Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics

Abstract Aim The aim of this study is to discuss the available methodological resources and best‐practice guidelines for the development and completion of scoping reviews relevant to nursing and midwifery policy, practice, and research. Design Discussion Paper. Data Sources Scoping reviews that exemplify best practice are explored with reference to the recently updated JBI scoping review guide (2020) and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Scoping Review extension (PRISMA‐ScR). Implications for nursing and midwifery Scoping reviews are an increasingly common form of evidence synthesis. They are used to address broad research questions and to map evidence from a variety of sources. Scoping reviews are a useful form of evidence synthesis for those in nursing and midwifery and present opportunities for researchers to review a broad array of evidence and resources. However, scoping reviews still need to be conducted with rigour and transparency. Conclusion This study provides guidance and advice for researchers and clinicians who are preparing to undertake an evidence synthesis and are considering a scoping review methodology in the field of nursing and midwifery. Impact With the increasing popularity of scoping reviews, criticism of the rigour, transparency, and appropriateness of the methodology have been raised across multiple academic and clinical disciplines, including nursing and midwifery. This discussion paper provides a unique contribution by discussing each component of a scoping review, including: developing research questions and objectives; protocol development; developing eligibility criteria and the planned search approach; searching and selecting the evidence; extracting and analysing evidence; presenting results; and summarizing the evidence specifically for the fields of nursing and midwifery. Considerations for when to select this methodology and how to prepare a review for publication are also discussed. This approach is applied to the disciplines of nursing and midwifery to assist nursing and/or midwifery students, clinicians, researchers, and academics.


| INTRODUC TI ON
Scoping reviews are an invaluable form of evidence synthesis.
Foundational concepts and evidence can be mapped, allowing for examination of practice, policy, and research and gaps in evidence and policy can be identified. The results of scoping reviews can provide indications for where further research may be required and inform the development of these research endeavours (Khalil et al., 2016;Munn, Peters, et al., 2018;Tricco et al., 2016). Scoping reviews have become increasingly popular, particularly in the health and social science disciplines, and they are broadly accepted as a helpful adjunct for informing new research projects (Pham et al., 2014;Tricco et al., 2016). As the popularity of scoping reviews has increased, so too have the criticisms of this methodological approach for synthesizing evidence (Davis et al., 2009;Tricco et al., 2016). Davis et al. (2009) undertook a review that explored the nature and status of scoping review studies in nursing literature. Their findings suggested that scoping reviews in the discipline were poorly understood and there was a lack of consistency and methodological rigour (Davis et al., 2009). Criticism of researchers' approaches to conducting scoping reviews is not limited to the field of nursing. Tricco et al. (2016) conducted a review of scoping reviews and found variability in approach among the 494 included reviews and highlighted the need for a standardized reporting guideline specific to the scoping review approach. The purpose of the current study is to highlight available methodological resources and best-practice guidelines for the development and completion of scoping reviews relevant to nursing and midwifery practice and research.

| BACKG ROU N D
The first framework for conducting a scoping review was proposed by Arksey and O'Malley (2005) and remains popular across disciplines (Pham et al., 2014). Extensions of this framework were later provided by Levac et al. (2010) in response to confusion and criticisms of the Arksey and O'Malley approach. These initial attempts have provided guidance to many researchers, but a lack of methodological clarity continues to exist, particularly with regards to the analysis of data. In response to ongoing concerns about the scoping review methodology, the JBI guidance for scoping reviews was developed by a working group of methodological experts (the Scoping Review Methodological working group). The aim in developing the guidance was to clarify each element required in a scoping review . This guidance was developed through a consultative process with key stakeholders Peters, Marnie, et al., 2020).

| DATA SOURCE S
Scoping reviews that exemplify best practice were explored with reference to the recently updated JBI scoping review guidance Peters, Marnie, et al., 2020) and  and  Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension (PRISMA-ScR) . This was supported by the varied experience of the authors Conclusion: This study provides guidance and advice for researchers and clinicians who are preparing to undertake an evidence synthesis and are considering a scoping review methodology in the field of nursing and midwifery. Impact: With the increasing popularity of scoping reviews, criticism of the rigour, transparency, and appropriateness of the methodology have been raised across multiple academic and clinical disciplines, including nursing and midwifery. This discussion paper provides a unique contribution by discussing each component of a scoping review, including: developing research questions and objectives; protocol development; developing eligibility criteria and the planned search approach; searching and selecting the evidence; extracting and analysing evidence; presenting results; and summarizing the evidence specifically for the fields of nursing and midwifery. Considerations for when to select this methodology and how to prepare a review for publication are also discussed. This approach is applied to the disciplines of nursing and midwifery to assist nursing and/or midwifery students, clinicians, researchers, and academics.

