PICO describes the process of defining a problem and creating a clinical question, e.g., a good clinical question will include all :
P Patient population of interest
I Intervention/issue of interest
C Comparison of interest
O Outcome of interest
Sometimes, a fifth element, Time, is added to the process
Example:How effective is glucosamine, compared to no treatment, in treating osteoarthritis in middle aged women?
P Patient population of interest and/or problem = Middle aged women with osteoarthritis
I Intervention/issue of interest = Glucosamine
C Comparison of interest = No treatment
O Outcome of interest = Decreased pain from osteoarthritis
Identify the topics and terms from your question to search the literature
Search Tip: Begin with a broader search by using only a couple of elements, such as P (population) and I (intervention). Based on your results, you can add in keywords that fit the other PICO(T) elements.
At some point in your graduate nursing program, you will most likely have to write a literature review about an assigned topic or a self-selected topic (e.g., your thesis, dissertation, or capstone project topic). Undergraduate students don’t typically have to write a full-blown literature review; however, the tips in this post will still help you when summarizing the literature for other assignments.
A review of the literature (ROL; AKA lit review) is a process of researching your topic or phenomenon of interest to find out what is known, and therefore, what is unknown. I’ll tell you why that is vital to know in a minute.
This post will discuss the basics of a literature review: what it is and is not, the benefits of doing the literature review, and provide some general guidelines to help you through the literature review process. Before I start, I have a free handout with some specifics about writing your literature review, if you want to download it! It contains specifics that I don’t have in this post, FYI. Get Your Free Literature Review Guide Now!
The Literature Review: What It Is
The process of reviewing the literature can be complicated or not, depending on the amount of research published on a topic.
For areas of new research, the lit review will most likely be limited because there may not be much published on your phenomenon of interest yet. In this case, it will probably be easy to create a search strategy and find the few published studies. This is a good thing – and a not-so-good thing!
It’s a good thing because the limited amount of studies means you only have to appraise those few. It should be easier to summarize studies with only one scope or a limited scope. Plus, the field is wide open to build the science, so your exploration of the topic is likely to unearth new areas for research and practice. And your research question for a thesis or dissertation is most likely not answered yet.
I say it may be a not-so-good thing because, with few published studies, you may not have a lot of information to help guide your study or project. One of the things the ROL does is to help you become aware of what is known and what is unknown – in this case, there are a lot of unknowns. So you may have to rely more heavily on the assistance of your research or project committee to help you determine the best methods to answer your study question or guide your project.
For areas with a lot of research, it’s likely that a lot of different studies on different aspects of the phenomenon have been conducted. If you are doing a comprehensive review of the literature, then your lit review may be lengthy and complicated to summarize all the relevant literature and compare one study to another. The good news is that you will see how the researchers conducted their studies and can use that information in your own study or project.
Why is a Literature Review Important?
As I said earlier, a literature review helps you to become aware of what is known about a phenomenon (or topic) and, therefore, what is unknown about a phenomenon. This level of understanding is important if you want to be knowledgeable about the phenomenon and be able to speak with a semblance of expertise.
A literature review enables you to:
- Use your time wiselyby not chasing questions that have already been answered!
- Conduct research or implement projectsthat will address gaps in the science of nursing and, therefore, help build the science of nursing.
- Become familiar with the previous research in this fieldso you know what has been studied to death and what questions still need to be answered. When reading the studies you found, use a literature matrix, evidence table, or spreadsheet to make a note of your answers to the following questions:
- What are the research questions being asked? What are the project goals (if a capstone or quality improvement [QI] project).
- What types of studies or projects are being conducted? (qualitative, quantitative, mixed methods, QI?)
- Which theoretical frameworks did the researchers choose to guide the studies?
- What methodologies are being used?
- Which settings are the research studies or projects being conducted in?
- How are the samples selected?
- Which research instruments are being used?
- How are the researchers conducting their studies (e.g., process, steps)?
- How are the researchers analyzing their data?
- What are the major conclusions of the study or project?
- What are the implications for future research, practice, and/or education?
- Hint: Implications for future research are the areas the researchers have determined still need to be studied about this phenomenon. This is a good place to look for the gaps in the science that you could possibly help to fill with your study or project!
“A literature review helps you to become aware of what is known about a phenomenon and, therefore, what is unknown about the phenomenon.”
