How to Write a Systematic Literature Review in Nursing

A systematic literature review in nursing uses a pre-planned, documented method to find, appraise and synthesize all relevant studies on a focused clinical question. Its process is transparent enough for someone else to repeat.

That rigor is exactly what your thesis or DNP committee will assess. This guide covers each stage, from question to write-up, and the mistakes that most often turn a systematic review back into a narrative one.

Systematic Versus Narrative Reviews

Systematic reviews rank highly in evidence hierarchies because their process limits selective use of studies, not because they find stronger studies.

Step 1: Frame a Focused Question

Use PICO to make the question precise: population, intervention, comparison and outcome. A question that is too broad returns thousands of irrelevant records; one that is too narrow may return almost none.

Run a quick scoping search before committing. If an up-to-date systematic review already answers your exact question, refine the angle or population.

Step 2: Set Inclusion and Exclusion Criteria

Decide your criteria before searching, and record them in a protocol. Typical criteria cover:

• Population, such as age group, condition or care setting.
• Intervention and comparison.
• Outcomes and how they are measured.
• Study designs, such as randomized trials only, or trials and quasi-experimental studies.
• Language and publication date range, with a reason for any limits.

Changing criteria after seeing the results introduces selection bias. If you must change something, report the change and the reason.

Step 3: Build a Reproducible Search Strategy

Translate each PICO element into keywords and subject headings, combine synonyms with OR and concepts with AND, and adapt the string for each database's own vocabulary.

("Diabetes Mellitus, Type 2"[MeSH] OR "type 2 diabetes")
AND ("Patient Education as Topic"[MeSH] OR "structured education" OR "self-management education")
AND (nurse* OR "nurse-led")
AND ("Glycated Hemoglobin"[MeSH] OR HbA1c)

This example uses PubMed syntax. In CINAHL, replace MeSH terms with CINAHL Subject Headings; the free-text terms usually carry over.

Record the date of each search, the exact string and the number of results. A librarian can review your strategy, and many reviews thank one for doing so.

Step 4: Screen Studies and Report with PRISMA

Screening usually happens in two stages: titles and abstracts first, then full texts. Ideally two reviewers screen independently and resolve disagreements; if you work alone, say so as a limitation.

1. Combine results from all databases and remove duplicates.
2. Screen titles and abstracts against your criteria.
3. Retrieve and assess full texts of possible studies.
4. Record the reason for each full-text exclusion.
5. Show the numbers at each stage in a PRISMA 2020 flow diagram.

Reference managers and screening tools make this easier to track. Whatever you use, keep a record that matches the numbers in your diagram.

Step 5: Appraise Study Quality

Each included study needs a structured quality assessment using a tool that matches its design. Using the wrong tool produces meaningless ratings.

Present appraisal results in a table and use them in your synthesis. Findings from studies at high risk of bias should carry less weight in your conclusions.

Step 6: Extract Data Consistently

Use one extraction form for every study so nothing is recorded differently. Typical fields include author and year, country and setting, design, sample size, intervention details, comparison, outcomes, measures, main results and appraisal rating.

Pilot the form on two or three studies first. You will often discover a field you forgot, and it is easier to add it before extracting from twenty papers.

Step 7: Synthesize by Outcome, Not by Study

Listing each study in turn is a summary, not a synthesis. Group findings by outcome or theme and say what the evidence shows collectively, where it agrees and why it differs.

Meta-analysis is only appropriate when studies are similar enough in population, intervention and outcome measures. Otherwise, a structured narrative synthesis is the correct choice, and you should explain why.

Writing up the Review

Most nursing systematic reviews follow an introduction, methods, results and discussion structure, reported in line with the PRISMA 2020 checklist.

• Introduction: the clinical problem, existing evidence and your question.
• Methods: criteria, databases, search strings, screening, appraisal and synthesis approach.
• Results: PRISMA diagram, study characteristics, appraisal table and synthesis.
• Discussion: what the evidence means for practice, certainty, limitations and gaps.

Match your certainty language to the evidence. Where most studies have moderate or high risk of bias, write "the available evidence suggests" rather than "the evidence shows".

Planning Your Timeline

Systematic reviews take longer than most students expect, mainly because screening and appraisal cannot be rushed. A rough plan for a term-long student review might look like this:

Build in time for your supervisor's feedback on the protocol before you search. Errors in the question or criteria are far cheaper to fix at that point.

Common Mistakes to Avoid

• Calling a thorough narrative review systematic without documented methods.
• Changing inclusion criteria after seeing the studies.
• Using one search string unchanged across every database.
• Applying an appraisal tool designed for a different study design.
• Listing findings study by study instead of synthesizing them.
• Leaving out the PRISMA flow diagram or reporting numbers that do not add up.
• Ignoring heterogeneity or publication bias in the discussion.

How EssayHorse Helps with Nursing Systematic Reviews

Send your question, protocol, search results, included studies and program guidelines. A nursing writer can draft custom methods and results sections, extraction and appraisal tables or a synthesis based strictly on the studies you have identified, for you to verify against your records.

Choose a Master or Elite writer for thesis-level work and see the price before you pay. Free revisions within your brief are available. Writers never invent studies, search results or data.