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• Volume 14, Issue 8
• Prevention and care of adult enterostomy with high output: a scoping review protocol
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• http://orcid.org/0009-0008-0113-2984 Ying Che 1 ,
• Tianming Wang 2 ,
• Caifeng Gao 3 ,
• Fei Sun 1 ,
• Shangke Li 4 ,
• Zhanlin Luo 5
• 1 Research Ward , Gansu Provincial Hospital , Lanzhou , China
• 2 Gansu University Of Chinese Medicine , Lanzhou , China
• 3 Department of radiotherapy , Gansu Provincial People's Hospital , Lanzhou , China
• 4 Gansu Provincial Hospital , Lanzhou , Gansu , China
• 5 Department of radiotherapy , Gansu Provincial Hospital , Lanzhou , Gansu , China
• Correspondence to Professor Zhanlin Luo; lzl120606{at}126.com

Introduction The purpose of this protocol is to investigate the risk factors, critical evaluation contents and preventive measures of high-output enterostomy.

Methods and analysis This scoping review will follow the Joanna Briggs Institute guidelines for scoping reviews. PubMed, EMBASE, CINAHL, the Chinese Biological Literature Database and the Cochrane Library will be searched for relevant literature published from January 2015 to January 2024. The Grading of Recommendations, Assessment, Development and Evaluation and the Risk Of Bias In Non-randomised Studies of Interventions will be used to assess the reliability of the evidence.

Ethics and dissemination As this scoping review involves database searches for literature analysis, informed consent and ethical approval from patients will not be required. The findings will provide essential decision-making information for researchers, clinicians and ostomy nursing staff. The results of the review will be presented at a scientific conference and published in a peer-reviewed journal.

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2023-078602

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STRENGTHS AND LIMITATIONS OF THIS STUDY

This protocol will strictly adhere to the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews.

The literature search will include only English and Chinese literature from the past 10 years, potentially limiting the comprehensiveness of the search. However, researchers will broaden the search scope based on the included literature and supplement it by searching grey literature.

The Grading of Recommendations, Assessment, Development and Evaluation and Risk Of Bias In Non-randomised Studies of Interventions tools will be used to grade the quality of the evidence obtained after quality evaluation, ensuring the scientific rigour of the research design and the appropriateness of evidence classification.

To reduce the risk of bias, researchers will triple-check the input data during the process of literature quality evaluation and evidence summarisation.

Introduction

In recent years, with the rapid development of living standards, people’s eating habits and lifestyles have undergone major changes, leading to a continuously increasing trend in the incidence and mortality of malignant tumours such as gastric cancer and colorectal cancer. 1 The treatment of colorectal cancer predominantly involves surgery, and the number of patients undergoing enterostomy is on the rise. 2 Enterostomy requires the removal of the cancerous end of the intestine, extraction of a section of the intestine through the abdominal incision, and its attachment to the abdominal wall skin to form a stoma. 3 As the anal sphincter loses its normal excretion function, patients must use a stoma bag to collect excreta postsurgery. In the USA, approximately 100 000 patients undergo enterostomy annually, with a current total of 1 million enterostomy patients. 4 Despite rapid advancements in surgical techniques, the incidence of high output in enterostomy patients ranges from 23.8% to 31.1% compared with other common surgical procedures. 5 6

Postoperative complications of enterostomy can be categorised into early and advanced complications based on the time of occurrence. Early complications refer to those occurring within the first 30 days postoperation. High output is a prevalent early complication of enterostomy. 7 Typically, the output from an enterostomy ranges from 500 to 2000 mL but varies based on the type of stoma, enteral feedings and other factors. A review of extensive literature reveals ambiguity in the normal output for different types of enterostomies; however, it is widely accepted that an output exceeding 1500 mL per day from a small bowel enterostomy is considered high. 8 Fluid losses postsurgery usually resolve within a few weeks due to adaptive changes in the remaining small intestine. In some patients, high-output enterostomy results from inadequate adaptation or other causes of diarrhoea, such as indigestible food intake, leading to significant water and electrolyte loss, and potentially causing complications like kidney function injury. 9 High output is also the most common reason affecting readmissions of enterostomy patients. 10 Moreover, the quality of life for patients with enterostomy is poor in the early stages due to insufficient knowledge about stoma care and influences such as psychological emotions. 11 Overall, the risk of postoperative complications after enterostomy is lifelong, with high output being a frequent complication. Specialist stoma nurses should proactively focus on complication prevention and provide guidance.

Currently, the literature on preventing high output has not received adequate attention, and there is no consensus to guide precise and effective nursing interventions for preventing high output in enterostomy patients. Monitoring of enterostomy discharge is also often overlooked by patients and clinical ostomy nurses. Additionally, the variable quality of relevant literature can waste medical resources and lead to misleading clinical practices.

Given these issues, it is urgent to determine a comprehensive and effective prevention programme for high output. The scoping review, based on evidence-based concepts, aims to help researchers understand the scope and characteristics of existing evidence and identify gaps in the evidence. Thus, the methods employed in this study were designed to retrieve, summarise and analyse relevant evidence on high output in enterostomy patients, providing an evidence-based foundation for clinical nurses, patients and caregivers to implement enterostomy care and reduce the incidence of high output.

Review questions

What are the risk factors for high output enterostomy?

What are the critical evaluation contents of high-output enterostomy?

What are the main interventions that can effectively prevent high-output enterostomy?

This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. 12 13 The study is scheduled to commence in April 2024 and conclude in August 2024. This protocol has been registered with the OSF ( https://doi.org/10.17605/OSF.IO/UF9B7 ).

Patient and public involvement

No patients and the public were involved.

Inclusion criteria

The subjects are patients who have undergone enterostomy (including colostomy, ileostomy, cecostomy, jejunostomy, etc) after a pathological diagnosis of malignant diseases such as stomach and colorectal cancer. The patients are 18 years or older. Enterostomy in children is excluded due to factors such as the thin cuticle of the skin, crying and different ostomy bag management needs. Additionally, children undergoing enterostomy often have various congenital diseases, such as anal absence and Hirschsprung’s disease, which differ significantly from adult enterostomy. Finally, the rehabilitation outcomes for minor enterostomy patients depend on the effectiveness of care provided by primary caregivers, which is a further reason for their exclusion from this study.

Exclusion criteria

The subjects are patients undergoing urostomy.

Conference abstracts, animal experiments or preclinical trial studies and studies without specifying the type of stoma.

Studies where the full text is not available.

Studies with incomplete data and unsuccessful attempts to contact the original authors.

The objective of this scoping review is to search, select and extract evidence for the prevention and care of high-output enterostomy patients. According to the requirements of different databases, appropriate search strategies will be developed, and a literature search will be conducted. The data that meet the inclusion criteria will be analysed. The main contents include (1) risk factors for high-output enterostomy patients; (2) critical evaluation contents of high-output enterostomy, such as symptoms and signs of high output in enterostomy patients and (3) interventions that can effectively prevent and improve high output.

Types of studies

The literature types included in this study encompass randomised controlled trials (RCTs), non-RCTs, cohort studies, case–control studies, cross-sectional studies, observational studies and descriptive studies. Qualitative studies and systematic reviews will also be considered and published in either English or Chinese, from January 2015 to January 2024. This review will include studies on high-output enterostomy conducted in any country or region.

Search strategy

The search for studies related to the prevention of high output in adult enterostomy patients will be conducted through PubMed, EMBASE, CINAHL, the Chinese Biological Literature Database and the Cochrane Library. We will employ the following MeSH terms and/or free-text terms: surgical stomas, enterostomy, ostomy, stoma, ileostomy, jejunostomy, colostomy, high output, fast transit, diarrhoea, risk factor, association, relative risk, factor, influence, correlation, management, treatment, therapy and care.

Additionally, grey literature sources, such as Google Scholar, will be searched to ensure comprehensive evidence incorporation. Grey literature includes materials published by government departments, academic institutions and commercial industries that are non-profit, helping to avoid publication bias. The flow chart of the study diagram is presented in figure 1 , and the detailed search strategy is outlined in online supplemental appendix S1 .

Supplemental material

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The flow diagram of the study selection.

Literature screening

The literature screening will be conducted independently and cross-checked by two reviewers (Che Y and Luo ZL). In the event of disagreements, decisions will be discussed in a group meeting. The reviewers will independently use EndNote V.X9 software to remove duplicate entries and initially exclude irrelevant literature by reviewing titles and abstracts. For literature retained after this initial screening, further exclusions will be made by reading the full text to ensure alignment with the study theme, such as research object consistency and intervention plans.

Data extraction and presentation

Two reviewers (Che Y and Luo ZL) will independently extract data, including (1) research design, title, author, year of publication, types of literature, country or region of publication, and publication languages; (2) baseline characteristics of participants: sample size, gender, age, type of enterostomy, characteristics of the research population; (3) intervention details: intervention measures, observation period and (4) primary outcomes: the incidence of high-output enterostomy, enterostomy output volume, the change of output and the factors contributing to high-output enterostomy. There will be no secondary outcome measures.

Strategy for data synthesis

The study design, baseline characteristics of participants and intervention details of this scoping review will be quantitatively summarised in table format. For the incidence of high output in enterostomy, enterostomy output volume, changes in output and factors contributing to high-output enterostomy will be presented in the form of frequency, percentage and descriptive summary.

Quality of evidence

The quality of evidence for outcome indicators will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 14 The GRADE evaluation criteria include five grading factors: research limitations, inconsistency, indirectness, imprecision and publication bias. The evidence quality will be rated across four levels: high, moderate, low and very low. The default evidence quality for RCTs is high, with one grade reduction to moderate, two reductions to low and three to very low.

For cohort studies, case–control studies and other non-RCTs included in this review, the risk of bias will be assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. 15 ROBINS-I tool divides bias into 7 domains with a total of 33 items: (1) confounding bias; (2) subject selection bias; (3) intervention classification bias; (4) intentional intervention deviation bias; (5) loss of data bias; (6) outcome measurement bias and (7) selective reporting bias. According to the evaluation results of each item, the researcher will make yes (Y), probably yes (PY), no (N), probably no (PN) and no information (NI) answers. ROBINS-I divided the evaluation results into five levels: low risk of bias, moderate risk of bias, high risk of bias, critical risk of bias and no information.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Since the literature related to the research topic will be obtained by searching the database for analysis in this scoping review, informed consent and ethical approval of patients will not be required. The results of this study will provide decision-making information for researchers, clinicians, and other ostomy nursing staff. The results of the review will be presented at a scientific conference and published in a peer-reviewed journal.

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Contributors All authors in the manuscript contributed substantially to the idea or design of the study and agreed to the manuscript’s publication; YC and SL: literature search and data extraction; YC and FS: quality assessment of systematic reviews and writing of papers; ZL: search literature and quality assessment of systematic reviews; TW and CG: search literature and quality assessment of systematic reviews; YC: design study and data extraction.

Funding This scoping review protocol was supported by Natural Science Foundation of Gansu Province, China (22JR5RA697).

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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• Open access
• Published: 02 September 2024

Construction and application of “organ-system-centered” undergraduate nursing professional training model

• Yuqing Li 1 ,
• Lei-lei Guo 2 ,
• Jiaofeng Gui 1 ,
• Xiaoyun Zhang 1 ,
• Ying Wang 1 ,
• Haiyang Liu 3 ,
• Jinlong Li 4 ,
• Yunxiao Lei 5 ,
• Xiaoping Li 6 ,
• Liu Yang 7 ,
• Ting Yuan 5 ,
• Congzhi Wang 7 ,
• Dongmei Zhang 8 ,
• Jing Li 9 ,
• Mingming Liu 9 ,
• Ying Hua 10 &
• Lin Zhang 7  

BMC Nursing volume  23 , Article number:  608 ( 2024 ) Cite this article

Metrics details

The purpose of this study is to construct an organ system-centered undergraduate nursing professional training model and explore its application effect.

This study is divided into two steps. In the early stage, literature review and expert consultation were used to establish the training mode (curriculum and assessment standard) of nursing undergraduate specialty based on organ system reform. Secondly, a cross-sectional survey method was used to investigate the training quality of nursing students who graduated from Jinzhou Medical University from 2007 to 2017 under this model.

A five-module curriculum system was established, including general courses, public basic courses, professional education courses, expanding elective courses and concentrated practical teaching. Under the teaching reform of organ system, the nursing graduates of Jinzhou Medical University, who are mainly employed in public hospitals, are generally not satisfied with their jobs, salaries, contents and prospects. Their overall satisfaction with their alma mater is very high; Graduates have certain independent core competence; Employers are basically satisfied with graduates.

The training mode of undergraduate nursing specialty based on organ system reform basically meets the training requirements and objectives.

Peer Review reports

Introduction

In 2020, “Guiding Opinions of General Office of the State Council on Accelerating the Innovative Development of Medical Education” [ 1 ] further emphasized: speeding up the basic and clinical integrated teaching reform based on organ system, researching and establishing the policy mechanism of ensuring medical students' clinical practice, strengthening the management of clinical practice process, and speeding up the ability-oriented reform of student examination and evaluation. Therefore, it has become an important trend of medical education reform to break the boundaries of disciplines and explore a new education and teaching model based on organ system and centered on disease. To carry out the teaching reform based on organ system, the core thread is to carry out the reform of talent training plan (teaching plan) on the basis of full investigation and demonstration.

