doing a literature review in nursing

Nursing: How to Write a Literature Review

• Traditional or Narrative Literature Review

Getting started

1. start with your research question, 2. search the literature, 3. read & evaluate, 4. finalize results, 5. write & revise, brainfuse online tutoring and writing review.

• RESEARCH HELP

The best way to approach your literature review is to break it down into steps.  Remember, research is an iterative process, not a linear one.  You will revisit steps and revise along the way.  Get started with the handout, information, and tips from various university Writing Centers below that provides an excellent overview.  Then move on to the specific steps recommended on this page.

• UNC- Chapel Hill Writing Center Literature Review Handout, from the University of North Carolina at Chapel Hill.
• University of Wisconsin-Madison Writing Center Learn how to write a review of literature, from the University of Wisconsin-Madison.
• University of Toronto-- Writing Advice The Literature Review: A few tips on conducting it, from the University of Toronto.
• Begin with a topic.
• Understand the topic. 
• Familiarize yourself with the terminology.  Note what words are being used and keep track of these for use as database search keywords. 
• See what research has been done on this topic before you commit to the topic.  Review articles can be helpful to understand what research has been done .
• Develop your research question.  (see handout below)
• How comprehensive should it be? 
• Is it for a course assignment or a dissertation? 
• How many years should it cover?
• Developing a good nursing research question Handout. Reviews PICO method and provides search tips.

Your next step is to construct a search strategy and then locate & retrieve articles.

•  There are often 2-4 key concepts in a research question.
• Search for primary sources (original research articles.)
• These are based on the key concepts in your research question.
• Remember to consider synonyms and related terms.
• Which databases to search?
• What limiters should be applied (peer-reviewed, publication date, geographic location, etc.)?

Review articles (secondary sources)

Use to identify literature on your topic, the way you would use a bibliography.  Then locate and retrieve the original studies discussed in the review article. Review articles are considered secondary sources.

• Once you have some relevant articles, review reference lists to see if there are any useful articles.
• Which articles were written later and have cited some of your useful articles?  Are these, in turn, articles that will be useful to you? 
• Keep track of what terms you used and what databases you searched. 
• Use database tools such as save search history in EBSCO to help.
• Keep track of the citations for the articles you will be using in your literature review. 
• Use RefWorks or another method of tracking this information. 
• Database Search Strategy Worksheet Handout. How to construct a search.
• TUTORIAL: How to do a search based on your research question This is a self-paced, interactive tutorial that reviews how to construct and perform a database search in CINAHL.

The next step is to read, review, and understand the articles.

• Start by reviewing abstracts. 
• Make sure you are selecting primary sources (original research articles).
• Note any keywords authors report using when searching for prior studies.
• You will need to evaluate and critique them and write a synthesis related to your research question.
• Consider using a matrix to organize and compare and contrast the articles . 
• Which authors are conducting research in this area?  Search by author.  
• Are there certain authors’ whose work is cited in many of your articles?  Did they write an early, seminal article that is often cited?
• Searching is a cyclical process where you will run searches, review results, modify searches, run again, review again, etc. 
• Critique articles.  Keep or exclude based on whether they are relevant to your research question.
• When you have done a thorough search using several databases plus Google Scholar, using appropriate keywords or subject terms, plus author’s names, and you begin to find the same articles over and over.
• Remember to consider the scope of your project and the length of your paper.  A dissertation will have a more exhaustive literature review than an 8 page paper, for example.
• What are common findings among each group or where do they disagree? 
• Identify common themes. Identify controversial or problematic areas in the research. 
• Use your matrix to organize this.
• Once you have read and re-read your articles and organized your findings, you are ready to begin the process of writing the literature review.

2. Synthesize.  (see handout below)

• Include a synthesis of the articles you have chosen for your literature review.
• A literature review is NOT a list or a summary of what has been written on a particular topic. 
• It analyzes the articles in terms of how they relate to your research question. 
• While reading, look for similarities and differences (compare and contrast) among the articles.  You will create your synthesis from this.
• Synthesis Examples Handout. Sample excerpts that illustrate synthesis.

Regis Online students have access to Brainfuse. Brainfuse is an online tutoring service available through a link in Moodle. Meet with a tutor in a live session or submit your paper for review.

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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
• Strategies for organizing the information for your review
• Literature reviews sections
• In-depth resources to assist in writing a literature review
• Templates to start your review
• Literature review examples

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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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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Doing a Literature Review in Nursing, Health and Social Care (Second edition) Coughlan Michael and Cronin Patricia Doing a Literature Review in Nursing, Health and Social Care (Second edition) 184pp £19.99 Sage Publishing 9781412962049 1412962048 [Formula: see text]

• PMID: 28326921
• DOI: 10.7748/nr.24.4.8.s3

This book provides a concise and informative guide to the process of literature review in nursing, health and social care, and is applicable to students and professionals.

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Doing a Literature Review in Nursing, Health and Social Care

• Michael Coughlan - Trinity College Dublin, Ireland
• Patricia Cronin - Trinity College Dublin, Ireland
• Description

A clear and practical guide to completing a literature review in nursing and healthcare studies.

