An integrative review was conducted to address the topics
listed above, which allows for the synthesis of findings
from a range of methodologies and a comprehensive portrayal
of complex concepts or healthcare problems.11,12
When conducting the review, the following procedures
were employed, which are similar to those used for a traditional
systematic review.
Inclusion criteria
Papers were accepted if they reported on research related to
patients with NSTACS, referred to the role of nurses in
management or guideline adherence and were published in
English between January 1990 and November 2011. The time
frame was chosen to reflect contemporary management of
NSTACS patients, as clinical trials comparing early invasive
and non-invasive treatment date from the 1990s.
Exclusion criteria
Non-research articles were not considered (e.g. editorials
or those describing a setting). Likewise, papers centred on
STEMI patients were excluded, as were those focused on
rehabilitation or moderating cardiovascular risk factors. In
addition, studies based in outpatient units were not included,
since the review was interested in the acute phase. Conference
abstracts were excluded because they provide limited
information about an investigation and its execution.
Search strategy
To identify relevant papers, databases searched included
BNI, CINAHL, EMBASE and Medline. A broad set of terms
was used to ensure the search was as comprehensive as
possible, including: acute coronary syndrome, unstable angina,
non-ST elevation myocardial infarction, non-STEMI,
NSTEMI, nurse, nursing. References from papers retrieved in
full for reading were examined for additional studies. Results
from the search are presented in Figure 1.
Initial filtering
Two authors (ST and CD) met to sift titles and abstracts
located via the databases for their potential relevancy.
References appearing eligible or lacking sufficient information
to make this decision were retrieved in full for reading.
Selection from reading full texts
Following the initial filtering of abstracts, two authors (ST
and CD) read retrieved papers independently to decide whether
or not to include them in the review. Agreement at this point
was good (kappa=0.733). Any disagreements were discussed
and resolved between ST and CD.