A systematic review and quality improvement nursing paper may have two linked sections. Section A systematically searches, appraises and synthesises published evidence. Section B uses the review findings to design a specific improvement in a local service. The bridge between them must be explicit: which finding justifies the change, how will the change work and how will its effect be measured?
Use the exact assessment brief first. Some universities ask for a completed quality improvement project; others ask only for a proposal. Do not describe planned PDSA cycles, baseline data or outcomes as though they have already happened. This guide focuses on the common format in which Section A is a review and Section B is an improvement proposal based on its findings.
Understand the two tasks before drafting
| Element | Section A: systematic review | Section B: quality improvement |
|---|---|---|
| Question | What does the published evidence show about the focused nursing problem or intervention? | What local change could address the identified problem, and how would it be tested? |
| Data | Eligible published studies selected by a documented search and screening process. | Local baseline and follow-up measures if implemented; a measurement plan if only proposed. |
| Method | Search, eligibility, screening, appraisal, extraction and synthesis. | Context, change idea, measures, small tests and evaluation plan. |
| Reporting guide | PRISMA 2020, as relevant to the review design. | SQUIRE 2.0 for a reported improvement project; use its principles to plan a proposal where appropriate. |
| Claim | Evidence-based conclusion within the limits of included studies. | A justified local proposal, or measured results if the improvement has actually been implemented. |
A background literature section alone is not necessarily a systematic review. The label requires reproducible methods. Likewise, a recommendation for staff training alone is not a complete quality improvement design. Our separate nursing quality improvement guide covers the project method in more depth.
Step 1: align the review question with the local improvement problem
Begin with one nursing problem that appears in both sections. For example, Section A might ask what evidence supports nurse-led medication education at discharge for adults with a long-term condition. Section B might propose testing a structured discharge conversation and teach-back prompt on one ward. The review informs the change idea, but the local baseline and stakeholders determine how it could be adapted.
Define the population, intervention or phenomenon, comparison where relevant, outcomes and setting. Choose a question framework suited to the evidence. Do not let Section B introduce a wholly new problem that the review never examined. If the strongest review finding concerns medication understanding, a project about hand hygiene needs a different rationale.
Step 2: write Section A as a transparent systematic review
State the review question and eligibility criteria. Report databases, dates, search concepts, full search strings, screening stages and reasons for full-text exclusion where required. Explain who screened studies if the brief asks. Extract study characteristics and outcomes consistently. Appraise methodological quality or risk of bias with a justified tool, then synthesise the findings across studies rather than summarising each article in isolation.
PRISMA 2020 offers a reporting checklist and flow diagram for systematic reviews. It supports transparent reporting but does not itself make a weak search systematic or guarantee study quality. Show the actual numbers from your own search; do not invent records or copy a diagram from another review. Our guide to developing a systematic review study matrix explains how to organise extracted evidence.
End Section A with a concise synthesis: what appears supported, where studies disagree, how applicable the evidence is to the proposed nursing setting and what remains uncertain. These conclusions provide the inputs for Section B.
Step 3: build an evidence-to-change bridge
A short transition table prevents Section B from becoming a disconnected project idea.
| Section A finding | Limitation or context | Section B decision | Measure |
|---|---|---|---|
| Patients often misunderstand discharge medicine changes in the included studies. | Evidence comes from varied settings and may not transfer directly to one ward. | Test a structured nurse-led explanation and teach-back prompt locally. | Proportion of eligible patients receiving the prompt and demonstrating understanding. |
| Follow-up support appears helpful but delivery varies. | Staffing capacity may limit a full follow-up service. | Start with a small, feasible test before considering wider adoption. | Reach, staff time and any unintended delay to discharge. |
The example is illustrative, not a claim that a particular intervention is proven effective. Select your real change idea from your actual review findings and local needs. Explain why that change is plausible and why alternatives were not prioritised.
Step 4: design Section B around a measurable local aim
Describe the service context, baseline problem and stakeholders. State an aim that identifies the population, setting, desired change and period. For a proposal, specify how baseline data would be collected rather than inventing a baseline rate. Define the intervention precisely enough for someone else to understand what staff would do and when.
Choose outcome, process and balancing measures. An outcome might concern patient understanding; a process measure might track completion of the discharge prompt; a balancing measure might check whether the change adds delay or workload. Explain data sources, denominators, collection frequency, confidentiality and how missing data would be handled. Plan a small test and learning cycle, such as Plan-Do-Study-Act, if appropriate to the brief.
SQUIRE 2.0 addresses context, intervention, measures, analysis, results and interpretation when reporting healthcare improvement. A proposal can use those questions to show what would be evaluated, but it must not present hypothetical results as observed results. A completed project should report what happened, including failed tests and adaptations.
Step 5: address governance and feasibility
Ask the supervisor and host service what approvals, data access and information-governance arrangements are required before any local data collection or intervention. Whether an activity is research, service evaluation or quality improvement depends on its purpose and design; the Health Research Authority provides tools for deciding whether NHS research ethics review is needed. A project that is not classified as research may still need local approval and data safeguards.
Consider staffing, patient involvement, training time, accessibility, safety and sustainability. If Section A found weak or inconsistent evidence, propose cautious local testing and evaluation rather than claiming the review mandates immediate service-wide adoption. State what evidence would cause the team to adapt or stop the change.
A practical structure for the combined paper
- Shared introduction: Define the nursing problem, rationale and relationship between Sections A and B.
- Section A methods: Review question, search, eligibility, screening, appraisal and synthesis.
- Section A results and discussion: Study flow, characteristics, synthesised findings, evidence quality and limitations.
- Bridge: Map the finding and uncertainty to the chosen local change.
- Section B plan: Context, aim, intervention, measures, tests, governance and evaluation.
- Integrated conclusion: State what the review established and what the improvement work could reasonably test next.
Use the word allocation and headings in your brief. If the assignment assesses Section A and B separately, make it easy for the marker to locate each required criterion. The combined conclusion should avoid pretending the proposed QI intervention has already improved patient outcomes.
Common mistakes to avoid
- Calling a narrative summary a systematic review without reproducible searching and appraisal.
- Jumping from a review finding to a major practice change without considering local context.
- Writing Section B as a list of recommendations with no aim, measures or testing plan.
- Mixing published study outcomes with local baseline data or hypothetical outcomes.
- Inventing PRISMA counts, PDSA cycles, patient data or implementation results.
- Assuming a QI label automatically removes all governance requirements.
Frequently asked questions
Can Section B be based only on Section A findings?
The review should justify the change idea, but Section B also needs local context, feasibility and a measurement plan. Check whether the brief requires additional local baseline evidence.
Should I use both PRISMA and SQUIRE?
Use PRISMA for reporting the systematic review. SQUIRE is designed for reports of completed improvement work. For a QI proposal, its topics can inform the plan without implying that results exist.
Can I write a QI proposal without implementing it?
Yes, if the assessment asks for a proposal. Label the aim, intervention and evaluation as planned. If implementation is required, a proposal alone will not meet that brief.
Conclusion
A two-section nursing paper works when Section A provides a transparent evidence synthesis and Section B translates a justified finding into a feasible local improvement plan. Keep the review and QI methods distinct, show the evidence-to-change link and report only work that has actually been completed.
References and further guidance
- Health Research Authority (n.d.) Student research toolkit.
- PRISMA (2020) PRISMA 2020 statement.
- SQUIRE (2015) SQUIRE 2.0 reporting guideline.
- NHS Improving Quality (n.d.) PDSA guidance and tools.
