How to conduct thematic analysis in a systematic review becomes much easier when you separate four stages: extracting findings from the included primary studies, coding those findings, grouping similar codes, and developing themes that answer the review question. In a nursing systematic review, this process should be transparent enough that a reader can trace each theme back to the evidence that produced it.
This guide focuses on qualitative evidence synthesis in nursing systematic reviews. It is different from analysing interview transcripts or focus-group data collected in a primary study. Here, the reviewer’s data come from the findings reported in already published primary articles. If you are analysing your own interview data, see our separate guide to thematic analysis in nursing research.
What thematic analysis means in a systematic review
In a qualitative or mixed-method systematic review, thematic synthesis is used to identify recurring ideas across the included studies and develop a higher-level interpretation. The basic logic is:
Included primary studies → extract relevant findings → code the extracted findings → group related codes → develop descriptive themes → develop analytical themes → report the synthesis
The important point is that the themes should come from the included evidence, not from assumptions made before the review. A defensible synthesis therefore needs an audit trail showing how the review moved from article-level findings to final themes.
The way we extracted data
Data extraction should come before theme development. The extraction table records the information needed to understand each included study and the findings relevant to the review question.
For a nursing qualitative systematic review, a practical extraction table may include:
| Study | Setting and sample | Method | Relevant finding | Supporting quotation or author interpretation | Initial code |
|---|---|---|---|---|---|
| Study A | Acute ward, 18 patients | Semi-structured interviews | Patients felt nurses had little time to discuss concerns | Author reported repeated experiences of rushed interactions | Limited consultation time |
| Study B | Community service, 15 nurses | Focus groups | Nurses described workload as a barrier to communication | Heavy caseloads reduced time for meaningful conversations | Workload pressure |
| Study C | Mental health unit, 20 service users | Interviews | Participants valued staff who listened without rushing | Listening was linked to trust and feeling respected | Being listened to |
The table above is an illustrative example only. A real systematic review should use the actual characteristics and findings of the included primary studies.
What should be extracted from primary articles?
Do not extract every sentence from every article. Extract the information that is relevant to the review question. Depending on the methodology, this may include:
- Study aim and setting
- Participant characteristics
- Sampling approach
- Data-collection method
- Qualitative analysis method used by the primary authors
- Relevant findings reported in the results section
- Participant quotations that support those findings
- Author interpretations that are clearly grounded in the study data
- Quality-appraisal information where required
Keep study characteristics separate from synthesis data. The first group helps describe the evidence base. The second group provides the material that you will code and synthesise.
How to extract the data from primary articles
Start with the results or findings section of each included study. Read the article with the review question in mind and identify text that directly addresses the phenomenon of interest.
A practical sequence is:
- Open the full-text article.
- Read the study aim, methods and participant details.
- Move to the findings/results section.
- Highlight text that answers the systematic review question.
- Record the finding in the extraction table.
- Record the page number or location if your university requires traceability.
- Keep enough context to avoid changing the meaning.
- Assign the study identifier so every extracted finding remains traceable.
For example, if your review asks, “What are patients’ experiences of nurse-patient communication in adult inpatient care?”, a paragraph about hospital parking would not belong in the synthesis even if it appears in the article. A finding about rushed conversations, lack of privacy or feeling listened to would be directly relevant.
Do not extract only the primary authors’ theme titles
This is one of the most common mistakes. Primary qualitative studies often already contain their own themes. Those themes were developed to answer the original study’s question, not your systematic review question.
You may extract relevant theme labels, supporting text and quotations, but you should still analyse the underlying findings across all included studies. Otherwise, the review can become a list of other researchers’ headings rather than a genuine synthesis.
How to perform thematic analysis
After extraction, begin coding. Coding means assigning a short label to an extracted finding that captures its meaning.
For example:
| Extracted finding | Initial code |
|---|---|
| Patients reported that nurses appeared too busy to talk | Limited nurse availability |
| Participants described interactions as rushed | Rushed communication |
| Nurses said staffing shortages reduced time for conversation | Staffing pressure |
| Patients valued nurses who sat down and listened | Attentive listening |
At this stage, keep codes close to the original meaning. Avoid creating broad themes too early. Early coding should help you see what the data are saying before you decide how the ideas fit together.
Code across studies, not one article at a time forever
You can begin by coding Study A and then move through the remaining studies. However, the synthesis becomes stronger when you compare codes across articles. Ask whether different studies describe the same underlying issue using different language.
For example:
- “Rushed consultations”
- “Not enough time to talk”
- “High workload”
- “Staffing pressure”
These are not necessarily four separate themes. They may represent a related code family concerning time and workload constraints.