Integrated medicine is to optimize the teaching content through the organic integration of disciplines, pay attention to cultivating medical students' holistic understanding of human health, improve their clinical practice ability [ 2 , 3 ], and effectively promote the development of medical teaching and human health. Integrated medicine is the inevitable trend of the development of social medicine and human health. The integrated teaching mode of medical courses based on organ system is to teach according to different organs, and to integrate the original subjects according to the organ system of human body, so that the teaching content is gradually adjusted to courses such as nervous system, urinary system, respiratory system, circulatory system and digestive system [ 4 ]. The integration model of medical courses based on organ system can enable students to systematically complete the study of different organ medical knowledge, highlight the professionalism of clinical medicine, and integrate into the original subject content, which is of positive significance for cultivating professional medical talents in different clinical departments.

A scientific and reasonable curriculum model is conducive to the cultivation of students’ knowledge skills and practical skills, and can effectively promote students’ all-round development in ethics, intellect, physique, aesthetics and labor. At present, China’s nursing colleges still adopt a “discipline-centered” three-stage teaching model: basic medicine, clinical medicine and clinical practice [ 5 ]. This model is repetitive in content, poor in street connection, long in time span, high in forgetting rate, out of touch with clinic and incomplete in knowledge framework [ 6 ]. Moreover, the nursing model has changed from “disease-centered” to “patient-centered” and “human health-centered”, focusing on the holistic care of human body and mind, and emphasizing that psychological and social care is an important part of holistic nursing [ 7 , 8 ]. Social aspects of care are an important part of holistic care, so the traditional curriculum model can no longer be adapted to undergraduate nursing education. The reform and development of the nursing curriculum model should meet the new needs brought about by the development of health care, conform to the current trend of educational reform, and be centered on the integration of the three aspects of the basic medical curriculum, the professional curriculum, and the comprehensive ability training curriculum.

The traditional “discipline-centered” medical education model has some problems [ 9 , 10 , 11 , 12 ], such as overlapping contents among disciplines, lack of links between disciplines, and disconnection between basic and clinical, which has gradually failed to meet the needs of modern higher medical education. At present, the “organ system-centered” curriculum model has been widely used in clinical medicine majors in medical colleges and universities all over the country. A large number of teaching reform research results showed that [ 13 , 14 , 15 ] this curriculum model is highly accepted by students and effectively improves the teaching quality. Compared with other models, it can solve the problems of knowledge fragmentation, lack of clinical practice ability, lack of interdisciplinary cooperation and lack of humanistic care in nursing education. By integrating multidisciplinary knowledge, strengthening clinical practice teaching and humanities education, this reform has provided strong support for cultivating comprehensive and high-quality nursing talents [ 16 , 17 , 18 , 19 ].

The model of nursing course centered on organ system was put into practice in 1996. It aims to improve the coherence and practicability of nursing education by integrating relevant medical knowledge and organizing teaching content around human organ system. However, due to the time needed for the popularization of this model and the preparation and feasibility of data collection, it was not until 2007 that relevant research data were collected to evaluate the teaching effect and influence of this model. This time difference reflects the natural process of teaching mode from initial implementation to wide acceptance, and then to becoming the focus of research.

In the model construction stage, we used the methods of literature review and expert consultation to construct the curriculum structure and assessment methods. In the practical application period, we used cross-sectional survey and designed questionnaires to collect some feedback from graduates trained in this model after graduation, including self-core competence evaluation, employment situation, employment prospects of this major, alma mater satisfaction, and evaluation feedback from alma mater and employers on the quality of talent training at alma mater.

Model construction

Mode construction method.

When constructing the nursing teaching mode centered on organ system, the methods of literature review and expert consultation were adopted to ensure the scientific and practical teaching mode. First of all, through literature review, this paper systematically combs the relevant literature of organ system nursing teaching at home and abroad, and deeply understands the theoretical basis, practical experience and teaching effect of the teaching model, which provides strong theoretical support and practical reference for the construction of the teaching model. And in the process of construction, it refers to the advantages and essence of various teaching modes, such as system integration teaching mode, problem-oriented learning PBL mode, case learning CBL mode, participatory and inquiry teaching mode. Second, invite experts in the field of nursing education to consult and listen to their opinions and suggestions on the teaching mode of organ system nursing to ensure that the teaching mode meets the actual needs and future development trend of nursing education. Through the combination of these two methods, a nursing teaching model centered on organ system is constructed.

Introduction of institutions

Jinzhou Medical University, located in Jinzhou City, Liaoning Province, China, is a multi-disciplinary, multi-level and multi-school-running provincial ordinary college. In 1992, Jinzhou Medical College took the lead in carrying out the "organ system-centered" course model reform at the level of domestic clinical medicine specialty. In 1996, Jinzhou Medical College carried out the "organ system-centered" curriculum reform in nursing specialty at undergraduate level, which actively promoted the reform and innovation of nursing education.

Combining the course with digital information and communication technology

In the course of curriculum reform, we have used some digital technologies. For example, we used multimedia elements's interactive digital teaching material and 3D human body structure model to help students intuitively understand the structure and function of organ system. At the same time, using public online interactive learning platforms, such as Rain Class, can provide sharing functions of course materials, video lectures and other resources, and has online testing, discussion forums and other functions to promote students' autonomous learning and interactive communication. Finally, through big data, analyze students' learning situation and give feedback on teaching effect in time.

In order to ensure the effective application of these digital information and communication technologies, we should strengthen teachers' training, ensure that teachers master the relevant technology usage methods and apply them to teaching. At the same time, schools need to provide necessary equipment and network support to ensure that teachers and students can use these technologies for teaching and learning smoothly. Finally, textbooks and teaching resources should be updated regularly to keep consistent with the latest technological trends.

Application investigation of the model

Participants of study.

The participants were nursing undergraduates who graduated from 2007 to 2017.

Questionnaire content

This stage is a cross-sectional study. On the basis of referring to relevant literature [ 20 , 21 ], the questionnaire was designed by myself. (Supplement material 2 shows the survey questionnaire). The main contents of the questionnaire include employment results, perception of employment prospects of this major, satisfaction of alma mater, talent training of alma mater, self-core competence evaluation and feedback from employers. Self-core competence mainly includes clinical nursing ability, communication ability, critical thinking, scientific research and innovation ability, organization and management ability, self-development ability, health education ability, comprehensive evaluation and so on. Feedback from employers mainly investigates the satisfaction of employers' managers and graduates' leaders with graduates. The evaluation of the above contents was conducted after graduation.

Investigation method

In 2016, our college conducted a survey on graduates' graduation quality, with cluster sampling centered on graduates' work units, assisted by convenient sampling forms such as WeChat, QQ mailbox and telephone interview. After the informed consent, the respondents distributed questionnaires through various channels. For the employer's satisfaction feedback, the following steps were followed. First of all, send a satisfaction questionnaire (paper or electronic version) to employers, asking their views on the performance, skills, knowledge and attitude of our graduates. Second, in addition to the questionnaire survey, you can also communicate with employers by email, telephone interview or face-to-face interview. This way can provide more in-depth and personalized feedback, so that employers have the opportunity to explain their views on graduates in detail and answer possible questions. In the process of investigation, the employer's personal information is treated confidentially to ensure fairness, objectivity and accuracy.

Exclusion criteria of the questionnaires: (1) Incomplete answers: There are a large number of unanswered questions in the questionnaire, especially the lack of key questions or core variables, which makes it impossible to conduct effective analysis. (2) Obvious errors in answering: There are obvious logical errors or contradictions in answering. For example, two contradictory questions give opposite answers, or the answers are seriously inconsistent with common sense. (3) Regular answer: all or most questions in the questionnaire are answered with the same answer, or the answer has obvious regularity (such as continuous choice of the same option). (4) Repeated answer: the same questionnaire is filled by the same person many times, or there are a large number of questionnaires with similar contents. Questionnaires were distributed. Of the 237 respondents, 224 were recovered, with a recovery rate of 94.51%, of which 182 were valid, with an effective recovery rate of 81.25%.

Statistical analysis

SPSS 25.0 was used for statistical analysis. Counting data are expressed in relative numbers.

Training objective

Cultivate students with systematic nursing and related basic theories, basic knowledge and basic skills, with basic clinical nursing abilities and preliminary teaching, management and scientific research abilities, as well as generous knowledge of humanities and social sciences, good professional ethics and dedication, innovative spirit, social responsibility and lifelong learning ability, and have professional development potential, so as to become senior applied nursing professionals who can engage in nursing work in various medical and health care institutions.

Training requirements

Overall training requirements.

Ideological and ethical standards Students should love the motherland, support the Communist Party of China (CPC)’s leadership and support the socialist system; Abide by the law, establish a scientific world outlook, outlook on life, values and socialist concept of honor and disgrace, and have good ideological and moral character, social responsibility and code of conduct; I love medical and health undertakings, and I am willing to fight for the development of Chinese medical undertakings and the physical and mental health of human beings for life.

Medical humanities and professional quality Have a broad foundation in humanities and social sciences, and understand the internal relationship between medicine and humanities and social sciences; Love medicine, cherish life, care for patients, and respect patients' personal beliefs, with humanitarian spirit and humanistic spirit of nursing, with good nursing ethics and communication skills between nurses and patients. Advocating science, seeking truth from facts, practicing medicine according to law, has the professional spirit of lifelong learning, continuous innovation, teamwork, scientific analysis and criticism. Supplement material 1 shows the nursing humanistic quality training plan.

Physical and mental quality Understand the basic knowledge of physical education and military affairs, master the basic skills of physical exercise, develop good physical exercise habits, and reach the national standards for college students' physical education and military training; Sound personality, firm will, correct self-awareness and self-control ability, good interpersonal relationship, good social and environmental adaptability and lifelong learning ability; Have a healthy body and good psychological quality.

Professional training requirements

Professional knowledge requirements Master the basic theories and knowledge of natural sciences, humanities and social sciences, basic medicine, clinical medicine, public health and preventive medicine related to nursing; Master the basic theory, knowledge and skills of nursing specialty; Master the basic etiology, pathogenesis, clinical manifestations, diagnosis and prevention principles and related nursing knowledge of common diseases and frequently-occurring diseases in all stages of life; Master the etiology, pathogenesis, clinical manifestations, diagnosis and prevention principles, nursing rescue techniques and related nursing knowledge of common critical patients; Master the basic knowledge of health education, preventive health care, health promotion and hospice care at all stages of life; Familiar with the prevention and control of infectious diseases and public health emergencies; Understand the basic principles, policies and regulations of national health work.

Professional competence requirements Master the technology of applying nursing procedures to implement holistic nursing for nursing objects; Have the ability to initially cooperate with critically ill patients and deal with emergencies; Have the ability to provide preventive health care and health education for nursing objects; Have the basic ability to engage in community nursing, and provide health care services consistent with their culture for individuals, families and communities; Have the ability to communicate and coordinate effectively with nursing objects and other medical staff; Self-study ability, self-improvement and professional development ability; Have the ability to acquire knowledge by using modern information technology, have certain critical thinking, solve practical clinical problems and innovate; Have the preliminary ability of nursing teaching, scientific research and management.

Study duration and degree awarding

The undergraduate nursing major study time is 4 years, full-time in school, the maximum period shall not exceed 6 years. A Bachelor of Science degree is awarded upon graduation.

Credit requirements

Undergraduate nursing students are required to complete a minimum of 196 points when they graduate. Among them, there are 40 compulsory courses with a total of 124 credits; Limited to 15 courses, a total of 18 credits; 10 credits for interdisciplinary elective courses; Centralized practical teaching has 44 credits, including 10 credits for graduation practice, 2 credits for early clinical practice and 2 credits for military training.

Course setting

A total of five modules, including general education courses, public basic courses, specialized courses, extended elective courses, and centralized practical teaching, are set up.

Theoretical courses

Table 1 shows the curriculum of general education courses, public basic courses, professional courses and extended elective courses, including course classification and class hours allocation. The basic courses of nursing specialty were integrated with clinical courses, and 15 integrated courses were formed, including the basic form and structure of human body, the general theory of clinical nursing and the nursing of respiratory diseases, which realized the integration of nursing courses from basic to clinical (see Table  2 ).

Practice teaching

Practice teaching is divided into four stages, namely military training, early clinical practice, graduation practice and social investigation. Table 3  and Fig.  1 show the practical content and structure of each stage. In addition, in daily study, clinical probation is interspersed, and practical skills are consolidated in time after receiving theoretical courses, which can help students better integrate theory with practice. (See Table  4 ) Fig.  2 shows the location of practice. Maps come from public website: http://datav.aliyun.com/portal/school/atlas/area_selector .

Practice teaching system of nursing specialty

The location of practice

Composition of teachers

Composition of full-time teachers.

Full-time teachers refer to full-time teachers, who must have a master's degree or above. In addition, full-time teachers need to be loyal to the nursing cause, have a solid level of theory and skill operation, have participated in general nursing post training, backbone training and teacher training, have teacher qualification certificates and be responsible for teaching tasks in schools full-time. Figure  3  shows the composition of full-time teachers.

The composition of full-time teachers

Composition of part-time teachers

“Part-time teachers” are mainly engaged in clinical nursing work in hospitals or communities, and when necessary, they are also engaged in teaching work in schools, with flexible teaching hours. But they also need to love nursing and have basic teacher qualities. Figure  4 shows the composition of part-time teachers.

Participant characteristics

Among the 182 people in this survey, aged 22–37 years, mean 29.36 ± 3.42 years, working years 1–12 years, average 5.92 ± 2.85 years. Table 5 shows the participant characteristics of study.

Research indicators

Self-core competence evaluation.