K E Y W O R D S
evidence synthesis, methodology, midwifery, nursing, PRISMA-ScR, reporting, scoping review who comprise methodologists, researchers, and clinicians who share an interest in evidence-based health care.

| When should a scoping review methodology be selected?
When planning any research project, it is important to select the correct methodology. There are several approaches for conducting evidence synthesis (Grant & Booth, 2009;. Each has its merits, but they are not all suitable for all research questions. Scoping reviews share some similar methodological principles as other types of evidence synthesis. For example, both scoping reviews and systematic reviews provide a synthesis of evidence to address a particular research question after a rigorous and systematic search of available literature .
The major differences between scoping and systematic reviews are the purposes for conducting these investigations and the intended use of the results . A systematic review should be conducted if the intention is to produce evidence to inform decisions about feasibility, appropriateness, meaningfulness, or effectiveness of a particular treatment or practice (Munn, Peters, et al., 2018;. For example, these decisions could relate to the effectiveness of an intervention, prognosis of a condition, diagnostic accuracy of a test, and experiences of a phenomenon . As such, systematic reviews will often inform policy decisions and clinical practice and may form the basis of trustworthy clinical guidelines. Scoping reviews map the literature and provide an overview of evidence, concepts, or studies in a particular field. Although scoping reviews may also be used to inform policy and practice, the type of decisions they inform are not necessarily related to questions of feasibility, appropriateness, or effectiveness, but more so around priorities for research, clari-  (Munn, Peters, et al., 2018;. Figure 1 provides an overview of the major considerations required for selecting a scoping review methodology. Of note, it is important to recognize that the role of a scoping review is not to provide recommendations for practice or to inform clinical guidelines. It is also not recommended that scoping reviews address questions about the experiences of populations unless it is designed as a preliminary search of literature that will inform the development of a systematic review. Reviews that seek to describe experiences or current practice will be more useful to the clinical and academic community if they are conducted using a systematic review methodology. There are some additional considerations when planning to undertake a scoping review. These include available resources, such as databases and other potential sources of data (e.g., policies or practice frameworks), co-authors for the study selection and extraction process, software to support the process (such as SUMARI and/or reference management software) (Munn et al., 2019), an academic librarian to assist with preparing the search strategy, and sufficient time . It may also be prudent to consider where the protocol and final review may be published once they have been completed.
Other suggestions that may assist with preparing a scoping review for publication in a peer-reviewed journal include: 1. Registering scoping review and/or develop a scoping review protocol to submit for peer-review publication.
2. Find a suitable target journal and review author guidelines to ensure that they publish scoping reviews.
3. Demonstrate that the review has been rigorously undertaken and complies with the JBI 2020 guide and PRISMA ScR .
You may also consider contacting the target journal's editor and asking if the review that is being proposed would be considered for inclusion in their publication. This is not a guarantee but may save some time if they do not consider the article to be suitable.

| JBI guidance
When the decision is made to pursue a scoping review, several choices can be made, including which guidelines to use. It is recommended that the JBI approach is followed, as it is, to date, the most rigorous and defined methodology. The JBI approach for scoping reviews contains nine steps

| Protocol development and registration
Scoping review protocols can be registered through Fig   .
Journal requirements for a registered, a priori scoping review protocol vary. The JBI and Scoping Review Methodological working group highly recommend that one is undertaken and indeed, JBI Evidence Synthesis requires a previously published protocol before they will accept a completed scoping review. There are a range of nursing and medical journals, besides JBI Evidence Synthesis, which will accept scoping review protocols. These include the Journal of Advanced Nursing, Systematic Reviews, BMC Medical Research Methodology, and BMJ Open. The advantage of developing a scoping review protocol is that it minimizes the potential for ad hoc decision-making that may reduce the methodological rigour of the scoping review. Changes made from the protocol to the final scoping review report are allowed but should be transparent and be reported in the final report. For example, Bobbette et al.'s (2020) scoping review addressed changes that have been made to their data extraction form since the protocol stage. Arksey and O'Malley (2005), Levac et al. (2010), and the JBI guidance Peters, Marnie, et al., 2020) offer differing perspectives on the importance of consultation with key stakeholders throughout scoping reviews. Arksey and O'Malley (2005) suggest it is an optional component, however, Levac et al. (2010) argued that it should be considered a required component. JBI recommends that consultation should occur with key stakeholders, information scientists, research librarians, and experts throughout the development of the protocol, execution, and dissemination of the evidence Peters, Marnie, et al., 2020).

