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Chapter 5: Literature Review
What is literature review
*Is a key step in the research process, as well as a separate section of a study
*An organized critique, systematic summary and critical evaluation of scholarly literature on a topic
*Is succinct; adequately represents positive and negative findings of an area
*Includes adequate number of resources
*Is a synthesis of the literature (a whole formed by combining the overall findings of studies)
Different types of literature: (2)
Data based literature
Scholarly or conceptually based literature: published & unpublished research & theoretical literature. Reports of theories or reviews, how-to types of articles.
Data based literature: reports of original research studies written by researchers who conducted them. Research literature, studies found in journals; also known as empirical, scientific.
*This could be quantitative or qualitative research.
Literature review relationships b/w theory, practice, research, and education
Overall literature review purposes
*Overall purpose: to discover what is known about a topic under review. (or not known-gaps)
*Uncovers knowledge that can be used in research
*Uncovers new knowledge that can be used to refine theory
*Reveals research questions related to nursing
*Identifies the most up to date knowledge on a topic
*Uncovers research findings that support EBP
Literature review: researcher
*For a study: the researcher
•Used to develop a research proposal
: gives the proposal a grounding or place to start.
•Known versus unknown (gaps)
•Discovers unanswered questions or aids in reframing questions.
- •Discovers frameworks used to study the problem: identifies their strengths & limitations.
- -Primary sources hold more weight but secondary sources
- may link the researcher to the primary source.
•Helps generate & refine research questions/hypotheses
•Helps to narrow design and methods
: considers the weaknesses in them.
•Aids in identifying the validity & reliability of measurement instruments.
•Helps to determine the need for study replication
Literature review: consumer
As a consumer:
•To identify multiple sources on a given topic or perspectives.
•Known versus unknown.
•Supports formal, academic or report writing.
•Supports nursing interventions & diagnosis: such as in CPGs (clinical practice guidelines).
•Strengths and weaknesses of an area.
Developing evidence-based practice uncovers a new practice that can be used or further tested or revised
Literature review: quantitative
The review is a step in the research process. Identifies need for the research re:gaps in what is know or why a study must be replicated
Helps to develop the:
*Need or significance or the problem
*Theoretical framework of the study
*Data collection methods
*Data analysis method
*Interpretation, implications & recommendations of findings
Literature review: qualitative
•Dependent upon the research approach. Usually a summary and critique of a theorist's or researcher's work. An in-depth analysis on a topic. Often comes at the end of the research process
•There may be limited data on the topic of study thus little literature.
•Phenomenology (qualitative approach that aims to describe experience as it's lived through, before conceptualized): compare findings with the literature.
•Grounded theory (constructed inductively from a base of observations of the world as it is lived by a selected group of people): constantly compares data with the literature.
•Ethnographic (describes cultural groups, to understand the natives' view of their world): provides a framework for the study.
•Case study (study of a selected contemporary phenomenon over time to provide an in-depth description of the essential dimensions and processes of the phenomenon): the literature is embedded in the report.
•Historical (evaluation and interpretation of facts regarding people, events, and occurrences of the past): the literature review is the source of the data.
Literature sources: (2)
: Data-based, theory, research by the original author.
•Example: Published research study
- Secondary: Usually a summary and critique of a theorists' or
- researcher's work. An in-depth analysis on a topic.
•Example: Article about an analysis of a clinical practice
•Considered because: The primary source is not available, a different way of looking at a problem is offered.
Type of secondary source: systematic
*Special kind of literature review that uses rigorous methods to identify, critically appraise, and synthesize primary studies
*Also known as evidence studies.
*They are unique in that they adhere to a strict scientific design in order to make them more comprehensive, to minimize the chance of bias, and to ensure their reliability.
*They offer the best available evidence on a topic for HCPs to make their clinical judgments.
*Consumer can filter this evidence through own evidence-based practice “lens”.
*The Cochrane database
houses only these types of reviews.
Two types of systematic review: qualitative & meta-analysis/quantitative
doesn't use statistics
uses statistics to combine findings of two or more studies
Characteristics of BOTH qualitative & meta-analysis/quantitative REVIEWS
- indicates the question, the method of retrieving primary sources, the selection process, the critiquing criteria, & the techniques to be used to synthesize the findings.
