Main Elements of the Systematic Review
In recent years, systematic reviews have attracted wide-ranging interest among nursing researchers and practitioners interested in generating and assessing evidence-based practices for clinical decision making processes (Polit & Beck, 2012). These reviews are premised upon several important elements.
Available literature shows that the main elements of a systematic review “include structuring a research question, searching and appraising the literature, data extraction, analysis and synthesis, and reporting the results” (Magarey, 2001 p. 376). Extant literature also demonstrates that an identification of an existing problem that needs to be resolved serves as a good starting point for a systematic review (Evans, 2001).
In the article titled “Evidence for Family-Centered Care for Children with Special Health Care Needs: A Systematic Review”, the problem statement was grounded on the fact that although many groups in healthcare settings endorse family centered care (FCC) as part of their integrated set of core objectives for children with special health care needs (CSHCN), no researcher was yet to conduct a systematic review of the literature to assess whether availing FCC enhances patient and family outcomes.
Consequently, the systematic review was focused on examining the evidence base for FCC to specifically determine the extent to which family-provider partnership (FPP) is associated with improvements among key outcomes for children and their families (Kuhlthau et al., 2011).
The second element involves searching and appraising the primary literature related to the research question or the clinical problem which needs to be addressed (Magarey, 2001). Here, it is clear the authors used four search engines (CINAHL, PSYCINFO, Medline and SSCI) employing keywords such as FCC/FPP, child/adolescent, CSHCN, and an outcome to come up with a range of primary research articles on the topic of interest. Inclusion criteria entailed
- articles examining both FCC and FPP,
- studies dealing with U.S. populations,
- studies employing quantitative techniques to assess an intervention to promote FCC,
- studies published in English between January 1 1986, and May 31, 2010, and
- articles investigating relationships between FCC and an outcome (Kuhlthau et al., 2011).
Appraisal of the articles was done by two independent authors, who reviewed titles and article abstracts and, after comprehensive discussion, retrieved potentially relevant articles for possible consideration. If a disagreement between the two authors about the inclusion or exclusion of a particular article arose, a third author was called in to assist in resolving the differences.
Afterwards, “the 3 authors then screened the full articles for eligibility criteria and study relevance and reached a consensus about which articles to include” (Kuhlthau et al., 2011 p. 137).
The third main element of a systematic review is data extraction, which is mainly done “to describe the study in general, to extract the findings from each study in a consistent manner to enable later synthesis, and to extract information to enable quality appraisal so that the findings can be interpreted” (Jones, n.d. p. 1).
Although the researchers did not expound on their data extraction technique, it is clear they relied on the study design and methods (out of the 98 articles that were identified as relevant, the authors used 24 articles to do the review whereby seven were based on randomized controlled trials, 11 were based on cross-sectional relationships with no intervention, and six investigated interventions with controls or before-and-after comparisons), components of FCC (family provider, partnership, family-provider partnership and parent peer support), outcomes measured (access, health status, satisfaction, family functioning, communication and efficient use of HCR), and strengths of the findings based on their research design paradigms (Kuhlthau et al., 2011).
The fourth element of a systematic review, according to Magarey (2001), is analysis and synthesis of the selected primary research articles. Here, it is important to note that the researchers undertook a quantitative analysis of the selected studies along the domains of
- satisfaction in using FCC,
- efficient use of healthcare resources,
- relationship between FCC and access to care,
- FCC and communication,
- family functioning, and
- family financial impact and cost (Kuhlthau et al., 2011).
In synthesizing the data from the primary research articles, it was found that FPP had a direct association with several health outcomes affecting CHSCN. In particular, “partnership in care was associated with less missed school, fewer unmet demands, and greater satisfaction; better transition services among adolescents and improved satisfaction; the use of genetic counseling; and the well-being of the health care environment” (Kuhlthau et al., 2011 p. 141).
The last element, which is the reporting of the results, is focused on providing answers to the initial research question or the problem statement (Magarey, 2001).
In summary, the researchers, through a review of the published literature, “found that family-centered care [FCC] for children with special health care needs is associated with improved health and well-being, improved satisfaction, greater efficiency, improved access, better communication, better transition services, and other positive outcomes” (Kuhlthau et al., 2011 p. 136). Such findings have the capacity to inform evidence-based practice in nursing and other health-related domains.
Article’s Potential to Impact Clinical Practice
Extant literature defines evidence-based practice “as the conscientious, explicit and judicious use of theory-derived, research based information in making decisions about care delivery” (Winch et al., 2005 p. 21). In line with this definition, it is plausible to argue that the article impacts clinical practice by providing objective findings on how family centered care (FCC) in general and family-provider partnership (FPP) in particular, can be used to improve the health and well-being of children with special healthcare needs (CSHCN).
Unlike in situations where the nurses and other practitioners rely on findings from one primary research article to inform their clinical decision making processes, hence becoming increasingly exposed to researcher bias and subjective interpretations (Evans, 2001), a systematic review of literature concerning a particular topic of interest provides them with broad-based and all-inclusive information from a multiplicity of sources to enable them engage in evidence-based practice (Veeramah, 2004). Such literature reviews have obvious positive ramifications for clinical practice.
In the context of the current article, it is clear that a gap in knowledge existed since no researcher had previously conducted a systematic review with the view to illuminating whether FCC and FPP are associated with key improvements among key outcomes for children with special healthcare needs as well as their families.
But upon undertaking the systematic review, the researchers shed light on the fact that nurses and other stakeholders charged with the responsibility of providing care could use FCC and FPP in dealing with children with special healthcare needs and their families in not only improving their health and level of satisfaction with the kind of care provided, but also in enhancing greater efficiency, improving access to health care, reinforcing communication patterns, and providing superior transition services (Kuhlthau et al., 2011). These are positive outcomes that will certainly impact clinical practice in contemporary health care settings.
Evans, D. (2001). Systematic reviews of nursing research. Intensive & Critical Care Nursing, 17(1), 51-57.
Jones. M.F. (n.d.). Data extraction. Web.
Kuhlthau, K.A., Bloom, S., Van Cleave, J., Knapp, A.A., Romn, D., Klatka, K…Perrin, J.M. (2011). Evidence for family-centered care for children with special health care needs: A systematic review. Academic Pediatrics, 11(2), 136-143.
Magarey, J.M. (2001). Elements of a systematic review. International Journal of Nursing Practice, 7(6), 376-382.
Polit, D.F., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Veeramah, V. (2004). Utilization of research findings by graduate nurses and midwives. Journal of Advanced Nursing, 47(2), 183-191.
Winch, S., Henderson, A., & Creedy, D. (2005). Read, think, do! A method for fitting research evidence into practice. Journal of Advanced Nursing, 50(1), 20-26.