Research librarians/information scientists play an important role
in the process of conducting a scoping review. Ideally, they should be contacted during the development of the protocol to help define the search strategy and to identify relevant databases. As each database has a different search approach, research librarians/information scientists can also help ensure equivalence with each search. Their time and expertise should be acknowledged in the scoping review publication.
Consulting with researchers or content experts in the relevant field is important during the process of conducting a scoping review.
This type of consultation can enhance the relevance of the research and ensure that the search strategy includes the appropriate terms.
They may also be useful in finding resources that may not be identified through the searching of databases, grey literature, and references.
For example, researchers may communicate with others in the field to ask if they have documents that could fit the inclusion criteria.
Other stakeholders may include patients and their informal caregivers, policymakers, government agencies, patient advocacy organizations, and healthcare providers (Cottrell et al., 2015). Cottrell et al. (2015) identified the following reasons stakeholders should be included when conducting evidence synthesis: • To inform researchers about topics that are needed and relevant to the identified community, thus reducing research waste (Glasziou & Chalmers, 2018).
• To assist with refining the research question, clarifying definitions, reviewing the research, and providing a deeper understanding of the phenomenon and; • To identify research gaps.
Acknowledging the involvement of stakeholder's involvement in any publications is required. This could either be in the acknowledgement section, or if they meet the necessary requirements, as an author of the scoping review.

| Developing review objectives and questions
Arguably, one of the most important steps to consider when producing a scoping review is the development of the review question.
Without a clear question, a scoping review will lack direction and coherence. The review question should be directly related to the overall objective of the review, it should be transparent, and located in the introduction section of the paper .
One benefit of scoping reviews is that the review question can projects' (Bench et al., 2018, p. 218). These questions seek information and knowledge regarding subjects in niche and emerging areas of healthcare provision and research. The results of these studies could lead to a refined and more specific systematic review or could identify a paucity of research in that area of interest.
Numerous formats have been developed to guide the inclusion of information in a review question, but not all of these are suitable for scoping reviews. When developing a question for a scoping review, the recommended format is the 'PCC' mnemonic, where the Population, Concept, and Context are described .

| Developing eligibility criteria
Eligibility criteria will dictate the papers that will be included in the review. If these criteria are too broad, the volume of included papers may be too cumbersome for one review. If these criteria are too narrow, there is a risk that no suitable papers will be located.
Eligibility criteria should be directly linked to the research objective(s) and question(s). The PCC framework used for developing the research objective(s) and question(s) will also inform inclusion and exclusion criteria and consequently the literature search strategy Peters, Marnie, et al., 2020). This is demonstrated well in Feo et al.'s (2020) scoping review and is outlined in Figure 2.
A rationale should be provided for all exclusion criteria . For example, if the review will be limited to a type of literature (peer-reviewed articles) year of publication (within previous 10 years), geographical location (rural and remote settings), or population (individuals with Type 2 diabetes mellitus), a reason should be provided for why these limitations are required.

F I G U R E 2
Relationship between research objectives, question(s) and eligibility criteria, Feo et al. (2020) To identify tools that measure actual rather than hypothetical behaviour and which can be used for assessment and evaluation in clinical practice, education and research -Behavioural aspects of the nurse-patient relationship -tools that exclusively measured behaviours or those that measured other aspects of the relationship (e.g., attitudes) in addition to behaviours -tools that exclusively measured nursing or those that measured other aspects of care (e.g. physician-patient relationships) in addition to nursing -tools that measured the frequency and/or quality of actual or simulated (but not hypothetical) behaviour -tools completed by the nurse (including self-report), patient, family member/carer, leader/manager, student nurse, lecturer, other educator or researcher -tools where the behavioural items could be viewed 4.7 | Describing the planned approach to evidence searching, selection, data extraction, and presentation of the evidence Planning how the searching, selection, data extraction, and presentation of the evidence will occur needs to be documented in an a priori protocol. During planning stages, it is recommended that an Academic Librarian assists with developing the search strategy.
While a protocol is recommended, scoping reviews can be iterative and flexible. Concepts that may not have been discovered in the initial exploratory search may become a focus. If this occurs, changes to the protocol are permitted, but deviations need to be described in the final scoping review manuscript.