How to extract them and convert them into themes
The transition from extracted findings to themes should be visible. A useful approach is to move through four levels: finding, initial code, grouped code and theme.
| Primary-study finding | Initial code | Grouped code | Descriptive theme | Analytical interpretation |
|---|---|---|---|---|
| Patients reported limited time to discuss concerns with nurses | Limited consultation time | Time pressure | Organisational barriers to communication | Service conditions can restrict person-centred communication even when patients and nurses value meaningful interaction. |
| Nurses described heavy workloads during shifts | Workload pressure | Time pressure | Organisational barriers to communication | |
| Patients valued nurses who listened without rushing | Being listened to | Therapeutic communication | Relational facilitators of communication |
The table shows that several findings can contribute to one broader theme without losing their original study-level meaning.
Step 1: Compare the initial codes
Review the full code list and identify codes that refer to similar experiences, barriers, facilitators or outcomes.
Step 2: Merge overlapping codes carefully
Combine codes only when they clearly represent the same underlying idea. For example, “high workload”, “insufficient time” and “rushed interactions” may form a broader code family such as “time and workload pressure”.
Do not merge codes merely to reduce the number. If “lack of privacy” and “limited time” affect communication in different ways, they may need to remain separate.
Step 3: Develop descriptive themes
Descriptive themes summarise recurring patterns in the extracted evidence. They remain relatively close to what the primary studies reported.
Possible descriptive themes might include:
- Organisational barriers to communication
- Relational facilitators
- Information and understanding
- Continuity and trust
Step 4: Develop analytical themes
Analytical themes move beyond description and answer the review question at a higher level. They ask what the combined evidence means.
For example, several descriptive themes about workload, privacy and continuity may support a broader analytical interpretation that person-centred communication depends not only on individual nurse behaviour but also on organisational conditions that enable or constrain therapeutic interaction.
A simple diagram of the thematic-synthesis process
1. Included studies
↓
2. Extract relevant qualitative findings
↓
3. Assign study IDs and preserve traceability
↓
4. Code each relevant finding
↓
5. Compare codes across studies
↓
6. Merge genuinely overlapping codes
↓
7. Build descriptive themes
↓
8. Develop analytical themes
↓
9. Check every theme against the extracted evidence
↓
10. Report the synthesis with study support
The direction is not completely linear. Reviewers often move back and forth between codes, themes and the extracted data to check whether the developing interpretation remains grounded in the included studies.
How to avoid duplication when creating themes
A systematic review should synthesise repeated findings rather than create a new theme every time another study reports a similar idea.
For example:
| Duplicate-looking findings across studies | What not to do | Better synthesis decision |
|---|---|---|
| Staff shortage; heavy workload; not enough time; rushed consultations | Create four separate themes with nearly identical meanings | Group them under a broader code family such as time/workload pressure |
| Being listened to; nurses showing interest; patients feeling heard | Repeat the same theme under three different names | Combine under a theme such as attentive and therapeutic communication |
| Lack of privacy; conversations interrupted | Merge automatically with workload | Keep separate if the data show that privacy is a distinct barrier |
Use a theme-definition table
Before finalising the synthesis, create a table that states what each theme includes and excludes.
| Theme | Includes | Excludes | Supporting studies |
|---|---|---|---|
| Organisational barriers | Workload, staffing, limited time, interruptions | Interpersonal disrespect unless linked to organisational conditions | Studies A, B, D, F |
| Relational facilitators | Listening, empathy, respect, trust | Information provision without a relational component | Studies C, E, F |
This makes duplication easier to detect because two themes with the same inclusion criteria probably need to be merged or more clearly differentiated.
How to show which studies support each theme
Theme development should not erase study-level traceability. One practical method is a study-by-theme matrix.
| Study | Organisational barriers | Relational facilitators | Information needs |
|---|---|---|---|
| Study A | ✓ | ✓ | |
| Study B | ✓ | ✓ | |
| Study C | ✓ | ✓ |
This does not replace qualitative interpretation. It simply helps demonstrate where each theme appears and prevents one influential article from being mistaken for a pattern across the evidence base.
Do not count themes as if frequency alone proves importance
A qualitative synthesis should not automatically treat the most frequently mentioned idea as the most important. A finding reported by fewer studies may still be highly relevant, particularly if it concerns safety, marginalised groups or a context-specific experience.
Frequency can be described when useful, but theme importance should also consider depth, relevance to the review question, consistency, contradictions and the quality of the supporting evidence.
How critical appraisal fits into thematic synthesis
Critical appraisal and thematic synthesis are related but distinct. Appraisal asks how much confidence you should place in each study. Thematic synthesis asks what patterns and interpretations emerge across the findings.
