inform practice or policy may interpretation, statements, assumptions and ideas; Toye et al.,
omit lower quality studies to enhance trustworthiness. 2014). Extracting both forms of data allows the reviewers to
Worldviews on Evidence-Based Nursing, 2016; 13:3, 241–249. 245

C 2016 Sigma Theta Tau International
The Qualitative Systematic Review Protocol

Table 4. Example SR Question: Reviewer Guidelines for Using the CASP Checklist

Item Guidelines

Question 2: Appropriate for qualitative methodology Exclude if inappropriate

Question 3: Research design Yes- Specifically states research design, with justification
Unsure- Outline of research design only
No- Not discussed or inappropriate to research question
Question 5: Data collection Yes- Addresses 4 or more items listed on the CASP checklist
Unsure- Addresses 2–3 items listed on the CASP checklist
No- Addresses less than 2 items
Question 7: Ethical considerations Exclude if unclear or unstated ethical approval
Question 10: Recommendations Yes- The following must be discussed: Contributions to existing knowledge,
identifies areas for future research, makes recommendations based on results
Unsure- only 2 items discussed
No- only 1 item discussed
Scoring system:
Yes: 1 point High-quality paper: Scores 9–10
Unsure: 0.5 points Moderate-quality paper: Scores 7.5-9
No: 0 points Low-quality paper: Less than 7.5
Exclude: Less than 6

view and work with the raw data (quotes) as well as the au- a meaning statement or set of statements which represent and
thors’ interpretations, which we argue helps ensure the review explain the phenomena under study (Munn, Tufanaru, & Aro-
findings are thoroughly grounded in the original experiences mataris, 2014). The meta synthesis of qualitative data has long
of the participants. been a contentious issue. Many scholars argue that by inter-
After the concept of data is well defined, the protocol should preting an interpretation, qualitative synthesis risks losing the
outline how it will be extracted, whether any other informa- essence of the original studies (Korhonen et al., 2013; Thomas
tion will be gathered during the extraction process, and how & Harden, 2008; Toye et al., 2014). However, a well-planned
many reviewers will be involved, similarly to the example pro- data synthesis process can help to ensure that the review find-
vided in Figure 4. Generally, data is extracted using a data ings remain firmly grounded in the original data, ensuring the
extraction tool, which also facilitates the extraction of bibli- results reflect the original participants’ experiences.
ographic and methodological information about each study, Several methods exist to guide the synthesis and analysis of
and ensures that data extraction is consistent amongst all re- qualitative systematic review data, each with its own strengths
viewers and across all studies (Aromataris & Pearson, 2014; and limitations (Dixon-Woods, Agarwal, Jones, Young, &
Bettany-Saltikov, 2012; Risenberg & Justice, 2014b). The ex- Sutton, 2005). The chosen method will depend largely on the
traction tool should be designed by the reviewers based on the type and purpose of the review being undertaken; for example,
needs of the study, and should be attached as an appendix in a meta synthesis typically requires reviewers reinterpret the
the protocol. Additionally, the protocol should outline whether qualitative data into a higher level of abstraction and may use
the tool will be piloted before use, and how any modifications similar thematic analysis techniques to those used in original
will be managed and reported. studies, whereas a meta summary may only require content
analysis to provide an aggregation of the overall findings
Data Synthesis (Dixon-Woods et al., 2005; Korhonen et al., 2013; Sandelowski,
Developing a plan for data analysis is the final stage of writing a 2006). Whatever the chosen method, each step should be
systematic review protocol. Generally speaking, the aim of data clearly outlined in the protocol (see Figure 5 for an example),
synthesis or analysis is to assemble the collective findings into alongside who will undertake the analysis and whether the

246 Worldviews on Evidence-Based Nursing, 2016; 13:3, 241–249.


C 2016 Sigma Theta Tau International
 Original Article

A data extracon tool has been developed for the purpose of this review. The tool will be piloted on
2-4 arcles prior to use, and will then be modified as required. Data extracon will be undertaken by
4 reviewers as per citaon screening.

The following informaon will be extracted from each arcle: Bibliographic informaon; study aims;
study design: methodological underpinnings; sample: strategy, size, inclusion/exclusion criteria and
parcipant characteriscs; data collecon methods; data analysis techniques; ethical consideraons
and issues; results: themes, quotes, author interpretaons or explanaons; strengths and
limitaons; and reviewer comments.

Figure 4. Example SR question: data extraction.

The extracted data will be analyzed ulising themac analysis techniques, allowing clear
idenficaon of themes arising from the data, and facilitang higher order abstracon and theory
development. The themac analysis and meta synthesis processes outlined by J. Thomas and
Harden (2008) are outlined below, and will be used to enhance transparency in the review process.
Data analysis will primarily be undertaken by the student reviewer, with findings connually
discussed in team meengs to ensure they appropriately reflect the original data.