| Searching for the evidence
The intention of this stage is to identify all relevant published and potentially unpublished evidence. Scoping reviews can include a broad scope of evidence, such as peer-reviewed articles, news articles, theses, opinion pieces, and letters to editors. This information is not always located easily through a database search. Nonetheless, the search strategy must be reproducible and therefore the search process requires detailed documentation. Ideally, the search should be sensitive enough to identify all the relevant evidence, but specific enough that the search does not contain an excessive volume of irrelevant articles. Aromataris and Riitano (2014) describe how to develop a search strategy for systematic reviews, but this approach can also be applied to scoping reviews. The article describes the development of concept maps and logic grids that can provide visual representation of the search strategy and assist with identifying items relevant to your review (Aromataris & Riitano, 2014). PsycInfo database can also be useful for questions which combine nursing/midwifery practice with mental health, psychological, and social science concepts, for example, identifying the range of tools to measure behavioural aspects of the nurse-patient relationship (Feo et al., 2020). If the inclusion criteria contain theses, ProQuest Dissertation and Theses databases should also be searched.
A benefit of scoping reviews is the potential to include a variety of document types other than academic literature. This 'grey literature' is the information not controlled by traditional academic publishers and can include conference abstracts, theses, government reports, patents, and clinical practice guidelines, to name a few (Aromataris & Riitano, 2014). This is particularly useful in emerging fields, where peer-reviewed publications may be limited, but other documents exist (Aromataris & Riitano, 2014). Grey Document these searches for inclusion in the final PRISMA flow chart . is a checklist developed by librarians is a useful tool (Sampson et al., 2009;Sampson et al., 2008). During this stage, analyse the title of the articles and assess if it aligns with the review inclusion criteria. Details of how many studies were identified in the reference list search should be included in the PRISMA flow chart .

| Selecting the evidence
Study selection is based on the eligibility criteria. Piloting the selection process, reviewing the management of disagreements, and the type of software that will be used in this stage need to be specified in the protocol and final scoping review manuscript.

| Piloting selection process
During each stage of evidence selection, at least two reviewers will review each article. Piloting this stage is important to ensure consistency across the review team. Developing an 'elaboration document', which provides details on each included and excluded document, can be helpful. There are various approaches to piloting source selection.
The JBI Reviewers Manual for Scoping Reviews, for example, suggests each member reviews a sample of 25 titles/abstracts and then meets to discuss discrepancies and potential modifications. When agreement among team reaches 75% or greater, the selection of articles can continue .

Managing disagreements
If there are disagreements between the two reviewers and consensus cannot occur, a third reviewer can assess the source to determine its eligibility.

Software for source selection
There are several applications suitable for assisting the selection of evidence. These include Covidence®, Endnote™, and Excel®. Peters (2017) has developed a step-by-step guide on managing source selection through endnote and has aligned this approach with PRISMA guidelines .

| Extracting the evidence
Once sources have been selected for inclusion, evidence can be extracted. Two steps should occur before data are formally extracted.
The first, during the protocol development stage, is to develop a standardized extraction form. Secondly, pilot testing of the form with two or more reviewers with two to three papers to ensure consistency. In scoping reviews, this may be an iterative process and the form may be adjusted. If the extraction form changes between the protocol stage and conducting the scoping review, it should be stated in the scoping review. An example of a data extraction table is provided in Table 2. 4.10.1 | Critical appraisal or risk of bias Critical appraisal and risk of bias assessments are not required in scoping reviews, however, some methodologists (Levac et al., 2010) do suggest that quality appraisal be considered. If critical appraisal or risk of bias is performed, an explanation for why it is being conducted should be outlined. The process and critical appraisal tools used also need to be described to improve transparency and methodological rigour.

| Analysis of the evidence
The intention of scoping reviews is to provide a map and summary of available evidence, not to synthesize results into a set of final estimates or findings to inform decision-making. Analysing the evidence gathered from the included studies is therefore normally descriptive, such as through frequency counting and basic coding. This can include organizing qualitative data into categories.
An example of this type of qualitative descriptive approach can be seen in a scoping review that was investigating the needs of individuals recovering from a first episode of mental illness (Davies et al., 2018). The purpose of the review was, in part, to identify the needs experienced by individuals from this population. To facilitate a meaningful response to the review question, items of need identified in included articles were extracted and placed into categories (Davies et al., 2018).
It is common to see attempts to thematically analyse information in scoping reviews. This approach is not inherently wrong, but it does conflict with the purpose of scoping reviews: to map and chart the available evidence. If a review requirement is to examine or explore the experiences of a given population, then a qualitative systematic review may be more appropriate (Lockwood et al., 2015).

