Research WEEK 4

Literature Review - is the documentation of a comprehensive review of the published and

unpublished work from primary and secondary sources of data in the areas of specific interest to
the researcher
 This literature review is an integral part of the entire research process and makes a
valuable contribution to almost every operational step

Types of Information for a Research Review

 Principal reliance on primary sources
o The actual research reports written by researchers who conducted the study
 Less reliance on secondary sources
o Summaries of studies by others
 Peripheral use of clinical anecdotes, option articles, and cases may broaden
understanding of a problem or demonstrate a need for research

Literature reviews
 Relevant literature helps with:
o Broaden your knowledge base in your research area
 Research problem identification, development, or refinement of RQs
 Orientation to what is “known” and “not known”
 Identify gaps or inconsistencies in a body of research
 Identification of relevant theoretical/conceptual frameworks for a
research problem

 Improve your methodology

o Identification of designs & data collection methods for a study
o Development of hypotheses to be tested

 Contextualise your findings

o Identify how your findings compare with the existing body of knowledge

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Main stages of a literature review
 Planning the review- ie. identifying the need for a review, and documenting the
methodology
 Conducting the review- ie. finding, selecting, appraising, extracting, and synthesizing
primary research studies
 Reporting and dissemination - ie. writing up and disseminating ther results of the
review

Different types of reviews

 Systematic review
 Realist synthesis/review
 Integrative review
 Narrative
 Meta-analyses
 Meta-syntheses

2 types of literature

1. Data based- reports of original research studies

1. No matter it is quantitative or qualitative research by the researchers who
conducted them
1. ex) research literature, studies found in journals, also known as
empirical, scientific

b. Conceptual-based: articles that comprise an author's theory or that discuss a

particular concept, theory, or topic
1. Nonresearch articles

Main stages of a literature review

-planning the review - ie. identifying the need for a review, and documenting the methodology

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- conducting the review - ie. finding, selecting, appraising, extracting and synthesizing primary
research studies
- reporting and dissemination-ie. Writing up and disseminating the results of the review

Effectiveness questions
PICO
P-partipants
I- intervention
C- Compasrsion
O-outocme
T-time

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Define research/review question
 Questions may be broad or narrow
 Well-formulated questions will guide many aspects of the review process
o Searching strategy
o inclusion/exclusion criteria
o Data extraction
o Choice of synthesis method
o presentation/discussion of findings

Define eligibility criteria for studies to be included

 Driven by the research question
 If poorly specified it could lead to the development of search strategies that are
insensitive (fail to identify some or all relevant studies)

Conducting your ssearch

 Search databases
 Look for grey literature
 Hand searching

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Types of search in electronic databases
 Subject search- search for topics or keywords in the database
 Textword search- search for specific words which can be keywords in text fields of the
database record (e.g in the abstract or title)
 Author search- search for prominent researchers in a field

Searching for information

 Types of
o Studies (RCTs, non-RCTs, cohort/case-controlled)
o Population and setting
o Interventions
o Outcome measures
 Cochrane Handbook and crd guidelines
o Both provide explanations re the different study designs, likely biases, and issues
to consider when including them

Tools for searching: wildcard characters

 Can extend a search to multiple words with the same root, by adding the databases
wildcard character to a truncated word
 A truncation symbol (often an asterisk, *) expands a search term to include all forms of a
root
 example) nurs* would search for nurse, nurses, nursing
 Different databases or software packages use diffeent wildcards, such as * or $

Searching for information

 MESH terms and key words/synomys
o Medical subject heading - controlled vocabulary thersuairs used for indexing
articles
o Young, adoles*, teen*, child*........
*end of the “stem” of the word it will automatically search for all the endings for
that word stem

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 Tools for searching: Boolean Operators
 Boolean operators: can be used to combine, restrict, or broaden searchers
 AND: instructs the computer to reservice references in which two or more
terms are present (eg. obesity and diabetes)
 OR: instructs computer to reteive references containing any of 2+ terms
separated by “OR” (e.g. obesity or diabetes )
 NOT: narrows a search by reteriving information for one term, not the
other
Tools for searching: quotation marks
 Yields citations in which the exact phrase appears in text fields
 The use of quotation marks around a phrase can change the search results
o For example) a search for “htn” would yield overlapping but nonidnetical results
to htn

