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Category: Nursing

  • 50 Nursing Dissertation Topics in PICO Format for UK Students, Each With a Review Question (2026)

    50 Nursing Dissertation Topics in PICO Format for UK Students, Each With a Review Question (2026)

    The nursing dissertation topic that fails is not the dull one. It is the one that cannot be turned into a review question with a population, an intervention, a comparison and an outcome, because a UK nursing dissertation is almost always a literature review, and a literature review lives or dies on its question. The fifty topics below cover the four fields of nursing and the areas of practice UK programmes actually assess, and every one is already a one-line PICO or PICo question, so the search, the inclusion criteria and the chapter plan follow from it. If the question is chosen and the proposal is still blank, Tesify drafts the proposal and the review chapters from your own question and your own included studies; the free tier covers the first chapter.

    Why the question comes before the topic

    PICO was set out by Richardson, Wilson, Nishikawa and Hayward in a 1995 ACP Journal Club editorial called “The well-built clinical question”, and it is still the frame UK nursing schools teach because it does three jobs: it tells the database what to search for, it tells you which studies to include, and it tells the marker in one sentence what the review is for. A topic (“pressure ulcers”) does none of those; a question (“in immobile adult inpatients, does two-hourly repositioning, compared with four-hourly, reduce pressure ulcer incidence?”) does all three. Where the question is about experience rather than effect, PICo (the Joanna Briggs Institute’s variant) or SPIDER (Cooke, Smith and Booth, Qualitative Health Research, 2012) applies.

    Framework Elements Use it when the question is about
    PICO Population, Intervention, Comparison, Outcome Whether a nursing intervention works: effectiveness, safety, adherence
    PICo Population, phenomenon of Interest, Context How patients, families or nurses experience something
    SPIDER Sample, Phenomenon of Interest, Design, Evaluation, Research type Qualitative or mixed-methods questions where study design matters

    The Nursing and Midwifery Council’s Standards of proficiency for registered nurses (2018) set out seven platforms, from being an accountable professional to coordinating care, and the fifty questions below are grouped by field and area of practice so that each sits inside one of them; qualitative questions are marked PICo. None repeats the falls and intentional-rounding example worked through in our guide to the nursing dissertation search strategy, which shows how any of these questions becomes a documented search.

    The Oxford Centre for Evidence-Based Medicine on turning a clinical problem into a PICO search question; the fifty questions below are written to that pattern.

    Adult nursing: acute and medical–surgical care

    1. Early warning scores. In adult ward patients, does NEWS2 with a mandated escalation protocol, compared with clinical judgement alone, reduce unplanned admissions to intensive care?
    2. Sepsis bundles. In adults presenting to the emergency department with suspected sepsis, does completion of the Sepsis Six within one hour, compared with later completion, reduce in-hospital mortality?
    3. Pressure ulcer prevention. In immobile adult inpatients, does two-hourly repositioning, compared with four-hourly repositioning on a high-specification foam mattress, reduce pressure ulcer incidence?
    4. Nurse-led discharge. In adults on acute medical wards, does nurse-led discharge, compared with doctor-led discharge, reduce length of stay without increasing 30-day readmission?
    5. Surgical site infection. In adults undergoing elective surgery, does preoperative chlorhexidine body washing, compared with plain soap, reduce surgical site infection?
    6. Post-operative pain. In post-operative adults, does a structured pain assessment tool used at every observation round, compared with unstructured assessment, improve pain scores at 24 hours?
    7. Malnutrition. In older adults admitted to hospital, does screening with the Malnutrition Universal Screening Tool linked to a care plan, compared with screening alone, improve nutritional intake?

    Mental health nursing

    1. Restrictive practice. In adult acute mental health wards, does the Safewards model, compared with usual care, reduce the use of restraint and seclusion?
    2. Observation. In inpatients assessed as at risk of self-harm, does engagement-based intermittent observation, compared with continuous observation, reduce self-harm incidents?
    3. Physical health. In adults with severe mental illness under community teams, does nurse-led physical health monitoring, compared with GP-led monitoring, increase completion of annual cardiometabolic checks?
    4. Crisis care. In adults presenting in mental health crisis, does a crisis resolution and home treatment team, compared with inpatient admission, reduce readmission at twelve months?
    5. Trauma-informed care (PICo). What are the experiences of adult inpatients of trauma-informed care on acute mental health wards in the UK?
    6. Peer support. In adults discharged from acute psychiatric care, does peer support worker follow-up, compared with standard follow-up, reduce readmission within 90 days?
    7. Eating disorders. In adolescents with anorexia nervosa, does family-based treatment, compared with individual therapy, improve weight restoration at twelve months?

