what are scoping studies? a review of the nursing literature
TRANSCRIPT
International Journal of Nursing Studies 46 (2009) 1386–1400
Review
What are scoping studies? A review of the nursing literature
Kathy Davis a,*, Nick Drey b, Dinah Gould b
a Consortium for Health Care Research, City University, Philpot Street, London E1 2 EA, United Kingdomb Community Health Sciences, City University, London, United Kingdom
A R T I C L E I N F O
Article history:
Received 2 February 2008
Received in revised form 13 February 2009
Accepted 23 February 2009
Keywords:
Scoping
Nursing
Review
Mapping and research
A B S T R A C T
Background: Scoping studies are increasingly undertaken as distinct activities. The
interpretation, methodology and expectations of scoping are highly variable. This
suggests that conceptually, scoping is a poorly defined ambiguous term. The distinction
between scoping as an integral preliminary process in the development of a research
proposal or a formative, methodologically rigorous activity in its own right has not been
extensively examined.
Aims: The aim of this review is to explore the nature and status of scoping studies within
the nursing literature and develop a working definition to ensure consistency in the future
use of scoping as a research related activity.
Design: This paper follows an interpretative scoping review methodology.
Data sources: An explicit systematic search strategy included literary and web-based key
word searches and advice from key researchers. Electronic sources included bibliographic
and national research register databases and a general browser.
Results: The scoping studies varied widely in terms of intent, procedural and
methodological rigor. An atheoretical stance was common although explicit conceptual
clarification and development of a topic was limited. Four different levels of inquiry
ranging from preliminary descriptive surveys to more substantive conceptual approaches
were conceptualised. These levels reflected differing dimensional distinctions in which
some activities constitute research whereas in others the scoping activities appear to fall
outside the remit of research. Reconnaissance emerges as a common synthesising
construct to explain the purpose of scoping.
Conclusions: Scoping studies in relation to nursing are embryonic and continue to evolve.
Its main strengths lie in its ability to extract the essence of a diverse body of evidence
giving it meaning and significance that is both developmental and intellectually creative.
As with other approaches to research and evidence synthesis a more standardized
approach is required.
� 2009 Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
International Journal of Nursing Studies
journal homepage: www.elsevier.com/ijns
What is already known about the topic?
� S
00
d
coping is a widely used but poorly defined termassociated with myriad of activities and is described in
* Corresponding author. Tel.: +44 208 725 1591; fax: +44 208 725 3174.
E-mail address: [email protected] (K. Davis).
20-7489/$ – see front matter � 2009 Elsevier Ltd. All rights reserved.
oi:10.1016/j.ijnurstu.2009.02.010
a range of literatures including nursing and healthcare.
� S coping involves the synthesis and analysis of a widerange of research and non research material to providegreater conceptual clarity about a specific topic or field ofevidence.
� S coping studies are commonly policy directed andintended to guide more focussed lines of research anddevelopment.
K. Davis et al. / International Journal of Nursing Studies 46 (2009) 1386–1400 1387
� S
coping tends to be synonymous with providing anoverview of the breadth rather than depth of evidence. � S coping as a stand alone activity in relation to the field ofnursing has not been extensively examined.
� InFig. 1. An example of key concepts of scoping proposed by the SDO.
consistencies in the interpretation and confusionas to the intent and expectations of scoping suggestthat it is an ambiguous term that is poorly understoodparticularly within the portfolio of research relatedactivities.
1. Introduction
As nursing matures as an evidence-based profession itis contingent on the profession to build its researchcapacity and capability, and maintain a diligence andconsistency in the language of its research activity. Acrossthe literature clear definitions of scoping are limited. Itmay be assumed that for most researchers it is a termgenerally synonymous with preliminary investigativeprocesses that identify the range and nature of existingevidence and help in the formulation of a researchquestion(s) and the development of research proposals.However, there is an extensive and international body ofliterature originating from a diverse range of academicdisciplines and industrial backgrounds, that presentscoping as a more formative, substantial and stand aloneactivity. These cover a broad range of purposes andinvestigations, as observed for example in studies asso-ciated with environmental impact assessment (Koornneefet al., 2008), international humanitarian development(Anh et al., 2007) or work related learning (Connor andMacFarlane, 2006). They characteristically involve thedevelopment, assimilation and synthesis of broad base ofevidence derived from a diverse range of research and non-research sources. They are generally multidisciplinary innature and commonly supplement existing evidence withthe consultative, consensus-building methodologies togain the benefit of expert opinion and other explicit valuejudgements such as those expressed by public consensusand preferences.
Scoping studies are a relatively recent addition to thenursing and health care literature and gaining in popu-larity. In the United Kingdom, the National Institute forHealth Research (NIHR) Service Delivery and OrganisationResearch and Development Programme (SDO) has spearheaded the scoping movement through academicallyrobust and practically relevant studies, although a cleardefinition of scoping is lacking (Anderson et al., 2008).Rather, scoping is variously conceptualised within therealms of research of research (Whittemore and Knafl,2005) providing an approach through which an overviewand critical analysis of existing evidence clarifies, definesand develops conceptual boundaries within a topic oracross a field of evidence. An example of key conceptsprovided to guide an SDO commissioned scoping study isseen in Fig. 1. Despite this lead, studies presented asscoping in the nursing literature assume a wide range ofinterpretation and applications that appear to be at oddswith these wider concepts of scoping. The distinctionbetween scoping as a preliminary fact finding element ofresearch or research related activity such as audit and
evaluation, and a more formalised approach, has to datereceived little attention.
