THE LITERATURE

REVIEW
 THE LITERATURE REVIEW
• A method used to support the value and/or the need to study the phenomenon of interest
• A critical component of the research process that provides an in-depth analysis of recently
published research findings relevant to the study that is being considered.
• The review informs the research question and guides development of the research plan.
 THE LITERATURE REVIEW
MUST:
• Be Comprehensive
• Articulate the findings effectively
• Gather information about a topic from relevant sources
• Be an integral part of the scholarly project development process
• Support the need for a practice change, perspective implementation, or alternative
recommendation
 DEFINITION OF THE REVIEW
• Written analytical summary of research finding on a topic of interest
• Comprehensive compilation of what is known about a phenomenon
• Purpose – assess the evidence
• Clear identification of the topic of interest important
 PURPOSE OF THE REVIEW
• Identifies a research problem and how it can be studied
• Helps clarify and determine the importance
• Identifies what is known
• Identifies gaps in the knowledge
• Provides examples
• Provides evidence of the importance of the problem
• Identifies theoretical frameworks and conceptual models
• Identifies experts in the field
• Identifies research designs and methodologies
• Provides a context for analysis
 RATIONALE FOR THE LITERATURE
REVIEW
• Adds credence to the importance of the topic
• Provides studies that can be replicated
• Locates instruments that have already been tested
• Reveals appropriate theoretical frameworks
• Establishes the basis for the subject under study
• Enhances the body of knowledge regarding a specific issue
 TYPES OF LITERATURE FOR THE
REVIEW
• Primary or Secondary sources
• Theoretical or Empirical literature
• Seminal works
 LITERATURE SEARCH
• A significant and crucial stage in the process of writing a literature review
• Labor intensive
• Should be based on a systematic, thorough and rigorous approach
• Utilize databases, journals, and books
• Utilize reference lists from relevant articles
 LITERATURE SEARCH FOR
RESEARCH
• Provides background and context
• Incorporates a theoretical framework
• Specific to a single research question
• Scholarly works from peer-reviewed sources
• Critical appraisal of single focused research reports
 THE LITERATURE SEARCH FOR
PRACTICE
• Focused on a clinical question limited in time frame
• Focuses on application of research to practice
• Specific to a clinical question
• From works in peer reviewed journals
• Critical appraisal of single studies and aggregate research reports
 CONDUCTING A SEARCH
• Seek the help of a professional librarian
• Research idea
• Brainstorm about an idea
• Other articles can provide suggestions for the next step
• Research question • Helps to be curious about topic
• Reading is great source for ideas
• Does not have to be etched in stone
 THE SEARCH STRATEGY
• Identify search terms
• Develop a search statement
• Locate appropriate sources of literature
• Perform the search
• Appraise the studies for quality and value
 THE BASICS OF SEARCHING
• Identify concepts from the research question to focus the search
• Determine any synonyms for identified concepts (search terms)
• Combine search strategies
• AND = reduces the number of citations
• OR = less restrictive
 DATABASES USED IN NURSING
• MEDLINE
• CINAHL
• Cochrane Library
• Nursing & Health Sciences
• Nursing Journal
• PsycINFO
• AID search
• EBSCOhost
 DATABASE OR SEARCH ENGINE?
• Search engines
• Take you to the information
• Help you retrieve accessible information
• Databases
• Organized body of related information
• Arranged for speed of access and retrieval
• Storage location like a library
• Two types – bibliographic and full text
 DATABASES
• Cumulative Index to Nursing and Allied Health Literature (CINAHL)
• Pubmed/MEDLINE
• National Library of medicine with biomedical literature
• Cochrane collaboration/Cochrane nursing care network
• Systematic reviews of interventions
• International organization that prepares systematic reviews on the effects of treatments, prevention, and screening
• “Gold Standard” for systematic reviews and meta-analyses
• Bibliographic Databases
• Literature published in journals
• Provide citation: author, title, source, abstract
• Many offer full text but do not limit search to full text
 APPROPRIATE RESOURCES FOR THE
LITERATURE SEARCH
•Electronic databases
• Books
•Dissertations
•Websites
•Journals
 KEY INFORMATION
Textbooks can be helpful to provide a foundation
• Determine the gaps in the literature and authors of major articles
• More precise the search = fewer number of resources
• More general the search = greater number of resources
 THE LITERATURE REVIEW
PROCESS
• Identify the research problem and review the question
• Plan the information retrieval process
• Carry out the search strategy
• Screen the initial list of citations and abstracts for relevance
Retrieve full text of relevant studies
• Critically appraise the study quality and findings • Summarize and synthesize the findings
 EVALUATING THE LITERATURE
• Must have analytical skills to base the evaluation upon
• Look at the discussion section of article to see the limitations identified for the study
• Driving force is to determine if the study supports the question identified and if any gaps are
seen
 PARTS OF THE STUDY TO
REVIEW
• Purpose of the study
• Sample size and selection
•Design of the study
•Data collection procedures
• Analysis of the data
• Conclusion
 CREATING A STRONG LITERATURE
REVIEW
• Identify the research problem and question
• Select the resources
• Identify inclusion and exclusion criteria
• Build the search strategy and conduct the search
• Screen the initial list of citations and organize them
• Retrieve the full text of relevant studies and summarize
• Critically appraise the study quality and findings
• Summarize and synthesize the findings
 REVIEW AREAS
• Articles: Author’s credentials, citation information
• Purpose – Helps to group similar type studies, organizes the material for later summarizing
• Sample – Selection process, size of the sample
• Method – Implementation of study, inclusion criteria, instruments or surveys used, data
collection procedures, data analysis
• Major Findings – Gaps noted, limitations, next step in the research process
 PROCESS OF REVIEWING
LITERATURE
• Use the library: public, academic and special (hospitals, health centers, certain
organizations)
• Identify sources: manual search or computer search
• Clarify a research topic: make it narrow by using synonyms
• Conduct computer search
 WRITING THE LITERATURE
REVIEW
• Not a summary of articles
• Synthesis of information about the topic
• Purpose – convince the need treader about the o do the study