    Children’s and young people’s nursing

    1. Procedural pain. In children undergoing venepuncture, does distraction with a tablet device, compared with standard comfort measures, reduce self-reported pain?
    2. Paediatric early warning. In hospitalised children, does a paediatric early warning score, compared with unstructured observation, reduce unplanned admissions to paediatric intensive care?
    3. Parental presence. In children undergoing induction of anaesthesia, does parental presence, compared with premedication alone, reduce preoperative anxiety?
    4. Asthma self-management. In school-age children with asthma, does nurse-led self-management education, compared with usual care, reduce emergency attendances?
    5. Transition (PICo). What are the experiences of young people with long-term conditions of the transition from children’s to adult services in the UK?
    6. Bronchiolitis. In infants admitted with bronchiolitis, does high-flow nasal cannula therapy, compared with standard oxygen, reduce escalation of treatment?
    A nursing student's notebook with a question written out in four labelled parts beside a laptop showing a database search screen
    Write the four elements on one line before you open CINAHL. The search string, the inclusion criteria and the chapter plan all come from that line.

    Learning disability nursing

    1. Annual health checks. In adults with a learning disability, do annual health checks in primary care, compared with usual care, increase detection of unmet health needs?
    2. Reasonable adjustments (PICo). What are the experiences of adults with a learning disability of reasonable adjustments during a hospital admission?
    3. Diagnostic overshadowing. In adults with a learning disability presenting with physical symptoms, does use of a hospital passport, compared with none, reduce delayed diagnosis?
    4. Positive behaviour support. In adults with a learning disability whose behaviour challenges services, does positive behaviour support, compared with usual care, reduce psychotropic prescribing?

    Older people, dementia and community nursing

    1. Delirium. In hospitalised adults over 65, does a multicomponent delirium prevention programme, compared with usual care, reduce incident delirium?
    2. Pain in dementia. In people with dementia unable to self-report, does routine use of an observational pain tool, compared with usual assessment, increase appropriate analgesia?
    3. Hospital at home. In frail older adults with an acute illness, does hospital-at-home care, compared with inpatient admission, reduce six-month mortality and care home admission?
    4. Continence. In older adults in care homes, does prompted voiding, compared with usual care, reduce episodes of urinary incontinence?
    5. Living alone (PICo). What are the experiences of older adults living alone of community nursing visits in the UK?
    6. Polypharmacy. In adults over 75 taking ten or more medicines, does a structured medication review by a nurse prescriber, compared with usual care, reduce adverse drug events?

    Infection prevention and patient safety

    1. Hand hygiene. In acute hospital staff, does electronic monitoring with feedback, compared with direct observation audit, improve hand hygiene compliance?
    2. Catheter infection. In adult inpatients with a urinary catheter, does a daily review-and-remove prompt, compared with usual care, reduce catheter-associated urinary tract infection?
    3. Medication errors. In hospital nurses, does a protected medication round with a no-interruption tabard, compared with usual practice, reduce administration errors?
    4. Handover. In acute wards, does structured SBAR handover, compared with unstructured handover, reduce missed care?
    5. Venous thromboembolism. In medical inpatients, does nurse-led VTE risk assessment on admission, compared with medical-led assessment, increase timely prophylaxis?
    6. Safety huddles. In inpatient wards, do daily safety huddles, compared with none, reduce reported patient harm events?

    Workforce, education and leadership

    1. Shift length. In UK registered nurses, is twelve-hour shift working, compared with eight-hour shifts, associated with higher burnout?
    2. Preceptorship (PICo). What are the experiences of newly registered nurses of preceptorship in NHS trusts?
    3. Skill mix. In acute wards, is a higher proportion of registered nurses in the staffing mix, compared with a lower proportion, associated with lower patient mortality?
    4. Simulation. In pre-registration nursing students, does high-fidelity simulation, compared with lecture-based teaching, improve recognition of clinical deterioration?
    5. Compassion fatigue. In oncology nurses, does a resilience training programme, compared with none, reduce compassion fatigue scores?
    6. Retention. Which factors are associated with intention to leave among early-career nurses in the NHS?