| Presentation of the results
There are various approaches for presenting data from included articles. The selected approach should be described in the protocol and final scoping review manuscript. Commonly, scoping reviews use a tabular format to present the information gathered in the extrac-

| Summarizing the evidence
The discussion and conclusion paragraphs provide an opportunity to summarize evidence described in the included papers and to link this to the broader clinical and academic context .
When undertaking this task, it can be tempting to discuss issues that are tangential to the purpose of the review. Alignment between the summarized evidence of the review and the review question and objectives is vital for the cohesion of a review. As such, a few considerations may assist with compiling the discussion and conclusion sections. Secondly, has the review question been addressed accurately? The discussion section provides an opportunity to demonstrate the alignment of review results with review questions and objectives.
When conducting a scoping review, the information that is located can highlight new avenues of inquiry. It can be tempting to discuss these tangential subjects in the discussion section, without re-focussing on the primary aim of the review. Ensuring alignment among the review question, objectives, results, and discussion will strengthen the integrity of the review.
Thirdly, has the paper been adequately situated within the context of the relevant field of literature, practice and/or policy? A good discussion section will highlight the contribution the review has made to the relevant field through reflecting on what has preceded the review and projecting the potential implications for future investigation and planning.
The purpose of many scoping reviews is to describe the nature and diversity of available evidence Peters, Marnie, et al., 2020). As such, the discussion section should describe, with detail, the gaps in knowledge relating to the phenomenon, context, or concept that is under investigation.
The discussion will include a description of the strengths and limitations of the review. A significant strength of a scoping review will be the demonstration of compliance with a rigorous methodological and reporting framework. This can be achieved by transparently documenting the review process and adhering to the JBI (2020) guidance and the PRISMA-ScR .
Review limitations that may be described can be divided into two broad categories: limitations relating to the methodology of the scoping review and limitations of the available research, literature, policy, and practice documents that were available to address the review questions and objectives. Limitations of the scoping review methodology include the absence of methodological and risk of bias evaluations and the resultant inappropriateness of the review to be used as evidence for clinical guidelines, limitations, and recommendations (Arksey & O'Malley, 2005;Tricco et al., 2016).
Implications for practice is often a section that is requested by nursing and midwifery journals. As the purpose of a scoping review should not be to provide recommendations for clinical practice or policy change, this section can be challenging to compose. Some suggestions for addressing this section in a scoping review have been included in the JBI 2020 guidance (Peters, Marnie, et al., 2020).
These include identifying gaps in knowledge identified in the review, describing specific implications for future research, and making suggestions for the conduct of a more specific research question that could be investigated through a systematic review .

| Using the PRISMA-ScR
Scoping reviews are required to demonstrate the same transparency and reporting standards applied to systematic reviews.
The original PRISMA was developed for systematic reviews and does not include some considerations relevant to scoping reviews. The PRISMA-ScR contains 20 essential items, which should be reported and two optional items (critical appraisal of individual sources and within sources of evidence) . The PRISMA-ScR is not to be used instead of the JBI guide Peters, Marnie, et al., 2020), but in conjunction. The JBI guidance provides a structure for how to initiate, develop, and undertake a scoping review; the PRISMA ScR is used to assist in developing a scoping review manuscript for publication to ensure it meets reporting standards .

| IMPLI C ATI ON S FOR N UR S ING AND MIDWIFERY
Scoping reviews are a valuable form of evidence synthesis. The scoping review approach to evidence synthesis is increasingly being adopted by nurses and midwives who are seeking to map evidence and describe relevant literature. As the methodology for undertaking a scoping review advances and becomes more refined, it is important for nurses and midwives to be using the most current and appropriate guidelines, particularly if wanting to publish results or to use the results to inform future research.
This study provides an overview of best practice and current guidelines for nursing and midwifery students, academics, and clinicians who are considering undertaking a scoping review.
Examples and advice are offered to assist with the appropriate adoption of this methodology and the distribution of results to the broader community.

| CON CLUS ION
The scoping review methodology presents nursing and midwifery academics and clinicians with a valuable and adaptable opportunity to synthesize evidence. This approach to evidence synthesis has certainly grown in popularity in these professions and will no doubt continue to be used in the future. As this type of review continues to be adopted, it is vital that they are conducted rigorously and in accordance with the latest methodological recommendations. The process for how to perform a scoping review from inception to publication has been outlined in this study with a goal of facilitating conceptual clarity for nursing and midwifery academics, clinicians, and policymakers who are undertaking a scoping review.

ACK N OWLED G EM ENTS
The team would like to thank Alexa McArthur, Midwife, and Researcher for reading the study to ensure it was appropriate for midwifery professionals.

PEER R E V I E W
The peer review history for this article is available at https://publo ns.