Systematic Review

Systematic Review Paper

NSG/515

Systematic Review Paper

A systematic review is an extensive review of literature that concentrates on a question and gathers knowledge to apply to evidence- based practice. The review will determine validity based on the interpretive results and apply it to clinical practice. The review must report an inclusion and exclusion criteria, a search strategy, sample, and analysis of the studies, data extraction, and data analysis of the integration of the evidence.  (Holopainen, Viitanen, and Tossavaine, 2008, p. 72).

The Problem

        In a systematic review, the question or issue should be clearly identified.  The issue is to “examine the relationship between nursing leadership practices and patient outcomes (Wong, Cummins, and Ducharme, 2013, p. 709).  The scope of the question is broad, bringing definition to the population; nursing leadership, exposure or what is of interest; the relationship between leadership practices and patients, and the outcomes of those relationships; patient outcomes (Polit & Beck, 2012).

The problem identified is significant to nursing practice because strong nursing leadership promotes quality interactions that encourage patient safety through dedication and nurturing a positive work environment. The significance of understanding the relationship between nursing leadership and patient outcomes will promote safe patient environments and the deliver quality care established with evidence-based practice.

The variables in this study are nursing leadership (independent) and patient outcomes (dependent), yielding a cause and effect connection that is adequately defined.

Integration approach of the review was characteristic of a meta-analysis. The data included in the studies was consistent showing strength, but the insufficient number of studies correlating nursing leadership and patient outcomes is viewed as a weakness indicating a lack of sufficient evidence to provide an adequate comparison.

Search Strategy

        The inclusion criteria for the reviewed studies were centered on the nursing leadership relationship in all health care settings, with attention to patient outcomes. Leadership features were determined to be leadership style (task-oriented or relationship- driven), behaviors, competency or self-reported practices” (Wong et al., 2013, p. 711). The studies included published English only articles and considered practices of nurses in formal leadership roles (Wong et al., 2013). Additional criteria for the primary study defined the impact of nursing leadership with adverse patient outcomes, length of stay, patient mortality patient satisfaction and patient welfare (Wong et al., 2013).

Patient outcome criteria were chosen from eight online bibliographic databases from May 2005- July 2012. Quality assessment, data extraction, and analysis were performed on all the included studies (Wong et al., 2013). Electronic databases were searched over a span of 20 years from 1985-2012, in an exhaustive effort to elicit the most comprehensive studies. Only 7 studies identified looked at the relationship between nursing leaders and patient outcomes (Wong et. al., 2013). The following databases were used “ABI- Inform Dateline, Academics Search Complete, Cochrane Database of Systematic Reviews (CDSR), MEDLINE, CINAHAL, EMBASE, ERIC, and Psych INFO”(Wong et al., 2013 p.711). Search words used  were: “nurse, and leaders and all patient outcomes, outcomes healthcare, urging outcomes, patient outcome, quality healthcare, outcomes of treatment, quality of care, or safety, or infection, or patient satisfactions, Or medication error, or incident report, or leadership” (Wong et al., 2013. P. 712, as shown in Table 1).   The search strategy included a search of journals such as “Journal of Nursing Management, Nursing Research, Nursing Leadership, The Leadership Quarterly, Journal of Nursing Administration, and the Journal of Organizational Behavior” (Wong et al., 2013, p. 711). Included in the review was a PRISMA-type flow chart to describe the breakdown of the article selection for review.         

The Sample

 According to Abalos, Carroli, Mackey, and Bergel, (2001, Para. 26), “it is of vital importance to ensure that the review is complete and up to date”. A complete and current analysis indicates quality research that is reproducible and comprehensive.  Multiple research strategies were employed by these authors, this reduced the likely hood of potentially omitting important or relevant studies.  The only studies that were included in the review were those that examined the association between leadership and patient outcomes by way of direct observation of patient outcomes or data extracted from administrative databases (Wong et al., 2013), indicating a limited construct suggesting weakness.