Providing students with straightforward guidance on how to successfully carry out a literature review as part of a research project or dissertation, this book uses examples and activities to demonstrate how to complete each step correctly, from start to finish, and highlights how to avoid common mistakes.

The third edition includes:

• Expert advice on selecting and researching a topic
• A chapter outlining the different types of literature review
• Increased focus on Critical Appraisal Tools and how to use them effectively
• New real-world examples presenting best practice
• Instructions on writing up and presenting the final piece of work

Perfect for any nursing or healthcare student new to literature reviews and for anyone who needs a refresher in this important topic.

Praise for the previous edition:

'This book is an excellent resource for practitioners wishing to develop their knowledge and understanding of reviewing literature and the processes involved. It uses uncomplicated language to signpost the reader effortlessly through key aspects of research processes. Practitioners will find this an invaluable companion for navigating through evidence to identify quality literature applicable to health and social care practice.' 

'Students often struggle with writing an effective literature review and this invaluable guide will help to allay their concerns. Key terms are clearly explained, and the inclusion of learning outcomes is a helpful feature for students and lecturers alike.  The examples are also very helpful, particularly for less confident students.  This is an accessible yet authoritative guide which I can thoroughly recommend.' 

'A must have - this book provides useful information and guidance to students and professionals alike. It guides the reader through various research methods in a theoretical and pragmatic manner.' 

' It's a very readable, concise, and accessible introduction to undertaking a literature review in the field of healthcare. The book’s layout has a logical format which really helped me to think methodically about my research question. An excellent reference for undergraduates who are about to undertake their first literature review.' 

'This book is an essential resource for students. Clearly written and excellently structured, with helpful study tools throughout, it takes the reader step by step through the literature review process in an easy, informative and accessible manner. This text gives students the skills they need to successfully complete their own review.' 

'The updating of the chapters will be exceptionally helpful given the rapid changes in online availability of resources and open-access literature.'  

Excellent resource. Useful for any stage of studying

Excellent text for masters and doctoral level students

An excellent primer to help the level 7 students write their systemised review for the assignment.

This book provides a comprehensive overview of the practical process of literature review in healthcare. It contains all details required to conduct a review by students.

This is an excellent clear and concise book on undertaking literature reviews being particularly good at demystifying jargon. It is timely given the move to student dissertations being primarily literature reviews in the current Covid pandemic. However nearly all the examples are drawn from nursing and health making the text less useful for social care and social work. A little disappointing given the title. SW students are likely to gravitate to texts where their subject is more prominent for a primary text.

Accessible, informative, step to step guide

This is a really helpful, accessible text for students and academic staff alike.

A really good addition to the repertoire of skills and techniques for understanding the essential process of literature reviewing.

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Carrying out systematic literature reviews: an introduction

Alan Davies

Lecturer in Health Data Science, School of Health Sciences, University of Manchester, Manchester

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Systematic reviews provide a synthesis of evidence for a specific topic of interest, summarising the results of multiple studies to aid in clinical decisions and resource allocation. They remain among the best forms of evidence, and reduce the bias inherent in other methods. A solid understanding of the systematic review process can be of benefit to nurses that carry out such reviews, and for those who make decisions based on them. An overview of the main steps involved in carrying out a systematic review is presented, including some of the common tools and frameworks utilised in this area. This should provide a good starting point for those that are considering embarking on such work, and to aid readers of such reviews in their understanding of the main review components, in order to appraise the quality of a review that may be used to inform subsequent clinical decision making.

Since their inception in the late 1970s, systematic reviews have gained influence in the health professions ( Hanley and Cutts, 2013 ). Systematic reviews and meta-analyses are considered to be the most credible and authoritative sources of evidence available ( Cognetti et al, 2015 ) and are regarded as the pinnacle of evidence in the various ‘hierarchies of evidence’. Reviews published in the Cochrane Library ( https://www.cochranelibrary.com) are widely considered to be the ‘gold’ standard. Since Guyatt et al (1995) presented a users' guide to medical literature for the Evidence-Based Medicine Working Group, various hierarchies of evidence have been proposed. Figure 1 illustrates an example.

Systematic reviews can be qualitative or quantitative. One of the criticisms levelled at hierarchies such as these is that qualitative research is often positioned towards or even is at the bottom of the pyramid, thus implying that it is of little evidential value. This may be because of traditional issues concerning the quality of some qualitative work, although it is now widely recognised that both quantitative and qualitative research methodologies have a valuable part to play in answering research questions, which is reflected by the National Institute for Health and Care Excellence (NICE) information concerning methods for developing public health guidance. The NICE (2012) guidance highlights how both qualitative and quantitative study designs can be used to answer different research questions. In a revised version of the hierarchy-of-evidence pyramid, the systematic review is considered as the lens through which the evidence is viewed, rather than being at the top of the pyramid ( Murad et al, 2016 ).

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Doing a literature review in nursing, health and social care (second edition), claire lee paediatric research nurse, department of paediatric gastroenterology, addenbrooke’s hospital, cambridge.

This book provides a concise and informative guide to the process of literature review in nursing, health and social care, and is applicable to students and professionals.