Collectively, definitions of primary research and evi-dence synthesis emphasize the importance of generatingand disseminating new knowledge by addressing clearlydefined questions through systematic, methodologicallyrigorous and auditable analytical processes that follow anethical framework (Clark and Hockey, 1989; Bortolotti andHenrichs, 2007). Implicit within these definitions is theneed to ensure, whether originating from quantitative orqualitative paradigms, transparency, validity and relia-bility. Quantitative empirical research or synthesis ofprimary research demonstrates external validity andreproducibility that enable the findings to be generalisedwith confidence to other settings. In qualitative research,although the criteria to address the issue of rigour is judgeddifferently (Mays et al., 2005), transparency, credibility,validity and relevance of findings that is grounded in theevidence, is equally applicable (Guba and Lincoln, 2005;Mays and Pope, 2000; Dixon-Woods et al., 2004). Similararguments are made in relation to other research relatedactivities such as clinical audit, service evaluation andpractice development (Gerrish and Mawson, 2005). Muchhas been written about the differences between primaryresearch and these activities but it is generally agreed thatthe key difference relates directly to seeking information oflocal relevance for service or practice improvement. This isjudged against specific criteria, rather than seeking newknowledge that has a wider application (Closs and Cheater,1996).
In this paper, the authors will contend that regardless ofthe level of inquiry a scoping study has to stand up to therigor required of all primary and secondary research withclear, consistent standards guiding and governing itsdesign. We suggest that the strengths of a scoping studyand what makes it successful lie in its ability to be bothdevelopmental and intellectually creative. Scoping givesmeaning to the ‘what’ and ‘why’ explanations of an inquiryas opposed to the ‘who’ ‘where’ and ‘how’ and provides a
K. Davis et al. / International Journal of Nursing Studies 46 (2009) 1386–14001388
comprehensive and panoramic overview that not onlyilluminates its extent and context but also has thepotential to influence policy and practice developments.
2. The review
2.1. Aims and objectives
The aim of this review is to evaluate the status ofscoping studies undertaken within the field of nursing.Specific objectives are to
� id
entify the extent, range and nature of scoping studiesin the nursing literature; � e xplore the processes used to undertake scoping; � id entify the quality, utility and position of scoping withinthe hierarchy of research evidence.
2.2. Design
An interpretative scoping literature review methodol-ogy based on the framework outlined by Arksey andO’Malley (2005) is used (Fig. 2). This method follows anarrative synthesis approach that is particularly suited tothe appraisal of a contrasting body of studies that areprincipally qualitative in nature. It is based on an iterative,conceptual and interpretative approach that emphasisesthe importance of developing a critique based on therelevance, credibility and contribution of evidence ratherthan by rigidly determined methodological considerationsof analysis and synthesis.
2.3. Method
Eligible papers were identified using explicit searchstrategies across a range of data sources. Techniques andterms used included search tools such as medical subjectheadings (MeSH) and Boolean operators to expand andnarrow searches. Single and combined search termsincluded: scoping, nursing, review, study and exercise,
Fig. 2. Summary of the scoping literature review fram
mapping and research. These searches were furtherrefined using a second layer of terms; nurs$, health$,midwi$ and healthvisit$. Electronic database searchesincluded: BNI/RCN index, CINAHL, Medline, AMED,EMBASE, PsychINFO and Maternity and Infant Care. Toensure that all appropriate references were identifiedhand searching of reference lists and a general Internetbrowser (Google Scholar) was undertaken to uncover anyadditional publications or grey literature. Further elec-tronic searches of the major UK research registers wereundertaken to supplement these searches includingNational Institute for Health Research, National ResearchRegister Archives (NHS NIHR), NHS Service Delivery andOrganisation Research and Development Programme(NCC SDO) and the Evidence for Practice and Policy Co-ordinating Centre (EPPI).
2.4. Data selection
Papers were included if they addressed any aspect ofscoping in relation to nursing research, practice orprofessional development, education or service provision.The search covered 1996–2008 as research prior to thisdate was deemed unlikely to reflect current researchtrends. Papers were excluded if they contained commen-taries or summary reports of otherwise untraceablestudies. An initial screening of 242 titles and abstractswas undertaken and any papers not meeting a broadinclusion/exclusion criterion were discarded. 46 paperswent through to a second test of relevance. A further 24papers, including the 9 studies identified from the researchregisters were excluded because they were project briefs ofstudies still in progress (see author for further details). Incases of dispute concerning eligibility for inclusion,decision was reached through third party arbitration. Allsearches and methods of data handling were recorded.Fig. 3 shows a flow diagram of the search and selection ofpapers through the review.
The final papers selected for inclusion were read in fullby two people and data extracted using a proforma
ework proposed by Arksey and O’Malley (2005).
Fig. 3. Overall flow of scoping literature search and selection.
K. Davis et al. / International Journal of Nursing Studies 46 (2009) 1386–1400 1389
developed especially for the review. Data from each of thepapers was sorted in relation to purpose and objectives,methodology, search and analytical strategies, outcomesand origins of the studies. Evidence tables were formulatedto manage the extracted data including charting of keyfeatures of the studies against criteria developed to assessthe value and utility of a scoping study proposed byAnderson et al. (2008). To develop a critique and identifykey categories and themes a narrative synthesis approachwas undertaken.
2.5. Findings
The findings of this review are organised around theobjectives set at the outset of the study.
2.5.1. Extent and range of the literature
Twenty-four papers derived from 18 studies met thecriteria for review (see Table 1). These covered a variety oftopic areas associated with four domains of nursing(Table 2). The majority of studies originated from theUK, two from Scotland, six from Australia, one from NewZealand and one from Spain. Fourteen studies were fundedor specifically commissioned by Government fundingbodies and local commissioners, the remainder wereunfunded.