• Format can vary
• Outlines are helpful to manage the amount of data to be organized
 PEER REVIEW
• One of the hallmarks of research
• Quantitative
• Thorough analysis focusing on potential sources of bias and error
• Applies strict standards to the evaluation of methodology and design
• Qualitative
• Focuses on efforts the author has made to ensure credibility and trustworthiness
 COMPETENT NURSES NEED TO POSSESS
LITERACY SKILLS
• Identify and succinctly state question or problem to be researched
• Use of appropriate resources
• Create effective search strategies
• Critical thinking and analysis skills
• Integrate evidence into practice
• Competence with computers
• Lifelong learning
 LITERATURE REVIEW
• Purposes:
• Gain a broad background of the information available related to the problem.
• Familiarizes the researcher with what work (theoretical and empirical) has been done
concerning a specific problem, what is considered to be the current knowledge about the
problem, gaps in knowledge and what further research is needed.
 FINDING THE EVIDENCE
• Sources
• Primary Literature
• Research
• Secondary Literature
• Clinical Practice Guidelines
• Textbooks
• Protocols
 FINDING THE EVIDENCE
• Primary
• written by the person who originated or is responsible for generating the published ideas
• Secondary
• summarizes or quotes from primary sources
• reported by someone other than the person who conducted the study or wrote the ideas.
 FINDING THE EVIDENCE
• National Guideline Clearinghouse
• http://www.guideline.gov
• Comprehensive database of practice guidelines
• Provides structured abstract for the guideline • Links to full text if available
 SEARCHING FOR GUIDELINES
AND POSITION PAPERS
• Specialty Organizations
• National Association of School Nurses
• American Society for Pain Management Nursing
• American Psychiatric Nurses Association
• American Academy of Nurse Practitioners
• American Academy of Pediatrics
• American Heart Association
• Position Statements are a lower level of evidence, but still useful
 SEARCHING FOR EVIDENCE
• CDSR – Cochrane Database of Systematic Reviews
• CCTR – Cochrane Central Register of Controlled Trials
• MEDLINE – US National Library of Medicine,
• NIH – National Institutes of Health
• CINAHL – Cumulative Index of Nursing and Allied Health Literature
• NGC – National Guideline Clearinghouse
 TYPES AND HIERARCHY OF
EVIDENCE
• Level I
• Systematic Reviews
• Rigorous appraisal of selected studies using a standardized method
• Meta-analysis – 2 parts
• Systematic Review
• Statistical method to combine and analyze the results of a number of studies from the
review
• Evidence-based Clinical Guidelines
• Based on meta-analysis and/or systematic review of Randomized controlled trials
• (RCTs)
 TYPES AND HIERARCHY OF EVIDENCE
• Level II
• Individual RCT
• Experimental design, intervention study
• Random assignment of treatment groups
• Level III
• Quasi-experimental study
• Intervention study • Non-randomized
• Level IV
• Non-experimental
• Case Controlled: comparing patients who have a condition with those who do
not
• Cohort: follows a population over time (Framingham Study)
• Level V
• Meta-synthesis
• Review of descriptive and qualitative studies
 TYPES AND HIERARCHY OF EVIDENCE
• Level VI
• Single descriptive or qualitative study
• Level VII
• Expert Opinion
• National Authorities
• Expert Committees
 EVALUATING THE LITERATURE
• Review of components:
• Purpose of this study
• Sample size and selection
• Design of the study • Theoretical framework, if included
• Data collection procedures
• Analysis of the data
• Author’s conclusion• Review of components:
 STRENGTH OF EVIDENCE
• Quality
• Critical appraisal using standard tools to assess limitations against strength of the evidence
• Quantity
• # of studies examining same question, their sample sizes, and strength of findings
• • Consistency
• The extent that the studies have similar or different designs, but have the same question and
similar findings
 CRITIQUING THE EVIDENCE
• Critical Appraisal using standard tools
• Research – many tools, one example
• Critical Appraisal Skills Programme (CASP)
http://www.phru.nhs.uk/Pages/PHD/CASP.htm
• Clinical Guidelines
• AGREE Instrument – Gold Standard, cannot accept guidelines without ` critiquing
http://www.agreecollaboration.org
• If guidelines implemented into DNP student project, critique with AGREE
should be included
 CASP
• CASP stands for Critical Appraisal Skills Programme
• Critical appraisal is the process of carefully and systematically examining research to judge
its trustworthiness, and its value and relevance in a particular context.
• CASP- http://www.casp-uk.net
 CASP CHECKLISTS
• CASP Randomized Controlled Trial
• CASP Systematic Review
• CASP Cohort Study
• CASP Case Control Study
• CASP Qualitative Research
• CASP Economic Evaluations • CASP Diagnostic Test
• CASP Clinical Prediction Rule
 AGREE II
• The Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument
• evaluates the process of practice guideline development and the quality of reporting.
• http://www.agreetrust.org/resour ce-centre/the-original-agree-instrument
 AGREE II
• Developed to address the issue of variability in guideline quality
• Tool that assesses the methodological rigor and transparency in which a
guideline is developed.
• Provides a framework to: • assess the quality of guidelines;
• provide a methodological strategy for the development of guidelines
• inform what information and how information ought to be reported in guidelines.
• 23 key items organized within 6 domains
• Each domain captures a unique dimension of guideline quality.
 REVIEW OF THE EVIDENCE
• Search terms from PICOT question or research question concepts
• Start with one or two terms and add limits as needed
• Document databases searched and yield of search
• Review abstracts using Inclusion/Exclusion criteria with justification
• Document final yield
 CRITICAL APPRAISAL OF THE
EVIDENCE
• Start with an introduction
• Adequately describe search strategies and yield
• Include databases searched
• Inclusion and exclusion criteria
• Explanation of review protocol or tool
• Define and provide source for levels of evidence
• Provide sufficient detail for at least 5 to 10 individual studies (include title, year and
authors for each study)
• Narrative summary and synthesis.
• Include synthesis table in appendix and synthesized across studies The review must
support the need for a practice change, perspective implementation, or alternative
recommendations
 WRITING THE LITERATURE
REVIEW
• Introduction:
• Indicates the focus or purpose of the study; identifies the purpose of the literature review; describe the
organization of the sources; should be brief to catch the reader’s interest.