Nurse Researcher . 24, 4, 8-8. doi: 10.7748/nr.24.4.8.s3

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22 March 2017 / Vol 24 issue 4

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Doing a Literature Review in Nursing, Health and Social Care Third Edition

A clear and practical guide to completing a literature review in nursing and healthcare studies.

Providing students with straightforward guidance on how to successfully carry out a literature review as part of a research project or dissertation, this book uses examples and activities to demonstrate how to complete each step correctly, from start to finish, and highlights how to avoid common mistakes.

The third edition includes:

• Expert advice on selecting and researching a topic
• A chapter outlining the different types of literature review
• Increased focus on Critical Appraisal Tools and how to use them effectively
• New real-world examples presenting best practice
• Instructions on writing up and presenting the final piece of work

Perfect for any nursing or healthcare student new to literature reviews and for anyone who needs a refresher in this important topic.

• ISBN-10 1526497514
• ISBN-13 978-1526497512
• Edition Third
• Publisher SAGE Publications Ltd
• Publication date March 9, 2021
• Language English
• Dimensions 6.69 x 0.44 x 9.53 inches
• Print length 192 pages
• See all details

Editorial Reviews

′This book is an excellent resource for practitioners wishing to develop their knowledge and understanding of reviewing literature and the processes involved. It uses uncomplicated language to signpost the reader effortlessly through key aspects of research processes. Practitioners will find this an invaluable companion for navigating through evidence to identify quality literature applicable to health and social care practice.′

′Students often struggle with writing an effective literature review and this invaluable guide will help to allay their concerns. Key terms are clearly explained, and the inclusion of learning outcomes is a helpful feature for students and lecturers alike. The examples are also very helpful, particularly for less confident students. This is an accessible yet authoritative guide which I can thoroughly recommend.′

′A must have - this book provides useful information and guidance to students and professionals alike. It guides the reader through various research methods in a theoretical and pragmatic manner.′

′It′s a very readable, concise, and accessible introduction to undertaking a literature review in the field of healthcare. The book’s layout has a logical format which really helped me to think methodically about my research question. An excellent reference for undergraduates who are about to undertake their first literature review.′

′This book is an essential resource for students. Clearly written and excellently structured, with helpful study tools throughout, it takes the reader step by step through the literature review process in an easy, informative and accessible manner. This text gives students the skills they need to successfully complete their own review.′

′The updating of the chapters will be exceptionally helpful given the rapid changes in online availability of resources and open-access literature.′

About the Author

Patricia Cronin is an Assistant Professor in the School of Nursing and Midwifery, Trinity College Dublin. She is a registered General Nurse and her clinical background is in surgical and gastrointestinal nursing. She has a special interest in theory, and research and systematic review methodologies and considerable expertise in qualitative research methodologies. She is also a contributor and member of the editorial board for an online clinical skills training tool. Her research interests lie in the areas of chronic illness and gastrointestinal health in people with intellectual disability. She has published widely, co-authoring four books and book chapters and journal articles related to clinical skills, gastrointestinal nursing, research and theory. Qualifications: PhD, MSc, MA, BSc Nursing & Education, DipN (Lond), RN.

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• Publisher ‏ : ‎ SAGE Publications Ltd; Third edition (March 9, 2021)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 192 pages
• ISBN-10 ‏ : ‎ 1526497514
• ISBN-13 ‏ : ‎ 978-1526497512
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• v.26(5); 2021 Aug

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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• Research article
• Open access
• Published: 16 May 2019

An analysis of current practices in undertaking literature reviews in nursing: findings from a focused mapping review and synthesis

• Helen Aveyard   ORCID: orcid.org/0000-0001-5133-3356 1 &
• Caroline Bradbury-Jones 2  

BMC Medical Research Methodology volume  19 , Article number:  105 ( 2019 ) Cite this article

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In this paper we discuss the emergence of many different methods for doing a literature review. Referring back to the early days, when there were essentially two types of review; a Cochrane systematic review and a narrative review, we identify how the term systematic review is now widely used to describe a variety of review types and how the number of available methods for doing a literature review has increased dramatically. This led us to undertake a review of current practice of those doing a literature review and the terms used to describe them.

We undertook a focused mapping review and synthesis. Literature reviews; defined as papers with the terms review or synthesis in the title, published in five nursing journals between January 2017–June 2018 were identified. We recorded the type of review and how these were undertaken.

We identified more than 35 terms used to describe a literature review. Some terms reflected established methods for doing a review whilst others could not be traced to established methods and/or the description of method in the paper was limited. We also found inconsistency in how the terms were used.

We have identified a proliferation of terms used to describe doing a literature review; although it is not clear how many distinct methods are being used. Our review indicates a move from an era when the term narrative review was used to describe all ‘non Cochrane’ reviews; to a time of expansion when alternative systematic approaches were developed to enhance rigour of such narrative reviews; to the current situation in which these approaches have proliferated to the extent so that the academic discipline of doing a literature review has become muddled and confusing. We argue that an ‘era of consolidation’ is needed in which those undertaking reviews are explicit about the method used and ensure that their processes can be traced back to a well described, original primary source.