Key database for nurse researchers

 CINAHL ( Cumulative index to nursing and allied health literature)
o It covers references to hundreds of nursing and allied health journals as well as to
books and disseerations
 Medline (medical literature on-line)
o The premier source for bibliographic coverage of the biomedical literature

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  Look at the database own guidance for searching they may vary

CINAHL
• Covers nursing and allied health literature from 1982 to present
• Contains citations, abstracts (for most entries), and names of any data collection instruments
• Can be searched through a commercial vendor (e.g., OVID) or directly through
www.cinahl.com

MEDLINE
• Developed by the U.S. National Library of Medicine
• Covers about 5,600 nursing, biomedical, and health journals and has more than 24 million
records
• Can be accessed for free anywhere in the world via PubMed
• Uses a controlled vocabulary called MeSH (Medical Subject Headings) to index entries

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Google Scholar
• It is a popular bibliographic search engine that was launched in 2004 and includes articles in
journals from scholarly publishers in all disciplines and books, technical reports, and other
documents
• One advantage of GS is that it is accessible free of charge over the Internet.
• It allows users to search by topic, by a title, and by author and uses Boolean operators and
other search conventions.

Screening, Documentation, and Abstracting

• After identifying potentially relevant citations, the references must be:
• Screened and gathered (best to work with a copy of the article)
• Documented—note search actions and results
• Abstracted and recorded—notes are made of key pieces of information (e.g., using a literature
review protocol).

Quality Assessment & Critical Appraisal

• What are we trying to achieve?
• Not all published and unpublished literature is rigorous!
– being in a journal doesn’t mean it is good
• Quality may be used as an explanation for differences in study results or to guide
interpretation of findings, strength of inferences

Quality Assessment & Critical Appraisal

• Quantitative studies
– Internal validity
– Bias: selection; performance; detection; attrition; reporting
– External validity

• Move away from checklists/numerical scores to domain-based assessment

– Cochrane Risk of Bias - RCTs
– QUADAS 2 – diagnostic accuracy
– ROBIS for systematic reviews

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Quality Assessment & Critical Appraisal
• Qualitative studies
• Three broad categories
– Rigour: has a thorough and appropriate approach been applied to key research methods in the
study?
– Credibility: are the findings well presented and meaningful?
– Relevance: how useful are the findings to you and your organisation?

CASP appraisal checklist

1. Clear aims of research (goals, why it is important, relevance)
2. Appropriate methodology
3. Sampling strategy
4. Data collection
5. Relationship between researcher and participants
6. Ethical issues
7. Data analysis
8. Findings
9. Value of research (context dependent)

Data Extraction
• Be clear what information you want from the studies:
– Study details
– Data for your analysis

• Information will need to be collected relating to:

– Methodology
– Population
– Interventions being compared
– Outcomes evaluated

Evaluating and Analyzing the Evidence

• Integrating and synthesizing information across studies for a research literature review have
much in common with a qualitative analysis.
• In both, the focus is on the identification of important themes.

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Analyzing the Evidence in a Literature Review #1
• A variety of themes (patterns) can be pursued
. • Substantive themes are likely to be especially important:
• What is the pattern of evidence?
• What findings predominate?
• How much evidence is there?
• How consistent is the body of evidence?
• What are key gaps in the body of evidence?

Analyzing the Evidence in a Literature Review #2

• Methodologic themes
• What methods have been used to address the question?
• What are major methodologic deficiencies and strengths?

• Generalizability themes
• To what populations does the evidence apply?
• Do the findings vary for different types of people?

Data Synthesis
• Building up; putting together; making a whole out of the parts; the combination of separate
elements of thought into a whole; reasoning from principles to a conclusion

Data Synthesis
• Results from different studies need to be synthesised
• Are studies and results similar enough to be combined into a single numerical result?
• NO – qualitative descriptive/narrative summary
• YES – quantitative meta-analysis

• Heterogeneity
• Difference in results can arise due to differences in study design, population, selection,
intervention delivery
• How similar is similar? Results from heterogeneous studies should not be pooled

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CHAPTER 2 &5

Nurses devise clinical questions based on their daily practice experiences

 This can improve the care they provide individausl, fsamilies, and communities

Each question requires to engage in knowledge devlopment process

This process begins with the identification of knowledge gaps: the absence of theoretical or
scientific knowledge relevant to the phenomenon of interest

Knwoeldege generations - with the conduct o fresearch that provides answers to well-thought
research questions
This knwoedlge is then distributed through journal articles, textbooks and public presnetations
to nurses