    End-of-life and palliative care

    1. Advance care planning. In adults with advanced heart failure, does nurse-led advance care planning, compared with usual care, increase documented preferences and death in the preferred place?
    2. Dying in hospital (PICo). What are the experiences of family members of end-of-life care on acute hospital wards?
    3. Breathlessness. In adults with advanced cancer, does a nurse-led breathlessness intervention, compared with usual care, improve breathlessness scores?
    4. Anticipatory prescribing. In community palliative care patients, does anticipatory medication prescribing, compared with reactive prescribing, reduce emergency admissions in the last week of life?

    Long-term conditions and public health

    1. Type 2 diabetes. In adults with type 2 diabetes, does nurse-led structured education, compared with usual care, reduce HbA1c at twelve months?
    2. Smoking cessation. In hospital inpatients who smoke, does nurse-delivered brief advice with referral, compared with advice alone, increase quit rates at six months?
    3. Heart failure. In adults discharged after a heart failure admission, does nurse-led telephone follow-up, compared with usual care, reduce 30-day readmission?
    4. COPD. In adults with COPD, does nurse-led self-management with a written action plan, compared with usual care, reduce hospital admissions?
    Printed research papers sorted into three piles on a desk with coloured tabs, beside a completed appraisal checklist and a highlighter
    A good question yields eight to fifteen primary studies from the last ten years. Fewer means widen the population; more means narrow the outcome.

    How to test a topic in an afternoon

    Three checks before the question goes in the proposal. First, search: put the population and intervention terms into CINAHL and MEDLINE, limit to the last ten years, and count the primary studies. Eight to fifteen is the range an undergraduate review can appraise properly; fewer than five means the question is too narrow or too new, more than forty means the outcome or population needs tightening. Second, check the outcome is measured the way the studies measure it: “patient experience” needs qualitative studies, “reduces readmission” needs trials or cohort studies reporting it. Third, check UK applicability: NICE guidance or a national programme on the topic gives you the implications section.

    Whether the result is a literature review or a systematic review is a matter of scale and method, and the difference is set out in our guide to literature review versus systematic review for a dissertation. If your programme allows a secondary-data project instead, the published NHS datasets a taught student can use without NHS ethics approval are catalogued in our guide to NHS and public health datasets for a dissertation; the Staff Survey and prescribing questions above can be answered from those data directly.

    What the marker is looking for

    Consistency. The question in the introduction has to be the one the search was built for, the one the inclusion criteria enforce, the one each study is appraised against and the one the synthesis answers. The commonest way a nursing dissertation drops a band is drift: the question says “adult inpatients”, and the search returned paediatric studies that were then included. The second is an appraisal chapter that describes the studies without judging them; the tools that stop that are in our guide to the CASP checklist for a nursing dissertation.

    The narrowing method that turns any of the fifty into a title the supervisor will sign is the one used across subjects in our pillar on dissertation topic ideas by subject: choose the population you can defend, the outcome you can measure and the setting you can write about.

    From one line to a proposal, with Tesify

    The stall point is rarely the question. It is the fortnight after, when the proposal form asks for aims, objectives, a search plan and a chapter outline, and the student with a good PICO question has a blank form.

    1. Paste the question. Tesify reads the four elements and drafts the aim, objectives and rationale around them in the British academic register your handbook expects.
    2. Build the search plan. Databases, search terms with synonyms and truncation, and inclusion criteria drawn from the question, ready to run in CINAHL and paste into the methods chapter.
    3. Add your included studies. Enter the studies you have appraised and Tesify structures the findings and synthesis chapters around your evidence.
    4. Edit with the AI Editor. A final read for clarity, consistent terms and British spelling, so the question in chapter one matches the answer in chapter five.

    The free tier covers the first chapter, and the text is yours to export at any point. Start with your question and let Tesify draft the proposal around it today. The judgement, the appraisal and every sentence remain 100% written by you; what you get is a dissertation that exists on the day the form is due.

    Frequently asked questions

    Do UK nursing dissertations have to be literature reviews?

    On most pre-registration programmes, yes, because the Health Research Authority has not accepted undergraduate applications for NHS ethics review since September 2021. Some programmes allow a secondary analysis of published data or a service improvement proposal; check your module handbook.

    Is PICO the only framework I can use?

    No. PICO fits questions about whether an intervention works; PICo or SPIDER fit questions about experience. Either is acceptable as long as the framework matches the studies you intend to include.