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Over the past twenty years in nursing, literature reviews have become an increasingly popular form of synthesising evidence and information relevant to the profession. Along with this there has been a proliferation of publications regarding the processes and practicalities of reviewing [ 1 , 2 , 3 , 4 ], This increase in activity and enthusiasm for undertaking literature reviews is paralleled by the foundation of the Cochrane Collaboration in 1993. Developed in response to the need for up-to-date reviews of evidence of the effectiveness of health care interventions, the Cochrane Collaboration introduced a rigorous method of searching, appraisal and analysis in the form of a ‘handbook’ for doing a systematic review [ 5 ] .Subsequently, similar procedural guidance has been produced, for example by the Centre for Reviews and Dissemination (CRD) [ 6 ] and The Joanna Briggs Institute [ 7 ]. Further guidance has been published to assist researchers with clarity in the reporting of published reviews [ 8 ].

In the early days of the literature review era, the methodological toolkit for those undertaking a literature was polarised, in a way that mirrored the paradigm wars of the time within mixed-methods research [ 9 ]. We refer to this as the ‘dichotomy era’ (i.e. the 1990s), The prominent methods of literature reviewing fell into one of two camps: The highly rigorous and systematic, mostly quantitative ‘Cochrane style’ review on one hand and a ‘narrative style’ review on the other hand, whereby a body of literature was summarised qualitatively, but the methods were often not articulated. Narrative reviews were particularly popular in dissertations and other student work (and they continue to be so in many cases) but have been criticised for a lack of systematic approach and consequently significant potential for bias in the findings [ 10 , 11 ].

The latter 1990s and early 2000, saw the emergence of other forms of review, developed as a response to the Cochrane/Narrative dichotomy. These alternative approaches to the Cochrane review provided researchers with reference points for performing reviews that drew on different study types, not just randomised controlled trials. They promoted a systematic and robust approach for all reviews, not just those concerned with effectiveness of interventions and treatments. One of the first published description of methods was Noblet and Hare’s (1998) ‘Meta-ethnography’ [ 12 ]. This method, although its name suggests otherwise, could incorporate and synthesise all types of qualitative research, not just ethnographies. The potential confusion regarding the inclusion of studies that were not ethnographies within a meta-ethnography, promoted the description of other similar methods, for example, the meta-synthesis of Walsh and Downe (2005) [ 13 ] and the thematic synthesis of Thomas and Harden (2008) [ 14 ]. Also, to overcome the dichotomy of the quantitative/qualitative reviews, the integrative review was described according to Whitemore and Knafl (2005) [ 15 ]. These reviews can be considered to be literature reviews that have been done in a systematic way but not necessarily adhering to guidelines established by the Cochrane Collaboration. We conceptualise this as the ‘expansion era’. Some of the methods are summarised in Table  1 .

Over the past two decades there has been a proliferation of review types, with corresponding explosion of terms used to describe them. A review of evidence synthesis methodologies by Grant and Booth in 2009 [ 20 ] identified 14 different approaches to reviewing the literature and similarly, Booth and colleagues [ 21 ] detailed 19 different review types, highlighting the range of review types currently available. We might consider this the ‘proliferation era’. This is however, somewhat a double-edged sword, because although researchers now have far more review methods at their disposal, there is risk of confusion in the field. As Sabatino and colleagues (2014) [ 22 ] have argued, review methods are not always consistently applied by researchers.

Aware of such potential inconsistency and also our own confusion at times regarding the range of review methods available, we questioned what was happening within our own discipline of nursing. We undertook a snap-shot, contemporary analysis to explore the range of terms used to describe reviews, the methods currently described in nursing and the underlying trends and patterns in searching, appraisal and analysis adopted by those doing a literature review. The aim was to gain some clarity on what is happening within the field, in order to understand, explain and critique what is happening within the proliferation era.

In order to explore current practices in doing a literature review, we undertook a ‘Focused Mapping Review and Synthesis’ (FMRS) – an approach that has been described only recently. This form of review [ 19 ] is a method of investigating trends in academic publications and has been used in a range of issues relevant to nursing and healthcare, for example, theory in qualitative research [ 23 ] and vicarious trauma in child protection research [ 24 ].

A FMRS seeks to identify what is happening within a particular subject or field of inquiry; hence the search is restricted to a particular time period and to pre-identified journals. The review has four distinct features: It: 1) focuses on identifying trends in an area rather than a body of evidence; 2) creates a descriptive map or topography of key features of research within the field rather than a synthesis of findings; 3) comments on the overall approach to knowledge production rather than the state of the evidence; 4) examines this within a broader epistemological context. These are translated into three specific focused activities: 1) targeted journals; 2) a specific subject; 3) a defined time period. The FMRS therefore, is distinct from other forms of review because it responds to questions concerned with ‘what is happening in this field?’ It was thus an ideal method to investigate current practices in literature reviews in nursing.

Using the international Scopus (2016) SCImago Journal and Country Rank, we identified the five highest ranked journals in nursing at that time of undertaking the review. There was no defined method for determining the number of journals to include in a review; the aim was to identify a sample and we identified five journals in order to search from a range of high ranking journals. We discuss the limitations of this later. Journals had to have ‘nursing’ or ‘nurse’ in the title and we did not include journals with a specialist focus, such as nutrition, cancer etcetera. The included journals are shown in Table  2 and are in order according to their ranking. We recognise that our journal choice meant that only articles published in English made it into the review.

