This protocol complies with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015) (10) (see additional file 1) and is guided by the Joanna Briggs Institute (JBI) Reviewer's Manual for Scoping Review (11). The review has been registered in JBI Systematic Review Register with the title ‘A scoping review of factors influencing caring efficacy of direct care workers providing care to older people’ (https://joannabriggs.org/ebp/systematic_review_register). This proposed review will comply with the ‘Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)’ checklist to facilitate complete and transparent reporting of results.
Inclusion Criteria
Inclusion criteria specify what is intended to be discussed in the review and the basis of inclusion of studies in the review (11, 12). Clear congruency between the title, objective/s, review question/s, and inclusion criteria is required to perform a scoping review. The inclusion criteria for studies to be included in this review are classified by the type of participants, concept or the principal focus, context, and the type of studies as recommended by JBI reviewer’s manual for scoping review (11).
Type of participants
Studies that include direct care workers as study participants will be considered. Direct care workers in this study refer to all nursing staff providing care directly to older people. All paid/formal direct care workers will be considered in the review.
Studies will be excluded if their participants are:
- Allied health workers
- Ancillary service providers in aged care (e.g., laundry and kitchen staff)
- Care workers in hospital settings
- Care workers providing home-based care
- Informal, unpaid caregivers, including volunteers, and
- Students
Concept
The key phenomenon of interest of this review is self-efficacy in caring. Self-efficacy of care workers in caring may be affected by various factors such as personal and environmental factors, including who they are caring for and where.
Context
Provision of aged care in residential aged care settings only will be included. Provision of home-based aged care will be excluded because studies have shown that working environment, including the experiences of nursing staff, in residential aged care was different from the home-based care (13).
Types of studies
The review will involve evidence from both quantitative, qualitative, and mixed-method studies on the phenomena of interest. Studies will be included if they are:
- studies written in the English language and
- any primary studies including masters or doctoral dissertations
Studies will not be excluded based on the date of publication.
This review will not include review articles, opinion pieces, book chapters or books, news articles or studies conducted to develop measures of caring self-efficacy.
Search strategy
An extensive search will be conducted using electronic databases – CINAHL, AgeLine, MEDLINE, PsycINFO, SCOPUS, and ProQuest Dissertations & Theses Global. The three-step search strategy will be followed based on the recommendation by JBI (11). The first step involves a limited search of few databases to analyse text words in the title and abstract and keywords and index terms that describe the article. Secondly, all databases considered for review are searched to extract relevant studies using all terms identified in the first stage. Finally, the search for additional studies will also be carried out by scanning the reference list of relevant papers after full-text review.
CINAHL and MEDLINE have been selected in this review to identify index terms and keywords for searching for relevant studies. The search strategy has been developed in consultation with the senior library research advisor and has undergone peer review before finalisation (see additional file 2). Keywords initially identified to search for studies in this review are illustrated in Table 1.
Table 1: Subject headings and keywords
PCC
|
Term
|
Subject heading/terms
|
Other Keywords
|
Participants
|
Direct care workers
|
Nurses
Nursing Assistants
Nursing Staff
Nursing Home Personnel
|
Assistant in nursing
Care assistant
Support worker
Care attendant
Nurse aide
Care aide
Nursing home aide
Paid carer
Formal carer
Care staff
Care worker
|
Concept
|
Caring efficacy
|
Self-efficacy
Professional Competence
Clinical Competence
|
Efficacy
Confidence
Competence
Nursing skill
|
Context
|
Aged care
|
Nursing homes
Assisted Living facilities
Assisted Living
Homes for the aged
Residential facilities
Residential care
Long term care
|
Extended care
Continuing care
Care home
Institutional care
Aged care
Assisted care facility
|
Study Selection
EndNote X9, a reference manager software programme, will be used to remove duplicates from the list of studies identified by databases included in the review. The refined list of studies will be then imported into a Covidence to help in the management of the studies in the review (14). Two reviewers will independently screen titles and abstracts based on the criteria for inclusion or exclusion of the studies for review. Any disagreements will be resolved by the third reviewer. The full text of prospective articles will be then reviewed in detail by two reviewers separately. Any specific reasons for exclusion of full-text studies will be recorded. The third reviewer will resolve the conflict but will also arrange a joint discussion with the review team in case of difficulty in deciding on the inclusion of the study in the review. The final decision will be made by consensus within the review team. The results of the search will be presented in the PRISMA-ScR flow diagram in the final report of the review (15).
Data extraction or Charting the results
Data extraction will be carried out by two independent reviewers following the finalisation of the studies to be included in this review. Data should be aligned with the objectives of the scoping review.
Quantitative data will be extracted from quantitative studies and the quantitative component of mixed methods studies. A draft data extraction form has been developed to record attributes and information of the studies relevant to the review objectives (Additional file 3) which is adapted from JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (16).
Qualitative data will be obtained from qualitative studies and the qualitative component of mixed methods studies using ‘Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI)’ (16) (see additional file 4).
Author(s), year of publication, year of study, type of publication, source origin, research questions/objectives, study design and setting, study population and sample size, measures used, variables of interest such as sociodemographic factors, organisational factors, and the self-efficacy of the study population including other findings that relate to the review question and objectives will be extracted. Additionally, participants’ quotes and researchers’ interpretation, statements, assumptions, and ideas will be extracted from the qualitative studies. However, refinement of the data extraction form is expected while carrying out the full review. The third reviewer will assess any discrepancies and discuss these with the review team to finalise data to be discussed in the result of the review.
Critical appraisal of studies
Critical appraisal of the included studies will be done to assess the methodological quality of these studies. This study will use the critical appraisal tools for different type of studies developed by the JBI (17). There are separate checklists for each type of studies including the critical appraisal checklist for qualitative research. Appropriate checklist will be used for each study depending on the type of study, for instance, checklist for analytical cross-sectional studies, checklist for cohort studies, checklist for randomised control trial, or checklist for qualitative research. The summary of the appraisal of each study will be presented. However, studies will not be excluded based on their appraisal ratings. Critical appraisal will be conducted by two reviewers independently of each other at first and any disagreements will be resolved by the third reviewer.
Data synthesis
The quantitative findings will be presented in narrative form accompanied by the tabulated or charted results from selected studies. If enough studies are available, a meta-analysis will be conducted to calculate pooled estimates of the impacts of various influencing factors on caring self-efficacy. Assuming that the effect size of studies to be included may vary, for instance, due to the characteristics of care workers such as nurses, nursing assistants etc., a random-effects meta-analysis will be performed. Similarly, considering the likelihood of use of different instruments to assess the caring self-efficacy of care workers, standardised mean difference will be considered to calculate the effect size of each studies as recommended by Borenstein et al (18).
Qualitative research findings will be synthesised using meta-aggregation approach (11). Findings will be compiled and then categorised into groups based on similarity in meaning. These categories will be aggregated to generate a set of statements that adequately correspond to the aggregation. These statements will be referred to as the findings of the review synthesized from the qualitative data of the studies included in the review. If the textual pooling is not possible, findings will be presented in the narrative form.