Systematic Review Of International Nursing Student Experience Essay. (70 Characters)

Discuss about the Systematic Review for Journal of Advanced Nursing.

The main aim of the systematic review is to evaluate the experience of international nursing students during their studies in abroad. The main objectives of the systematic review are as follows:

• The examine the live experiences of international nursing students of studying abroad
• To identify negative and positive experiences of nurses related to studying in foreign countries
• To assess the challenges or facilitators of pursuing nursing program or courses abroad.

To get relevant articles that can meet the key aim and objectives of the review, the search process was guided by the following inclusion criteria:

Type of research articles: As the main aim is to evaluate experience of international nurse, all types of qualitative studies, systematic reviews and quantitative studies should be included for the review.

Type of publication: Only those research articles need to be included in the review which is published within the year 2010 to 2018.  

Type of participants: The main sample of interest for all studies should be nursing students.

Intervention studied: The main intervention should be exposure to a foreign country for nursing education.

Language used in the study: Only those articles need to be taken in the review which are published in English Language.

Type of outcomes evaluated:  The main focus of all the included studies should be to evaluate the experiences of nurses studying in international countries. The main outcome of interest can be the quality of experience, satisfaction with the experience and quality of life.

There were certain exclusion criteria for the studies too. The studies were excluded if:

• The participants for the research were registered or other nurses apart from the student nurses
• Those studies would be excluded where study or experience were evaluated in home countries of nursing students and not in foreign countries
• Research articles published before 2010 were excluded
• Research studies published in other languages were excluded 

The search strategy is guided by the use of PRISMA checklist where all relevant information sources or database has been used to retrieve relevant articles related to the study topic. Full electronic search strategy for the database has been presented with the use of specific data collection and data abstraction process. The advantage of the use of PRISMA while writing the systematic review is that the PRISMA checklist has all the items deemed necessary for transparent reporting of a systematic review. The PRISMA flow diagram is an effective process to review and segregate articles for analysis and systematic review. The different phases of systematic review such as identification, screening, eligibility and inclusion provide a good overview of the search process. Use of the checklist ensures transparent and complete reporting of systematic reviews (Liberati et al. 2009). The discussions mentioned below gives an overview about database used, key search term, number of hits achieved and a summary of the search process by going through the four phases of systematic review.

Inclusion and exclusion criteria

 A comprehensive search process was used to select all research articles that are related to the topic of the systematic review. The databases that were searched to select research articles for the systematic review included CINAHL, ProQuest and PsychINFO. The rationale for selecting the above database is that all of them published peer-review research literature in the field of biomedical and health care and there are high chances to get maximum number of hits from these databases. With the availability of peer-reviewed research studies in thee databases, the reliability of the work can be high. The search process in all the databases were limited by setting the publication date from 2010 to the current data. Other limits used during the search process include age and language. For example, as the main population of interest were nursing students, the age limits of participants that were necessary for all research articles were 19-44 years. English was used as one of limits to narrow down the search process.

Several keywords and other terms were used in various combinations to retrieve high quality and suitable research articles for the review. Boolean operator ‘AND’ was applied in along with several groups of similar search terms to retrieve research articles. The key search terms included ‘experience’ or ‘attitudes’, international’ or ‘foreign’ or ‘overseas’, ‘nursing students’ or ‘student nurse’ or ‘undergraduate nurse’, ‘academics or education’ and ‘In Abroad’. The eligibility criteria for selection of articles were determined by comparison with inclusion and exclusion criteria. The number of hits achieved for each databases, specific key terms used and details of key resources and action has been provided in Table 1 in appendix.

The process of identifying articles from database search and the number of articles excluded or included with rational has been provided by the PRISMA flow diagram. It gives clear idea about the identification stage by giving details on the records identified through data base search and other articles retrieved from other sources. The screening of articles has been done by removing duplicate. This section gives an overview of the screening stage of the systematic review. The number of articles assesses for eligibility and the final selection of articles based on the eligibility criteria has been provided in the form of PRISMA flow Diagram below:

Figure 1: PRISMA flow diagram for the selection of research articles. 

The studies selected on the basis of eligibility criteria were extracted and summarized according to the following data extraction table.