A key decision in a FMRS is the time-period within which to retrieve relevant articles. Like many other forms of review, we undertook an initial scoping to determine the feasibility and parameters of the project [ 19 ]. In our previous reviews, the timeframe has varied from three months [ 23 ] to 6 years [ 24 ]. The main criterion is the likelihood for the timespan to contain sufficient articles to answer the review questions. We set the time parameter from January 2017–June 2018. We each took responsibility for two and three journals each from which to retrieve articles. We reviewed the content page of each issue of each journal. For our purposes, in order to reflect the diverse range of terms for describing a literature review, as described earlier in this paper, any paper that contained the term ‘review’ or ‘synthesis’ in the title was included in the review. This was done by each author individually but to enhance rigour, we worked in pairs to check each other’s retrieval processes to confirm inter-rater consistency. This process allowed any areas of uncertainty to be discussed and agreed and we found this form of calibration crucial to the process. The inclusion and exclusion criteria are shown in Table  3 .

Articles meeting the inclusion criteria, papers were read in full and data was extracted and recorded as per the proforma developed for the study (Table 4 ). The proforma was piloted on two papers to check for usability prior to data extraction. Data extraction was done independently but we discussed a selection of papers to enhance rigour of the process. No computer software was used in the analysis of the data. We did not critically appraise the included studies for quality because our purpose was to profile what is happening in the field rather than to draw conclusions from the included studies’ findings.

Once the details from all the papers had been extracted onto the tables, we undertook an analysis to identify common themes in the included articles. Because our aim was to produce a snap-shot profile, our analysis was thematic and conceptual. Although we undertook some tabulation and numerical analysis, our primary focus was on capturing patterns and trends characterised by the proliferation era. In line with the FMRS method, in the findings section we have used illustrative examples from the included articles that reflect and demonstrate the point or claim being made. These serve as useful sources of information and reference for readers seeking concrete examples.

Between January 2017 and June 2018 in the five journals we surveyed, a total of 222 papers with either ‘review’ or ‘synthesis’ in the title were retrieved and included in our analysis. We identified three primary themes: 1) Proliferation in names for doing a review; 2) Allegiance to an established review method; 3) Clarity about review processes. The results section is organised around these themes.

Proliferation in names for doing a review

We identified more than 35 terms used by authors to describe a literature review. Because we amalgamated terms such as ‘qualitative literature review’ and ‘qualitative review’ the exact number is actually slightly higher. It was clear from reading the reviews that many different terms were used to describe the same processes. For example qualitative systematic review, qualitative review and meta-synthesis, qualitative meta-synthesis, meta-ethnography all refer to a systematic review of qualitative studies. We have therefore grouped together the review types that refer to a particular type of review as described by the authors of the publications used in this study (Table  5 ).

In many reviews, the specific type of review was indicated in the title as seen for example in Table  5 . A striking feature was that all but two of the systematic reviews that contained a meta-analysis were labelled as such in the title; providing clarity and ease of retrieval. Where a literature review did not contain a meta-analysis, the title of the paper was typically referred to a ‘systematic review’; the implication being that a systematic review is not necessarily synonymous with a meta-analysis. However as discussed in the following section, this introduced some muddying of water, with different interpretations of what systematic review means and how broadly this term is applied. Some authors used the methodological type of included papers to describe their review. For example, a Cochrane-style systematic review was undertaken [ 25 ] but the reviewers did not undertake a meta-analysis and thus referred to their review as a ‘quantitative systematic review’.

Allegiance to an established literature review method

Many literature reviews demonstrated allegiance to a defined method and this was clearly and consistently described by the authors. For example, one team of reviewers [ 26 ] articulately described the process of a ‘meta-ethnography’ and gave a detailed description of their study and reference to the origins of the method by Noblet and Hare (1988) [ 12 ]. Another popular method was the ‘integrative review’ where most authors referred to the work of one or two seminal papers where the method was originally described (for example, Whitemore & Knafl 2005 [ 15 ]).

For many authors the term systematic review was used to mean a review of quantitative research, but some authors [ 27 , 28 , 29 ],used the term systematic review to describe reviews containing both qualitative and quantitative data.

However in many reviews, commitment to a method for doing a literature review appeared superficial, undeveloped and at times muddled. For example, three reviews [ 30 , 31 , 32 ] , indicate an integrative review in the title of their review, but this is the only reference to the method; there is no further reference to how the components of an integrative review are addressed within the paper. Other authors do not state allegiance to any particular method except to state a ‘literature review’ [ 33 ] but without an outline of a particular method for doing so. Anther review [ 34 ] reports a ‘narrative review’ but does not give further information about how this was done, possibly indicative of the lack of methods associated with the traditional narrative review. Three other reviewers documented how they searched, appraised and analysed their literature but do not reference an over-riding approach for their review [ 35 , 36 , 37 ]. In these examples, the review can be assumed to be a literature review, but the exact approach is not clear.