    How many studies should a nursing literature review include?

    Most UK undergraduate reviews appraise between six and twelve primary studies in full, with the search documented and exclusions accounted for; a master’s review is usually larger. The number follows from the question.

    Can I use a topic from my placement?

    Yes, provided the question is in PICO form and answered from published evidence rather than anything observed or recorded on placement. Never include patient or staff information from the placement itself.

    Is using Tesify on a nursing dissertation academic misconduct?

    Not where your university permits AI assistance and you follow its declaration rules. Tesify structures and drafts from your own question and your own appraised studies; the appraisal, the synthesis and the final text are yours, declared where your handbook asks.

    How much does Tesify cost?

    There is a free tier that covers the first chapter and the core drafting and bibliography features. Paid plans are priced for students in pounds and can be cancelled at any time.

    Does Tesify store patient or placement data?

    Never enter patient, staff or placement data into any writing tool; a literature review does not need any. Tesify works from your question, your included published studies and your own drafting, and the text remains yours.

    Can I change the question after the proposal is approved?

    Usually, with your supervisor’s agreement, and narrowing is the commonest change. Widening the population or swapping the outcome after the search means re-running it, so settle the question first.

  • How Do You Write the Search Strategy Section of a Nursing Dissertation? (2026)

    How Do You Write the Search Strategy Section of a Nursing Dissertation? (2026)

    Write your search strategy as a reproducible record, not a narrative. It needs five things: a structured review question (usually PICO), the databases you searched with the dates you searched them, the exact search string including Boolean operators and truncation symbols, your inclusion and exclusion criteria with a justification for each, and a PRISMA flow diagram accounting for every record from initial hits to final included studies. If a second person could rerun your search and land on roughly the same papers, the section has done its job.

    Most UK undergraduate nursing dissertations are literature-based rather than empirical, and the search strategy is where a mid-2:1 separates from a first. Markers cannot assess the quality of a synthesis if they cannot see how the papers arrived. This guide walks the section in the order you should write it, with the level of detail a Faculty of Health and Social Care marking rubric actually expects.

    Why does the search strategy carry so many marks?

    In an empirical dissertation, the methodology chapter explains how you produced data. In a literature-based nursing dissertation, the search strategy is your methodology chapter. It is the only evidence a marker has that your sample of studies was assembled systematically rather than by convenience.

    Marking criteria across UK nursing programmes typically award credit under headings such as “rigour of the review process” or “systematic approach to literature retrieval”. The predictable failure is a paragraph reading: “A search was conducted using CINAHL and Medline using keywords relating to the topic.” That sentence is unrepeatable, unverifiable, and reads as though the papers were chosen because they were convenient. If you are still deciding whether your project is a narrative review or something more formal, settle the question of whether you need a systematic review or a literature review before you write a word of this section, because the two demand different levels of procedural detail.

    How do you turn your topic into a PICO question?

    PICO forces a vague clinical interest into a searchable structure. For most nursing dissertations the four elements are:

    • P — Population: who, specifically. Not “patients” but “adults aged 65 and over admitted to acute medical wards”.
    • I — Intervention: the thing being done. “Intentional rounding”, “early mobilisation”, “structured handover using SBAR”.
    • C — Comparison: usual care, an alternative intervention, or nothing. Comparison is legitimately absent in qualitative reviews.
    • O — Outcome: what changes. “Incidence of hospital-acquired pressure ulcers”, “patient-reported anxiety”, “call-bell frequency”.

    A worked example: In adults aged 65 and over on acute medical wards (P), does hourly intentional rounding (I), compared with usual nursing observation (C), reduce the incidence of in-hospital falls (O)?

    If your review is qualitative — nurses’ experiences of something, patients’ perceptions of something — PICO fits awkwardly. Use SPIDER instead (Sample, Phenomenon of Interest, Design, Evaluation, Research type), and say in the text that you selected SPIDER because it is better suited to retrieving qualitative evidence. Naming the framework and justifying the choice is itself worth marks.

    Which databases should a UK nursing student search?

    Search a minimum of three, and say why you chose each. The defensible core for nursing:

    • CINAHL Complete — the primary nursing and allied health database. Non-negotiable for a nursing dissertation, and its absence will be noticed.
    • Medline (via Ovid or EBSCO) — biomedical coverage, indexed with MeSH terms.
    • British Nursing Index (BNI) — UK-focused nursing literature, useful when your question has NHS-specific relevance.
    • PsycINFO — add it if your outcome is psychological: anxiety, coping, wellbeing, mental health nursing.
    • Cochrane Library — search it for existing systematic reviews. If a Cochrane review already answers your exact question, you need to narrow your angle, and finding this out in week two is far better than in week ten.