Search strategy

Table 2: Summary of included studies

The initial number of studies that were selected via the search of the keywords from the databases was screened for the removal of the duplicate. The selected unique studies were then screened on the basis of their tiles. The shortlisted articles which have qualified on the basis of their titles were then screened via study of the abstract. The detailed of the study of the abstract of the short listed articles lead to exclusion of the some articles. The articles which were selected after the short listing of the abstract are then analysed in a standard tabular format. The Data from the selected studies were systematically extracted via the use of the standard tabulated format (as discussed in table: 4). In order to stringently address the aims and the objectives of the research, the data were extracted on the basis of the aim of the selected study, the research design, the process employed for the purpose of the data collection, the sample details (focus group selected), the key findings of the research, the associated research limitations and the interlinkage of the chosen study with the aims and objectives of the research (Miles, Huberman, and Saldana 2013). The finally selected articles were then passed through the quality appraisal tool, AMSTAR. 

The criteria used for accessing the finally selected study were mainly based on the AMSTAR quality appraisal tool. According to Harrison et al. (2016), the quality in the research included two main aspects that is methodological and reporting quality. Here quality is not associated with the importance of the topic or enjoys ability of the research but the term “quality” is associated with the values of the research. The methodological quality of the research is associated the research design and the manner in which the entire research is conducted and how the fundamental understandings of the results relates with the level of confidence in the findings of the research (Harrison et al. 2016). So in order to critically analyse the quality of the research, the researcher here will use AMSTAR critical appraisal tool. According to Shea et al. (2007), AMSTAR critical appraisal tool is a measurement tool that is used to assess the methodological quality of the systematic reviews. AMSTAR is an abbreviated from of assessment of multiple systematic reviews. This tool consists of 11 items that provides good face along with proper content validity for measuring the overall methodological quality of the systematic reviews. Proper analysis of the systematic reviews via the critical appraisal tools help in the quality assessment of the research papers based on the research design and the methodology used. This quality assessment helped the researcher to select quality rich paper that will help to stringently address the research aims and objectives. 

Search methods

Apart from analysis of research findings and results, evaluation of methodological quality of research article is also essential to understand the reliability and transferability of the research work. Bias is a systematic error found in results or other stages of research that can lead to underestimation of overestimation of the true intervention effect. Consideration of risk of bias in each study and differences in risk of bias may help to understand variation in the studies included in the systematic review. A research article with rigorous methodology are more like to provide results closer to reality that those with bias in sample selection or analysis method (Moher et al. 2015).

` To conduct risk of bias assessment for the included studies in this systematic review, the Cochrane Risk of Bias Assessment tool has been used. It is a tool that supports an appraiser to identify different kinds of bias in research such as performance bias, selection bias, detection bias, attrition bias and other kinds of bias (Sterne, Higgins and Reeves 2015). The following criteria have been used to consider an article to have the following biases:

Selection bias: Selection bias can be identified by the presence of systematic differences in baseline characteristics of research participants. By the use of Cochrane risk of Bias Assessment tool, two types of bias assessment can be identified. These include random sequence generation and allocation concealment. Risk of bias in allocation sequence is identified by analysing the method used to generate allocation sequence. Inadequate generation of randomized sequence means selection bias is present. Bias in allocation concealment can be identified by reviewing the method used to conceal the allocation sequence.

Performance bias: Performance bias may arise by identifying differences in the treatment of intervention and control group apart from the exposure to intervention. Effective blinding is the process to minimize performance bias. Blinding of participants and study personnel may denote that the study is free from performance bias.

Attrition bias: Attrition bias can be identified by events like poor follow-up and withdrawal from clinical trials. This may lead to incomplete data. The Cochrane risk of bias assessment tools supports researchers to identify attrition bias by analysing whether attritions and exclusions were reported in the study or not.  

Detection bias: Detection bias relates to identification of differences in groups by the method of measuring the outcome. Detection bias may arise when assessors have the knowledge about the allocated intervention.

Research summary

Other kinds of bias: Apart from the above mentioned sources, other forms of bias identified in research study may include risk of biasness in design or possibility of bias due to contextual issues found in clinical setting (Higgins et al. 2011).

The risk of bias assessment will be summarized in the form of following risk assessment table:

Table 3: Risk of bias assessment table

The symbols as mentioned above in the table denote the level of bias found in the studies. Positive signs in the table will indicate high risk of bias in the assigned section and negative sign will indicate low risk of bias. In addition, question mark sign indicates unclear risk of bias. 

