Review of Literature in Nursing Research
A comprehensive guide to understanding and conducting literature reviews for nursing students
Table of Contents
Introduction to Literature Review
A literature review is a comprehensive survey of scholarly sources on a specific topic, providing an overview of current knowledge and theoretical frameworks. It serves as the foundation for nursing research by identifying gaps, establishing the significance of a research problem, and guiding the methodology.
Key Concept
The literature review is not merely a summary of existing research but a critical evaluation that synthesizes, analyzes, and interprets information to create a clear picture of the current state of knowledge in nursing practice.
What a Literature Review IS:
- A critical analysis and synthesis of existing research
- An organized presentation of what has been published on a topic
- An evaluation of the quality and findings of existing research
- A foundation that demonstrates how your research fits within the field
- A method to identify knowledge gaps and conflicting evidence
What a Literature Review IS NOT:
- A simple annotated bibliography
- A summary list of sources without critical analysis
- An essay expressing your personal opinions without evidence
- A chronological description of the development of a topic
- A collection of quotes from existing research
Importance in Nursing Research
In the nursing profession, where evidence-based practice is paramount, conducting a thorough literature review is essential. It provides the scientific basis for nursing interventions and helps improve patient outcomes through informed decision-making.
Nursing Example
A nurse conducting research on infection prevention protocols in surgical units would perform a literature review to identify current best practices, rates of hospital-acquired infections across different interventions, and gaps in existing protocols. This review would then inform the development of an evidence-based intervention that addresses the identified knowledge gaps.
The Literature Review Helps Nurses:
Avoid Duplication
Ensures research doesn’t unnecessarily repeat existing studies
Identify Gaps
Discovers areas where further research is needed in nursing practice
Refine Methods
Learns from methodological strengths and weaknesses of previous studies
Build on Foundations
Establishes the theoretical framework for the research
Improve Patient Care
Implements evidence-based practice based on research findings
Meet Ethical Standards
Ensures research is justified and beneficial to patients
Location of Literature
When conducting a literature review in nursing research, knowing where to locate relevant scholarly materials is crucial. Literature can be found in various physical and digital locations.
Physical Locations
Academic Libraries
University and college libraries with specialized nursing and medical collections
Hospital Libraries
Libraries within healthcare facilities that curate clinical resources
Professional Organizations
Resource centers at nursing associations and organizations
Digital Locations
Online Databases
Specialized databases like CINAHL, MEDLINE, and Cochrane Library
Digital Journal Archives
Electronic repositories of nursing and medical journals
Academic Repositories
Institutional repositories hosting theses, dissertations, and research papers
Open Access Platforms
Free access resources like PLOS ONE and BioMed Central
Mnemonic: “PLACE”
Use this mnemonic to remember where to find literature for your nursing research:
- P – Professional organization repositories
- L – Library resources (academic and hospital)
- A – Academic databases and journals
- C – Citation tracking from key papers
- E – Electronic open access resources
Sources of Literature
A comprehensive literature review in nursing research involves exploring various types of sources. Understanding the hierarchy of evidence is essential for evaluating the quality and relevance of the literature.
Primary Sources
Original research and firsthand accounts that present original thinking, report on discoveries, or share new information.
Research Articles
Original studies published in peer-reviewed journals
Clinical Trials
Controlled research studies on treatments and interventions
Dissertations/Theses
Original research conducted by graduate students
Patents
Documents describing new inventions or methods in healthcare
Secondary Sources
Works that analyze, evaluate, interpret, or discuss information originally presented elsewhere.
Systematic Reviews
Comprehensive summaries of research on specific questions
Meta-Analyses
Statistical analyses that combine results of multiple studies
Literature Reviews
Critical evaluations of published research on a topic
Clinical Guidelines
Evidence-based recommendations for clinical practice
Tertiary Sources
Sources that compile or digest information from primary and secondary sources.