In other reviews, the methods for doing a literature review appear to be used interchangeably. For example in one review [ 38 ] the term narrative review was used in the title but in the main text an integrative review was described. In another review [ 39 ] two different and distinct methods were combined in a ‘meta-ethnographic meta-synthesis’.

Some authors [ 40 , 41 ] referred to a method used to undertake their review, for example a systematic review, but did not reference the primary source from where the method originated. Instead a secondary source, such as a textbook is used to reference the approach taken [ 20 , 42 ].

Clarity about review processes

Under this theme we discerned two principal issues: searching and appraisal. The majority of literature reviews contain three components- searching, appraisal and analysis, details of which are usually reported in the methods section of the papers. However, this is not always the case and for example, one review [ 43 ] provides only a search strategy with no information about the overall method or how critical appraisal or analysis were undertaken. Despite the importance of the process of analysis, we found little discussion of this in the papers reviewed.

The overwhelming trend for those doing a literature review was to describe a comprehensive search; although for many in our sample, a comprehensive search appeared to be limited to a database search; authors did not describe additional search strategies that would enable them to find studies that might be missed through electronic searching. Furthermore, authors did not define what a comprehensive search entailed, for example whether this included grey literature. We identified a very small number of studies where authors had undertaken a purposive sample [ 26 , 44 ]; in these reviews authors clearly stated that their search was for ‘seminal papers’ rather than all papers.

We reviewed the approaches to critical appraisal described in the papers and there were varying interpretations of what this means and which aspect of the included articles were to be subject to appraisal. Some authors [ 36 , 45 , 46 ] used the term ‘critical appraisal’ to refer to relevance of the paper to the review, rather than quality criteria. In that sense critical appraisal was used more as an inclusion criterion regarding relevance, rather than quality in the methods used. Mostly though, the term was used to describe the process of critical analysis of the methodological quality of included papers included in a review. When the term was used in this way to refer to quality criteria, appraisal tools were often used; for example, one review [ 47 ] provides a helpful example when they explain how a particular critical appraisal tool was used to asses the quality of papers in their review. Formal critical appraisal was undertaken by the vast majority reviewers, however the role of critical appraisal in the paper was often not explained [ 33 , 48 ]. It was common for a lot of detail to be provided about the approach to appraisal, including how papers were assessed and how disagreements between reviewers about the quality of individual papers were resolved, with no further mention of the subsequent role of the appraisal in the review. The reason for doing the critical appraisal in the review was often unclear and furthermore, in many cases, researchers included all papers within their review regardless of quality. For example, one team of reviewers [ 49 ] explained how the process, in their view, is not to exclude studies but to highlight the quality of evidence available. Another team of reviewers described how they did not exclude studies on the basis of quality because of the limited amount of research available on the topic [ 50 ].

Our review has identified a multiplicity of similar terms and approaches used by authors when doing a literature review, that we suggests marks the ‘proliferation era’. The expansion of terms used to describe a literature review has been observed previously [ 19 , 21 ]. We have identified an even wider range of terms, indicating that this trend may be increasing. This is likely to give the impression of an incoherent and potentially confusing approach to the scholarly undertaking of doing a literature review and is likely to be particularly problematic for novice researchers and students when attempting to grapple with the array of approaches available to them. The range of terms used in the title of papers to describe a literature review may cause both those new to research to wonder what the difference is between a qualitative evidence synthesis and a qualitative systematic review and which method is most suitable for their enquiry.

The clearest articles in our review were those that reported a systematic review with or without a meta-analysis. For example, one team of reviewers [ 25 ] undertook a Cochrane-style systematic review but did not undertake a meta-analysis and thus referred to their review as a ‘quantitative systematic review’. We found this form of labelling clear and helpful and is indeed in line with current recommendations [ 8 ]. While guidelines exist for the publication of systematic reviews [ 8 , 51 ], given the range of terms that are used by authors, some may be unclear when these guidelines should apply and this adds some confusion to the field. Of course, authors are at liberty to call their review processes whatever they deem appropriate, but our analysis has unearthed some inconsistencies that are confusing to the field of literature reviewing.

There is current debate about the status of literature reviews that are not ‘Cochrane’ style reviews [ 52 ]. Classification can be complex and whilst it might be tempting to refer to all non Cochrane-style reviews as ‘narrative reviews’ [ 52 ], literature reviews that conform to a recognised method would generally not be considered as such [ 53 ] and indeed the Cochrane Collaboration handbook refers to the principles of systematic review as applicable to different types of evidence, not just randomised controlled trials [ 5 ] .This raises the question as to whether the term systematic review should be an umbrella term referring to any review with an explicit method; which is implicit in the definition of a systematic review, but which raises the question as to how rigorous a method has to be to meet these standards, a thorny issue which we have identified in this study.

This review has identified a lack of detail in the reporting of the methods used by those doing a review. In 2017, Thorne raised the rhetorical question: ‘What kind of monster have we created?‘ [ 54 ]. Critiquing the growing investment in qualitative metasyntheses, she observed that many reviews were being undertaken that position themselves as qualitative metasyntheses, yet are theoretically and methodologically superficial. Thorne called for greater clarity and sense of purpose as the ‘trend in synthesis research marches forward’ [ 54 ]. Our review covered many review types, not just the qualitative meta-synthesis and its derivatives. However, we concur with Thorne’s conclusion that research methods are not extensively covered or debated in many of the published papers which might explain the confusion of terms and mixing of methods.