Scoping was referred to under an assortment ofdescriptions including a scoping review (While et al.,2005; Forbes et al., 2007), rapid scoping review (Griffithset al., 2007), scoping project (McKinnon and Cross, 2008),exercise (Traynor et al., 2006; Pulsford et al., 2007;McKenna et al., 2008; Bewley, 2007; Fotheringhamet al., 2006), study (Ross et al., 2004; Wand and White,2007; Clinton, 2000) and report (Moreno-Casbas, 2005).Three studies described their investigations in terms ofeither a developmental project (Mallik and McGowan,
2007), programme evaluation (Ellis, 2006) and ‘rapidappraisal rather than in depth examination’ (Richardsonet al., 2001 p. 289). Studies were located across a range ofjournals from international nursing journals to thoseaddressing specific nursing domains. It was of note thatalthough three were undertaken within a very short time(3–4 months) they all identified key issues from which toguide further research for example in relation to guidefurther areas of investigation relating for example to thefuture development and organisation of UK cancer nursingservices (Richardson et al., 2002), research priority areasfor UK nursing and midwifery services (Ross et al., 2004)and strategies to increase partnership working to sustainand grow nursing research in Scotland (Fyffe and Hanley,2002).
2.5.2. Nature and processes of scoping
The topics, interpretation and application of scopingwere highly variable (see Table 1). Details of the processes,assumptions and methods undertaken ranged from beinginadequately to well described. Scoping was variouslypresented in the form of systematic or non-systematicapproaches to a literature review. In some instances thesewere contextualised by policy and other related ororganisational documentary analyses, consultancy withstakeholder/key informants, scoping questionnaire sur-veys, individual semi-structured and case study interviewsor focus groups. The methodological combinations of theseinquiries fell within three overarching categories asillustrated in Table 3. The purpose of these studies rangedfrom providing clarity within a topic, exemplified throughthe evaluation of current Australian professional docto-rates for nurses and midwives which involved an in depthmapping of documentary evidence and stakeholder views(Ellis, 2006), to investigations involving a field of evidenceillustrated through the study exploring nurse, midwife and
Table 1
A summary table demonstrating the key features of the 24 included studies.
Authors/date/country Key aim(s) and OBJECTIVES Ethical
consideration
(U yes, � no)
Data search strategy Commissioned/
funded
(U yes, � no)
Analysis and
synthesis
1) Griffiths et al.
(2007), UK
To scope the extent and nature of learning
disability nursing research between 1996
and 2006 to determine whether the
research base is sufficient and fit for purpose.
n/a Literature review U (Dept of Health
(Policy Research
Programme))
Analysis described
systematic enquiry with
descriptive thematic
synthesis
2) Walsh and Downe
(2006), UK
To scope the issue of quality appraisal of
qualitative research in relation to free
standing midwife units.
n/a Literature review � Analysis described
Conceptual analysis
using ‘redundancy
approach’ and
summary synthesis
framework
3) Wand and White (2007),
Australia
To construct a solid background and clear
rationale for implementation of formalised
MHNP outpatient service in Emergency Dept.
U Extensive literature
review Plus Key
informant focus
groups
� Analysis described
qualitative content
analysis
4) Moreno-Casbas (2005),
Spain Network Report
To scope the situation of nursing research
across five European countries to map
current state of nursing research in Europe
three key objectives.
� (not described) Extensive literature
search plus Key
informant
communication
U (European
Commission
(ERA-CARE)
Network)
Analysis not described
Findings presented
with descriptive
summary statistics
and narrative
5) While et al. (2005) UK
SDO/68/2003 report
Related publication
Forbes et al. (2007)
To explore actual and potential contribution
of N M and HV’s to child health and child
health services within context of current and
future service provision. Six key objectives.
� (not described) Three phase study
guided by expert panel
Targeted topic literature
reviews plus Expert
stakeholder conference/
consultation plus
Synthesis of findings
U (UK NCC SDO) Analysis described thematic
content analysis with
descriptive narrative
approach to synthesis
informed by methods
developed by Forbes
and Griffiths (2002).
6) Ross et al. (2002), UK
SDO/20/2002 report
Related publication Ross
et al. (2004)
To identify research priorities for research
funding in fields of nursing and midwifery
in England and Wales and make
recommendations to inform future SDO
research commissioning two key objectives.
� (not described) Extensive literature
review, document
mapping and policy
analysis plus Service
user representatives
focus groups plus Key
stakeholder telephone
interviews
U (UK NCC SDO) Analysis described thematic
content analysis framework
7) Traynor et al. (2006), UK
SDO/90/2005 Related
publication Drennan
et al. (2007)
To map and define the range and types
of entrepreneurial NMHV activity in UK
in particular relation to patient choice and
identify gaps in current knowledege six
key objectives
U Scoping literature
review plus Expert
seminar consultancy
plus Policy mapping
and analysis
U (UK NCC SDO) Analysis described modified
framework analysis, with
thematic descriptive
narrative synthesis
informed by aspects of
discourse analysis.
8–11) Clinton and Hazelton
(2000d), Australia
Government Report
Related publications
Clinton and Hazelton
(2000a,b,c, 2002)
To identify issues responsible for current
difficulties in recruiting and retaining
mental health nurses in Australia and
challenges facing mental health nursing
education two key objectives.
� (not described) Extensive scoping
literature review plus
policy and
documentary analysis
plus Key stakeholder
consultations
U (Mental Health Branch
of Australian Dept of
Commonwealth
Department of Health
and Aged Care
(ANZ-CHMN))
Analysis described in-depth
qualitative analysis with
descriptive narrative
synthesis
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12) Mallik and McGowan
(2007), UK
To provide an account of the
inter-professional, inter-cultural
and effectiveness issues involved
in supporting practice-based learning
in nursing drawing comparisons from
case studies of four other
professional groups.
U (Scoping classified
as developmental
project)
Survey questionnaire
(informed by scoping
literature review not
described in detail
and key stakeholder
focus groups), plus
Policy and
documentary data
analysis.