Textbooks
Comprehensive overviews of nursing knowledge and practice
Encyclopedias
Reference works with summary information on topics
Handbooks
Compilations of facts and data for quick reference
Review Articles
Articles that summarize the current state of understanding
| Level | Type of Evidence | Strength | Examples |
|---|---|---|---|
| Level I | Systematic reviews and meta-analyses of randomized controlled trials | Highest | Cochrane reviews, JBI systematic reviews |
| Level II | Randomized controlled trials (RCTs) | High | Double-blind clinical trials of nursing interventions |
| Level III | Controlled trials without randomization | Moderate-High | Quasi-experimental studies, cohort studies |
| Level IV | Case-control and cohort studies | Moderate | Prospective studies tracking patient outcomes |
| Level V | Systematic reviews of descriptive and qualitative studies | Moderate | Meta-syntheses of qualitative nursing research |
| Level VI | Single descriptive or qualitative studies | Lower | Interviews with patients about care experiences |
| Level VII | Expert opinion and consensus statements | Lowest | Clinical practice guidelines without research base |
Nursing Example
A nurse researching best practices for preventing pressure ulcers would prioritize evidence in this order: First, look for systematic reviews from Cochrane or JBI on pressure ulcer prevention (Level I). Next, examine individual RCTs testing specific interventions like turning schedules or pressure-redistributing surfaces (Level II). Then, consider cohort studies tracking risk factors and outcomes (Level IV). Finally, consult qualitative studies exploring patient experiences with preventive measures (Level VI) to gain a holistic understanding of the issue.
Online Search Databases
Digital databases are essential tools for conducting a thorough literature review in nursing research. They provide access to vast collections of peer-reviewed articles, systematic reviews, and evidence-based practice resources.
CINAHL (Cumulative Index to Nursing and Allied Health Literature)
CINAHL
CINAHL is the premier database for nursing and allied health literature, providing full-text access to more than 5,500 journals dating back to 1937.
Key Features:
- Specialized nursing subject headings
- Evidence-based care sheets and quick lessons
- Research instruments and clinical trials
- Care plans and critical paths
- Access to nursing dissertations
CINAHL Search Tips
- Use CINAHL Subject Headings (similar to MeSH) for more precise results
- Apply limiters for research articles, evidence-based practice, and peer-reviewed content
- Use the “Suggest Subject Terms” feature to find relevant controlled vocabulary
- Utilize the special limiters for “Evidence-Based Practice” to focus on high-quality studies
Cochrane Library
Cochrane
The Cochrane Library is a collection of databases containing high-quality, independent evidence to inform healthcare decision-making. It’s recognized as the gold standard for systematic reviews in healthcare.
Key Components:
- Cochrane Database of Systematic Reviews (CDSR)
- Cochrane Central Register of Controlled Trials (CENTRAL)
- Cochrane Clinical Answers
- Cochrane Methodology Register
Cochrane Search Tips
- Focus on the CDSR for high-quality systematic reviews
- Use MeSH terms for more precise searching
- Check for recent updates as Cochrane reviews are regularly revised
- Look for “plain language summaries” for quick understanding of findings
Other Relevant Databases
MEDLINE (via PubMed)
Comprehensive medical research database from the U.S. National Library of Medicine
Joanna Briggs Institute (JBI)
Evidence-based practice database focused on nursing and allied health
Embase
Biomedical database with strong coverage of European and pharmaceutical research
PsycINFO
Database focusing on psychological aspects of nursing and healthcare
TRIP Database
Clinical search engine designed to quickly find high-quality research evidence
ProQuest Nursing & Allied Health
Comprehensive collection of nursing journals, dissertations, and evidence-based resources
| Database | Content Focus | Unique Features | Best For |
|---|---|---|---|
| CINAHL | Nursing and allied health | Nursing-specific subject headings, care sheets | Nursing-specific research and practice guidelines |
| Cochrane | Systematic reviews, clinical trials | Highest quality systematic reviews, plain language summaries | Evidence-based intervention research |
| MEDLINE/PubMed | Broad biomedical research | MeSH terminology, PMC free full-text articles | Interdisciplinary medical research |
| JBI | Evidence implementation | Evidence summaries, implementation reports | Practice change and implementation science |
| Embase | Pharmaceutical and European research | Drug and disease focused, conference abstracts | Pharmacological interventions, adverse events |
Mnemonic: “SEARCH”
Remember these key steps when searching nursing databases:
- S – Select appropriate database for your topic
- E – Employ controlled vocabulary (CINAHL Headings/MeSH)
- A – Apply filters (peer-reviewed, publication date, etc.)
- R – Refine with Boolean operators (AND, OR, NOT)
- C – Cite and save relevant results
- H – Holistically evaluate search effectiveness and revise as needed
Purposes of Literature Review
A literature review serves multiple essential functions in nursing research. Understanding these purposes helps researchers conduct more focused and effective reviews.