Knowledge - is adopted - nurses alter their practice based on published information or as health
care organizations develop polices and protocols that are informed by newly generated
knowledge

Finally KNOWLEDGE - IS REVIEWED AND REVISED as new health health issues arise,
advances in clinical practice occur or knowledge becomes outdated

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Paradigm - meaning pattern
 Paradigm are different ways of viewing the world and often form the foundation from
which research is undertaken
 They consist of a set of assumptions about what is reality, how knowledge is created, and
what is valuable to learn
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Ontology- to be
 Is the science or study of being or existence and its relationship to nonexistence
 Addresses 2 questions
1. What exists or what is real?
2. Into what categories can existing things be sorts?

Epistemology
 Addresses 4 questions
1. What is knowledge?
2. What are the sources of knowledge?
3. What are some ways we come to know something, in contrast to believing,
wondering, guessing, or imagining?
4. What is the truth and what role does it play in knowledge?

methodology- refers to the principles, rules, and procedures that guide the process through
which knowledge is acquired
 The aim of inquiry to the goals or specific objectives of the research
 Context refers to the personal, social, organizational, cultural, and/or political
environment in which a phenomenon or interest (that thing of interest occurs)
 The context of research studies can include physical settings, such as the hospital or
home, or less concrete “environments”

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Positivism- is a philosophical orientation, as part of a movement from religious knowing to
reasoning and science
 Positvisirc research aims for objectivity and impartially with a goal of producing
unbiased, generalizable research

Post-postivism- emerged in response to the realizationt that such objectivity is usually not
possible and our observation cannot always be relied upon because they are subject to error and
human bias
 We all have different values, cultures, and life experiences, and thus, generate different
inteprations

Constuctivism- which is referred to as interpretivism or relativism- points to the centrality of

human experiences, social and cultural constructs, values, perspectives and lanage
 It is a philopical orientation that suggests that the reality and the way in which we
understand pir world are largely dependent on our perceptions and context
 Truth about life experience is regarded as relative and multiple rather than absolute
 The value of knowledge development lies in the ablituy to understand how people
perceive their world
 Knowledge development occurs through observation, diagloue with people, or both

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  Costructivits tap into personal experience rather than seeking measurement and elusive
objectivity
o This form of research is aimed at creating an understanding of people and their
life experiences from their point of view

Critical realism - harnesses the strengths and addresses the weakness of positivism and
constructivism by acknowledging that, although there is a single reality we cannot know it for
sure
 In critical realism, social entities exist independently of human understanding
 Forex) discrimination and power imbalances exist regardless of whether humans
recognize their influence
 However, human perceptions and experiences can still be incorporated into an
understanding of reality
 From a research perspective- truth and reality are ascertained through varied
approaches to data collection and analysis to increase the accuracy with which social
phenomena are understood

Qaultive and Qauntitiave research methods – these techniques, procedures, and processes used
by researchers to organize a study so that it provides answers to the research question

Depending on the research - if a researcher wishes to test a cause and effect relationship, such as
how different levels of social support (cause) leads to high blood pressure (effect), quantitive
methods are most appropriate

If a researcher wishes to discover and understand the meaning of an experience or process such
as death and dying, a qualtiive approach would be apprioate

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Conceptual framework - is a structure or assembly of concepts that is used as a map or a
scaffolding ideas for the study
 A synthesis or integration of existing views and knowledge on a topic, developed from a
review of the literature
 Defines main ideas and network of relationships between them, grounding the study in
the knowledge bases that are relevant to the study
o A specific theory may not be guiding the study but concepts always are
Theoretical framework-
 A theory is a unified set of interrelated concepts that serves the purpose of explaining or
predicting phenomena
 A theory is like a blueprint, which depicts the elements of a structure and the
relationship of each element to the other, just as a theory unified and depicts both the
concepts that compose it and how they are related
 The theory is an expression of knowledge….. The creative and rigorous structuring of
ideas that project a tentative, purposeful, and systematic view of phenomena
 Theory guides practice and research, practice enables testing of theory and generates
questions for research, and research contributes to theory building
The framework depcits how people health and well-being are determined by 14 factors
 Aboriginal status

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  Gender
 Disablity
 Housing
 Early childhood development
 Income and income distribution
 Education
 Race
 Employment and working conditions
 Social exclusion
 Food insecrutiu
 Social safety net
 Health services
 Unemployment and job security

Model - a symbolic representation of a set of concepts that is created to depict relationships