So What? Why is this Information Important for You to Know?
Why is knowing about the research or projects already completed (and the details) important for your research or capstone project? Answer:Because this knowledge will enable you to Demonstrate your mastery of the phenomenon or topic.
You will be expected to have a scholarly discussion about what is known surrounding the topic of your choice with your Research/Project Chair and committee. This is where you show your committee that you understand what the state of the science is around your topic.
These discussions may be informal, as with a quick question of a committee member in the hallway or through email. You will also need to show your mastery of your topic during formal discussions, such as in a 1:1 meeting with your Chair, for comprehensive exams, and/or for your thesis/dissertation/capstone proposal defense.
A good grasp of the literature will also help you Become recognized as an expert related to your phenomenon by your classmates and in clinical practice.
You can become an expert on this topic because you will know what is known and unknown! You have read and appraised the literature! Your knowledge will help you be successful in your research or project because you’ll know what still needs to be studied and implemented.
You can use your expertise to get on policy committees in your institution and to improve clinical practice.
In addition, knowing the literature will Give you the confidenceto speak about the phenomenon with other students, faculty, colleagues, and researchers.
When you present your research or capstone during Nurse’s Week or at a conference, you will feel more confident when speaking about your project, answering questions, and in talking with other researchers, colleagues, or students interested in the same topic.
Guidelines for Writing a Literature Review: The 4Ps
First let me make a point to say that a literature review or state-of-the-science review is NOTthe same as a systematic review! While there is an orderly method to doing a lit review, it is not as exhaustive and deliberate as a systematic review (Thompson, 2011). A literature review is a broad report, which may discuss key points of a phenomenon but is not necessarily exhaustive in scope. A systematic review is a thorough, comprehensive, and systematic examination of a broad or narrow look at a phenomenon or topic. If conducted in a rigorous and transparent manner, a systematic review one of the highest levels of evidence we look for to support evidence-based practice.
In a chapter I wrote on for a book on evidence-based practice, I talked about using a mnemonic of 4Ps for designing studies: Prepare, Proceed, Publicize, Practice (Thompson, 2011). I’ve modified those 4Ps for conducting a lit review as: Prepare, Proceed, Produce, Proofread.
The preparatory phase is important for any project.
Decide on your phenomenon of interest and determine your research objectives or questions. Ask a question using a structured format such as PICOT. Create a sensitive and specific search strategy using keywords from your PICOT question. Decide which databases you will search.
Develop a form to abstract the data from the studies you read in an organized fashion. You can do this as a spreadsheet using the questions I outlined above or use an evidence table or literature synthesis matrix form you find online or from a faculty member. These forms typically have columns and rows in which you quickly summarize data from each study or theoretical paper you read on your phenomenon. I have an example of an evidence table in my book chapter (Thompson, 2011) and have had my students buy an excellent book on the subject by Garrard (2014) – I’ll link to it here and in the references.
A literature matrix or evidence table will help organize the studies you read and remind you of what they were about. This is an extremely helpful device that you should make a habit of creating – especially if you are a graduate student or plan on becoming a researcher. I’ll write more about this in a future post.
Create a folder and/or subfolders on your computer to keep your documents: articles, studies, notes, references, etc. Garrard (2014) has a good audit trail system outlined in her book to keep track of your work.
Conduct your literature search. Review the titles of the search results for relevance to your phenomenon; further refine your result list by reviewing the abstracts of the studies, if available. Keep the articles that are relevant to your topic.
Acquire the full-text articles. I suggest you save the pdfs to a folder on your computer, as Garrard (2014) describes, or that is specific to your class and/or project (e.g., 7200/PainResearch or EBP/QI/PressureUlcers).
Come up with a labeling system that will help you find the saved articles again. My system is to label the article pdf with the first author’s last name, an abbreviated title, and year of publication. So for example, ThompsonDesignStudies2011.
Read and abstract the information from each article to your data abstraction sheet or evidence table. You might organize your evidence table by publishing date, themes you identify as you read, types of studies, or results (e.g., significant, equivocal, not significant).
You should always assess the quality of the research studies you are including in a review. Make notes about the methodological rigor of research studies (i.e., critically appraise each study) and add comments about any other points you want to remember. Review the reference list of each article for other articles that might help you (this is called hand searching the reference list); acquire those articles and repeat.