Research Development
Identify Knowledge Gaps
Reveals what is unknown or unclear in current nursing knowledge
Establish Research Context
Places new research within the broader framework of existing knowledge
Refine Research Questions
Helps focus and sharpen research questions based on existing evidence
Develop Theoretical Framework
Identifies theories and conceptual models to guide the research
Methodological Purposes
Inform Research Design
Guides selection of appropriate methods based on previous studies
Identify Valid Measures
Discovers tested and validated instruments for data collection
Avoid Methodological Pitfalls
Learns from limitations and challenges in previous research
Establish Benchmarks
Provides comparison points for interpreting new findings
Clinical Practice Benefits
Improve Patient Care
Identifies evidence-based practices to enhance clinical outcomes
Guide Clinical Decision Making
Provides evidence to support nursing interventions and care plans
Identify Best Practices
Synthesizes findings to determine optimal approaches to care
Evaluate Intervention Effectiveness
Assesses the impact of nursing interventions across different studies
Scholarly Purposes
Demonstrate Researcher Knowledge
Shows familiarity with the body of knowledge in the field
Build Academic Credibility
Establishes the researcher’s scholarly perspective and expertise
Contribute to Knowledge Synthesis
Organizes and integrates fragmented research findings
Identify Contradictions
Highlights conflicting evidence that requires further investigation
Nursing Example
A nurse conducting a literature review on interventions for preventing falls in elderly patients might discover that while there’s substantial evidence supporting multifactorial assessment and intervention programs, there’s limited research specifically addressing fall prevention in patients with cognitive impairment. This identified gap becomes the focus of their research. The review also reveals methodological inconsistencies in how falls are documented across studies, allowing the researcher to develop a more standardized measurement approach for their study.
Key Questions a Literature Review Answers:
What is known about this topic in nursing practice?
What are the gaps in current knowledge?
How has this topic been researched previously?
What theories have been applied to understand this phenomenon?
What methods have proven effective in studying this area?
What contradictions exist in the evidence?
How has this knowledge evolved over time?
What are the implications for nursing practice?
Methods of Literature Review
Different methods of literature review serve distinct purposes in nursing research. The choice of method depends on the research objectives, available evidence, and intended outcomes.
Narrative Review
Narrative Review
Traditional, comprehensive overview
A narrative review provides a broad overview of a topic based on published literature, synthesizing findings to create a comprehensive summary. It’s the most common form of literature review in nursing education.
Strengths
- Provides comprehensive coverage of a topic
- Flexible format and methodology
- Incorporates diverse types of evidence
- Identifies themes across literature
Limitations
- Potential for selection bias
- Less rigorous methodology
- Difficult to replicate
- May lack critical appraisal
Systematic Review
Systematic Review
Rigorous, explicit methodology
A systematic review follows a rigorous, pre-defined methodology to identify, evaluate, and synthesize all relevant studies on a specific research question, minimizing bias through comprehensive search strategies and explicit inclusion criteria.
Strengths
- Transparent, reproducible methodology
- Minimizes selection and reporting biases
- Comprehensive search strategy
- Rigorous quality assessment
Limitations
- Time and resource intensive
- May exclude relevant studies due to strict criteria
- Requires methodological expertise
- Limited flexibility once protocol is established
Meta-Analysis
Meta-Analysis
Statistical pooling of results
A meta-analysis is a statistical method that combines the results of multiple scientific studies addressing the same question to derive pooled estimates with greater statistical power than individual studies.
Strengths
- Increased statistical power
- Quantitative synthesis of evidence
- More precise effect estimates
- Can resolve conflicting findings
Limitations
- Requires homogeneity in study designs
- Limited to quantitative studies
- Statistical complexity
- Risk of “garbage in, garbage out”
Integrative Review
Integrative Review
Combines diverse methodologies
An integrative review synthesizes findings from diverse research methodologies (qualitative, quantitative, and mixed methods) to provide a comprehensive understanding of a healthcare phenomenon or problem.