Self-core competence mainly includes clinical nursing ability, communication ability, critical thinking, scientific research and innovation ability, organization and management ability, self-development ability, health education ability, comprehensive assessment and so on. Table 6 shows the self-core competence evaluation. The evaluation criteria of graduates' self-core competence, and the specific content is put in the supplementary material 3.

The employment results

The employment results of the respondents are as follows: (1) See Fig.  5 for the graduates' graduation destination. The graduates of our school mainly go to public hospitals; (2) 61 people were satisfied with their work, accounting for 33.5%, 85 people were fairly satisfied, accounting for 46.7%, 33 people were common, accounting for 18.1%, and 3 people were relatively dissatisfied and very dissatisfied, accounting for 1.6%; (3) 41 people are very satisfied with the salary of their jobs, accounting for 22.5%, 56 people are relatively satisfied, accounting for 30.8%, 58 people are common, accounting for 31.9%, and 27 people are relatively dissatisfied and very dissatisfied, accounting for 14.8%; (4) 44 people are very satisfied with their job and career development prospects, accounting for 24.2%, 85 people are relatively satisfied, accounting for 46.7%, 50 people are common, accounting for 27.5%, and 3 people are relatively dissatisfied and very dissatisfied, accounting for 1.6%; (5) Job satisfaction: 45 people are very satisfied, accounting for 24.7%, 90 people are relatively satisfied, accounting for 49.5%, 44 people are common, accounting for 24.2%, and 3 people are relatively dissatisfied and very dissatisfied, accounting for 1.6%. Figure  5 shows the employment results.

Employment results

Participants’ perception of employment prospects of this major

There are 46 students (25.3%) who think that the employment situation of this major is very satisfied, 97 students (53.3%) are relatively satisfied, 38 students (20.9%) are common, and 1 student (0.5%) is relatively less satisfied and very dissatisfied. Figure  6 shows Participants’ perception of employment prospects of this major.

Participants' perception of employment prospects of this major

Overall satisfaction of alma mater

Among the graduates’ overall satisfaction with their alma mater, 83 (45.6%) thought they were very satisfied, 85 (46.7%) were fairly satisfied, and 14 (7.69%) were generally satisfied. No one chose to be less satisfied or very dissatisfied. 139 people are willing to recommend their alma mater to their relatives and friends in similar colleges with the same score, accounting for 76.4%, 37 people are uncertain, accounting for 20.3%, and 6 people are unwilling, accounting for 3.3%. Figure  7  shows overall satisfaction of alma mater.

Feedback on the quality of talent training in our alma mater

Feedback on the quality of the alma mater’s talent training: (1) The overall satisfaction of the alma mater’s education and teaching. Among the graduates' overall satisfaction with the alma mater, 75 are very satisfied, accounting for 41.2%, 93 are relatively satisfied, accounting for 51.1%, and the overall satisfaction of education and teaching is 92%; (2) Satisfaction of practical teaching links (including experimental teaching, internship, etc.) of the alma mater. Among the graduates’ satisfaction with practical teaching links, 66 are very satisfied, accounting for 36.3%, 99 are relatively satisfied, accounting for 54.4%, and the overall satisfaction of education and teaching is 91%; (3) Strengthening practical teaching, 34.1% people think that experimental teaching needs to be strengthened, 23.6% people think that internship needs to be strengthened, 18.1% people think that production practice needs to be strengthened, and 24.2% people think that college students' innovation plan needs to be strengthened; (4) In addition to practical teaching, professional teaching should be improved. 44.5% people think that the courses offered need to be improved, 26.9% people think that the course content needs to be improved, 19.2% people think that classroom teaching needs to be improved, and 9.3% people think that the course assessment method needs to be improved. (5) The overall satisfaction of the teachers in the alma mater. Among the graduates’ satisfaction with the practice teaching in the alma mater, 61 were very satisfied, accounting for 33.5%, 101 were relatively satisfied, accounting for 55.5%, and the overall satisfaction of education and teaching reached 89%. (6) Satisfaction of teachers’ teaching attitude. Among the graduates’ satisfaction with teachers’ teaching attitude, 68 are very satisfied, accounting for 37.4%, 98 are relatively satisfied, accounting for 53.8%, and the overall satisfaction of education and teaching is 91%. (7) Satisfaction of teachers’ teaching level in our alma mater. Among the graduates’ satisfaction with teachers' teaching level, 67 were very satisfied, accounting for 36.8%, 99 were relatively satisfied, accounting for 54.4%, and the overall satisfaction of education and teaching reached 91%. (8) Satisfaction of extracurricular communication between teachers and students in alma mater. Among the graduates' satisfaction with extracurricular communication between teachers and students in alma mater, 61 are very satisfied, accounting for 33.5%, 82 are relatively satisfied, accounting for 45.1%, and the overall satisfaction of education and teaching is 79%; (9) The degree to which the teaching auxiliary facilities (teaching rooms, books, equipment, information resources, etc.) of the alma mater meet the learning needs. Among the graduates’ satisfaction with the teaching auxiliary facilities (teaching rooms, books, equipment, information resources, etc.), 50 are very satisfied, accounting for 27.5%, 119 are relatively satisfied, accounting for 65.4%, and the overall satisfaction of education and teaching reaches 93. (10) Satisfaction of the degree of coincidence between professional teaching and work needs: Among the graduates’ satisfaction of the degree of coincidence between professional teaching and work needs, 50 are very satisfied, accounting for 27.5%, 124 are relatively satisfied, accounting for 68.1%, and the overall satisfaction of education and teaching is 96%. Figure  8 shows feedback on the quality of talent training in our alma mater.

Employer feedback

Among the employers’ overall satisfaction with graduates, 18 are very satisfied, accounting for 9.9%, 94 are fairly satisfied, accounting for 51.6%, 64 are generally satisfied, accounting for 35.2%, and 6 are not quite satisfied or very dissatisfied, accounting for 3.3%. 127 people are willing to hire our graduates again, accounting for 69.8%, 49 people are uncertain, accounting for 26.9%, and 6 people are unwilling, accounting for 3.3%. Figure  9 shows the employer feedback.

The employer feedback

“Organ-system-centered” integrated medicine emphasizes taking organ system as a module, synthesizing and reorganizing multidisciplinary related knowledge [ 22 , 23 ], organically integrating theoretical knowledge and clinical practice from the perspective of people as a whole, integrating social, environmental, psychological and other influencing factors, reducing data evidence into facts, upgrading symptom summary to experience exploration, and repeatedly practicing between facts and experiences, so as to finally enable medical students to form a holistic medical knowledge framework with visibility and initiative [ 24 ].

The organ system-centered teaching model proposed by Jinzhou Medical University recombines the basic knowledge of medicine and nursing and clinical professional knowledge according to the actual situation of clinical medical care, breaks the boundaries between the existing medical discipline systems, downplays the awareness of the disciplines, and emphasizes the integration of the knowledge between the disciplines, so as to enable the students to systematically master the basic courses and the clinical professional courses [ 25 , 26 ].

The development of the teaching model on organ system reform has gone through three stages. The first stage was the reform of the basic courses of nursing specialty, which horizontally integrated the basic courses of anatomy, histoembryology, physiology, biochemistry, etc., and formed 17 integrated courses, such as the basic morphology and structure of the human body, the metabolism and regulation of the human body, the basics of genetics, and the biology of pathogenicity. The second stage is to reform the clinical courses of nursing, forming 11 integrated courses such as nursing of respiratory system diseases, nursing of circulatory system diseases, and nursing of blood system diseases. The third stage is to integrate the basic courses of nursing and clinical courses, forming 15 integrated courses such as basic human body form and structure, general theory of clinical nursing, nursing of respiratory system diseases, etc., which realizes the integration and coherence of nursing courses from basic to clinical. This model realizes interdisciplinary synthesis and forms a holistic and optimized curriculum system that closely connects basic and clinical knowledge and makes them intrinsically linked, which is compatible with the trend of integrative medicine. Moreover, the curriculum model is in line with the outline of nurse qualification examination, which is helpful for students to review and pass the examination. However, this curriculum model requires great changes in teaching materials, and the allocation of teachers also requires unified organization and coordination between nursing teachers and basic medical teachers. Therefore, the construction of teaching staff is the key to the effective development of this curriculum model.

In terms of application effect, we paid a return visit to the graduates trained in this mode after graduation, and comprehensively evaluated the graduates' self-core ability, graduates' employment situation, satisfaction with the talent training mode of their alma mater, their views on the employment prospects of their major and employers' satisfaction with graduates. The results show that under the teaching reform of organ system, our graduates have certain self-core ability, and they are mainly employed in public hospitals, and their overall satisfaction with their alma mater is high. Put forward various suggestions for the training of talents in the alma mater, such as strengthening teaching practice, improving professional teaching, improving extracurricular communication between students and teachers, and improving teaching facilities in the alma mater; Employers are basically satisfied with the feedback of graduates. It shows that the nursing teaching mode centered on organ system has a good effect on cultivating students. However, graduates are not satisfied with their work, salary, content and prospect. This may be because the teaching mode emphasizes the systematization of medical knowledge, but it may neglect the effective docking with real work scenes in practice, resulting in graduates feeling uncomfortable in the face of complex clinical environment and career challenges. In addition, factors such as salary level failing to meet expectations, heavy work pressure and limited career promotion space may also affect graduates' job satisfaction. Therefore, it is necessary to further optimize the teaching mode, strengthen practical education, and improve the overall treatment and social status of the nursing industry in order to improve the job satisfaction of graduates.

The reform based on organ system highlights many advantages: it not only strengthens early, multi-point and repeated clinical practice, but also enables students to contact the clinic earlier and enhance clinical thinking; Modern teaching methods such as PBL and CBL are adopted, combined with case teaching, to deepen students' understanding of knowledge; At the same time, humanities education, including nursing psychology and ethics, has been strengthened to cultivate students' professional quality. Moreover, the proportion of practical teaching has been increased, and participatory and inquiry teaching methods have been adopted to improve students' practical ability. In addition, innovation and entrepreneurship courses have been added to encourage students to participate in the project to cultivate their innovative spirit; Teaching methods such as small class teaching and group discussion are also adopted to cultivate students' comprehensive ability; In the way of evaluation, pay attention to formative and summative evaluation, and feedback the teaching effect in time; In the end, the curriculum system is highly consistent with the training objectives, and the quality of students is comprehensively cultivated.

For the current nursing education, our system has the following advantages. This model consolidates knowledge from various disciplines based on the human organ system, fostering coherence and systematic learning. By eliminating overlapping content, it streamlines the curriculum and improves efficiency in mastering nursing knowledge. The organ-system-centered approach cultivates clinical thinking skills, enabling students to deeply understand the normal-to-abnormal transitions of human systems and their nursing measures. Integrated with clinical practice, this model enhances practical nursing skills and prepares students for the clinical work environment. Furthermore, it fosters interdisciplinary integration, broadening horizons and laying a solid foundation for future career development.

Limitations

Although the reform has made some achievements at present, there are still some problems, such as how to better connect basic courses with professional courses, how to cooperate with professional teachers in teaching basic medicine, and how to connect the contents of organ system courses with clinical practice, which need further reform and improvement.

Availability of data and materials

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy reasons.

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Acknowledgements

We thank the members of the research as well as all participants for their contribution.

This work was supported by the Internal Medicine Nursing Teaching Team (2021jxtd02).

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Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu, An Hui, P.R. China

Yuqing Li, Jiaofeng Gui, Xiaoyun Zhang & Ying Wang

Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou, Liaoning, P.R. China

Lei-lei Guo

Student Health Center, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu, An Hui, P.R. China

Haiyang Liu

Department of Occupational and Environmental Health, Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan, Hebei, P.R. China

Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu, An Hui, P.R. China

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Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu, An Hui, P.R. China

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Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu, An Hui, P.R. China

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Department of Pediatric Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu, An Hui, P.R. China

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Contributions

Conceived and designed the research: LZ. Wrote the paper: Y-q L. Analyzed the data: Y-q L and LZ. Revised the paper: Y-q L, L-l G, J-f G, LZ, YW, X-y Z, H-y L, J-l L, Y-x L, X-p L, LS, LY, TY, C-z W, D-m Z, JL, M-m L, and YH. The authors read and approved the final manuscript.

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Correspondence to Lin Zhang .

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Approval for the study was obtained from the College of Nursing’s Research Ethics Committee at Jinzhou Medical University (2015007), and all methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from the participants for this study.

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Li, Y., Guo, Ll., Gui, J. et al. Construction and application of “organ-system-centered” undergraduate nursing professional training model. BMC Nurs 23 , 608 (2024). https://doi.org/10.1186/s12912-024-02235-x

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Literature Review Overview

What is a Literature Review? Why Are They Important?

A literature review is important because it presents the "state of the science" or accumulated knowledge on a specific topic. It summarizes, analyzes, and compares the available research, reporting study strengths and weaknesses, results, gaps in the research, conclusions, and authors’ interpretations.

Tips and techniques for conducting a literature review are described more fully in the subsequent boxes:

• Literature review steps
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• Literature reviews sections
• In-depth resources to assist in writing a literature review
• Templates to start your review
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Literature Review Steps

Graphic used with permission: Torres, E. Librarian, Hawai'i Pacific University

1. Choose a topic and define your research question

• Try to choose a topic of interest. You will be working with this subject for several weeks to months.
• Ideas for topics can be found by scanning medical news sources (e.g MedPage Today), journals / magazines, work experiences, interesting patient cases, or family or personal health issues.
• Do a bit of background reading on topic ideas to familiarize yourself with terminology and issues. Note the words and terms that are used.
• Develop a focused research question using PICO(T) or other framework (FINER, SPICE, etc - there are many options) to help guide you.
• Run a few sample database searches to make sure your research question is not too broad or too narrow.
• If possible, discuss your topic with your professor. 