• Concise presentation or summary of the state of knowledge in the area.

• Include theoretical and empirical literature

• Include a summary section—gaps of knowledge and how the proposed study will generate essential
information that will fill the gap.

• Synthesize the studies

 SYNTHESIS OF LITERATURE
• Synthesis Table
• tool to organize critique of articles
• Critique each article individually
• Basic understanding of statistical tests important
• Put pertinent information into table
• Use table to synthesize across studies • Include table in report
 SUMMARY POINTS
• Foundation of an EBP project
• Begins with a good literature search
• Engage a professional librarian to help
• Database searches using subject headings yield more precise information
• Identify what is known and unknown about the topic
• Identify gaps in the literature
• Gaps in the literature should support the research question
 RESOURCES
• • Agency for Healthcare Research and Quality (AHRQ) www.ahrq.gov
• • US Preventive Services Task Force www.ahrq.gov/CLINIC/uspstfix.htm
• • Veterans Evidence-Based Research Dissemination Implementation Center (VERDICT):
Translating Medical Evidence into Medical Practice www.verdict.research.va gov.
 RESOURCES
• Evidence-Based Practice Tutorial, University of Minnesota Libraries
www.biomed.lib.umn.edu/learn/ebp
• Evidence-Based Nursing, University of Toronto http://www.cebm.utoronto.ca/syllabi/nur/
(includes sample scenarios, searches, and completed worksheets)
 RESOURCES
• The Doctor of nursing practice scholarly project– framework for success, Moran, Burson &
Conrad, Jones and Bartlett Learning, 2014
• Introduction to nursing research –incorporating evidence-based practice, 3rd edition,
Boswell & Cannon, Jones and Bartlett Learning, 2014
• Evidence-Based Medicine: how to practice and teach it, Strauss, Glasziou, Richardson, &
Haynes , 4th edition, 2011
• Nursing research-generating and assessing evidence for nursing practice, 8th edition, Polit
& Beck, Lippincott, Williams and Wilkins, 2008
• Fairleigh Dickinson University Doctor of Nursing Practice student manual, 2013
• CASP- http://www.casp-uk.net/ • AGREE- http://www.agreetrust.org/resource-centre/the-
original-agree-gov