Strengths
- Incorporates diverse methodologies
- Provides comprehensive perspective
- Addresses complex nursing phenomena
- Balances rigor with inclusivity
Limitations
- Methodological complexity
- Challenging quality assessment
- Difficult synthesis of disparate findings
- Requires expert knowledge
| Method | Purpose | Search Strategy | Quality Assessment | Best Used For |
|---|---|---|---|---|
| Narrative | Broad overview of topic | Typically non-systematic | Variable, often limited | Educational purposes, topic exploration |
| Systematic | Answer specific clinical question | Comprehensive, explicit, reproducible | Rigorous, standardized tools | Determining efficacy of interventions |
| Meta-Analysis | Statistical synthesis of findings | Systematic, focused on comparable studies | Critical for inclusion decisions | Pooling data from similar studies |
| Integrative | Comprehensive understanding of phenomenon | Systematic but broad | Method-specific assessment | Complex nursing phenomena requiring multiple perspectives |
| Scoping | Map key concepts and evidence types | Broad, evolving | Optional, not primary focus | Clarifying concepts, identifying research types |
Nursing Example
Consider how different review methods might be applied to the topic of pain management in postoperative patients:
- Narrative Review: A nurse educator might conduct a narrative review to provide nursing students with a comprehensive overview of pain management approaches, covering pharmacological and non-pharmacological interventions.
- Systematic Review: A clinical nurse researcher might conduct a systematic review to determine the effectiveness of specific non-opioid analgesics for postoperative pain management, following PRISMA guidelines.
- Meta-Analysis: A researcher might perform a meta-analysis to statistically combine results from multiple RCTs comparing the efficacy of patient-controlled analgesia versus nurse-administered pain medication.
- Integrative Review: A nurse scientist might conduct an integrative review to understand both the effectiveness of interventions and patients’ experiences with different pain management approaches, incorporating both quantitative and qualitative studies.
Step-by-Step Process for Conducting a Literature Review
A systematic approach to conducting a literature review ensures thoroughness and maintains quality throughout the process. Follow these steps to effectively review literature for nursing research.
Define Your Research Question
Formulate a clear, focused question that guides your literature search.
Develop a Search Strategy
Create a comprehensive plan for identifying relevant literature.
- Identify keywords and subject headings
- Select appropriate databases
- Determine inclusion/exclusion criteria
- Define date ranges and language restrictions
Conduct Database Searches
Execute your search strategy across selected databases.
Screen and Select Studies
Review titles and abstracts to identify potentially relevant studies, then evaluate full texts against your criteria.
- Initial screening of titles and abstracts
- Full-text review of potentially relevant studies
Assess Study Quality
Evaluate the methodological rigor and validity of included studies.
- JBI Critical Appraisal Tools
- CASP (Critical Appraisal Skills Programme) Checklists
- GRADE system for evidence quality
- Risk of bias assessment tools
Extract and Organize Data
Systematically extract relevant information from each study and organize it for analysis.
Analyze and Synthesize Findings
Interpret the collected data, identify patterns, themes, and relationships across studies.
- Thematic analysis for qualitative data
- Meta-analysis for comparable quantitative data
- Narrative synthesis for heterogeneous studies
- Concept mapping to visualize relationships
Write the Review
Present your findings in a logical, coherent manner that addresses your research question.
- Introduction and rationale
- Methods (search strategy and selection criteria)
- Results (characteristics of included studies)
- Discussion (synthesis of findings)
- Conclusions and implications for practice
Practical Tips
Managing Your Search
- Use citation management software (e.g., Zotero, Mendeley)
- Create search alerts for ongoing updates
- Document all search strings and results
- Use controlled vocabulary when available
Quality Improvement
- Consider using two reviewers for screening
- Consult a librarian for search strategy refinement
- Pilot test your data extraction forms
- Follow reporting guidelines (e.g., PRISMA)
Nursing Example: Literature Review Process
A nurse researcher interested in non-pharmacological interventions for managing anxiety in mechanically ventilated patients would follow these steps:
- Define Question: “What non-pharmacological interventions are effective in reducing anxiety in mechanically ventilated adult patients in intensive care settings?”
- Search Strategy: Identify keywords (mechanical ventilation, anxiety, non-pharmacological, interventions, ICU) and plan to search CINAHL, MEDLINE, Cochrane, and PsycINFO.
- Database Search: Execute searches using Boolean operators, document finding 157 potentially relevant articles.
- Screening: Review titles and abstracts, narrowing to 42 articles for full-text review; apply inclusion criteria (adult patients, ICU setting, anxiety outcomes measured) to select 18 studies.