2. Determine the scope of your review

The scope of your review will be determined by your professor during your program. Check your assignment requirements for parameters for the Literature Review.

• How many studies will you need to include?
• How many years should it cover? (usually 5-7 depending on the professor)
• For the nurses, are you required to limit to nursing literature?

3. Develop a search plan

• Determine which databases to search. This will depend on your topic. If you are not sure, check your program specific library website (Physician Asst / Nursing / Health Services Admin) for recommendations.
• Create an initial search string using the main concepts from your research (PICO, etc) question. Include synonyms and related words connected by Boolean operators
• Contact your librarian for assistance, if needed.

4. Conduct searches and find relevant literature

• Keep notes as you search - tracking keywords and search strings used in each database in order to avoid wasting time duplicating a search that has already been tried
• Read abstracts and write down new terms to search as you find them
• Check MeSH or other subject headings listed in relevant articles for additional search terms
• Scan author provided keywords if available
• Check the references of relevant articles looking for other useful articles (ancestry searching)
• Check articles that have cited your relevant article for more useful articles (descendancy searching). Both PubMed and CINAHL offer Cited By links
• Revise the search to broaden or narrow your topic focus as you peruse the available literature
• Conducting a literature search is a repetitive process. Searches can be revised and re-run multiple times during the process.
• Track the citations for your relevant articles in a software citation manager such as RefWorks, Zotero, or Mendeley

5. Review the literature

• Read the full articles. Do not rely solely on the abstracts. Authors frequently cannot include all results within the confines of an abstract. Exclude articles that do not address your research question.
• While reading, note research findings relevant to your project and summarize. Are the findings conflicting? There are matrices available than can help with organization. See the Organizing Information box below.
• Critique / evaluate the quality of the articles, and record your findings in your matrix or summary table. Tools are available to prompt you what to look for. (See Resources for Appraising a Research Study box on the HSA, Nursing , and PA guides )
• You may need to revise your search and re-run it based on your findings.

6. Organize and synthesize

• Compile the findings and analysis from each resource into a single narrative.
• Using an outline can be helpful. Start broad, addressing the overall findings and then narrow, discussing each resource and how it relates to your question and to the other resources.
• Cite as you write to keep sources organized.
• Write in structured paragraphs using topic sentences and transition words to draw connections, comparisons, and contrasts.
• Don't present one study after another, but rather relate one study's findings to another. Speak to how the studies are connected and how they relate to your work.

Organizing Information

Options to assist in organizing sources and information :

1. Synthesis Matrix

• helps provide overview of the literature
• information from individual sources is entered into a grid to enable writers to discern patterns and themes
• article summary, analysis, or results
• thoughts, reflections, or issues
• each reference gets its own row
• mind maps, concept maps, flowcharts
• at top of page record PICO or research question
• record major concepts / themes from literature
• list concepts that branch out from major concepts underneath - keep going downward hierarchically, until most specific ideas are recorded
• enclose concepts in circles and connect the concept with lines - add brief explanation as needed

3. Summary Table

• information is recorded in a grid to help with recall and sorting information when writing
• allows comparing and contrasting individual studies easily
• purpose of study
• methodology (study population, data collection tool)

Efron, S. E., & Ravid, R. (2019). Writing the literature review : A practical guide . Guilford Press.

Literature Review Sections

• Lit reviews can be part of a larger paper / research study or they can be the focus of the paper
• Lit reviews focus on research studies to provide evidence
• New topics may not have much that has been published

* The sections included may depend on the purpose of the literature review (standalone paper or section within a research paper)

Standalone Literature Review (aka Narrative Review):

• presents your topic or PICO question
• includes the why of the literature review and your goals for the review.
• provides background for your the topic and previews the key points
• Narrative Reviews: tmay not have an explanation of methods.
• include where the search was conducted (which databases) what subject terms or keywords were used, and any limits or filters that were applied and why - this will help others re-create the search
• describe how studies were analyzed for inclusion or exclusion
• review the purpose and answer the research question
• thematically - using recurring themes in the literature
• chronologically - present the development of the topic over time
• methodological - compare and contrast findings based on various methodologies used to research the topic (e.g. qualitative vs quantitative, etc.)
• theoretical - organized content based on various theories
• provide an overview of the main points of each source then synthesize the findings into a coherent summary of the whole
• present common themes among the studies
• compare and contrast the various study results
• interpret the results and address the implications of the findings
• do the results support the original hypothesis or conflict with it
• provide your own analysis and interpretation (eg. discuss the significance of findings; evaluate the strengths and weaknesses of the studies, noting any problems)
• discuss common and unusual patterns and offer explanations
•  stay away from opinions, personal biases and unsupported recommendations
• summarize the key findings and relate them back to your PICO/research question
• note gaps in the research and suggest areas for further research
• this section should not contain "new" information that had not been previously discussed in one of the sections above
• provide a list of all the studies and other sources used in proper APA 7

Literature Review as Part of a Research Study Manuscript:

• Compares the study with other research and includes how a study fills a gap in the research.
• Focus on the body of the review which includes the synthesized Findings and Discussion

Literature Reviews vs Systematic Reviews

Systematic Reviews are NOT the same as a Literature Review:

Literature Reviews:

• Literature reviews may or may not follow strict systematic methods to find, select, and analyze articles, but rather they selectively and broadly review the literature on a topic
• Research included in a Literature Review can be "cherry-picked" and therefore, can be very subjective

Systematic Reviews:

• Systemic reviews are designed to provide a comprehensive summary of the evidence for a focused research question
• rigorous and strictly structured, using standardized reporting guidelines (e.g. PRISMA, see link below)
• uses exhaustive, systematic searches of all relevant databases
• best practice dictates search strategies are peer reviewed
• uses predetermined study inclusion and exclusion criteria in order to minimize bias
• aims to capture and synthesize all literature (including unpublished research - grey literature) that meet the predefined criteria on a focused topic resulting in high quality evidence

Literature Review Examples

• Breastfeeding initiation and support: A literature review of what women value and the impact of early discharge (2017). Women and Birth : Journal of the Australian College of Midwives
• Community-based participatory research to promote healthy diet and nutrition and prevent and control obesity among African-Americans: A literature review (2017). Journal of Racial and Ethnic Health Disparities

• Vitamin D deficiency in individuals with a spinal cord injury: A literature review (2017). Spinal Cord

Resources for Writing a Literature Review

These sources have been used in developing this guide.

Resources Used on This Page

Aveyard, H. (2010). Doing a literature review in health and social care : A practical guide . McGraw-Hill Education.

Purdue Online Writing Lab. (n.d.). Writing a literature review . Purdue University. https://owl.purdue.edu/owl/research_and_citation/conducting_research/writing_a_literature_review.html

Torres, E. (2021, October 21). Nursing - graduate studies research guide: Literature review. Hawai'i Pacific University Libraries. Retrieved January 27, 2022, from https://hpu.libguides.com/c.php?g=543891&p=3727230

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• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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See an example

Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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What are Systematic Reviews? (3 minutes, 24 second YouTube Video)

Systematic Literature Reviews: Steps & Resources

These steps for conducting a systematic literature review are listed below . 

Also see subpages for more information about:

• The different types of literature reviews, including systematic reviews and other evidence synthesis methods
• Tools & Tutorials

Literature Review & Systematic Review Steps

• Develop a Focused Question
• Scope the Literature  (Initial Search)
• Refine & Expand the Search
• Limit the Results
• Download Citations
• Abstract & Analyze
• Create Flow Diagram
• Synthesize & Report Results

1. Develop a Focused   Question 

Consider the PICO Format: Population/Problem, Intervention, Comparison, Outcome

Focus on defining the Population or Problem and Intervention (don't narrow by Comparison or Outcome just yet!)

"What are the effects of the Pilates method for patients with low back pain?"

Tools & Additional Resources:

• PICO Question Help
• Stillwell, Susan B., DNP, RN, CNE; Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN; Melnyk, Bernadette Mazurek, PhD, RN, CPNP/PMHNP, FNAP, FAAN; Williamson, Kathleen M., PhD, RN Evidence-Based Practice, Step by Step: Asking the Clinical Question, AJN The American Journal of Nursing : March 2010 - Volume 110 - Issue 3 - p 58-61 doi: 10.1097/01.NAJ.0000368959.11129.79

2. Scope the Literature

A "scoping search" investigates the breadth and/or depth of the initial question or may identify a gap in the literature. 

Eligible studies may be located by searching in:

• Background sources (books, point-of-care tools)
• Article databases
• Trial registries
• Grey literature
• Cited references
• Reference lists

When searching, if possible, translate terms to controlled vocabulary of the database. Use text word searching when necessary.

Use Boolean operators to connect search terms:

• Combine separate concepts with AND  (resulting in a narrower search)
• Connecting synonyms with OR  (resulting in an expanded search)

Search:  pilates AND ("low back pain"  OR  backache )

Video Tutorials - Translating PICO Questions into Search Queries

• Translate Your PICO Into a Search in PubMed (YouTube, Carrie Price, 5:11) 
• Translate Your PICO Into a Search in CINAHL (YouTube, Carrie Price, 4:56)

3. Refine & Expand Your Search

Expand your search strategy with synonymous search terms harvested from:

• database thesauri
• reference lists
• relevant studies

Example: 

(pilates OR exercise movement techniques) AND ("low back pain" OR backache* OR sciatica OR lumbago OR spondylosis)

As you develop a final, reproducible strategy for each database, save your strategies in a:

• a personal database account (e.g., MyNCBI for PubMed)
• Log in with your NYU credentials
• Open and "Make a Copy" to create your own tracker for your literature search strategies

4. Limit Your Results

Use database filters to limit your results based on your defined inclusion/exclusion criteria.  In addition to relying on the databases' categorical filters, you may also need to manually screen results.  

• Limit to Article type, e.g.,:  "randomized controlled trial" OR multicenter study
• Limit by publication years, age groups, language, etc.

NOTE: Many databases allow you to filter to "Full Text Only".  This filter is  not recommended . It excludes articles if their full text is not available in that particular database (CINAHL, PubMed, etc), but if the article is relevant, it is important that you are able to read its title and abstract, regardless of 'full text' status. The full text is likely to be accessible through another source (a different database, or Interlibrary Loan).  

• Filters in PubMed
• CINAHL Advanced Searching Tutorial

5. Download Citations

Selected citations and/or entire sets of search results can be downloaded from the database into a citation management tool. If you are conducting a systematic review that will require reporting according to PRISMA standards, a citation manager can help you keep track of the number of articles that came from each database, as well as the number of duplicate records.

In Zotero, you can create a Collection for the combined results set, and sub-collections for the results from each database you search.  You can then use Zotero's 'Duplicate Items" function to find and merge duplicate records.

• Citation Managers - General Guide

6. Abstract and Analyze

• Migrate citations to data collection/extraction tool
• Screen Title/Abstracts for inclusion/exclusion
• Screen and appraise full text for relevance, methods, 
• Resolve disagreements by consensus

Covidence is a web-based tool that enables you to work with a team to screen titles/abstracts and full text for inclusion in your review, as well as extract data from the included studies.

• Covidence Support
• Critical Appraisal Tools
• Data Extraction Tools

7. Create Flow Diagram

The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow diagram is a visual representation of the flow of records through different phases of a systematic review.  It depicts the number of records identified, included and excluded.  It is best used in conjunction with the PRISMA checklist .

Example from: Stotz, S. A., McNealy, K., Begay, R. L., DeSanto, K., Manson, S. M., & Moore, K. R. (2021). Multi-level diabetes prevention and treatment interventions for Native people in the USA and Canada: A scoping review. Current Diabetes Reports, 2 (11), 46. https://doi.org/10.1007/s11892-021-01414-3

• PRISMA Flow Diagram Generator (ShinyApp.io, Haddaway et al. )
• PRISMA Diagram Templates  (Word and PDF)
• Make a copy of the file to fill out the template
• Image can be downloaded as PDF, PNG, JPG, or SVG
• Covidence generates a PRISMA diagram that is automatically updated as records move through the review phases

8. Synthesize & Report Results

There are a number of reporting guideline available to guide the synthesis and reporting of results in systematic literature reviews.

It is common to organize findings in a matrix, also known as a Table of Evidence (ToE).

• Reporting Guidelines for Systematic Reviews
• Download a sample template of a health sciences review matrix  (GoogleSheets)

Steps modified from: 

Cook, D. A., & West, C. P. (2012). Conducting systematic reviews in medical education: a stepwise approach.   Medical Education , 46 (10), 943–952.

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What type of review, how to conduct a review, find articles, evaluating articles, full text access tool.

• How to Get Full Articles
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Researchers, academics and librarians all use various terms to describe different types of literature reviews. Indeed there is often inconsistency between the ways the types are discussed. Here are a couple of simple explanations.

The image below describes common review types in terms of speed, detail, risk of bias and comprehensiveness:

"Schematic of the main differences between the types of literature review" by Brennan, M. L., Arlt, S. P., Belshaw, Z., Buckley, L., Corah, L., Doit, H., Fajt, V. R., Grindlay, D., Moberly, H. K., Morrow, L. D., Stavisky, J., & White, C. (2020). Critically Appraised Topics (CATs) in veterinary medicine: Applying evidence in clinical practice. Frontiers in Veterinary Science, 7 , 314. https://doi.org/10.3389/fvets.2020.00314 is licensed under CC BY 3.0

The table below has been adapted from a widely used typology of fourteen types of reviews, (Grant & Booth, 2009).  Here are four of the most common types:

For a more detailed list of review types, see:

Grant, M.J. & Booth, A. (2009).  A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26 (2), 91-108.  DOI: 10.1111/j.1471-1842.2009.00848.x

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) outlines standards of practice completing a systematic review to ensure consistency and high-quality results.