U (Dept of Employment
and Learning
(N. Ireland ) and the
Education Funding
Council (England)
grant)
Analysis described
non-systematic,
literature review,
triangulation with
Qr and focus group
data—descriptive
narrative appraisal
of current issues
13) Ellis (2006), Australia To provide a detailed mapping and
complete account of the professional
doctorate for nurses and midwives in
three Australian universities to inform
development of the professional
doctorate within UK and elsewhere.
Three key objectives.
U (Scoping classified
as ‘Programme
evaluation’)
Documentary analysis
plus Semi-structured
case study interviews
� Analysis described
in-depth thematic
content analysis with
descriptive narrative
approach to synthesis
informed by a modified
form of illuminative
evaluation (Parlett and
Hamilton, 1987)
14) Richardson et al. (2001),
UK (1 of 2 papers)
To build an evidence base to support
development delivery and evaluation
of cancer nursing services and the
development of a services directory.
� (not described) Scoping
classified as rapid
appraisal rather than
in depth examination
Three element
study Extensive
literature review
plus Key stakeholder
consultation plus
Rapid appraisal
questionnaire
survey and four
semi-structured
individual follow
up interviews
U (Grant funded UK
DH R&D Directorate)
Analyses not described
descriptive summary
statistics with thematic
narrative presentation
of findings
15) Richardson et
al. (2002), UK
To explore and evaluate critical issues
faced by lead cancer nurses around
specific aspects of care in the continuing
development of cancer nursing services
and provide information to support
service development and organisation.
� (not described) rapid
appraisal findings to
be viewed in
conjunction with other
CN service information
(DoH 2000)
16) Pulsford et al. (2007),
UK
To ascertain how far the content of
provision of pre and post registration
and CPD dementia courses in UK HEI’s
matched the recommendations of the
dementia curriculum.
Considered but not
required
Questionnaire survey � Analysis not described
descriptive statistical
summary with thematic
narrative presentation
of findings
17) White and Roche
(2006), Australia
To examine the extent of clinical
supervision in mental health nursing
services in the state of New South
Wales, Australia.
U Questionnaire census
survey
U (Mental Health
Nursing Enhancement
programme of NSW
Health Dept.)
Analysis not described
descriptive thematic
narrative presentation
of findings
18) Fotheringham et al.
(2006), Scotland
To re-establish and develop a validated,
higher level of orthopaedic education for
orthopaedic nurses in Scotland.
� (not described) Questionnaire survey
and training course
evaluation
� Analysis described
education needs analysis
and course evaluation
summary findings presented
as descriptive summary
statistics and narrative
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Table 1 (Continued )
Authors/date/country Key aim(s) and OBJECTIVES Ethical
consideration
(U yes, � no)
Data search strategy Commissioned/
funded
(U yes, � no)
Analysis and
synthesis
19) Farrell et al. (2006),
Australia
To identify occurrence of workplace
aggression experienced by nurses in
Tasmania, Australia.
U Questionnaire survey
(design and
development informed
by scoping literature
review and focus
groups (not detailed))
U (Australian Nursing
Federation and The
Hobart Clinic,
Tasmania)
Analysis not described
Statistical analysis
descriptive summary
of statistical data
20) McKinnon and Cross
(2008), Australia
To review the issues relating to occupational
violence among mental health nurses four
key objectives.
U Literature review plus
Descriptive
questionnaire survey
� Analysis not described
Statistical analysis
descriptive summary
of statistical data
21) McKenna et al.
(2008), NZ
To investigate the feasibility of developing
specialty return to mental health nursing
programmes.
U Questionnaire survey
plus Stakeholder
consultation with
semi structure
interviews and
focus group
U (Northern District
Health Board Agency)
Analysis described
thematic content
analysis with
descriptive summary
of statistical data
22) Bewley (2007) UK To evaluate current situation in NW England
in relation to paediatric prescribing.
� (not described) Facilitated workshops
plus semi structured
questionnaires of
prescribers and HEI’s
plus evaluation of a
pilot PGD’s NP
training programme
U (Commissioners
not specified)
Analysis not described
findings presented as
descriptive narrative
23) Kelly et al. (2006), UK To explore existing post-registration cancer
continuing professional education provision
for nurses and allied health professionals
throughout a cancer network, identify
deficits in current provision provide
recommendations for future CPE.
U Qualitative study—focus
groups, face to face and
telephone interviews
with key stakeholders
plus documentary
data analysis
U (London Cancer
network grant)
Analysis described
informed by training
needs analysis Gould
et al. (2004). Descriptive
thematic narrative
presentation of findings
24) Fyffe and Hanley (2002)
Scotland Related publication
Downing and Fyffe (2004)
N Times 100(16) 20–26
To examine and report current research
capacity in N and M professions in Scotland.
� (not described) Questionnaire survey
plus documentary
evidence review
U (Scottish Executive
Health Department)
Analysis not described
descriptive thematic
narrative presentation
of findings
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Table 2
Categories of scoping by nursing domain.
Nursing Domain Authors Topic
Research Griffiths et al. (2007) Learning disability nursing research
Walsh and Downe (2006) Qualitative research appraisal
Moreno-Casbas (2005) Nursing research capacity
Ross et al. (2002) Nursing research priorities
Fyffe and Hanley (2002) Nursing research and capacity
Education and training McKenna et al. (2008) Return to mental health nursing
Ellis (2006) Professional nursing doctorates
Mallik and McGowan (2007) Multi-professional practice based learning
Pulsford et al. (2007) CPD/HE dementia education provision
Kelly et al. (2006) CPD/HE cancer education provision
Fotheringham et al. (2006) Orthopaedic nurse education
Clinton and Hazelton (2000a) Mental health nurse education
Clinical practice McKinnon and Cross (2008) Occupational violence in mental health nursing
Forbes et al. (2007) N, M HV’s contribution to child health
Wand and White (2007) Mental health nurse practitioners in Accident and Emergency Dept.