- Quality Assessment: Use the JBI critical appraisal tools to evaluate methodological quality, excluding 3 studies with significant methodological flaws.
- Data Extraction: Create an evidence table capturing intervention details, patient characteristics, outcome measures, and findings.
- Synthesis: Group interventions by type (music therapy, relaxation techniques, communication aids), analyze effectiveness by intervention type and patient subgroup.
- Write Review: Present findings showing music therapy (5 studies) and guided imagery (3 studies) demonstrated strongest evidence for anxiety reduction, while results for other interventions were mixed.
This review might identify that while music therapy is effective for most patients, there’s insufficient evidence for patients with delirium—highlighting a gap for future research.
Tips for Effective Literature Review
A well-executed literature review requires attention to detail, critical thinking, and organizational skills. These tips will help nursing students produce high-quality reviews that contribute meaningfully to nursing knowledge.
Organization Strategies
- Create a literature matrix to organize key information from each study (methods, sample, findings, limitations)
- Develop a coding system to track themes, methodologies, or quality ratings across studies
- Use reference management software like Zotero, EndNote, or Mendeley to organize citations
- Create concept maps to visualize relationships between studies and identify emerging themes
- Schedule regular writing time to avoid last-minute rushing and ensure quality
Critical Appraisal
- Evaluate methodological rigor using standardized appraisal tools appropriate for each study design
- Consider sample characteristics and their relevance to your population of interest
- Assess clinical significance of findings, not just statistical significance
- Identify potential biases in study design, analysis, or reporting
- Consider funding sources and potential conflicts of interest
Search Techniques
- Use both subject headings and keywords to ensure comprehensive retrieval
- Implement Boolean operators (AND, OR, NOT) to refine your search
- Employ truncation and wildcards to capture variations (e.g., nurs* for nurse, nurses, nursing)
- Use citation tracking to find related studies (both forward and backward)
- Consult a research librarian to refine search strategies and identify additional resources
Synthesis Strategies
- Organize by themes rather than simply summarizing each study
- Identify patterns, trends, and contradictions across the literature
- Contextualize findings within nursing practice and current healthcare challenges
- Articulate gaps in the existing evidence and implications for future research
- Develop visual representations (tables, figures) to summarize complex relationships
Common Pitfalls to Avoid
- Confirmation bias: Only including studies that support your preconceived ideas
- Inadequate search: Limiting to one database or using overly restrictive search terms
- Poor organization: Failing to systematically track and organize your findings
- Outdated literature: Not including current research (typically within 5 years)
- Mere description: Summarizing studies without critical analysis or synthesis
- Ignoring limitations: Failing to acknowledge weaknesses in the reviewed studies
- Misinterpreting findings: Drawing conclusions beyond what the evidence supports
- Plagiarism: Not properly citing sources or paraphrasing without attribution
Mnemonic: “REVIEW”
Remember these principles for conducting an effective literature review:
- R – Rigorous search strategy (comprehensive and systematic)
- E – Evaluate study quality (critical appraisal)
- V – Verify information (check facts and interpretations)
- I – Integrate findings (synthesize, don’t just summarize)
- E – Explain gaps (identify what’s missing in current knowledge)
- W – Write clearly and logically (organized presentation)
Conclusion
A well-conducted literature review forms the foundation of high-quality nursing research and evidence-based practice. It requires a systematic approach to searching, organizing, critically appraising, and synthesizing existing knowledge.
Key Takeaways
Location matters – Utilize multiple sources including specialized nursing databases
Quality counts – Critically evaluate evidence using appropriate appraisal tools
Synthesis is key – Go beyond summarizing to identify patterns and themes
Search strategically – Use controlled vocabulary and comprehensive search techniques
Method matters – Select the review approach that best fits your research question
Purpose guides process – Keep your research aims in focus throughout
By mastering the skills of literature review, nursing students contribute to the advancement of nursing science and the improvement of patient care. The ability to critically analyze and synthesize existing evidence is fundamental to developing evidence-based nursing interventions and improving healthcare outcomes.
Remember that a literature review is not merely a requirement for academic papers or research projects—it is an essential process that informs clinical decision-making and ensures that nursing practice is grounded in the best available evidence. As nursing continues to evolve as a profession, the skills of searching, evaluating, and synthesizing literature will remain central to delivering high-quality, evidence-based care.