 Highlights the process in which support from peers and professionals influences the
stressful life situations, coping behaviors, and health care - related behaviorus of
homeless youths


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Inductive reasoning - is the pattern of figuring out what is there from the details of the nursing
practice and is the foundation for most qualitative inquiry
 Research injury related to the issue of meaning of experience for the patient care
 Inductive reasoning is a process of starting with the details of experiences and building
toward a general picture

Deductive reasoning
 Followed by quantitative researcher
 Involves a process of starting with the general picture, in this case, the theory- and
moving toward the specific
 The researcher measures concepts that, when combined, enable the researchers to
suggest relationships between the concepts
 Begins with a structure that guides searching for what is there

Conceptual definition- is conveying the general meaning of the concept

 Goes beyond the general meaning found in the dictionary, the concept is defined as it is
rooted in the theoretical literature
Operational defintion-specifies how the concept will be measured-that is what instruments will
be used to capture the feature of the variable

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Chapter 5: Finding and Appraising the Literature

Literature review- used in both research and evidence-informed practice projects, searching for
retrieving critically appraising, and synthesizing the literature is a key step in the process for
researchers and nurses implementing evidence-based practice
 Your ability to locate and retrieve research studies, critically appraise them, and decide
that you have the best available evidence to inform your practice decision-making is a
skill essential for your current role as a student and future nurse

Evidence-informed practice approach- you search the literature widely and gather multiple
resources to answer a clinical question or to solve a clinical problem

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  This process includes
1. Asking clinical questions
2. Identifying and gathering the evidence
3. Critically appraising and synthesizing the evidence or literature
4. Acting to change practice by using the best available evidence, coupled with your clinical
experience and patient preferences (values, setting, and resources)
5. Evaluating the use of the research evidence found to assess the applicability of the
research findings to the practice change

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  The literatu review in a research study is used to develop a sound research proposal for
research study that will generate knowledge
 From a broader perspective, the major focus of reviewing the literature for an evidence-
infromed project is to uncover multiple sources of evidence on a given topic that have
been generated by researchers in their research studies that can potenitlaly be used to
improve clinical practrcie and pt outcomesw

Searching for evidence

 Primary sources- where the articles, books, or other documents written by the person
who conducted the study, developed the theory, or prepared the scholarly dsicussiion on
a concept, topic, proble, or issue of interest
 Secondary spouse- can eventually lead to mistintrepation and misrepresentation of the
original study or theory

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Step 1: determine the topic and generate keywords
 To define the question or topic
 Use the PICOT or SPIDER questions should be refined prior to starting your search
 These mnemooniv that structure the elements of a practice question


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Step 2: choosing online, academic databases
 There are many websites that are not appropriate or efficient to find the latest and
strongest research on a topic
 Academic database are designs for advanced searching, are discipline specific, and often
gave direct access to academic journals and books, giving you more relevant resources

Step 3: Conduct your search

 Is to acquire several resources to answer your question using the databases and the
keywords that you generated previously
 Search and results needs to be specific enough so that you are not too overwhelmed with
articles that are not relevant
 Boolean operrtoars refines your search elmit
o It dictates the relpatioship between the words and concepts, “AND” “OR” “NOT”
o AND- requires both concepts be located within teh results that are returned
o OR - allows you to group together like terms or synonyms
o NOT- eliminates terms from your search

Step 4: refine search results

 Most searchies with electronic databases include not only citation information but also
the abstract but also the abstract of the article and options for obtaining the full text

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  Reading the abstract is critical for determining whether you need to retrieve the full text
of an article

Step 5: select literature

 Once you have reviewed the abstract and selected the articles you wish to keep, you need
to review the full text and either print or download the full articles
 Now critical reading begins which is searching and preserving materials you want to use
 A preliminary reading of the full article may result in further discarding articles that are
not relevant to your topic

Step 6: critically read, summarize, and synthesize

 Assess the articles for quality and review it
 The info that you selected should offer the best and most appropriate evidence available
on the topic
 You will likely read the articles several times to ensure that looking for the same details
across the articles

Step 7: formatting the literature review

 Familiarity with the format and process of the literature review it will help you to
critically appraise the literature used in a research report
 The literature review should be written in a logical and organized manner
 It is presented chronologically, thematically, or methodically
o Influenced by:
o The research or clinical question or topic
o The number of retrieved sources reviewed
o The number and type of research materials vs conceptual materials

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