• PRISMA 2020 Explanations
• PRISMA 2020 Checklist
• PRISMA 2020 Flow Diagram
• PRISMA Flow Diagram Generator
• PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews

Techniques from the PRISMA process can also be used with other types of reviews to have a systematic process for searching and evaluating results.

• Article Evaluation Handout Key questions to evaluate each section of original research studies (RCTs, cohort studies, etc)

LibKey Nomad is a browser extension that connects you with articles that are library-licensed or open access. LibKey Nomad is available for Google Chrome, Firefox, Safari, Microsoft Edge, Brave, and Vivaldi.

Here is a short demonstration of how it works:

When using LibKey Nomad, you will automatically be directed to the best available version of an article so you don't need to search in multiple places. When the full text of an article is not available, you will be provided with options to request the article through  Interlibrary Loan (ILL).

LibKey Nomad does not require you to create a personal account. It does not track users or hold credentials, and it is only active when you are on the web page of a scholarly publisher or database.  

Getting Started

• Install the LibKey Nomad extension for your browser of choice. (Note: A user account is  not  required to use the extension.)
• Search for and select "James Madison University" from the list of institutions. See images below.
• When you are on publisher websites, Wikipedia, PubMed, and more, you can l ook for the LibKey Nomad button to download PDFs.

Publisher Websites

When you're browsing publisher sites and other web pages, LibKey Nomad provides a link to download the PDF of an article available through the JMU Libraries. It is not necessary to first connect through the JMU Libraries website. If the full text of the article is not available through the JMU Libraries subscriptions, an "Access Options" button will appear, and you will see options for requesting the article through ILL. See example in the image below.

LibKey Nomad also works with Wikipedia. When you're viewing the list of references for an entry, a "Download PDF" button will appear after the citations, if the full text of the article is available from JMU Libraries. An "Article Link" button may appear for citations that are from sources that do not support linking directly to the PDF. For articles not available from JMU Libraries, an "Access Options..." button will appear that provides options for requesting the articles through ILL. See example in the image below.

When you're searching PubMed, LibKey Nomad shows options for downloading a PDF, linking to an article, or additional access options. You can also view the cover images of the journals that articles appear in. LibKey Nomad also provides a link to the complete issue of a journal. Click "View Complete Issue" to browse the table of contents for the issue in which an article appears, helping you find similar articles from the same publication. See example in the image below.

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Literature Review

Literature review steps.

• Scholarly Writing

Lit Review Templates

• Literature search strategy planner
• Literature search log template
• Review Literature
• Literature Matrix

A literature review is an essay or part of an essay that summarizes and analyzes research in a particular discipline. It assess the literature by reviewing a large body of studies on a given subject matter. It summarizes by pointing out the main findings, linking together the numerous studies and explaining how they fit into the overall academic discussion on that subject. It critically analyzes the literature by pointing out the areas of weakness, expansion, and contention. 

Literature Review Sections:

• Introduction: indicates the general state of the literature on a given subject.
• Methodology: states  where (databases), how (what subject terms used on searches), and what (parameters of studies that were included); so others may recreate the searches and explain the reasoning behind the selection of those studies.
• Findings: summary of the major findings in that subject.
• Discussion: a general progression from broader studies to more focused studies.
• Conclusion: for each major section that again notes the overall state of the research, albeit with a focus on the major synthesized conclusions, problems in the research, and even possible avenues for further research.
• References: a list of all the studies using proper citation style. 

Literature Review Tips:

• Beware of stating your own opinions or personal recommendations (unless you have evidence to support such claims).
• Provide proper references to research studies.
• Focus on research studies to provide evidence and the primary purpose of the literature review.
• Connect research studies with the overall conversation on the subject.
• Have a search strategy planner and log to keep you focused.

Literature reviews are not a book reports or commentaries; make sure to stay focused, organized, and free of personal biases or unsubstantiated recommendations.

Literature Review Examples:

• Lemetti, T., Stolt, M., Rickard, N., & Suhonen, R. (2015). Collaboration between hospital and primary care nurses: a literature review. International Nursing Review , 62 (2), 248-266. doi:10.1111/inr.12147  

1. Choose a topic and define your research question.

Your literature review should be guided by a focus research question.   Consider PICO and FINER criteria for developing a research question.

• Make sure your research question is not too broad or too narrow. Do a couple of pre-searches to see what information is out there and determine if it is a manageable topic.
• Identify the main concepts of your research question and write down terms that are related to them. Keep a list of  terms that you can use when searching.
• If possible, discuss your topic with your professor. 

2. Decide on the scope of your review.

Check with your assignment requirements and your professor for parameters of the Literature Review.

• How many studies are you considering?
• How comprehensive will your literature review be?
• How many years should it cover? 

3. Select appropriate databases to search.

Make a list of the databases you will search. 

• Don't forget to look at books, dissertations or other specialized databases .
• Contact your librarian to make sure you are not missing any vital databases for that topic.

4. Conduct searches and find relevant literature.

As you are searching in databases is important to keep track and notes as you uncover information.

• Read the abstracts of research studies carefully instead of just downloading articles that have good titles.
• Write down the searches you conduct in each database so that you may duplicate or avoid unsuccessful searches again.
• Look at the bibliographies and references of research studies you find to locate others .
• Look for subject terms or MeSH terms that are associated with the  research studies you find and use those terms in more searches.
• Use a citation manager such as Zotero or Endnote Basic to keep track of your research citations.

5. Review the literature. 

As you are reading the full articles ask the following questions when assessing studies:

• What is the research question of the study?
• Who are the author(s)? What are their credentials and how are they viewed in their field?
• Has this study been cited?; if so, how has it been analyzed?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.  Does the research seem to be complete?  What further questions does it raise?
• Are there any conflicting studies; if so why?

Throughout the process keep careful notes of your searches and findings so it is easier to put it together when it comes to the writing part.

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Nursing: Literature Review

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Good Place to Start: Citation Databases

Interdisciplinary Citation Databases:

A good place to start your research  is to search a research citation database to view the scope of literature available on your topic.

TIP #1: SEED ARTICLE Begin your research with a "seed article" - an article that strongly supports your research topic.  Then use a citation database to follow the studies published by finding articles which have cited that article, either because they support it or because they disagree with it.

TIP #2: SNOWBALLING Snowballing is the process where researchers will begin with a select number of articles they have identified relevant/strongly supports their topic and then search each articles' references reviewing the studies cited to determine if they are relevant to your research.

BONUS POINTS: This process also helps identify key highly cited authors within a topic to help establish the "experts" in the field.

Begin by constructing a focused research question to help you then convert it into an effective search strategy.

• Identify keywords or synonyms
• Type of study/resources
• Which database(s) to search
• Asking a Good Question (PICO)
• PICO - AHRQ
• PICO - Worksheet
• What Is a PICOT Question?

Seminal Works: Search Key Indexing/Citation Databases

• Google Scholar
• Web of Science

TIP – How to Locate Seminal Works

• DO NOT: Limit by date range or you might overlook the seminal works
• DO: Look at highly cited references (Seminal articles are frequently referred to “cited” in the research)
• DO: Search citation databases like Scopus, Web of Science and Google Scholar

Web Resources

What is a literature review?

A literature review is a comprehensive and up-to-date overview of published information on a subject area. Conducting a literature review demands a careful examination of a body of literature that has been published that helps answer your research question (See PICO). Literature reviewed includes scholarly journals, scholarly books, authoritative databases, primary sources and grey literature.

A literature review attempts to answer the following:

• What is known about the subject?
• What is the chronology of knowledge about my subject?
• Are there any gaps in the literature?
• Is there a consensus/debate on issues?
• Create a clear research question/statement
• Define the scope of the review include limitations (i.e. gender, age, location, nationality...)
• Search existing literature including classic works on your topic and grey literature
• Evaluate results and the evidence (Avoid discounting information that contradicts your research)
• Track and organize references
• How to conduct an effective literature search.
• Social Work Literature Review Guidelines (OWL Purdue Online Writing Lab)

What is PICO?

The PICO model can help you formulate a good clinical question. Sometimes it's referred to as PICO-T, containing an optional 5th factor. 

Search Example

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How to Write a Literature Review

At some point in your graduate nursing program, you will most likely have to write a literature review about an assigned topic or a self-selected topic (e.g., your thesis, dissertation, or capstone project topic). Undergraduate students don't typically have to write a full-blown literature review; however, the tips in this post

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Nursing: How to Write a Literature Review

Traditional or narrative literature review, other types of literature reviews.

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This guide addresses how to prepare a traditional or narrative literature review. 

Why is a literature review important?

“The primary purpose of a literature review is to summarize evidence on a topic – to sum up what is known and what is not known . ” ( Polit & Beck, 2018, p. 107)

Polit, D.F., & Beck, C.T. (2018). Essentials of nursing research: Appraising evidence for nursing practice. (9th ed.). Philadelphia: Wolters Kluwer

A traditional or narrative review is one type of review.  Others include:

• systematic review
• integrative review
• scoping review

For more information on various types of reviews:

• A typology of reviews: an analysis of 14 review types and associated methodologies Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26(2), 91-108. doi:10.1111/j.1471-1842.2009.00848.x
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What is a Literature Review?

The Scholarly Conversation

A literature review provides an overview of previous research on a topic  that critically evaluates, classifies, and compares what has already been published on a particular topic. It allows the author to synthesize and place into context the research and scholarly literature relevant to the topic. It helps  map the different approaches to a given question and reveals  patterns.  It  forms the foundation for the author’s subsequent research and justifies the significance of the new investigation.

A literature review can be a short introductory section of a research article or a report or policy paper that focuses on recent research. Or, in the case of dissertations, theses, and review articles, it can be an extensive review of all relevant research.

• The  format  is usually a bibliographic essay; sources are briefly cited within the body of the essay, with full bibliographic citations at the end.
• The  introduction  should define the topic and set the context for the literature review. It will include the author's perspective or point of view on the topic, how they have defined the scope of the topic (including what's not included), and how the review will be organized. It can point out overall trends, conflicts in methodology or conclusions, and gaps in the research.
• In the  body of the review , the author should organize the research into major topics and subtopics. These groupings may be by subject, (e.g., globalization of clothing manufacturing), type of research (e.g., case studies), methodology (e.g., qualitative), genre, chronology, or other common characteristics. Within these groups, the author can then discuss the merits of each article and analyze and compare the importance of each article to similar ones.
• The  conclusion  will summarize the main findings, make clear how this review of the literature supports (or not) the research to follow, and may point the direction for further research.
• The  list of references  will include full citations for all of the items mentioned in the literature review.

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Literature Review Research

What is a literature review, how to complete a literature review, how to write a literature review.

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Researching Instruction will cover: 

Discussion about what is a literature review and how to complete a literature review. 

Use of Smart Search and Google Scholar

A literature review is an account of what has been published on a topic by accredited scholars and researchers. Occasionally you will be asked to write one as a separate assignment (sometimes in the form of an annotated bibliography —see the bottom of the next page), but more often it is part of the introduction to an essay, research report, or thesis. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are.

From  Taylor, D. (n/a). The Literature Review: A Few Tips On Conducting It. University of Toronto, Health Sciences Writing Centre. 

• The Literature Review: A Few Tips On Conducting It Writing Advice from the University of Toronto, Canada.
• Record Title: Writing & Research. Writing a Literature Review. Neill, C. (2017). Writing & Research. Writing a Literature Review. Radiation Therapist, 26(1), 89–91.

There are several steps in developing a literature review.  These include:

• Define your paper’s goal
• Literature review will match paper’s goal
• Review articles related to your paper’s topic
• Articles are written by scholars
• Identify top scholars in the field about your topic
• Include most pertinent publications by those scholars
• Summarize articles you identified
• Provide the importance of the article as it relates to your thesis/project statement
• Establish its relevance to the discussion
• What where the earliest ideas on the?
• How did grow and evolve in the academic conversation?
• As you write you will include author and date
• Create comprehensive citation for each article
• Follow APA format
• Literature Reviews From Purdue OWL
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Conducting integrative reviews: a guide for novice nursing researchers

Shannon dhollande.

Lecturer, School of Nursing, Midwifery & Social Sciences, CQ University Brisbane, Australia

Annabel Taylor

Professor, School of Nursing, Midwifery & Social Sciences, CQ University Brisbane, Australia

Silke Meyer

Associate Professor, School of Social Sciences, Monash University, Australia

Emergency Consultant, Emergency Department, Caboolture Hospital, Australia

Integrative reviews within healthcare promote a holistic understanding of the research topic. Structure and a comprehensive approach within reviews are important to ensure the reliability in their findings.

This paper aims to provide a framework for novice nursing researchers undertaking integrative reviews.

Established methods to form a research question, search literature, extract data, critically appraise extracted data and analyse review findings are discussed and exemplified using the authors’ own review as a comprehensive and reliable approach for the novice nursing researcher undertaking an integrative literature review.

Providing a comprehensive audit trail that details how an integrative literature review has been conducted increases and ensures the results are reproducible. The use of established tools to structure the various components of an integrative review increases robustness and readers’ confidence in the review findings.

Implications for practice

Novice nursing researchers may increase the reliability of their results by employing a framework to guide them through the process of conducting an integrative review.