Bewley (2007) Paediatric nurse prescribing
Farrell et al. (2006) Workplace aggression
Richardson et al. (2002) Current cancer practice
Clinton and Hazelton (2000b) Mental health nursing practice
Professional/service development Traynor et al. (2006) Nurse entrepreneurship
White and Roche (2006) Clinical supervision in mental health
Richardson et al. (2002) Cancer nursing services
Clinton and Hazelton (2000c,d) MHN recruitment and retention
K. Davis et al. / International Journal of Nursing Studies 46 (2009) 1386–1400 1393
health visitor entrepreneurs and their contribution topatient choice (Traynor et al., 2007). None of the studiesinvolved collection of data from patients.
Overall, methods of data analysis were poorly formu-lated, poorly described or absent. Only 12 papers providedany detail of the analytical processes undertaken. Of the 11studies that specifically reported undertaking a literaturereview as part of the study design, only eight provided anydetail of the review processes or approach to evidencesynthesis (While et al., 2005; Forbes et al., 2007; Griffithset al., 2007; McKinnon and Cross, 2008; Richardson et al.,2002; Ross et al., 2004; Traynor et al., 2006; Walsh andDowne, 2006). With the exception of two (Forbes et al.,
Table 3
Methodological approaches used in scooping.
1) Review and analysis of the literature
Literature review Griffi
Literature review plus stakeholder/key
informant type consultancy
Forb
Literature review, policy and related
documentary analysis plus stakeholder/key
informant type consultancy
Clin
2) Combination of one or more dimensions from
Category 1 plus other qualitative research elements
Ellis (2006), Mallik and McGowan (2007),
Richardson et al. (2001), Richardson et al. (2002)
3) Primary research elements presented as scoping
Questionnaire surveys Farr
et al
Literature review and questionnaire survey Fyffe
Questionnaire survey, interviews and focus groups McK
Workshop focus groups, questionnaires and
pilot evaluation of training
Bew
Focus groups, interviews and secondary data review Kelly
2007; Ross et al., 2004), no study attempted a formal criticalappraisal of the quality of evidence included in the literaturereview. The findings were generally presented in the form ofdescriptive, thematic, narratives that in some cases includeddescriptive summaries of statistical data.
2.5.3. Positioning scoping
In attempting to position the studies reviewed, eachwas mapped against a scoping assessement criteriaproposed by Anderson et al. (2008) to assist commissionersand other researchers review the quality of scoping studiescommissioned by the SDO (see Table 4). Different levels ofinquiry emerged. Many of the studies presented an
ths et al. (2007), Walsh and Downe (2006)
es and Griffiths (2002), Moreno-Casbas (2005), Wand and White (2007)
ton (2000), Ross et al. (2004), Traynor et al. (2006)
ell et al. (2006), Fotheringham et al. (2006), Pulsford
. (2007), White and Roche (2006)
and Hanley (2002), McKinnon and Cross (2008)
enna et al. (2008)
ley, 2007
et al. (2006)
Table 4
Features of scoping interpreted in nursing literature mapped against key criteria for assessing the value and utility of a commissioned scoping study proposed by Anderson et al. (2008). (+ not clearly identified, U
clearly identified).
Authors/year Criteria of scoping
Conceptual clarification
of topic where
definitions unclear
Evidence of a review of the range and
nature of existing research (S = systematic,
NS = Non-Systematic lit review) may include
mapping of concepts (C), policies evidence
(P) and/or consultancy views (CON)
Identification of
strengths and
weaknesses of
research base
Identification of
research gaps
Recommendations
for further research
Value of further
systematic/empirical
research
Acts as resource of
research findings
Griffiths et al. (2007), UK U U S U U U U U
Downe and Walsh (2004), UK U U NS U U + + U
Wand and White (2007), Australia U U NS, CON U U U U +
Moreno-Casbas (2005), Spain U U NS, P, CON U U + U U
While et al. (2005), UK SDO/68/2003 U U NS, P, C, CON U U U U U
Ross et al. (2004), UK SDO/20/2002 U U S, P, CON U U U U U
Traynor et al. (2006), UK SDO/90/2005 U U S, P, C, CON U U U U U
Clinton (2000), Australia U U NS, P, C, CON U U U U U
Mallik and McGowan (2007), UK U U NS, P, CON + + + + +
Ellis (2006), Australia + + (Focus of inquiry—evaluation of
professional doctorate programmes)
+ + + + U
Richardson et al. (2001, 2002), UK + U S, CON U U U U U
Pulsford et al. (2007), UK + + (Focus of inquiry—national survey of
HEI’s provision related to dementia care)
+ + + U +
White and Roche (2006), Australia + + (Focus of inquiry—national census
relating to MNHN clinical supervision)
+ + + + +
Fotheringham et al. (2006), Scotland + + (Focus of study—othopaedic education
needs analysis/course evaluation )
+ + + + +
Farrell et al. (2006), Australia U + (Focus of inquiry statewide survey
MHN workplace aggression)
+ + U U U
McKinnon and Cross (2008), Australia U U NS (focus of inquiry—local survey
MHN occupational violence)
+ + + + U
McKenna et al. (2008), NZ U + (focus of inquiry—nationwide
feasibility survey of return to MHN
programmes)
+ + + + U
Bewley (2007), UK + + (Focus of inquiry—regional evaluation
and survey paediatric nurse prescribing)
+ + + + U
Kelly et al. (2006), UK + + (Focus of inquiry—local evaluation of
CPE cancer education)
+ + + + U
Fyffe and Hanley (2002), Scotland + + (Focus of inquiry—survey and
documentary review of nursing
research capacity)
+ + + + +
K.