Do not remove a study simply because it has one limitation unless your protocol specifies an exclusion threshold. Instead, follow your planned appraisal method and consider whether weaker evidence should influence the confidence placed in a particular theme.
For more detail, see how to appraise qualitative research for a nursing dissertation.
How to write the thematic synthesis in the results chapter
Each theme should be presented as a synthesis rather than as a sequence of article summaries.
A useful structure is:
- Name and define the theme.
- Explain the central pattern across studies.
- Compare similarities and differences between studies.
- Use selected study evidence or quotations where appropriate.
- Identify important contradictions or contextual differences.
- Avoid moving into full discussion of external literature until the discussion chapter unless your review design combines synthesis and discussion.
Instead of writing “Study A found this, Study B found this, Study C found this”, write around the shared concept and use the studies as evidence for the synthesis.
Common mistakes when conducting thematic analysis in a systematic review
- Copying the primary authors’ themes without analysing the underlying findings.
- Creating one theme for every included paper.
- Extracting findings without recording which study they came from.
- Using quotations without enough context.
- Merging different concepts simply because they appear related.
- Creating several near-identical themes.
- Treating frequency as the only measure of importance.
- Developing themes before completing data extraction.
- Changing the meaning of the primary findings during paraphrasing.
- Inventing quotations, study findings, reviewer decisions or themes.
Worked nursing example: from extracted finding to final theme
Assume a systematic review examines barriers and facilitators to therapeutic communication between adult inpatients and nurses.
| Study evidence | Code | Code family | Descriptive theme |
|---|---|---|---|
| Patients said nurses were often too busy to talk | Low nurse availability | Time constraints | Organisational barriers to therapeutic communication |
| Nurses reported high caseloads and interruptions | Workload and interruptions | Time constraints | |
| Participants described conversations ending when staff were called away | Interrupted interaction | Environmental disruption | |
| Patients valued nurses who sat with them and listened | Attentive listening | Relational presence | Relational facilitators of therapeutic communication |
| Service users linked respectful dialogue with greater trust | Respect builds trust | Relational presence |
The descriptive themes could then support an analytical conclusion that therapeutic communication depends on both relational nursing behaviours and service conditions that create enough time, continuity and privacy for those behaviours to occur.
Checklist before finalising your themes
- Every extracted finding has a study identifier.
- Codes reflect the meaning of the original findings.
- Similar codes have been compared across studies.
- Overlapping themes have been merged where appropriate.
- Distinct concepts have not been forced together.
- Each theme has a clear definition.
- Each theme is supported by actual included studies.
- Contradictory findings are retained rather than hidden.
- Analytical themes answer the systematic review question.
- No findings, quotations or themes have been fabricated.
Frequently asked questions
Is thematic analysis suitable for every systematic review?
No. The synthesis method should match the review question and the type of included evidence. Quantitative effectiveness reviews may require meta-analysis or narrative synthesis, while qualitative reviews may use thematic synthesis, meta-ethnography, framework synthesis or another qualitative evidence-synthesis approach.
Should I code participant quotations or the authors’ findings?
Follow your chosen synthesis method and protocol. Many qualitative reviews code both relevant author-reported findings and supporting participant quotations, while maintaining enough context to understand how the primary authors interpreted the data.
Can I use NVivo for a systematic review?
Yes. NVivo can help organise extracted text, codes, study attributes and theme development. It does not decide what the themes mean. For software-specific support, see our nursing NVivo analysis support.
How many themes should a systematic review have?
There is no correct number. The final structure should be detailed enough to answer the review question but concise enough to avoid several overlapping or weakly supported themes.
Do all studies need to contribute to every theme?
No. A theme may be supported by only part of the evidence base. What matters is that the review reports the pattern accurately and does not imply that every study found the same thing.
Related Nursing Guides
- How to Conduct a Critical Appraisal in Nursing Research: CASP, JBI and Other Tools
- A Priori vs Post Hoc Power Analysis in Nursing
- Nursing Likert-Scale Data in SPSS: Analysis Guide
Conclusion
Learning how to conduct thematic analysis in a systematic review requires more than collecting the theme titles from primary articles. Begin with transparent data extraction, preserve study-level traceability, code relevant findings, compare codes across studies and merge only genuinely overlapping concepts. From there, develop descriptive themes and then analytical themes that answer the review question. A clear extraction-to-theme audit trail reduces duplication and makes the nursing evidence synthesis easier to defend.
For broader review planning, see our nursing systematic review support and nursing literature review synthesis guide.