    Google Scholar is a supplementary tool, not a database in this sense. You may use it for citation chaining, but declare it as such rather than listing it alongside CINAHL. For a broader map of the platforms available and how their interfaces differ, see the comparison of databases worth searching for dissertation literature.

    State the interface too. “CINAHL Complete via EBSCOhost, searched 14 October 2026” is what reproducibility looks like. Record the date of every search — results change as records are added, and an undated search is not repeatable.

    How do you build the actual search string?

    Take each PICO element, generate synonyms, join synonyms with OR, then join the blocks with AND. Add truncation and phrase searching.

    Working from the falls example:

    • Population block: (older adult* OR elderly OR geriatric* OR “aged 65”)
    • Intervention block: (“intentional rounding” OR “hourly rounding” OR “comfort round*” OR “nursing round*”)
    • Outcome block: (fall* OR “falls prevention” OR “patient safety incident*”)

    Combined: (older adult* OR elderly OR geriatric*) AND ("intentional rounding" OR "hourly rounding" OR "nursing round*") AND (fall* OR "falls prevention")

    Three mechanics to get right, because markers check them:

    1. Truncation. The asterisk retrieves word variants. nurs* catches nurse, nurses, nursing. Be careful with short stems — car* returns care, caring, carer, but also cardiac, carcinoma and carbohydrate.
    2. Phrase searching. Quotation marks keep multi-word concepts intact. Without them, intentional rounding may be read as two separate terms and your precision collapses.
    3. Subject headings. CINAHL headings and Medline MeSH terms are the controlled vocabulary applied by indexers. Searching MH "Accidental Falls" alongside your free-text terms catches papers whose authors used wording you did not think of. Combining subject headings with free-text terms is the single clearest signal of a competent search, and it is worth a sentence in your text explaining that you did it.

    Present the search in a table with one row per database: database, interface, date searched, full string as entered, and number of hits. Put the table in the chapter itself, not buried in an appendix — markers should not have to hunt for your central evidence.

    What inclusion and exclusion criteria are defensible?

    Every criterion needs a reason attached. A bare list looks arbitrary; a justified list looks methodological.

    Criterion Decision Justification you write
    Date range 2016–2026 Captures practice since the current NMC standards, keeping evidence contemporary to today’s clinical context.
    Language English only Translation resources unavailable at undergraduate level; acknowledged as a limitation.
    Peer review Peer-reviewed only Provides a baseline quality threshold before formal appraisal.
    Setting Acute hospital settings Aligns with the population in the review question; community settings differ materially in staffing.
    Study design Primary research only Reviews and editorials excluded to avoid double-counting findings from included primary studies.
    Geography OECD countries Health systems broadly comparable to the NHS, supporting transferability of findings.

    Two honesty points. “English only” is a real limitation — write it into your limitations section rather than hoping nobody notices. And do not exclude on geography as narrowly as “UK only” unless your question is genuinely NHS-specific; you will usually strand yourself with three papers and no review.

    How do you build the PRISMA flow diagram?

    PRISMA 2020 gives you a four-stage diagram, and every number in it must reconcile. The stages:

    1. Identification: total records retrieved from each database, plus records identified through other methods such as reference-list searching. State each database’s contribution separately, then the total.
    2. Screening: duplicates removed, then titles and abstracts screened. Record how many were excluded here.
    3. Eligibility: full texts assessed. This is the stage students most often get wrong — you must give reasons for full-text exclusions with counts, for example “wrong population (n = 7), wrong outcome (n = 4), not primary research (n = 3)”.
    4. Included: the final studies carried into your synthesis.

    A worked reconciliation: 412 records identified (CINAHL 187, Medline 148, BNI 61, reference chaining 16). 68 duplicates removed, leaving 344 screened on title and abstract. 316 excluded, leaving 28 full texts assessed. 20 excluded with reasons stated. 8 studies included. The arithmetic must work in both directions — markers do check, and a diagram whose numbers do not add up undermines everything downstream of it.

    Eight to twelve included studies is a normal, healthy yield for an undergraduate nursing dissertation. Three suggests your criteria were too tight. Forty suggests your question was too broad and you have more reading than the timetable allows.