Da
vis
eta
l./Intern
atio
na
lJo
urn
al
of
Nu
rsing
Stud
ies4
6(2
00
9)
13
86
–1
40
01
39
4
Fig. 4. A Hierarchy of levels of inquiry in nursing related scoping studies.
K. Davis et al. / International Journal of Nursing Studies 46 (2009) 1386–1400 1395
atheoretical stance with limited conceptual clarificationand development. A pyramid framework was used toreflect a hierarchy of levels of inquiry (Fig. 4). Weattempted to relate this to whether they were more orless likely to conform to the concepts of scoping referred toearlier in this paper and will now be discussed in moredetail.
2.5.4. Level IV elementary descriptive survey studies
Six studies interpreted and presented scoping as asingle method, descriptive survey inquiry either in theform of a literature review or questionnaire. In oneexample this involved an investigation of the evidenceavailable to support nursing practice in the complex area oflearning disability and assess whether it was fit for purpose(Griffiths et al., 2007). A descriptive summary of thefindings clearly demonstrated that not only was thiscurrent body of evidence very small, but also much of itwas deemed poor quality and therefore had limited valuein terms of supporting evidence-based practice. Otherexamples presented a questionnaire survey approach toscoping conducted among selected study samples at eitherlocal, regional or national levels. The nature and context ofthe topics being investigated were illustrated to the readerthrough combinations of categorised numerical andtextual data. Surveys were undertaken across a range oftopic areas. These included investigations of the currentstatus of higher education provision in relation todementia care (Pulsford et al., 2007), occupationalviolence, and workplace aggression in mental healthnursing (Farrell et al., 2006; McKinnon and Cross, 2008),current working circumstances with particular referenceto clinical supervision among mental health nurses (Whiteand Roche, 2006) and the feasibility of a mental healthnurse practitioner in emergency outpatient departments(Wand and White, 2007). In general, each study providedan insightful, illuminative and descriptive summary of theinformation. However, insufficient detail of the processesand procedures undertaken limited the applicability of thefindings beyond the setting of the surveys.
2.5.5. Level III evaluative appraisal studies
Six studies interpreted and applied scoping within aframework of evaluative appraisal. These tended toaddress questions aimed at assessing the scope and scaleof what was currently known about a topic andproviding information through which to direct localchange. Scoping studies at this level were particularlylocated around the domains of education, research andservice development. They ranged in intent fromproviding full and comparative accounts of the currentAustralian nursing doctorate programmes (Ellis, 2006),to an overview of the adequacy of continuing provisionalcancer education provision for nurses and allied healthworkers (Kelly et al., 2006), the nature of practice-basedlearning (Mallik and McGowan, 2007), and an evaluationof paediatric nurse prescribing (Bewley, 2007). Inrelation to research activity, Fyffe and Hanley (2002)used this approach to provide an update on the nursingand midwifery research capacity in Scotland, whileMoreno-Casbas (2005) investigated this issue morewidely mapping current nursing research activity andcapacity across five selected partner countries in Europe.While the conceptual underpinning of these studies wasimplicit few studies provided adequate detail of theprocesses undertaken. The reporting focus tended toconcentrate on providing descriptive analyses of the keydata collection activities used, such as case study and/orindividual interview, focus group and/or questionnairesurvey data. The majority provided additional contextthrough the mapping of findings against relevantsecondary policy, professional and organisational data.An overview of the major themes, key issues ofimportance to and recommendations for further avenuesof investigation were highlighted. The main limitationsof this application of scoping related to a lack oftransparency in the decision trails undertaken to explainthe findings.
2.5.6. Level II progressive development studies
Three studies were organised and built on a review ofexisting research evidence. These reflected a level ofinquiry in which a more progressive approach to scopingwas presented. The general focus at this level was ondeveloping and contributing to that an evidence base forexample, exploring unresolved issues associated with theassessement of quality of qualitative research in relation tostand alone midwife units (Walsh and Downe, 2006).Richardson et al. (2001, 2002) described a multidimen-sional approach to the data collected in relation to theprovision of cancer nursing services in the UK. This enableda number of critical issues to be explicated that producedclear proposals for further educational and professionaldevelopment. A slightly different perspective was pre-sented by Mckenna et al. interpreting scoping with in aframework of a feasibility study. A phased study designwas described in which a mixed method approach to datacollection was used to bring together evidence relating toissues surrounding workforce retention from research andnon research sources. The central purpose of this extensiveinvestigation was to make the case for the development ofspecialist return to mental health nursing programmes in
K. Davis et al. / International Journal of Nursing Studies 46 (2009) 1386–14001396
Australia (McKenna et al., 2008). In this example reportingcentred on calculating demand, uptake and potentialsupport for the development of a specialist educationprogramme. The key transferable finding to emerge fromthe subsequent critical thinking was the identification of acentral principle relating to the paradigm of a recoveryapproach to service and practice development.
2.5.7. Level I substantial conceptual studies
The four remaining studies covered an eclectic mix oftopic areas and were grouped together at the apex of thishierarchy. These represented a level of scoping that wasmost reflective of the concepts found in the wider scopingliterature, and outlined in Section 1 of this review. Thesewere also specifically commissioned studies that tended tohave a policy interest and involved investigations under-taken at a national level requiring a multi-professionalexpert approach. These studies demonstrated more robustacademic, methodological and procedural rigor in theevidence retrieved. Concurrent phases of investigation weredescribed that commenced with clearly detailed, systematicapproaches to reviews of the literature and contextualisedwith secondary analysis of relevant policy and organisa-tional data. This approach clearly provided the conceptualbase of the investigation (although the relative weight orquality of evidence reviewed was addressed by only two).They all proceeded to well described critical syntheses thatinvolved the integration and re-interpretation of the originalevidence (Clinton, 2000; While et al., 2005; Forbes et al.,2007; Ross et al., 2004; Traynor et al., 2006). Consensusbuilding methodologies such as, expert seminars, partici-patory conferences or workshops formed an integralcomponent of these studies.