Stage 1: Coding text: Free line by line coding of the findings from the primary studies will occur.
Data will be examined for meaning and content during the coding. The codes will then be entered
into a code book. This process will allow the translaon of codes and concepts between studies.

Stage 2: Developing descripve themes: The codes will then be examined and analysed for their
meanings, and reorganized into related categories. Each category will be analyzed for its properes.

Stage 3: Generang analycal themes: Each category will then be examined and compared to other
categories, specifically looking for similaries and differences. Similar categories will be merged into
higher level constructs and then themes, going beyond the findings of the original studies into a
higher order abstracon of the phenomena.

Figure 5. Example SR question: data synthesis.

findings will be discussed with other reviewers. This not only 2011; Moher et al., 2015). It also ensures that reviewers adhere
allows the results to be reproduced by other researchers, but to the predefined review processes, as deviation from the
also enhances the transparency and overall trustworthiness of protocol is easily identifiable and requires justification during
the review findings. publication of the review findings (Booth et al., 2011; Moher
et al., 2015). Additionally, publication of the review protocol
Publishing the Protocol ensures other researchers are aware that the review is being
Once completed, the protocol should be made available to undertaken, minimizing the amount of time and resources
other researchers. Most commonly, this is achieved by regis- wasted on duplicate reviews (Booth et al., 2011). Overall,
tering the protocol with review databases such as the Joanna the publication or registration of review protocols increases
Briggs Institute, The Cochrane Collaboration, or PROSPERO, the trustworthiness of the review findings, ensuring that the
although there are also a limited number of nursing journals recommendations are based on high-quality review of the best
which will publish a review protocol (Booth et al., 2011; Moher available evidence at the time.
et al., 2015). Publication encourages transparency of the
review methodology and enables peer review and feedback
prior to the review being undertaken, improving the quality CONCLUSIONS
and trustworthiness of the subsequent review findings and The qualitative systematic review remains relatively new to the
recommendations (Aromataris & Pearson, 2014; Booth et al., discipline of nursing, providing greater insight into the needs

Worldviews on Evidence-Based Nursing, 2016; 13:3, 241–249. 247


C 2016 Sigma Theta Tau International
The Qualitative Systematic Review Protocol

of participants than any one single study. The systematic review REFERENCES
should be based on a predeveloped protocol which outlines the Aromataris, E., & Pearson, A. (2014). The systematic review: An
methods and processes which will be used in the review before overview. Synthesizing research evidence to inform nursing
it is undertaken, enhancing transparency and trustworthiness practice. American Journal of Nursing, 114(3), 53–58.
of the review findings. However, given that the techniques Aromataris, E., & Riitano, D. (2014). Constructing a search strategy
used to design and undertake the qualitative review itself are and searching the evidence: A guide to the literature search for
systematic review. American Journal of Nursing, 114(5), 49–56.
still developing, there are very few resources available to guide
nurse researchers through the process of developing a review Bellefontaine, S., & Lee, C. (2014). Between black and white: Exam-
ining grey literature in meta-analyses of psychological research.
protocol. This paper highlights the importance of developing Journal of Child & Family Studies, 23(8), 1378–1388.
a systematic review protocol for qualitative reviews, and uses
Bettany-Saltikov, J. (2012). How to do a systematic literature review
an example review question to guide researchers through the in nursing: A step-by-step guide. Berkshire, England: McGraw-Hill
protocol development process. By learning to design and im- Education.
plement a systematic review protocol, researchers can help to Booth, A., Clarke, M., Ghersi, D., Moher, D., Petticrew, M., &
ensure that their findings and recommendations are based on Stewart, L. (2011). An international registry of systematic-review
trustworthy, high-quality evidence, improving care delivery to protocols. The Lancet, 377(9760), 108–109.
patients and their families. WVN CASP International Network. (2013). 10 questions to help you
make sense of qualitative research. Retrieved from http://www.
caspinternational.org/mod_product/uploads/CASP%20Quali-
tative%20Research%20Checklist%2031.05.13.pdf
Charmaz, K. (2006). Constructing grounded theory: A practical guide
LINKING EVIDENCE TO ACTION through qualitative analysis. London, England: SAGE Publica-
tions.
r Develop a review protocol prior to undertaking the Charmaz, K. (2014). Constructing grounded theory (2nd ed.). Lon-
don, England: SAGE Publications.
review to enhance rigor.
Corbin, J., & Stauss, A. (2008). Basics of qualitative research: Tech-
r Utilize a framework (such as PICO) to design an niques and procedures for developing grounded theory (3rd ed.). Los
appropriate and answerable review question. Angeles, CA: SAGE Publications.
r Consult an expert librarian for assistance in Dixon-Woods, M., Agarwal, S., Jones, D., Young, B., & Sutton,
A. (2005). Synthesising qualitative and quantitative evidence: A
developing keywords, identifying appropriate review of possible methods. Journal of Health Services Research &
databases, and designing the search strategy. Policy, 10(1), 45–53.
r Use two or more reviewers at each stage of the Dixon-Woods, M., Bonas, S., Booth, A., Jones, D. R., Miller, T.,
Sutton, A. J., . . . Young, B. (2006). How can systematic reviews
review to reduce personal bias and minimize po-
incorporate qualitative research? A critical perspective. Qualita-
tential for error. tive Research, 6(1), 27–44.
r Publish the protocol before undertaking the review Downe, S. (2008). Metasynthesis: A guide to knitting smoke.
to enhance transparency of the review process and Evidence-Based Midwifery, 6, 4–8.
trustworthiness of the findings. Holloway, I., & Wheeler, S. (2010). Qualitative research in nursing
and healthcare (3rd ed.). Oxford, England: Wiley-Blackwell.
Korhonen, A., Hakulinen-Viitanen, T., Jylha, V., & Holopainen,
A. (2013). Meta-synethesis and evidence-based health care—A
method for systematic review. Scandinavian Journal of Caring
Sciences, 27(4), 1027–1034.
Author information Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Beverly Hills,
Ashleigh Butler, PhD candidate, School of Nursing and Mid- CA: SAGE Publications.
wifey, Monash University, and Clinical Nurse Specialist, Adult Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Pre-
and Pediatric Intensive Care Unit, Monash Health, Melbourne, ferred reporting items for systematic reviews and meta-analyses:
Victoria, Australia; Helen Hall, Lecturer, School of Nursing and The PRISMA statement. BMJ, 339(7716), 332–336.
Midwifery, Monash University, Melbourne, Victoria, Australia; Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petti-
Beverley Copnell, Senior Lecturer, School of Nursing and Mid- crew, M., & . . . Group, P.-P. (2015). Preferred reporting items for
wifery, Monash University, Melbourne, Victoria, Australia systematic review and meta-analysis protocols (PRISMA-P) 2015
statement. Systematic Reviews, 4(1). doi: 10.1186/2046-4053-4-1
Address correspondence to Ashleigh Butler, C/O Intensive
Care Unit, Monash Medical Centre, 246 Clayton Rd., Clayton, Munn, Z., Tufanaru, C., & Aromataris, E. (2014). Data extraction
and synthesis: The steps following study selection in a systematic
Victoria, Australia, 3168; aebut2@student.monash.edu review. American Journal of Nursing, 114(7), 49–54.