    What comes immediately after the search strategy?

    Two things, and both belong in the same chapter.

    First, quality appraisal. Having found your studies you must show you judged them rather than accepted them. In UK nursing dissertations that almost always means a CASP checklist matched to each study’s design — a different checklist for qualitative studies, cohort studies and randomised trials. If you have not chosen an appraisal tool yet, work through what a CASP checklist is and whether your nursing dissertation needs one before drafting your findings.

    Second, your synthesis approach. Name the method. For a qualitative or mixed set of papers this is usually thematic synthesis, and you should describe how codes became themes across studies rather than merely asserting that themes “emerged”. The mechanics transfer directly from primary research — the sequence in the six phases of thematic analysis applies whether your data are interview transcripts or findings sections of published papers.

    Do you need ethics approval for a literature-based nursing dissertation?

    Almost never — but you still need to say so explicitly. A review of already-published literature involves no human participants and no identifiable data, so most UK schools of nursing either exempt it or require a short self-declaration form rather than full committee review. Write one sentence stating that ethical approval was not required because the study involved secondary analysis of published literature, and reference your school’s policy. The rules shift the moment your project touches patients, staff or NHS data, which is covered in detail in the guide to ethics approval for an undergraduate dissertation.

    Five errors that cost marks in this section

    1. Reporting hits without the string. “CINAHL returned 187 results” proves nothing without the search that produced them.
    2. Free-text terms only. Ignoring CINAHL headings and MeSH is the most common reason a search misses obvious papers.
    3. A PRISMA diagram that does not reconcile. Numbers that fail to add up read as fabricated even when they are simply careless.
    4. No reasons for full-text exclusions. PRISMA 2020 requires them; omitting them is a straightforward compliance failure.
    5. Undated searches. Without dates the search is not reproducible, which defeats the section’s entire purpose.

    A realistic order of work

    Draft the section in this sequence and it assembles itself: finalise the PICO question, build and test the string in CINAHL first, adjust once you see the hit count, replicate across your other databases, export everything to your reference manager and deduplicate there, screen titles and abstracts, screen full texts recording every exclusion reason as you go, then draw the PRISMA diagram from your own running tally rather than reconstructing it from memory afterwards.

    Keep a search log from day one — a simple spreadsheet with database, date, string, hits. Students who reconstruct their search a fortnight before submission always lose numbers, and the diagram never reconciles. Because you will already be tracking references at this stage, having a realistic sense of how many references a dissertation needs helps you judge whether your yield is on target before you commit to the synthesis.

    Get the section drafted while the search is fresh

    The search strategy is the most mechanical chapter in a nursing dissertation, which makes it the one most worth drafting immediately rather than leaving to the end. Tesify can turn your PICO question, database list and screening numbers into a structured first draft of the section, formatted with the search table and PRISMA narrative in place, so you spend your remaining time on appraisal and synthesis rather than on prose scaffolding. The searching, screening and judgement stay yours — the drafting stops being the bottleneck.

    Frequently asked questions

    How many databases should I search for an undergraduate nursing dissertation?

    Three as a minimum, and CINAHL must be one of them. A typical defensible set is CINAHL, Medline and British Nursing Index, with PsycINFO added when the outcome is psychological. Check your module handbook, as some schools specify a required number.

    Do I need a PRISMA diagram if my dissertation is not a systematic review?

    It is rarely mandatory for a narrative review but almost always improves your mark. It demonstrates transparency in a single figure and costs nothing beyond keeping accurate counts as you screen.

    How many studies should my final review include?

    Eight to twelve is typical for an undergraduate nursing dissertation. Fewer than five usually signals overly restrictive criteria; more than twenty is more appraisal than the word count and timetable can support.

    Can I include grey literature such as NICE guidance or NHS reports?

    Yes, if you declare it as a separate search stream and state how it was appraised. Grey literature is not peer reviewed, so it typically informs your background rather than sitting inside the synthesis of primary studies.

    Does the search strategy go in the methodology chapter or an appendix?

    The strategy, the search table and the PRISMA diagram belong in the main body. Appendices are for supporting material such as completed CASP checklists and full data extraction tables.

    What if my search returns almost nothing?

    Widen in this order: add synonyms and subject headings, loosen the date range, drop the comparison element, then broaden the population. Broadening the population first is the usual mistake because it changes the question you set out to answer.