A cumulative, contextual and intellectual overview ofthe evidence formed the focus of reporting. One study thatexemplifies this level of scoping inquiry is illustratedthrough the multiple phase investigation of the contribu-tion of nurses, midwives and health visitors to child healthand child health services. Here, conceptual clarificationand definition of this complex topic commenced with acomprehensive literature review and consultation with anexpert panel (While et al., 2005; Forbes et al., 2007). Aninitial theoretical framework was developed that providedthe structure and guidance for the rest of the investigation.Due to the potential enormity of available evidence,consensual agreement at the outset meant that theevidence for this study was targeted to include theprofessional contribution of the nurses working acrossdifferent boundaries in specific areas such as, children withcomplex needs, asthma, cancer, minor ailments, teenagepregnancies children in protection and school healthpromotion. This enabled more meaningful dialogue to beconstructed in the proceeding stakeholder consultations.The final phase involved drawing together all the materialand through a critical content analysis, facilitated thedevelopment of new theoretical constructs. The mappingof this new information onto current policy and healthneeds provided a clear indication of the range and nature ofthe contribution the nurses collectively made and high-lighted major trends, inhibitors and enablers for emergingroles, structures and policy.
3. Discussion
The intention of this paper was to stimulate debateabout what is scoping and where it is positioned in terms ofresearch. Over the past decade, studies reported as scopinghave increasingly begun to appear within the nursingliterature. It has been argued that within the portfolio ofresearch related activities, scoping conceptually, is ‘littlemore than umbrella term, having a variety of functions’(Anderson et al., 2008 p. 3). As the emphasis increases onthe need to base clinical practice and decision making onhigh quality research evidence, inconsistencies in theinterpretation and confusion as to the intent andexpectations of scoping suggest that the value of scopingevidence may be questionable. Research is defined ashaving a question or problem to solve that requires asystematic, rigorous approach to its design, data collection,interpretation and dissemination. This definition appliesequally to primary or secondary research such as,systematic literature reviews and interpretative synthesisthat employ qualitative, quantitative or mixed methodol-ogies. In nursing research the implications of this areespecially important when considering the types ofquestions likely to be posed and the interpretativemethods needed to address them. The criticism surround-ing the lack of scientific rigour subsequently leviedremains an area of much debate. The focus of this paperhas been to determine the range, nature and position ofscoping in terms of a research related activity in thenursing literature. It has not specifically set out to examinethe findings of the studies reviewed but to provide greaterclarity to scoping and develop a working definition toensure consistency in the future use of scoping as aresearch related activity.
We have demonstrated that scoping comprises severaldifferent levels of inquiry that vary enormously inprocedural and methodological rigor. In the absence of astandardized approach, we conceptualised a hierarchy oflevels of inquiry. These range from an elementary factfinding approach to a more substantive level of scopingthat has a number of interrelating dimensions asillustrated in Fig. 5. We suggest at the higher levels ofscoping, critical appraisal of a mixed body of research andnon-research evidence obtained from a wide variety ofsources enables the interpretation and analysis of numer-ical and/or textual data to be extended. This provides apanoramic and intellectual overview of what is currentlyknown and draws attention to areas where there areprominent knowledge gaps. We propose that a commonsynthesising construct emerges to explain the purpose ofscoping, namely that of ‘reconnaissance’. In the medicaland military arenas, reconnaissance is a widely used term.It is generally synonymous with a preliminarily investiga-tion in which information is systematically gathered andexamined in order to establish strengths and weakness andguide in which ever context, future decision-making(Correa and Gisselquist, 2006). Reconnaissance is there-fore, particularly suited to our perception of the purpose ofscoping. Furthermore, we concur with the suggestions ofAnderson et al. (2008) that by spelling out that purposethrough descriptive statements such as ‘‘a scoping study
Fig. 5. Conceptual representation of the key dimensions of a research related scoping inquiry.
K. Davis et al. / International Journal of Nursing Studies 46 (2009) 1386–1400 1397
designed to provide an initial indication of the size and
location of the literature relating to a particular topic as a
prelude to a comprehensive review’’ or ‘‘scoping study
designed to establish how a particular term is used in what
literature by whom and for what purpose (p. 8)’’, the functionand utility of scoping will be greatly increased.
We identified few studies that adequately demon-strated a robust, academic approach to scoping. Regardlessof the level of inquiry, insufficient detail relating to theprocesses and procedures undertaken was available. Inmany cases the theoretical underpinning and transparencyof analysis and synthesis to explain how the findings werearrived at, was lacking. For these reasons we suggest that inrelation to fulfilling the essential standards expected ofresearch, many of the studies we reviewed were sig-nificantly flawed. This may simply be explained by poorreporting or poor dissemination. However, we argue thatthese flaws are more likely to result from poor design andpoor understanding of the role and utility of scoping. Weidentified a number of studies in which the findings werelittle more than a descriptive summary. Little attempt wasmade to provide any critical review or reinterpretation ofthe data. Without further explanation we would suggestthat scoping in this context falls outside of the remit ofresearch and simply becomes a fact finding exercise.
We therefore propose that what differentiates scopingas a substantive, research related activity is its multi-
dimensional approach that enables the essence of a widerange of evidence to be intellectually captured. Within thisframe of reference scoping has the potential to contributeto the generation of new understanding by providingconceptual clarification particularly around complex topicareas where limited evidence exists or where morefocussed lines of inquiry are required. As a preliminaryactivity, scoping provides a compelling stepping off pointinto the investigation of a specific field and encourages anelement of ‘blue sky thinking’. There are however, severalnotes of caution that need to be raised when consideringthe strengths and weaknesses of scoping as a researchrelated activity, especially in relation to the way thefindings may be interpreted and used by others.