A literature review is a critical analysis of published research literature based on a specified topic ( Pluye et al., 2016 ). Literature reviews identify literature then examine its strengths and weaknesses to determine gaps in knowledge ( Pluye et al. 2016 ). Literature reviews are an integral aspect of research projects; indeed, many reviews constitute a publication in themselves ( Snyder, 2019 ). There are various types of literature reviews based largely on the type of literature sourced ( Cronin et al. 2008 ). These include systematic literature reviews, traditional, narrative and integrative literature reviews ( Snyder, 2019 ). Aveyard and Bradbury-Jones (2019) found more than 35 commonly used terms to describe literature reviews. Within healthcare, systematic literature reviews initially gained traction and widespread support because of their reproducibility and focus on arriving at evidence-based conclusions that could influence practice and policy development ( Boell and Cecez-Kecmanovic, 2015 ). Yet, it became apparent that healthcare-related treatment options needed to review broader spectrums of research for treatment options to be considered comprehensive, holistic and patient orientated ( Boell and Cecez-Kecmanovic, 2015 ). Stern et al. (2014) suggest that despite the focus in healthcare on quantitative research not all pertinent questions surrounding the provision of care can be answered from this approach. To devise solutions to multidimensional problems, all forms of trustworthy evidence need to be considered ( Stern et al. 2014 ).

Integrative reviews assimilate research data from various research designs to reach conclusions that are comprehensive and reliable ( Soares et al. 2014 ). For example, an integrative review considers both qualitative and quantitative research to reach its conclusions. This approach promotes the development of a comprehensive understanding of the topic from a synthesis of all forms of available evidence ( Russell, 2005 ; Torraco, 2005 ). The strengths of an integrative review include its capacity to analyse research literature, evaluate the quality of the evidence, identify knowledge gaps, amalgamate research from various research designs, generate research questions and develop theoretical frameworks ( Russell, 2005 ). Aveyard and Bradbury-Jones (2019) suggested that integrative reviews exhibit similar characteristics to systematic reviews and may therefore be regarded as rigorous.

Integrative reviews value both qualitative and quantitative research which are built upon differing epistemological paradigms. Both types of research are vital in developing the evidence base that guides healthcare provision ( Leppäkoski and Paavilainen, 2012 ). Therefore, integrative reviews may influence policy development as their conclusions have considered a broad range of appropriate literature ( Whittemore and Knafl, 2005 ). An integrative approach to evidence synthesis allows healthcare professionals to make better use of all available evidence and apply it to the clinical practice environment ( Souza et al. 2010 ). For example, Aveyard and Bradbury-Jones (2019) found in excess of 12 different types of reviews employed to guide healthcare practice. The healthcare profession requires both quantitative and qualitative forms of research to establish the robust evidence base that enables the provision of evidence-based patient-orientated healthcare.

Integrative reviews require a specific set of skills to identify and synthesise literature ( Boell and Cecez-Kecmanovic, 2010 ). There remains a paucity of literature that provides explicit guidance to novice nursing researchers on how to conduct an integrative review and importantly how to ensure the results and conclusions are both comprehensive and reliable. Furthermore, novice nursing researchers may receive little formal training to develop the skills required to generate a comprehensive integrative review ( Boote and Beile, 2005 ). Aveyard and Bradbury-Jones (2019) also emphasised the limited literature providing guidance surrounding integrative reviews. Therefore, novice nursing researchers need to rely on published guidance to assist them. In this regard this paper, using an integrative review conducted by the authors as a case study, aims to provide a framework for novice nursing researchers conducting integrative reviews.

Developing the framework

In conducting integrative reviews, the novice nursing researcher may need to employ a framework to ensure the findings are comprehensive and reliable ( Boell and Cecez-Kecmanovic, 2010 ; Snyder, 2019 ). A framework to guide novice nursing researchers in conducting integrative reviews has been adapted by the authors and will now be described and delineated. This framework used various published literature to guide its creation, namely works by Aveyard and Bradbury-Jones (2019) , Nelson (2014), Stern et al. (2014) , Whittemore and Knafl (2005) , Pluye et al. (2009) , Moher et al., (2009) and Attride-Stirling, (2001) . The suggested framework involves seven steps ( Figure 1 ).

Integrative review framework ( Cooke et al. 2012 ; Riva et al. 2012 ).

Step 1: Write the review question

The review question acts as a foundation for an integrative study ( Riva et al. 2012 ). Yet, a review question may be difficult to articulate for the novice nursing researcher as it needs to consider multiple factors specifically, the population or sample, the interventions or area under investigation, the research design and outcomes and any benefit to the treatment ( Riva et al. 2012 ). A well-written review question aids the researcher to develop their research protocol/design and is of vital importance when writing an integrative review.

To articulate a review question there are numerous tools available to the novice nursing researcher to employ. These tools include variations on the PICOTs template (PICOT, PICO, PIO), and the Spider template. The PICOTs template is an established tool for structuring a research question. Yet, the SPIDER template has gained acceptance despite the need for further research to determine its applicability to multiple research contexts ( Cooke et al., 2012 ). Templates are recommended to aid the novice nursing researcher in effectively delineating and deconstructing the various elements within their review question. Delineation aids the researcher to refine the question and produce more targeted results within a literature search. In the case study, the review question was to: identify, evaluate and synthesise current knowledge and healthcare approaches to women presenting due to intimate partner violence (IPV) within emergency departments (ED). This review objective is delineated in the review question templates shown in Table 1 .

Comparison of elements involved with a PICOTS and SPIDER review question.

( Cooke et al. 2012 ; Riva et al. 2012 ).

Step 2: Determine the search strategy

In determining a search strategy, it is important for the novice nursing researcher to consider the databases employed, the search terms, the Boolean operators, the use of truncation and the use of subject headings. Furthermore, Nelson (2014) suggests that a detailed description of the search strategy should be included within integrative reviews to ensure readers are able to reproduce the results.

The databases employed within a search strategy need to consider the research aim and the scope of information contained within the database. Many databases vary in their coverage of specific journals and associated literature, such as conference proceedings ( Boell and Cecez-Kecmanovic, 2010 ). Therefore, the novice nursing researcher should consult several databases when conducting their searches. For example, search strategies within the healthcare field may utilise databases such as Cumulative Index to Nursing and Allied Healthcare Literature (CINAHL), Cochrane Library, Science Direct, ProQuest, Web of Science, Scopus and PsychInfo ( Cronin et al. 2008 ). These databases among others are largely considered appropriate repositories of reliable data that novice researchers may utilise when researching within healthcare. The date in which the searches are undertaken should be within the search strategy as searches undertaken after this date may generate increased results in line with the publication of further studies.

Utilising an established template to generate a research question allows for the delineation of key elements within the question as seen above. These key elements may assist the novice nursing researcher in determining the search terms they employ. Furthermore, keywords on published papers may provide the novice nursing researcher with alternative search terms, synonyms and introduce the researcher to key terminology employed within their field ( Boell and Cecez-Kecmanovic, 2010 ). For example, within the case study undertaken the search terms included among others: ‘domestic violence’, ‘domestic abuse’, ‘intimate partner violence and/or abuse’. To refine the search to the correct healthcare environment the terms ‘emergency department’ and/or ‘emergency room’ were employed. To link search terms, the researcher should consider their use of Boolean operators ‘And’ ‘Or’ and ‘Not’ and their use of truncation ( Cronin et al. 2008 ). Truncation is the shortening of words which in literature searches may increase the number of search results. Medical subject headings (MeSH) or general subject headings should be employed where appropriate and within this case study the headings included ‘nursing’, ‘domestic violence’ and ‘intimate partner violence’.

Inclusion and exclusion criteria allow the novice nursing researcher to reduce and refine the search parameters and locate the specific data they seek. Appropriate use of inclusion and exclusion criteria permits relevant data to be sourced as wider searches can produce a large amount of disparate data, whereas a search that is too narrow may result in the omission of significant findings ( Boell and Cecez-Kecmanovic, 2010 ). The novice nursing researcher needs to be aware that generating a large volume of search results may not necessarily result in relevant data being identified. Within integrative reviews there is potential for a large volume of data to be sourced and therefore time and resources required to complete the review need to be considered ( Heyvaert et al. 2017 ). The analysis and refining of a large volume of data can become a labour-intensive exercise for the novice nursing researcher ( Boell and Cecez-Kecmanovic, 2010 ).

Stern et al. (2014) suggest various elements that should be considered within inclusion/exclusion criteria:

• the type of studies included;
• the topic under exploration;
• the outcomes;
• publication language;
• the time period; and
• the methods employed.

The use of limiters or exclusion criteria are an effective method to manage the amount of time it takes to undertake searches and limit the volume of research generated. Yet, exclusion criteria may introduce biases in the search results and should therefore be used with caution and to produce specific outcomes by the novice nursing researcher ( Hammerstrøm et al. 2017 ).

Whittemore and Knafl (2005) suggest that randomised controlled trials, prospective and retrospective cohort studies, case control studies, cross sectional studies, systematic reviews and meta-analyses should all be included within the search strategy. Therefore, there are no biases based on the type of publication sourced ( Hammerstrøm et al. 2017 ).

There should be no restriction on the sample size within the studies recognising that qualitative studies generally have smaller sample sizes, and to capture the breadth of research available. There was no restriction on the date of publication within the case study as quality literature was limited. Scoping widely is an important strategy within integrative reviews to produce comprehensive results. A manual citation search of the reference list of all sourced papers was also undertaken by a member of the research team.

Literature may be excluded if those papers were published in a language foreign to the researcher with no accepted translation available. Though limiting papers based on translation availability may introduce some bias, this does ensure the review remains free from translational errors and cultural misinterpretations. In the case study, research conducted in developing countries with a markedly different healthcare service and significant resource limitations were excluded due to their lack of generalisability and clinical relevance; though this may have introduced a degree of location bias ( Nelson, 2014 ).

A peer review of the search strategy by an individual who specialises in research data searches such as a research librarian may be a viable method in which the novice healthcare researcher can ensure the search strategy is appropriate and able to generate the required data. One such tool that a novice nurse may employ is the Peer Review of the Search Strategy (PRESS) checklist. A peer review of the caste study was undertaken by a research librarian. All recommendations were incorporated into the search strategy which included removing a full text limiter, and changes to the Boolean and proximity operators.

After the search strategy has been implemented the researcher removes duplicate results and screened the retrieved publications based on their titles and abstracts. A second screening was then undertaken based on the full text of retrieved publications to remove papers that were irrelevant to the research question. Full text copies should then be obtained for critical appraisal employing validated methods.

Step 3: Critical appraisal of search results

The papers identified within the search strategy should undergo a critical appraisal to determine if they are appropriate and of sufficient quality to be included within the review. This should be conducted or reviewed by a second member of the research team, which occurred within this case study. Any discrepancies were discussed until consensus was achieved. A critical appraisal allows the novice healthcare researcher to appraise the relevance and trustworthiness of a study and, therefore, determine its applicability to their research (CASP, 2013). There are several established tools a novice nurse can employ in which to structure their critical appraisal. These include the Scoring System for Mixed-Methods Research and Mixed Studies Reviews developed by Pluye et al. (2009) and the Critical Appraisal Skills Programme (CASP, 2018) Checklists.

The review undertaken by the authors employed the scoring system for mixed-methods research and mixed-studies reviews developed by Pluye et al. (2009) . This scoring system was specifically designed for reviews employing studies from various research designs and therefore was utilised with ease ( Table 2 ).

The scoring system for mixed-methods research and mixed-studies reviews ( Pluye et al. 2009 ).

Using the CASP checklist aids the novice nursing researcher to examine the methodology of identified papers to establish validity. This critical appraisal tool contains 10 items. These items are yes or no questions that assist the researcher to determine (a) if the results of the paper are valid, (b) what the results are and (c) if it is relevant in the context of their study. For example, the checklist asks the researcher to consider the presence of a clear statement surrounding the aims of the research, and to consider why and how the research is important in regard to their topic (CASP, 2013). This checklist supports the nurse researcher to assess the validity, results and significance of research, and therefore appropriately decide on its inclusion within the review ( Krainovich-Miller et al., 2009 ).

Step 4: Summarise the search results

A summary of the results generated by literature searches is important to exemplify how comprehensive the literature is or conversely to identify if there are gaps in research. This summary should include the number of, and type of papers included within the review post limiters, screening and critical appraisal of search results. For example, within the review detailed throughout this paper the search strategy resulted in the inclusion of 25 qualitative and six quantitative papers ( Bakon et al. 2019 ). Many papers provide a summary of their search results visually in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram ( Boell and Cecez-Kecmanovic, 2015 ). PRISMA is a method of reporting that enables readers to assess the robustness of the results ( Leclercq et al. 2019 ; Moher et al. 2009 ). PRISMA promotes the transparency of the search process by delineating various items within the search process ( Leclercq et al. 2019 ; Moher et al. 2009 ). Researchers may decide how rigorously they follow this process yet should provide a rationale for any deviations ( Leclercq et al. 2019 ; Moher et al, 2009 ). Figure 2 is an example of the PRISMA flow diagram as it was applied within the case study.

Example PRISMA flow diagram ( Bakon et al. 2019 ; Moher et al. 2009 ).

Step 5: Data extraction and reduction

Data can be extracted from the critically appraised papers identified through the search strategy employing extraction tables. Within the case study data were clearly delineated, as suggested by Boell and Cecez-Kecmanovic (2010) , into extraction or comparison tables ( Table 3 ). These tables specify the authors, the date of publication, year of publication, site where the research was conducted and the key findings. Setting out the data into tables facilitates the comparison of these variables and aids the researcher to determine the appropriateness of the papers’ inclusion or exclusion within the review ( Whittemore and Knafl, 2005 ).

