A nursing or healthcare systematic review reports its study selection with exactly the same PRISMA 2020 flow diagram as a review in any other field, because PRISMA is discipline-neutral by design. What differs for nursing is not the figure but the inputs that feed it: the databases you search, such as CINAHL alongside MEDLINE, and the breadth of study designs you include, since nursing evidence spans randomised trials, cohort studies, and qualitative research. You can produce the diagram for a nursing review in our free PRISMA 2020 flow diagram generator, and this guide explains the discipline-specific choices that shape the numbers inside it.
Nursing reviews are sometimes held back by a mistaken belief that healthcare evidence needs a special flow diagram. It does not. The same four phases apply, and treating the figure as field-specific only invites inconsistency.
What Makes Nursing Reviews Distinctive
The PRISMA structure is fixed, but the evidence base in nursing has features that influence how you populate it. Nursing questions frequently concern complex interventions, patient experience, and care processes rather than a single drug versus placebo. That has three practical effects on the flow diagram:
- The search reaches into nursing-specific databases, so the identification counts come from sources a medical review might not use.
- The eligibility criteria often admit mixed study designs, including qualitative and mixed-methods work, which widens what survives screening.
- The volume of records can be large because nursing terms are broad, so deduplication and title screening carry heavy traffic.
None of this changes the boxes. It changes the numbers and the reasons you record at the exclusion stage. Our step-by-step walkthrough on how to conduct a systematic review sets out the underlying method that nursing reviews follow without modification.
Databases That Feed the Identification Box
The identification phase should reflect every source you searched, counted per database so the totals are transparent. A typical nursing review searches:
- CINAHL, the Cumulative Index to Nursing and Allied Health Literature, which indexes journals a biomedical database may omit.
- MEDLINE or PubMed for the biomedical core.
- Embase for broader international and pharmacological coverage.
- The Cochrane Library for existing trials and reviews. If your nursing review is being prepared for Cochrane itself, the flow diagram has a few extra expectations around labelling and the reasons recorded at full text, which our guide to aligning a healthcare review with Cochrane flow diagram conventions sets out in full.
- Discipline sources such as the Joanna Briggs Institute database when qualitative or implementation evidence is in scope.
Enter each database as its own line in the identification box so a reader can see, for example, that CINAHL returned 412 records and MEDLINE returned 533. Collapsing them into a single total hides the search structure and invites a reviewer query. Because nursing searches often run across several platforms, choosing the layout that includes an "other sources" column for handsearching and citation chasing is common; our overview of the PRISMA 2020 flow diagram templates explains when that column is the right choice.
Screening a Mixed Evidence Base
When a review admits qualitative and quantitative studies together, the screening phase needs clear, design-aware criteria so that two reviewers exclude consistently. The flow diagram only records the counts, but the decisions behind them must be reproducible. Best practice for a nursing review is dual independent screening at both the title-and-abstract and full-text stages, with disagreements resolved by discussion or a third reviewer.
The exclusion reasons at the full-text stage carry particular weight when designs are mixed, because a study can be excluded for the wrong population, the wrong phenomenon of interest, or an unsuitable design. Each excluded full text must map to one documented reason, and those reasons must sum to the total excluded. Our guide to systematic review screening best practices covers dual screening and the agreement metrics that make a large nursing screen defensible.
Reporting Qualitative and Mixed-Methods Inclusions
A nursing review that synthesises qualitative findings still ends its flow diagram with a count of included studies. The synthesis method that follows, whether thematic synthesis, meta-aggregation, or a narrative approach, sits in the methods text, not the figure. The diagram's job is unchanged: prove that the included studies emerged from a thorough, transparent process. If your review combines a quantitative meta-analysis with a qualitative strand, each strand can be described in the text while the single flow diagram accounts for the whole screening process.
Common Pitfalls in Healthcare Reviews
Two issues recur in nursing submissions. First, authors sometimes omit CINAHL or another nursing database and then cannot defend the comprehensiveness of the search; the fix is to search the discipline-specific sources and show them in the identification box. Second, the exclusion reasons are often too generic for a mixed-design review, blurring why a qualitative study and a trial were each excluded. Specific, protocol-anchored reasons solve both the credibility problem and the arithmetic, keeping the figure clean from the identification box down to the included count.
Frequently Asked Questions
Do nursing systematic reviews use a different PRISMA flow diagram?
No. Nursing and healthcare reviews use the standard PRISMA 2020 flow diagram with the same identification, screening, eligibility, and inclusion phases. Only the databases searched and the study designs included differ, and those affect the numbers, not the structure of the figure.
Which databases should a nursing review search?
A typical nursing review searches CINAHL, MEDLINE or PubMed, Embase, and the Cochrane Library, often adding the Joanna Briggs Institute database for qualitative and implementation evidence. Each source is counted separately in the identification box.
Can a PRISMA diagram include qualitative studies?
Yes. The flow diagram records counts regardless of study design, so qualitative, quantitative, and mixed-methods studies all flow through the same boxes. The synthesis method for qualitative findings is described in the methods text, not the diagram.
How do I show CINAHL in the flow diagram?
List CINAHL as its own line in the identification box with its record count, alongside the other databases you searched. Reporting each database separately makes the search transparent and lets a reviewer confirm the totals.
Is dual screening required for a nursing review?
It is strongly recommended. Dual independent screening at the title-abstract and full-text stages, with disagreements resolved by a third reviewer, produces the reliable counts a credible flow diagram depends on, especially when the review admits mixed study designs.