Accepted 14 June 2015 Pappas, C., & Williams, I. (2011). Grey literature: Its emerging
Copyright 
C 2016, Sigma Theta Tau International
importance. Journal of Hospital Librarianship, 11(3), 228–234.

248 Worldviews on Evidence-Based Nursing, 2016; 13:3, 241–249.


C 2016 Sigma Theta Tau International
 Original Article
Polit, D., & Beck, C. (2010). Essentials of nursing research: Appraising Stern, C., Jordan, Z., & McArthur, A. (2014). Developing the review
evidence for nursing practice (7th ed.). Philadelphia, PA: Lippincott question and inclusion criteria: The first steps in conducting a
Williams and Wilkins. systematic review. American Journal of Nursing, 114(4), 53–56.
Porritt, K., Gomersall, J., & Lockwood, C. (2014). Study selection Thomas, E., & Magilvy, J. K. (2011). Qualitative rigor or research
and critical appraisal: The steps following the literature search validity in qualitative research. Journal for Specialists in Pediatric
in a systematic review. American Journal of Nursing, 114(6), 47– Nursing, 16(2), 151–155.
52. Thomas, J., & Harden, A. (2008). Methods for the thematic synthe-
Risenberg, L., & Justice, E. (2014). Conducting a successful sys- sis of qualitative research in systematic reviews. BMC Medical
tematic review of the literature, part 1. Nursing, 44(4), 13–17. Research Methodology, 8, 45–45.
Risenberg, L., & Justice, E. (2014). Conducting a successful sys- Toye, F., Seers, K., Allcock, N., Briggs, M., Carr, E., & Barker, K.
tematic review of the literature, part 2. Nursing, 44(6), 22–26. (2014). Meta-ethnography 25 years on: Challenges and insights
Sandelowski, M. (1986). The problem of rigor in qualitative re- for synthesising a large number of qualitative studies. BMC
search. Advances in Nursing Science, 8(3), 27–37. Medical Research Methodology, 14, 80–80.

Sandelowski, M. (2006). ‘Meta-jeopardy’: The crisis of representa- Whittemore, R., Chase, S. K., & Mandle, C. L. (2001). Validity in
tion in qualitative metasynthesis. Nursing Outlook, 54(1), 10–16. qualitative research. Qualitative Health Research, 11(4), 522–537.

Shelton, T., Jeppson, E., & Johnson, B. (1987). Family-centered care

for children with special health needs. Washington, D.C.: Associa- doi 10.1111/wvn.12134
tion for the Care of Children’s Health. WVN 2016;13:241–249

Worldviews on Evidence-Based Nursing, 2016; 13:3, 241–249. 249


C 2016 Sigma Theta Tau International