Example of a data extraction table.

Step 6: Analysis

Thematic analysis is widely used in integrative research ( Attride-Stirling, 2001 ). In this section we will discuss the benefits of employing a structured approach to thematic analysis including the formation of a thematic network. A thematic network is a visual diagram or depiction of the themes displaying their interconnectivity. Thematic analysis with the development of a thematic network is a way of identifying themes at various levels and depicting the observed relationships and organisation of these themes ( Attride-Stirling, 2001 ). There are numerous methods and tools available in which to conduct a thematic analysis that may be of use to the novice healthcare researcher conducting an integrative review. The approach used in a thematic analysis is important though a cursory glance at many literature reviews will reveal that many authors do not delineate the methods they employ. This includes the thematic analysis approach suggested by Thomas and Harden (2008) and the approach to thematic networking suggested by Attride-Stirling (2001) .

Thomas and Harden (2008) espouse a three-step approach to thematic analysis which includes: (a) coding, (b) organisation of codes into descriptive themes, and (c) the amalgamation of descriptive themes into analytical themes. The benefit of this approach lies in its simplicity and the ease with which a novice nurse researcher can apply the required steps. In contrast, the benefit of the approach suggested by Attride-Stirling (2001) lies in its ability to move beyond analysis and generate a visual thematic network which facilitates a critical interpretation and synthesis of the data.

Thematic networks typically depict three levels: basic themes, organising themes and global themes ( Attride-Stirling, 2001 ). The thematic network can then be developed. A thematic network is a visual depiction that appears graphically as a web like design ( Attride-Stirling, 2001 ). Thematic networks emphasise the relationships and interconnectivity of the network. It is an illustrative tool that facilitates interpretation of the data ( Attride-Stirling, 2001 ).

The benefits of employing a thematic analysis and networking within integrative reviews is the flexibility inherent within the approach, which allows the novice nursing researcher to provide a comprehensive accounting of the data ( Nowell et al. 2017 ). Thematic analysis is also an easily grasped form of data analysis that is useful for exploring various perspectives on specific topics and highlighting knowledge gaps ( Nowell et al. 2017 ). Thematic analysis and networking is also useful as a method to summarise large or diversified data sets to produce insightful conclusions ( Attride-Stirling, 2001 ; Nowell et al. 2017 ). The ability to assimilate data from various seemingly disparate perspectives may be challenging for the novice nursing researcher conducting an integrative review yet this integration of data by thematic analysis and networking was is integral.

To ensure the trustworthiness of results, novice nursing researchers need to clearly articulate each stage within the chosen method of data analysis ( Attride-Stirling, 2001 ; Nowell et al. 2017 ). The method employed in data analysis needs to be precise and exhaustively delineated ( Attride-Stirling, 2001 ; Nowell et al. 2017 ). Attride-Stirling (2001) suggests six steps within her methods of thematic analysis and networking. These steps include:

• code material;
• identify themes;
• construct thematic network;
• describe and explore the thematic network;
• summarise thematic network findings; and
• interpret patterns to identify implications.

In employing the approach suggested by Attride-Stirling (2001) within the case study the coding of specific findings within the data permitted the development of various themes ( Table 4 ). Inclusion of both quantitative and qualitative findings within the themes facilitated integration of the data which identified patterns and generated insights into the current care provided to IPV victims within ED.

Coding and theme formation.

Step 7: Conclusions and implications

A conclusion is important to remind the reader why the research topic is important. The researcher can then follow advice by Higginbottom (2015) who suggests that in drawing and writing research conclusions the researcher has an opportunity to explain the significance of the findings. The researcher may also need to explain these conclusions in light of the study limitations and parameters. Higginbottom (2015) emphasises that a conclusion is not a summary or reiteration of the results but a section which details the broader implications of the research and translates this knowledge into a format that is of use to the reader. The implications of the review findings for healthcare practice, for healthcare education and research should be considered.

Employing this structured and comprehensive framework within the case study the authors were able to determine that there remains a marked barrier in the provision of healthcare within the ED to women presenting with IPV-related injury. By employing an integrative approach multiple forms of literature were reviewed, and a considerable gap was identified. Therefore, further research may need to focus on the developing a structured healthcare protocol to aid ED clinicians to meet the needs of this vulnerable patient population.

Integrative reviews can be conducted with success when they follow a structured approach. This paper proposes a framework that novice nursing researchers can employ. Applying our stepped framework within an integrative review will strengthen the robustness of the study and facilitate its translation into policy and practice. This framework was employed by the authors to identify, evaluate and synthesise current knowledge and approaches of health professionals surrounding the care provision of women presenting due to IPV within emergency departments. The recommendations from the case study are currently being translated and implemented into the practice environment.

Key points for policy, practice and/or research

• Integrative literature reviews are required within nursing to consider elements of care provision from a holistic perspective.
• There is currently limited literature providing explicit guidance on how to undertake an integrative literature review.
• Clear delineation of the integrative literature review process demonstrates how the knowledge base was understood, organised and analysed.
• Nurse researchers may utilise this guidance to ensure the reliability of their integrative review.

Shannon Dhollande is a Lecturer, registered nurse and researcher. Her research explores the provision of emergency care to vulnerable populations.

Annabel Taylor is a Professorial Research Fellow at CQ University who with her background in social work explores methods of addressing gendered violence such as domestic violence.

Silke Meyer is an Associate Professor in Criminology and the Deputy Director of the Gender and Family Violence Prevention Centre at Monash University.

Mark Scott is an Emergency Medical Consultant with a track record in advancing emergency healthcare through implementation of evidence-based healthcare.

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics: Due to the nature of this article this article did not require ethical approval.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Shannon Dhollande https://orcid.org/0000-0003-3181-7606

Silke Meyer https://orcid.org/0000-0003-3964-042X

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• Volume 24, Issue 2
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• http://orcid.org/0000-0003-0157-5319 Ahtisham Younas 1 , 2 ,
• http://orcid.org/0000-0002-7839-8130 Parveen Ali 3 , 4
• 1 Memorial University of Newfoundland , St John's , Newfoundland , Canada
• 2 Swat College of Nursing , Pakistan
• 3 School of Nursing and Midwifery , University of Sheffield , Sheffield , South Yorkshire , UK
• 4 Sheffield University Interpersonal Violence Research Group , Sheffield University , Sheffield , UK
• Correspondence to Ahtisham Younas, Memorial University of Newfoundland, St John's, NL A1C 5C4, Canada; ay6133{at}mun.ca

https://doi.org/10.1136/ebnurs-2021-103417

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Introduction

Literature reviews offer a critical synthesis of empirical and theoretical literature to assess the strength of evidence, develop guidelines for practice and policymaking, and identify areas for future research. 1 It is often essential and usually the first task in any research endeavour, particularly in masters or doctoral level education. For effective data extraction and rigorous synthesis in reviews, the use of literature summary tables is of utmost importance. A literature summary table provides a synopsis of an included article. It succinctly presents its purpose, methods, findings and other relevant information pertinent to the review. The aim of developing these literature summary tables is to provide the reader with the information at one glance. Since there are multiple types of reviews (eg, systematic, integrative, scoping, critical and mixed methods) with distinct purposes and techniques, 2 there could be various approaches for developing literature summary tables making it a complex task specialty for the novice researchers or reviewers. Here, we offer five tips for authors of the review articles, relevant to all types of reviews, for creating useful and relevant literature summary tables. We also provide examples from our published reviews to illustrate how useful literature summary tables can be developed and what sort of information should be provided.

Tip 1: provide detailed information about frameworks and methods

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Tabular literature summaries from a scoping review. Source: Rasheed et al . 3

The provision of information about conceptual and theoretical frameworks and methods is useful for several reasons. First, in quantitative (reviews synthesising the results of quantitative studies) and mixed reviews (reviews synthesising the results of both qualitative and quantitative studies to address a mixed review question), it allows the readers to assess the congruence of the core findings and methods with the adapted framework and tested assumptions. In qualitative reviews (reviews synthesising results of qualitative studies), this information is beneficial for readers to recognise the underlying philosophical and paradigmatic stance of the authors of the included articles. For example, imagine the authors of an article, included in a review, used phenomenological inquiry for their research. In that case, the review authors and the readers of the review need to know what kind of (transcendental or hermeneutic) philosophical stance guided the inquiry. Review authors should, therefore, include the philosophical stance in their literature summary for the particular article. Second, information about frameworks and methods enables review authors and readers to judge the quality of the research, which allows for discerning the strengths and limitations of the article. For example, if authors of an included article intended to develop a new scale and test its psychometric properties. To achieve this aim, they used a convenience sample of 150 participants and performed exploratory (EFA) and confirmatory factor analysis (CFA) on the same sample. Such an approach would indicate a flawed methodology because EFA and CFA should not be conducted on the same sample. The review authors must include this information in their summary table. Omitting this information from a summary could lead to the inclusion of a flawed article in the review, thereby jeopardising the review’s rigour.

Tip 2: include strengths and limitations for each article

Critical appraisal of individual articles included in a review is crucial for increasing the rigour of the review. Despite using various templates for critical appraisal, authors often do not provide detailed information about each reviewed article’s strengths and limitations. Merely noting the quality score based on standardised critical appraisal templates is not adequate because the readers should be able to identify the reasons for assigning a weak or moderate rating. Many recent critical appraisal checklists (eg, Mixed Methods Appraisal Tool) discourage review authors from assigning a quality score and recommend noting the main strengths and limitations of included studies. It is also vital that methodological and conceptual limitations and strengths of the articles included in the review are provided because not all review articles include empirical research papers. Rather some review synthesises the theoretical aspects of articles. Providing information about conceptual limitations is also important for readers to judge the quality of foundations of the research. For example, if you included a mixed-methods study in the review, reporting the methodological and conceptual limitations about ‘integration’ is critical for evaluating the study’s strength. Suppose the authors only collected qualitative and quantitative data and did not state the intent and timing of integration. In that case, the strength of the study is weak. Integration only occurred at the levels of data collection. However, integration may not have occurred at the analysis, interpretation and reporting levels.

Tip 3: write conceptual contribution of each reviewed article

While reading and evaluating review papers, we have observed that many review authors only provide core results of the article included in a review and do not explain the conceptual contribution offered by the included article. We refer to conceptual contribution as a description of how the article’s key results contribute towards the development of potential codes, themes or subthemes, or emerging patterns that are reported as the review findings. For example, the authors of a review article noted that one of the research articles included in their review demonstrated the usefulness of case studies and reflective logs as strategies for fostering compassion in nursing students. The conceptual contribution of this research article could be that experiential learning is one way to teach compassion to nursing students, as supported by case studies and reflective logs. This conceptual contribution of the article should be mentioned in the literature summary table. Delineating each reviewed article’s conceptual contribution is particularly beneficial in qualitative reviews, mixed-methods reviews, and critical reviews that often focus on developing models and describing or explaining various phenomena. Figure 2 offers an example of a literature summary table. 4

Tabular literature summaries from a critical review. Source: Younas and Maddigan. 4

Tip 4: compose potential themes from each article during summary writing

While developing literature summary tables, many authors use themes or subthemes reported in the given articles as the key results of their own review. Such an approach prevents the review authors from understanding the article’s conceptual contribution, developing rigorous synthesis and drawing reasonable interpretations of results from an individual article. Ultimately, it affects the generation of novel review findings. For example, one of the articles about women’s healthcare-seeking behaviours in developing countries reported a theme ‘social-cultural determinants of health as precursors of delays’. Instead of using this theme as one of the review findings, the reviewers should read and interpret beyond the given description in an article, compare and contrast themes, findings from one article with findings and themes from another article to find similarities and differences and to understand and explain bigger picture for their readers. Therefore, while developing literature summary tables, think twice before using the predeveloped themes. Including your themes in the summary tables (see figure 1 ) demonstrates to the readers that a robust method of data extraction and synthesis has been followed.

Tip 5: create your personalised template for literature summaries

Often templates are available for data extraction and development of literature summary tables. The available templates may be in the form of a table, chart or a structured framework that extracts some essential information about every article. The commonly used information may include authors, purpose, methods, key results and quality scores. While extracting all relevant information is important, such templates should be tailored to meet the needs of the individuals’ review. For example, for a review about the effectiveness of healthcare interventions, a literature summary table must include information about the intervention, its type, content timing, duration, setting, effectiveness, negative consequences, and receivers and implementers’ experiences of its usage. Similarly, literature summary tables for articles included in a meta-synthesis must include information about the participants’ characteristics, research context and conceptual contribution of each reviewed article so as to help the reader make an informed decision about the usefulness or lack of usefulness of the individual article in the review and the whole review.

In conclusion, narrative or systematic reviews are almost always conducted as a part of any educational project (thesis or dissertation) or academic or clinical research. Literature reviews are the foundation of research on a given topic. Robust and high-quality reviews play an instrumental role in guiding research, practice and policymaking. However, the quality of reviews is also contingent on rigorous data extraction and synthesis, which require developing literature summaries. We have outlined five tips that could enhance the quality of the data extraction and synthesis process by developing useful literature summaries.

• Aromataris E ,
• Rasheed SP ,

Twitter @Ahtisham04, @parveenazamali

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

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What is a Literature Review?

Key questions for a literature review, examples of literature reviews, useful links, evidence matrix for literature reviews.