First, approaches to reviewing and synthesising evi-dence vary and choosing the right approach is dependenton the aim and purpose of the study. From our findings wesuggest that scoping involves more than just a review ofthe literature although the terms ‘literature scoping’ and‘rapid scoping reviews’ are frequently used. Proponents ofscoping, particularly within the emerging field of inter-pretative systematic qualitative reviews, contend thatscoping offers an alternative form of review that aims to‘map rapidly the key concepts underpinning a researcharea and the sources and types of evidence available’ (Mayset al., 2005). It is an approach that shares many of theprocesses associated with traditional systematic reviews
K. Davis et al. / International Journal of Nursing Studies 46 (2009) 1386–14001398
but differs in that the appraisal and inclusion of evidence isnot limited by the methodological quality of that evidence(Arksey and O’Malley, 2005). Rather, the processesproposed in the selection and charting of evidence thatby its nature includes evidence that uses mixed meth-odologies, require that the subsequent synthesis begrounded within interpretative, narrative descriptive-analytical methods (Pope et al., 2007). By exploring therelationships and links between different elements of aconcept within and across the evidence, theories can bedeveloped that move the presentation and usefulness ofthe findings beyond a descriptive summary. We concurwith Forbes et al. (2007) that while there are clearadvantages to capturing the breadth rather than the depthof existing evidence, the usefulness of the findings may stillbe limited. This is especially so, if the initial conceptualisa-tion of the topic and specific areas to be explored areunclear. It may also be that the rich descriptive narrativegenerated by this type of review becomes just too broadand is therefore, unable to shed new light on a topic orgenerate the development of new theoretical constructs.Alternatively, there is the potential risk that scoping canlead to widely differing interpretations being made bydifferent readers of the same literature.
The second note of caution surrounds consensusconsultancy which is increasingly recognised as animportant aspect of healthcare research. The key infor-mant technique is a qualitative research method that hasits origins within ethnographic social research principles.It is an approach that aims to provide a deeper insight intoa specific area capitalising on the first hand, specialisedknowledge and perspectives gathered over a relativelyshort period of time (Marshall, 1996). The main advantagesof this approach are that information is obtained directlyfrom experts in a field which in itself provides greaterflexibility to explore new ideas, and provides a relativelyquick and inexpensive approach to such rich data.However, there are inherent limitations in this approachthat need to be made clear in the reporting. These includethe appropriateness of consultancy if quantitative data isrequired, bias if the informants are not specifically selectedor susceptibility to interviewer biases and lastly, thevalidity of findings may be difficult to prove.
Finally, we consider the issue of the quality of scopingevidence. As previously stated, proponents of scopingsuggest that in relation to the scoping literature reviewelement the breadth rather than the depth (quality) ofevidence is the prime consideration in generating anintellectual overview of what is known around a topic.Therefore, this requires assimilating evidence drawn from adiverse range of qualitative, quantitative, research, non-research and other related documentary sources that doesnot easily lend itself to traditional methods of qualityappraisal. We would argue that as scoping evolves andscoping studies continue to gain popularity, awareness isneeded to ensure greater transparency and methodologicalrigor that will increase the legitimacy of findings and assistin peer review processes. Clearly, different types of researchquestions are best answered by different types of researchmethods. There is an emerging consensus that the tradi-tional criteria for judging the quality of quantitative studies
and the formal hierarchies of evidence that apply primarilyto levels of evidence in relation to trial data such aseffectiveness and outcomes of interventions, are proble-matic and inappropriate when considering the relevanceand value of findings that answer questions not concernedwith effectiveness. Traditional systematic reviews and metaanalyses for example, form the gold standard or Level 1evidence while qualitative data and anecdotal/expert oruser opinion, form the two lowest levels at 6 and 7,respectively. This may explain why only two of the studieswe reviewed attempted to appraise the quality of evidenceretrieved. However, standardized measurement criteriahave yet to be defined although several innovative methodsare being developed to address the issue of quality ofqualitative data and synthesis of data from mixed sources ofevidence. These include approaches that combine differentevidence syntheses of different types of evidence broughttogether under a single overarching synthesis (Pope et al.,2007), the integrative review (Whittemore and Knafl, 2005),critical interpretative synthesis (Dixon-Woods et al., 2006)and the current framework being used in this review (Arkseyand O’Malley, 2005). These all potentially serve to countermuch of the criticism levied at both the synthesis ofqualitative and mixed method research in terms of theoverall quality, appropriateness, and legitimacy of findings.Such methods would not only provide a reasonablesummary of evidence considered trustworthy and relevant,but also provide a basis for decision-making that increasesconfidence among researchers commissioners and policymakers in the utility of that evidence.
4. Conclusion
In conclusion, we believe that scoping is essentially adevelopmental, research related activity that in relation toresearch in nursing is embryonic and continues to evolve.The main strengths of a scoping study lie in its ability toextract the essence of a diverse body of evidence and givemeaning and significance to a topic that is both develop-mental and intellectually creative. As with otherapproaches to research and evidence synthesis a morestandardized approach is required. We suggest that atwhatever level of inquiry, the optimal scoping study is onethat demonstrates procedural and methodological rigourin its application. In addition, explicit identification ofpractical, methodological and theoretical limitations of theapproach undertaken should be described to ensure thatthe usefulness and value of the findings are appropriatelyinterpreted and used by others.
Author’s contribution
All authors contributed to the design of this paper. KDwas the principle investigator and wrote all the drafts. Allauthors contributed to the development of the final draftand approved the final manuscript.
Conflicts of interest: None declared.
Ethical approval: Not required.
Funding: Review undertaken as part of postdoctoralfellowship funded by Burdett Institute.
K. Davis et al. / International Journal of Nursing Studies 46 (2009) 1386–1400 1399
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