Received: 6 July 2017 | Accepted: 6 July 2017
DOI: 10.1002/nur.21812
EDITORIAL
Challenges of finding and filling a gap in the literature
K E Y W O R D S : dissertation, nursing science, research evidence, scholarly publishing
A significant original contribution to science is required for award of
a PhD and for acceptance of any research article in RINAH. Most of
us would agree that a significant contribution is one that fills a
problematic gap in existing evidence and thereby advances the
science in that field. It is relatively easy to recognize research
designed well enough to contribute trustworthy knowledge, but it is
much less easy to determine whether even a perfectly designed
study fills a gap in the literature. Editors and reviewers must judge
the value of manuscripts’ contributions, so I have been mulling over
this problem.
T H E LI T E R A T U R E
First, what is “the literature”? This question is more complex than it first
appears. The singular noun implies a single stream of knowledge, but
knowledge, even if defined narrowly as published research evidence,
flows from many regions, traditions, epistemologies, disciplines, and
theoretical camps within disciplines. To identify what is known and not
known is not as simple as conducting a search in the main biomedical
and social science publication databases. We must ponder where to
look for relevant knowledge.
I remember pursuing literature on addiction for my doctoral
thesis on pregnant crack cocaine users. At that time, there was
some information in nursing sources, mainly focused on caring for
individuals in substance use treatment. There was much more in
the fields of epidemiology, anthropology, sociology, criminal
justice, psychology, and neurology. Depending on the disciplinary
and theoretical orientation, addiction could be understood as an
inherited genetic weakness, an alteration in brain structure and
function as a result of chemical exposure, a curious form of social
deviance, an understandable way for persons harmed by main-
stream society to find community and solace, a normal sociocul-
tural variation involving a consistent proportion of a population, a
grave risk to society worthy of criminal penalties, a learned
response to a stimulus, or an epidemic that was contagious. These
views all were based on evidence, and they were not mutually
exclusive. To which literature was I aiming to contribute?
Because a strong mentor was available in medical sociology, I
focused on that literature. The work eventually was published in
nursing, social science, and drug policy journals, so it may have
had some impact in those fields, but it made no contribution
Res Nurs Health. 2017;40:393–395. wileyonlinelibrary.com/journal/nur
whatever to the neurological or epidemiological literature on
addiction. The important thing is that I was aware of these
literatures, made sure that my question had not already been
answered in a field outside my own, and made an informed
decision on the knowledge stream into which I would dive deeply
and to which I might eventually add.
Strong mentors insure that their students and mentees
develop a deep and nuanced understanding of relevant literature.
This kind of guidance is best rooted in the mentor’s mature
awareness of who is working in the field, which contributions
have had major impact, where the big questions are found, and
the assumptions underpinning the line of inquiry. Even within
disciplines, different research paths are pursued by researchers
with different theoretical lenses. Mentor teams and dissertation
committees must include at least one content expert, preferably
with closely aligned current research, to insure that the novice’s
work will in fact move their shared science forward (Kearney,
2017).
TH E GAP
Second, what is a gap, where literature is concerned? Simply put,
a gap is an unanswered question that, until answered, hampers
our ability to achieve the social mission of our discipline. Claiming
that one is filling a gap requires identification of a problem of
some degree of social import and pursuit of a piece of knowledge
that will move us closer to solving that problem. The problem may
be large or small. If we do not know the frequency of nurse home
visits needed to prevent serious complications after heart surgery
or whether telemedicine can replace some or all of these visits 1 ,
we are hampered in providing optimal postoperative care. If we
do not know whether a shortened psychometric instrument
functions as well as a longer one, we are hampered in doing
research toward filling gaps in health knowledge. Testing an
approach to health care delivery fills a large gap, and testing a
research instrument, I will argue, fills a smaller one. Nonetheless,
each solves a problem that can be linked to the social goals of the
discipline.
If a finding has been documented in a given population, does
studying it in a different population fill a gap in the literature? Not
necessarily. Certainly, each setting or sample is unique in some
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ways, and many phenomena could be argued as “unstudied” in
new contexts. Nonetheless, the argument should be based on a
documented difference between the studied and unstudied
settings. For example, if telemedicine worked as well as nurse
home visits for an urban population, would testing it in a rural
population fill a gap? Only if I can present an evidence-based
argument that telemedicine might not work in the same way in
the new setting, based on, say, documented rural-urban differ-
ences in cultural acceptability of having biomedical equipment in
the home or using it in place of face-to-face communication with
a health care provider. Likewise, findings that social support
improves coping with chemotherapy in a well-educated, high-
income group may or may not apply to members of a less-
educated, lower-income group, but to make a case that studying
this relationship in the second group fills a gap would require
some evidence that social support and/or coping and/or
chemotherapy have different impacts in the new context.