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The Scholarly Conversation

A literature review provides an overview of previous research on a topic that critically evaluates, classifies, and compares what has already been published on a particular topic. It allows the author to synthesize and place into context the research and scholarly literature relevant to the topic. It helps map the different approaches to a given question and reveals patterns. It forms the foundation for the author’s subsequent research and justifies the significance of the new investigation.

A literature review can be a short introductory section of a research article or a report or policy paper that focuses on recent research. Or, in the case of dissertations, theses, and review articles, it can be an extensive review of all relevant research.

• The format is usually a bibliographic essay; sources are briefly cited within the body of the essay, with full bibliographic citations at the end.
• The introduction should define the topic and set the context for the literature review. It will include the author's perspective or point of view on the topic, how they have defined the scope of the topic (including what's not included), and how the review will be organized. It can point out overall trends, conflicts in methodology or conclusions, and gaps in the research.
• In the body of the review, the author should organize the research into major topics and subtopics. These groupings may be by subject, (e.g., globalization of clothing manufacturing), type of research (e.g., case studies), methodology (e.g., qualitative), genre, chronology, or other common characteristics. Within these groups, the author can then discuss the merits of each article and analyze and compare the importance of each article to similar ones.
• The conclusion will summarize the main findings, make clear how this review of the literature supports (or not) the research to follow, and may point the direction for further research.
• The list of references will include full citations for all of the items mentioned in the literature review.

A literature review should try to answer questions such as

• Who are the key researchers on this topic?
• What has been the focus of the research efforts so far and what is the current status?
• How have certain studies built on prior studies? Where are the connections? Are there new interpretations of the research?
• Have there been any controversies or debate about the research? Is there consensus? Are there any contradictions?
• Which areas have been identified as needing further research? Have any pathways been suggested?
• How will your topic uniquely contribute to this body of knowledge?
• Which methodologies have researchers used and which appear to be the most productive?
• What sources of information or data were identified that might be useful to you?
• How does your particular topic fit into the larger context of what has already been done?
• How has the research that has already been done help frame your current investigation ?

Example of a literature review at the beginning of an article: Forbes, C. C., Blanchard, C. M., Mummery, W. K., & Courneya, K. S. (2015, March). Prevalence and correlates of strength exercise among breast, prostate, and colorectal cancer survivors . Oncology Nursing Forum, 42(2), 118+. Retrieved from http://go.galegroup.com.sonoma.idm.oclc.org/ps/i.do?p=HRCA&sw=w&u=sonomacsu&v=2.1&it=r&id=GALE%7CA422059606&asid=27e45873fddc413ac1bebbc129f7649c Example of a comprehensive review of the literature: Wilson, J. L. (2016). An exploration of bullying behaviours in nursing: a review of the literature.   British Journal Of Nursing ,  25 (6), 303-306. For additional examples, see:

Galvan, J., Galvan, M., & ProQuest. (2017). Writing literature reviews: A guide for students of the social and behavioral sciences (Seventh ed.). [Electronic book]

Pan, M., & Lopez, M. (2008). Preparing literature reviews: Qualitative and quantitative approaches (3rd ed.). Glendale, CA: Pyrczak Pub. [ Q180.55.E9 P36 2008]

• Write a Literature Review (UCSC)
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The  Evidence Matrix  can help you  organize your research  before writing your lit review.  Use it to  identify patterns  and commonalities in the articles you have found--similar methodologies ?  common  theoretical frameworks ? It helps you make sure that all your major concepts covered. It also helps you see how your research fits into the context  of the overall topic.

• Evidence Matrix Special thanks to Dr. Cindy Stearns, SSU Sociology Dept, for permission to use this Matrix as an example.
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How to Search

Need more articles, but can't seem to find the right ones? Try these techniques!

Backwards searching: Once you find a relevant article, check the reference list at the end of the article. This will help you find other pertinent articles. 

Forward searching : Once you find a relevant article, look at whether it has been cited in more-recent research. If a researcher cited it, it is likely that their paper will also relate to your topic. ResearchGate is a community for students and researchers. It lists where each of their publications have been cited, if at all. This can be found under the "citations" tab that pops up when you click on any publication. 

When stuck, ask yourself, "What else is related to my topic?"

Get creative! You might find useful literature that you did not initially anticipate.

Fonseca, M. (2013, November 4) 5 tips to write a great literature review. https://www.editage.com/insights/5-tips-to-write-a-great-literature-review?refer=scroll-to-1-article&refer-type=article

What is a Literature Review?

"A literature review is a critical summary of all the published works on a particular topic" (Fonseca, 2013). A literature review provides background for your paper by quickly bringing the reader up-to-date on relevant findings, controversies, and dilemmas. It is the author's chance to "set the scene" and demonstrate why their topic is of interest to academia. In your literature review, you will describe "where your project comes from and how it fits in with existing knowledge" (Lloyd, 2017-2018). Further, you will provide "an argument for why your project makes a valuable contribution" (Lloyd, 2017-2018).

References: 

Lloyd, C.(2017-2018). Literature reviews for sociology senior theses . [PowerPoint Slides]. https://socthesis.fas.harvard.edu/files/socseniorthesis/files/pres-litreview.pdf

Step One: Define Your Research Question

What are you trying to determine for your literature review? What specifically do you want to learn more about? Choose a topic that you are genuinely interested in. Next, conduct a broad search on it. Determine what trending and popular research is available, then narrow your topic down. You can refine it by one or more of the following:

• Geographic location
• Time period
• Discipline/field of study, etc.

Research terms will help define your question.

• A broad question might be something like: What is the homeless population like?
• A narrow and specific question may include: What social and political factors have affected the growth of the middle-aged homeless population in Toronto within the past five years?

Once you have determined an appropriate research question/topic, move on to planning your approach.

Dermody, K., Literature Reviews. (2020, January 23). Retrieved from https://learn.library.ryerson.ca/literaturereview.

Step Two: Plan Your Approach 

After you have landed a research question, ask yourself "Which specific terms will I use, and where am I going to begin?" Determine what kind of literature you want to look at, whether it be journal articles, books, electronic resources, newspapers, or even other literature reviews on similar topics.

Your keywords are the main concepts or ideas of your paper.  For example, the keywords for a paper on “youth employment in Canada” would be:

Use synonyms: Often there are multiple ways to express the same concept. Make sure to use synonyms in your research. For instance, "employment" can be researched as:

Lastly, use “ AND ” and “ OR .” By bridging your truncated keywords and synonyms with the capitalized search words “AND” and “OR” (known as Boolean operators), you can search for multiple concepts effectively. For more information, visit the "electronic resources" tab of this research guide. There is a box on Boolean operators. 

Step Four: Analyze Material

When searching for material, it is important to analyze your sources for credibility, accuracy, currency, and authenticity. Ask these questions when analyzing a source:

• What is the purpose of the work?
• How current is it?
• Who is the author? 
• What are the author's biases?
• Is this work peer reviewed? 
• How accurate is this information? What facts/empirical evidence support it?
• What time frame are you looking at for your literature review, and does the work fall within that range?

Step Five: Manage Your Results 

After analyzing your research and determining what sources you want to use, it's important to keep track of what you have looked through. Keep a list of the following:

• What searches you have completed.
• Which ones were successful and unsuccessful.
• What databases you used.
• What sources you want to use for your literature review.
• What else you may want to search for next.

You can do this using software such as Zotero , Mendeley , and EndNote .

Congratulations! You are making progress towards an exceptional literature review.

Literature Review vs. Annotated Bibliography  Both a literature review (A.K.A. literature synthesis) and an annotated bibliography summarize the existing body of knowledge on a given topic.

What is the difference between a literature review and an annotated bibliography?  Unlike literature reviews, annotated bibliographies summarize entire research articles. An annotated bibliography looks like this:

Annotated Bibliography

•    Summarizes each article separately.

o    First, students discuss article one, then two, etc.  o    Topic: Blood Donation

• Paragraph 1: Bonnie and Clyde (2019) wrote "this" on blood donation.
• Paragraph 2: Rose and Jack (1997) wrote "this" on blood donation.
• Paragraph 3: Mary-Kate and Ashley (2001) wrote "this" on blood donation.
• Result: Multiple summaries of individual research articles (Lloyd, 2017-2018).

•    Describes the existing body of knowledge by integrating and synthesizing the literature to create something new.

o     Topic: Blood Donation

• Paragraph 1: Information/research findings on red blood cells pulled from multiple sources.
• Paragraph 2: Information/research findings on platelets pulled from multiple sources.
• Paragraph 3: Information/research findings on white blood cells pulled from multiple sources.
• Paragraph 4: Information/research findings on the drawbacks of donating blood from multiple sources (Lloyd, 2017-2018).
• Result: The author points out "themes, concepts, gaps and disagreements" between articles (Hofer, Hanick & Townsend, 2019, p. 216). Students use these to describe the existing body of knowledge on their topic one concept at a time. 

References:

Hofer, A. R., Hanick S. L., & Townsend, L. (2019). Designing activities for conceptual teaching. Transforming information literacy instruction: Threshold concepts in theory and practice. (p. 209-224). Libraries Unlimited.

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Nursing Literature Reviews

What is a Literature (Lit) Review? 

A Literature Review is Not: 

• a quick summary of sources
• a grouping of broad, unrelated sources
• a compilation of everything that has ever been written on a topic
• a literature criticism or book review

So, what is it then?

A literature review is an integrated analysis-- not just a summary-- of scholarly writings that are related directly to your research question.  That is, it represents the literature that provides background information on your topic and shows a correspondence between those writings and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

Adapted from:  https://libguides.uwf.edu/c.php?g=215270&p=4439026  by Hillary Fox, University of West Florida,  hfox @uwf.edu.

Creating a Literature Review using the Matrix Method: 

A matrix review allows you to quickly compare and contrast articles in an easy to read format. It can help you to easily spot differences and similarities between journal articles and your nursing research topic. Review matrices are especially helpful for health sciences literature reviews that cover the scope of research over a given amount of time. 

Most literature reviews are set up in this format: 

Chart adapted from the book below: 

• Check out the e-book above for more help in creating a literature review matrix. 

Steps for Conducting a Literature Review

1. Choose Your Topic

• Review your PICO question and think about your central research question. To review the PICO process, please see Kerry Sewell's LibGuide on this subject. 

2. Decide on the scope of your review

• How many studies do you need to look at? 
• How comprehensive should it be? 
• How many years should it cover? 

3. Select the databases you want to use to conduct your searches (See the Databases Tab Above!)

4. Conduct your searches and find the literature. (Keep track of your searches, try using the Search Strategy Lab Notebook!)

• Review the abstracts and conclusions carefully. This will help you decide which articles actually fit the criteria you are looking for. 
• Write down the keywords you used and where you found them. 
• You can also use RefWorks to keep track of your citations. 

5. Review the Literature (This will probably be the most time consuming part)

• What was the research question of the study you are reviewing?  What were the authors trying to discover? 
• Was the research funded by a company or source that could influence the findings? (Such as Colgate® sponsoring a toothpaste study?)
• What were the research methodologies? Analyze the paper's literature review, the samples and variables used, the results and conclusions. Does the research seem to be complete? Could it have been conducted more soundly? What questions does it raise? 
• If there are conflicting studies, why do you think that is? 
• How are the authors of the paper viewed in the field? Has this study been cited by other publications? 

Literature Review Examples

Remember, a lit review provides an intelligent overview of the topic. There may or may not be a method for how studies are collected or interpreted. Lit reviews aren't always labeled specifically as "literature reviews," they may often be embedded with other sections such as an introduction or background. 

• Mentes, J.C., Salem, N., & Phillips, L.R. (2017). Ethnocultural gerontological nursing. An integrative literature review. Journal of Transcultural Nursing, 28(1), 79-97.  https://journals.sagepub.com/doi/pdf/10.1177/1043659615601483
• Rosa, D.F., Carvalho, M.V., & Pereira, N.R, et al. (2019). Nursing care for the transgender population: genders from the perspective of professional practice. Revista Brasilerira de Enfermagem, 72 (Suppl 1), 299-306.  http://www.scielo.br/pdf/reben/v72s1/0034-7167-reben-72-s1-0299.pdf
• Dahlke, S.A., Hunter, K.F., Negrin, K. (2019). Nursing practice with hospitalized older people: Safety and harm. International Journal of Older People Nursing, 14 (1), Article e1220.  https://onlinelibrary.wiley.com/doi/full/10.1111/opn.12220

Adapted from:  https://libguides.uwf.edu/c.php?g=215270&p=4439026  by Hillary Fox, University of West Florida, [email protected].

Carrie Forbes, MLS

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Nursing Literature Reviews

• Literature and Other Types of Reviews
• Starting Your Search
• Developing a Research Question and the Literature Search Process
• Conducting a Literature Search
• Levels of Evidence
• Creating a PRISMA Table
• Literature Table and Synthesis
• Other Resources

PRISMA Diagrams

• PRISMA 2020 Template
• PRISMA 2009 Template

Introduction to a PRISMA Table

PRISMA stands for Preferred Reporting Instrument for Systematic Reviews and Meta-Analysis. It is intended to show the research process from search to abstract review to full text selection. Those reading an article should pay attention to inclusion and exclusion criteria, and how authors determined articles for inclusion in their final research.

From the PRISMA website: "PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. PRISMA focuses on the reporting of reviews evaluating randomized trials, but can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions."

PRISMA Flow Diagram (PDF and downloadable Word doc)

Introduction to PRISMA Tables

Examples of prisma tables.

Folkestad, T., Brurberg, K.G., Nordhuus, K.M. et al. Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis. Crit Care 24, 2 (2020). https://doi.org/10.1186/s13054-019-2710-4

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