- the criteria used enables another researcher to use it & draw the same conclusions.
- condenses information into a usable objective format
Journals: refereed (peer reviewed journals)
•The preferred means of communicating latest theory & research findings.
•Blind reviewed by external reviewer(s).
•Judged using a set of criteria.
•Most research articles that are reviewed for publication are declined.
Steps of EBP
- *The usage of research findings is referred to as research
- utilization or uptake.
- How does one start the process of utilizing EBP.
- 1. problem focused: problems identified by staff in practice. Ex: ↑occurrence of pulmonary emboli post DVT.
- 2. knowledge focused: results from staff reading & listening. Ex: Prevention of skin breakdown in bed ridden patients
*Once you have identified a problem focused or knowledge focused trigger formulate an EBP question using PICO = guides literature search on the problem of interest and the EBP change process & will transform an unstructured clinical scenario into a structured question to facilitate use of research literature
Review of PICO
- *P = Patient/Population/Problem - who do you want information on? maybe necessary to specify age, gender, disease
- type, disease severity.
I = Intervention
- what are the main interventions being considered? treatments for conditions, diagnostic tests, exposure to a possible cause, risk factors, lifestyle etc.
- what could be done instead of the intervention? This might be a placebo, another drug, another style of treatment or you may be treating or diagnosing for the first time therefore there is no comparison.
- What results are you looking for - improvement of symptoms, healing, side effects, improved quality of life, cost effectiveness for the service provider.
EBP process steps (???)
*Retrieve the evidence.
*Rate & critique the evidence.
*Look at the level of evidence (measure of the strength of evidence found in a research study)
*Synthesis the study findings.
*Make recommendations for EBP.
*Decide if a change is required in practice.
*Implementation of practice change.
*Evaluation of the practice change.
Types of research studies:
random controlled trials - therapy
cohort studies - etiology, prognosis, prevention
case control - etiology, prognosis, prevention
case series/case reports - answers prognosis, etiology, prevention
**certain study designs are superior to others when answering particular questions
RCT (avoids selection bias) = considered the best for addressing questions about therapy
Case control & cohort studies = etiology questions
- Cohort studies (answers prognosis, etiology, prevention questions)
- Cohorts are defined populations that, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. Researchers identify and compare two groups over a period of time. At the start of the study, one of the groups has a particular condition or receives a particular treatment, and the other does not. At the end of a certain amount of time, researchers compare the two groups to see how they did.
- Case control studies (answers prognosis, etiology, prevention questions) Case control studies are studies that identify patients who already have the outcome of interest and
- control patients without that outcome, and look back to see if they had the exposure of interest or not.
- -An example could be smoking linked to stroke in middle aged women.
- Case series/case reports:
- Consist either of collections of reports on the treatment of individual patients, or of reports on a single patient.
LEVELS OF EVIDENCE: depends on type of research method being used
meta analysis is at the top
Research consumer types:
nurses in clinical settings
professional nursing organizations
implementing research-based nursing interventions: undergrad students, nurses in clinical settings
developing scholarly academic papers: faculty members, graduate students
developing practice guidelines: governmental agencies, professional nursing organizations
developing research proposals for master's theses: graduate
evalueating hospital continuous quality improvement programs: governmental agencies
revising curricula: faculty members
Secondary or primary
summaries of research studies: s
first-hand accounts: p
client records: p
reports written by the researcher: p
dissertations or master's theses: p
true or false
you have access at home to the cumulative index to nursing and allied health literature (CINAHL) database and can now do your literature search wo any additional cost - F
Info about CINAHL products and links to other nursing sources can be accessed at http://www.cinahl.com - T
Which of the following is the best database for a search of nursing literature? Medline or CINAHL - CINAHL
print databases like CINAHL print index, must be used for lit searches of material published before 1982 - T
there is usually extra charge for access ot the full text of an article by fax or modem over the internet from CINAHL - T
Examples of conceptual or database
published quantitate and qualitative studies - D
published articles or books disccusing theories or concepts - C
Unpublished abstracts of research studies from research conferences - D
Published studies (in journals) describing relationships between variables - D