Replication of research is a good practice in general, but
replication of studies with human participants is only
warranted if there is evidence that the original findings do not
apply.
Do pilot studies fill a gap in the literature? Sometimes, but not
always. Some pilot studies described in papers received at RINAH
were important for the study team to confirm feasibility of a larger
study but do not fill a gap in the literature. In particular, pilot work
prior to a descriptive study rarely contributes evidence useful
elsewhere. By contrast, a pilot test of an innovative intervention, if
designed appropriately to answer well-defined and important
questions, may move the science forward.
TH E SM ALLER T HE G AP , TH E G REATER T HE
N E E D F O R RI G O R
Third, how small can a gap be and still be significant? Quite small—
but the smaller the gap being filled, the more definitively the study
should fill it. Small gaps include, in my view, whether an instrument
has two or three factors or whether a successful intervention works
equally well in two similar cities. It would be helpful to know the
answers, but we can continue to use the instrument or intervention
without them.
In a well-understood topic area, so much is known about the
phenomenon that a very robust and well-informed study is
needed to push that science further forward. The study should be
designed to put the question to rest by improvements in rigor.
The small-gap examples above might call for a larger, more
representative sample and enhanced statistical techniques to test
the instrument’s factorial structure, or a robust multi-site
comparison test of the intervention with greater attention to
covariates and contextual influences. Knowledge is not advanced
by adding yet another study that repeats the previous studies’
limitations.
LARGE GA PS CAN BE LESSE NED B Y
CAREFUL EXPLO RATOR Y WORK
By contrast, if the gap is large because much less is known about how
to fill it, or the known challenge to filling it is great, a more tentative
advance can be a significant contribution. Exploratory descriptive
studies, both qualitative and quantitative, and intervention pilots can
do this, if thoughtfully designed and conducted. Such studies provide a
glimpse of the possible, rather than a prediction of the probable, but
such a glimpse can generate insight for readers across a discipline when
we are far from solving a given problem.
For example, a colleague is studying the problem of excessive
weight gain in pregnancy, in a population in which it regularly occurs
with lifelong harmful consequences and for which no interventions to
date have made much headway. If she conducted a single-group pilot
intervention with 10 representative women, all of whom faithfully
adhered to it, and it prevented excessive weight gain in all 10 and
produced lasting change in their behavior and health metrics,2 given
those outcomes it would be worthy of note in the field, even without a
randomized design. The level of adherence is noteworthy, the effects
are very different from what one would expect given their at-risk group
membership, and the representativeness of the sample goes some
distance toward allaying fears that this was a highly unusual group of
individuals. Clearly, this little pilot study has many threats to validity,
and a randomized design is a good next step. Nonetheless, it has shed a
bit of light on how we might eventually bridge a very challenging gap.
Such an effort would be worthy of dissemination, although authors
should communicate a level of confidence in their advances
proportionate to the study rigor.
Students often are tempted to approach large gaps, given the
excitement of venturing into uncharted territory and making a large
difference. Caution is advised because only the most sophisticated
and convincing high-risk ventures are likely to be publishable, and
success cannot be assured. If the prenatal weight gain intervention
depicted above had had low adherence or minimal effect (as
expected based on past literature), little progress would have been
made toward filling the gap, and publishing it would be difficult. It is
far better for a student to make a less exciting but more rigorous and
definitive contribution in an area that a mentor knows well and can
see through to publication.
FINDIN G A ND FILL ING A GAP
In sum, to make a significant contribution to the literature, we must
first explore thoroughly a wide range of contributions from all
related fields to identify a meaningful gap we can fill. Then we must
accurately appraise the nature of the study that will be needed to fill
it. Some gaps may be beyond our capacity to fill, due to limits in
expertise, time, or resources. Mentors should ensure that novices
not embark on studies with a high risk of failure to make a
contribution, whether due to misjudgment of the literature, weak

design, or too many unknowns. Whether the gap is large or small, the
study designed to fill it must be sufficiently rigorous to enable real
forward motion in the field.
Margaret H. Kearney
University of Rochester
Correspondence
Margaret H. Kearney, University of Rochester,
Rochester, New York.
Email: rinah@rochester.edu
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ENDNOTES
1
Examples of studies other than my own are hypothetical and not
necessarily based on current evidence.
2
I regret that this example also is only hypothetical.
REFERENCE
Kearney M. H., (2017). Making dissertations publishable. Research in
Nursing & Health; 40, 3–5. https://doi.org/10.1002/nur.21780