Despite the proliferation in terms for doing a literature review, and corresponding associated different methods and a lack of consistency in their application, our review has identified how the methods used (or indeed the reporting of the methods) appear to be remarkably similar in most publications. This may be due to limitations in the word count available to authors. However for example, the vast majority of papers describe a comprehensive search, critical appraisal and analysis. The approach to searching is of particular note; whilst comprehensive searching is the cornerstone of the Cochrane approach, other aproaches advocate that a sample of literature is sufficient [ 15 , 20 ]. Yet in our review we found only two examples where reviewers had used this approach, despite many other reviews claiming to be undertaking a meta-ethnography or meta-synthesis. This indicates that many of those doing a literature review have defaulted to the ‘comprehensive search’ irrespective of the approach to searching suggested in any particular method which is again indicative of confusion in the field.

Differences are reported in the approach to searching and critical appraisal and these appear not to be linked to different methods, but seem to be undertaken on the judgement and discretion of the reviewers without rationale or justification within the published paper. It is not for us to question researchers’ decisions as regards managing the flow of articles through their reviews, but when it comes to the issue of both searching and lack of clarity about the role of critical appraisal there is evidence of inconsistency by those doing a literature review. This reflects current observations in the literature where the lack of clarity about the role of critical appraisal within a literature review is debated . [ 55 , 56 ].

Our review indicates that many researchers follow a very similar process, regardless of their chosen method and the real differences that do exist between published methods are not apparent in many of the published reviews. This concurs with previously mentioned concerns [ 54 ] about the superficial manner in which methods are explored within literature reviews. The overriding tendency is to undertake a comprehensive review, critical appraisal and analysis, following the formula prescribed by Cochrane, even if this is not required by the literature review method stated in the paper. Other researchers [ 52 ] have questioned whether the dominance of the Cochrane review should be questioned. We argue that emergence of different methods for doing a literature review in a systematic way has indeed challenged the perceived dominance of the Cochrane approach that characterised the dichotomy era, where the only alternative was a less rigourous and often poorly described process of dealing with literature. It is positive that there is widespread acknowledgement of the validity of other approaches. But we argue that the expansion era, whereby robust processes were put forward as alternatives that filled the gap left by polarisation, has gone too far. The magnitude in the number of different approaches identified in this review has led to a confused field. Thorne [ 54 ] refers to a ‘meta-madness’; with the proliferation of methods leading to the oversimplification of complex literature and ideas. We would extend this to describe a ‘meta-muddle’ in which, not only are the methods and results oversimplified, but the existence of so many terms used to describe a literature review, many of them used interchangeably, has added a confusion to the field and prevented the in-depth exploration and development of specific methods. Table  6 shows the issues associated with the proliferation era and importantly, it also highlights the recommendations that might lead to a more coherent reviewing community in nursing.

The terms used for doing a literature review are often used both interchangeably and inconsistently, with minimal description of the methods undertaken. It is not surprising therefore that some journal editors do not index these consistently within the journal. For example, in one edition of one journal included in the review, there are two published integrative reviews. One is indexed in the section entitled as a ‘systematic review’, while the other is indexed in a separate section entitled ‘literature review’. In another edition of a journal, two systematic reviews with meta-analysis are published. One is listed as a research article and the other as a review and discussion paper. It seems to us then, that editors and publishers might sometimes also be confused and bewildered themselves.

Whilst guidance does exist for the publication of some types of systematic reviews in academic journals; for example the PRISMA statement [ 8 ] and Entreq guidelines [ 51 ], which are specific to particular qualitative synthesis, guidelines do not exist for each approach. As a result, for those doing an alternative approach to their literature review, for example an integrative review [ 15 ], there is only general publication guidance to assist. In the current reviewing environment, there are so many terms, that more specific guidance would be impractical anyway. However, greater clarity about the methods used and halting the introduction of different terms to mean the same thing will be helpful.

Limitations

This study provides a snapshot of the way in which literature reviews have been described within a short publication timeframe. We were limited for practical reasons to a small section of high impact journals. Including a wider range of journals would have enhanced the transferability of the findings. Our discussion is, of course, limited to the review types that were published in the timeframe, in the identified journals and which had the term ‘review’ or ‘synthesis’ in the title. This would have excluded papers that were entitled ‘meta-analysis’. However as we were interested in the range of reviews that fall outside the scope of a meta-analysis, we did not consider that this limited the scope of the paper. Our review is further limited by the lack of detail of the methods undertaken provided in many of the papers reviewed which, although providing evidence for our arguments, also meant that we had to assume meaning that was unclear from the text provided.