Review the reference list of each article for other articles that might help you learn more about your topic (this is called hand searching the reference list); acquire those articles and repeat the process.
You’ve read a lot of literature on this topic – now you need to synthesize the information and produce a logical and coherent review of the literature.
Start your literature review by creating an outline. Trust me – make a habit of creating an outline before you write! An outline will help keep you focused and help you ensure that your thoughts flow in a logical manner.
Of course, you should rearrange your outline if you find that you are bouncing around one idea to another and not following a coherent line of thought. When I read student papers, I jot down an outline from what they’ve written to follow their train of thought and to remember what I’ve read!
After your introduction, your paper should include a brief description of the process you used to find the evidence for your paper, e.g., the search process. This section will give your reader an idea of the extent and comprehensiveness of your search. The description of the details of your search process will depend on the purpose of your lit review: is it for a class assignment? for a proposal defense? or to justify a project, such as a QI initiative? Follow your instructor’s instructions or the journal guidelines.
Okay, now synthesize all the information you collected, using your outline as a guide for what goes where. You could consider presenting an overall or general description of the literature you found (a descriptive analysis), as well as a more detailed description of the common themes you noted in the reading of the studies (a thematic analysis). As you discuss the studies, you can compare those using a similar methodology or presenting similar findings; don’t forget to contrast the studies in your critical review, also.
The usual format is to summarize each study in your own words (follow the guidelines from your faculty or journal), giving enough information so that the reader can understand what the project or study was about, how it was conducted, and what the results were. Don’t rewrite the abstract or rewrite the article! See my post on how to write an annotation and Download my free handout for more specific advice on how to summarize an article.
If the purpose of the literature review is only to discover the state-of-the-science around a topic, without relating the lit to your particular project, then just present the summaries with a conclusion.
If the purpose of the literature review is to provide the evidence for your capstone project or research study, then be sure to interpret the findings in the context of your project objectives or research questions. Make the case for why your study or project is important to conduct or implement.
Don’t forget to write concluding sentences for your paragraphs or for specific sections before you transition to another thought. Your last sentence at the end of a section should transition naturally into your next section topic.
Be sure to identify the gaps in the science either in your summaries or as a separate section. Identified gaps will give you the evidence you need to segue into the reasons why you want to study what you want to study.
Get additional tips on how to write a literature review. Download Your Free Literature Review Guide Now!
Make sure to proofread your paper before you turn it in. After all your hard work to research your phenomenon, don’t be sloppy with your writing! Many points are lost because of illogical flow, incoherent sentences, or grammar and spelling mistakes. Many campuses have resources to help students with language and writing skills. You can have someone read your paper and give you suggestions for editing or you can use the campus Writing Center experts to edit your paper.
Write coherently and logically. Keep your paragraphs relevant to your premise. Paragraphs that take up an entire page (i.e., run-ons) most likely have too many disparate thoughts and should be divided in a way that makes sense.
Please note that the paragraphs in my blog are deliberately short and truncated for easier readability (sometimes only one sentence!), but this format would not be appropriate for a formal paper or journal manuscript.
Realize that all of this preparation and process can only be accomplished if you’ve given yourself enough time to complete the paper! If you have a tendency to procrastinate, read the series of blog posts I published in November 2016 on productivity, starting with how not to procrastinate. You’ll find a free handout on strategies to help you form good work habits included with these posts.
If you are finding these posts and resources valuable, I would appreciate you sharing this website with your friends and colleagues! Thank You!
Garrard, J. (2017). Health sciences literature review made easy: The matrix method(5th ed.). Burlington, MA: Jones & Bartlett Learning.
Thompson, C. J. (2011). Designing studies for EBP. In J. Houser & K. S. Oman (Eds.). Evidence-based practice: An implementation guide for healthcare organizations(pp. 151-173). Sudbury, MA: Jones & Bartlett Learning.
Favorite Texts on this Topic
Bonnel, W., & Smith, K. V. (2014). Proposal writing for nursing capstones and clinical projects. New York, NY: Springer Publishing.
Garrard, J. (2017). Health sciences literature review made easy: The matrix method(5th ed.). Burlington, MA: Jones & Bartlett Learning.
Moran, K., Burson, R., & Conrad, D. (2017). The doctor of nursing practice scholarly project: A framework for success (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
How-To, Nursing Education, Professional writinglit review, literature review, review of the literature, steps for writing, tips for students