The systematic review gave a summary about the methods used to retrieved articles related to experience of international nursing students regarding studying abroad. The PRISMA checklist was followed to report about the systematic review and cover important sections such as eligibility criteria, search strategy, data analysis and quality appraisal method. This chapter provides an insight into inclusion and exclusion criteria used to collect research articles. The search strategy and the process of screening and including research articles have been provided in the form of PRISMA flow diagram. The analysis of research articles is first done by the review of title and abstract. The second stage focus on review of full articles. Furthermore, the quality appraisal of the research article has been done with the use of AMSTAR tool and the Cochrane Risk of Bias assessment tool. The data extraction table gives an overview of the study and significance of the research findings. 

Reference:

Charles, L., Maltby, H., Abrams, S., Shea, J., Brand, G. and Nicol, P., 2014. Expanding worldview: Australian nursing students’ experience of cultural immersion in India. Contemporary nurse, 48(1), pp.67-75.

Cruz, J. P., Aguinaldo, A. N., Estacio, J. C., Alotaibi, A., Arguvanli, S., Cayaban, A. R. R., ...and  Idemudia, E. S. 2018. A Multicountry Perspective on Cultural Competence Among Baccalaureate Nursing Students. Journal of Nursing Scholarship, 50(1), 92-101.

De Natale, M.L. and Waltz, C.L., 2015. Reflections of nursing students travel abroad experiences in Ireland: A global nursing perspective. Nursing Education Perspectives, 36(3), pp.188-189.

Gilliland, I., Attridge, R.T., Attridge, R.L., Maize, D.F. and McNeill, J., 2016. Building cultural sensitivity and interprofessional collaboration through a study abroad experience. Journal of Nursing Education, 55(1), pp.45-48.

Gower, S., Duggan, R., Dantas, J.A. and Boldy, D., 2017. Something has shifted: Nursing students’ global perspective following international clinical placements. Journal of advanced nursing, 73(10), pp.2395-2406.

Harrison, J.K., Reid, J., Quinn, T.J. and Shenkin, S.D., 2016. Using quality assessment tools to critically appraise ageing research: a guide for clinicians. Age and ageing, 46(3), pp.359-365.

Higgins, J.P., Altman, D.G., Gøtzsche, P.C., Jüni, P., Moher, D., Oxman, A.D., Savovi?, J., Schulz, K.F., Weeks, L. and Sterne, J.A., 2011. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj, 343, p.d5928.

Hilde, C., Marion, W. and Marianne, N., 2018. The lived experiences of flemish midwifery students undertaking an internship in Suriname: A phenomenological study. Nurse education in practice, 30, pp.79-85.

Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gøtzsche, P.C., Ioannidis, J.P., Clarke, M., Devereaux, P.J., Kleijnen, J. and Moher, D., 2009. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine, 6(7), p.e1000100.

Long, T., 2014. Influence of international service-learning on nursing student self-efficacy toward cultural competence. Journal of Nursing Education, 53(8), pp.474-478.

Maltby, H.J., de Vries-Erich, J.M. and Lund, K., 2016. Being the stranger: Comparing study abroad experiences of nursing students in low and high income countries through hermeneutical phenomenology. Nurse education today, 45, pp.114-119

Miles, M.B., Huberman, A.M. and Saldana, J., 2013. Qualitative data analysis. Sage.

Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P. and Stewart, L.A., 2015. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), p.1.

Philips, L., Bloom, T., Gainey, T. and Chiocca, E., 2017. Influence of short-term study abroad experiences on community health baccalaureate students. Journal of Nursing Education, 56(9), pp.528-533.

Sealey, L.J. and Hathorn, D., 2014. The lived experience of Honduran and USA nursing students working together in a study abroad program. The Qualitative Report, 19(48), pp.1-20.

Shea, B.J., Grimshaw, J.M., Wells, G.A., Boers, M., Andersson, N., Hamel, C., Porter, A.C., Tugwell, P., Moher, D. and Bouter, L.M., 2007. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC medical research methodology, 7(1), p.10.

Sterne, J.A.C., Higgins, J.P.T. and Reeves, B.C., 2015. on behalf of the development group for ACROBAT-NRSI. A Cochrane Risk Of Bias Assessment Tool: for non-randomized studies of interventions (ACROBAT-NRSI), Version 1.0. 0, 24 September 2014. 2014-10-11)[2014-10-21] https://www. riskofbias. info.