The development of rigorous methods for doing a literature review is to be welcomed; not all review questions can be answered by Cochrane style reviews and robust methods are needed to answer review questions of all types. Therefore whilst we welcome the expansion in methods for doing a literature review, the proliferation in the number of named approaches should be, in our view, a cause for reflection. The increase in methods could be indicative of an emerging variation in possible approaches; alternatively, the increase could be due to a lack of conceptual clarity where, on closer inspection, the methods do not differ greatly and could indeed be merged. Further scrutiny of the methods described within many papers support the latter situation but we would welcome further discussion about this. Meanwhile, we urge researchers to make careful consideration of the method they adopt for doing a literature review, to justify this approach carefully and to adhere closely to its method. Having witnessed an era of dichotomy, expansion and proliferation of methods for doing a literature review, we now seek a new era of consolidation.

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Aveyard, H., Bradbury-Jones, C. An analysis of current practices in undertaking literature reviews in nursing: findings from a focused mapping review and synthesis. BMC Med Res Methodol 19 , 105 (2019). https://doi.org/10.1186/s12874-019-0751-7

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• DOI Help: Digital Object Identifiers (DOIs) How to find an article's Digital Object Identifier, or DOI.
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• Literature Review: A Self-Guided Tutorial A step-by-step guide to conducting a literature review.
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• RefWorks: Analysis & Synthesis How to use RefWorks to help with the synthesis of articles for a literature review. Part of a comprehensive subject guide from Kennesaw State University.
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Top Tips for doing your literature review!

07 September, 2010 By NT Contributor

Many undergraduates and qualified nurses who have returned to study do a literature review as the final part of their degree. Helen Aveyard’s advice will ease the process and make it more enjoyable

Many undergraduate students and qualified nurses who have returned to study embark on a literature review as the final dissertation component of their degree. If this applies to you then there are various things that you can do and people you can see to make this process easier, more rewarding and even enjoyable!

The following tips will guide you through the literature review process:

Choose a topic that interests you. This might sound obvious but it does make all the difference in keeping your interest and motivation.From this topic, identify a specific question that you can answer from the literature. The key is to find a question that is not too broad.

Discuss this topic with everyone who will listen to you! This way you will mull over and refine your question until you feel you have a useful question that you can answer.

Work out what literature you need to answer your question . Not everything relating to your question will be relevant and some information will be more relevant than others… be selective.

Most questions need to be answered using primary research . In general terms, if your question involves measuring or evaluating care or an intervention then you will probably need to use quantitative research. If your question is more explorative, then qualitative research is likely to be most relevant. However this is not absolute. Remember that identifying which literature you need is one of the most important aspects of doing your literature review and it is useful to discuss in detail your approach with your supervisor. Think carefully about the type of literature that is likely to be most useful to you. Once you know what you are looking for, you can start to think about how to search for it!

Go and see your subject librarian . Most academic libraries offer drop in sessions for dissertation students. These will enable you to work out how to search for literature on your topic.

Identify key words and search terms . Think laterally about this and don’t forget to use words that are less common or have become outdated. This is because relevant articles might have been indexed using these words and you will miss them if you do not include them in your list of key words.

Now consider which databases you will search through . Go to your academic library website and read through the descriptions of each database and what each holds and select those databases that seem most relevant to your topic.

You are now ready to start searching . Remember to familiarise yourself with the basic functions of the database you are using, remembering that each database is slightly different from another. Take advantage of the Boolean operators (AND/OR/NOT) which allow you to narrow or broaden a search. It is always a good idea to supplement electronic searching with additional searching strategies, for example hand searching relevant journals or reference lists. This is because some key articles might be missed through electronic searching due to the way the paper is indexed.

Look at the abstracts of the articles you come across . It is usually possible to identify from the abstract whether the paper is useful for your review.

Start getting hold of the articles that seem relevant . Sometimes you will need an inter-library loan to do this. At this stage you need to be ruthless. If the article is not relevant to your review, then do not include it. However anything that might be relevant must be looked at.

Collect together all the articles that address your research question . At undergraduate level, if you have around 10 articles, then this is ideal. Significantly more will mean that you are not able to refer to the articles in sufficient detail and too few will not give you enough data to write your review.

Be pragmatic! If needs be, refine your review question to fit the articles that you have. If you have too many articles, try limiting the focus of your question somehow. Can you restrict the focus to the UK only? or a particular nursing speciality?

The next step is to consider the quality of the articles you have . You might have a paper that is directly relevant to your research question but if the quality of the paper is poor it may not help you as much as you think. It is generally a good idea to use a critical appraisal tool that is specific to the research design of your given paper. This might mean that you need to use a few different critical appraisal tools if your literature review question requires you to access a wide range of literature. Discuss this with your supervisor. Using the critical appraisal tool, consider the strengths and limitations of the literature you have identified and consider how much impact each paper has in addressing your research question.

Bring all the papers together and provide an answer for your research question . It is often useful to make a chart of key themes that arise in the papers, the authors of the papers, when they were written and their strengths and weaknesses. You can then see at a glance which other papers identify similar (or different) themes.

As you do this, you will begin to see patterns emerging in the literature and will be able to form an answer to your question. Remember that your answer may well be incomplete. It is quite permissible to say ‘there is some evidence that…’ rather than to provide a definitive answer. What is not permissible is to make out that you have a clear answer when in fact the literature does not support this. In this case, honesty really is the best policy.

Above all remember to answer the question!

Finally remember to put your literature review on your CV and be prepared to discuss at interview. It is a strong selling point when you apply for your first job or a new job.

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