6. Reviewing the literature
Key points
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• A review of the literature is the critical analysis of good-quality relevant work on a topic.
• Carrying out a review has a great deal to offer individual midwives and clinical areas in increasing the standard of evidence-based practice; it is also the focus of many student assignments and theses.
• Reviewing the literature is a skill that can be developed by following the principles outlined in this chapter.
• Sourcing the literature is influenced firstly by the identification of the relevant key words that allow access to the literature through databases. A search strategy should be produced at the start of the search and a record kept of the experiences with the databases.
• It is important to be systematic in the method of retrieving information from individual books and articles.
• In writing the review, the topic should be presented under relevant themes.
• A review of the literature is not a series of critiques joined together but an examination of the body of knowledge on a stated topic following the selection criteria stated in the review.
• If a review is to be relevant to practice, it should include both description and critical analysis. It should end with clear recommendations for practice.
A review of the literature can be defined as the critical examination of a defined selection of published literature on a particular topic or issue. According toMurphy and Cowman (2008)its purpose is to produce a picture of what is currently known about a problem or situation and to identify what knowledge gaps may exist. A review of the literature is not simply a task carried out by researchers; it has now become an important part of evidenced-based practice as well as a familiar activity in many educational course assignments. The aim of this chapter is to provide practical advice on producing critical reviews of the literature suitable for many situations.
The process of reviewing the literature has changed considerably over time from a simple summary of what some of the literature says to a critical evaluation and synthesis of carefully sourced high-quality research evidence that can be used to support clinical decision making. However, we will start with the following simple definition:
A review of the literature is the systematic and critical examination of a defined selection of published literature on a particular topic or issue.
The key aspects highlighted in this definition are that reviews must be planned very carefully to provide the best-quality evidence, and that evidence should be subject to critical analysis to ensure that the findings are sound and transferable to practice. Reviews come in a number of forms, such as the following suggested by Mileham (2009):
• Narrative: where the emphasis is on summarising the literature,
• Integrated: where a critical evaluation of key studies are brought together in a systematic way,
• Meta-analyses: where similar types of quantitative studies are combined statistically to try to overcome the problem of small sample sizes,
• Systematic review: where a strict system of selecting and extracting key information is used by teams of reviewers to ensure only the highest quality to inform evidence-based practice.
In addition to the meta-analysis of quantitative studies a similar process is carried out with qualitative studies referred to as meta-synthesis or meta-studies (Ploeg 2008). In evidence-based practice the most sophisticated and highly sought source of evidence is the systematic review. This is because of the strict quality control placed on the studies included and the expertise of those who conduct them. In most academic courses and clinical settings the goal is usually a well-conducted integrated review that critically evaluates the studies. Such reviews rarely cover the kind of material included in systematic reviews such as the grey literature (conference papers and theses). This chapter will mainly focus on the skills involved in the integrated review.
Why carry out a review? There are perhaps four main reasons for reviewing the literature, two of which are clinical and two academic:
• as part of clinical effectiveness where clinicians search for evidence of best practice on which to base clinical decisions,
• as the basis for standards, protocols and guidelines for practice that will later lead to an audit of ‘best practice’ based on the review,
• as part of the research process where its purpose is to inform the researcher on the present state of knowledge on the topic to be covered by the study and to locate the current study within the context of that knowledge,
• as an integral part of a student assignment, or as the main focus of an assignment or dissertation for an educational course.
This demonstrates that reviews are not simply, as Mileham (2009) points out, an academic exercise left behind at the end of a course; they are an essential skill for all health professionals.
The method of producing a review will be different within each of these four activities. In the educational setting, the depth of analysis will vary by the academic level of the course or programme of study. Most academic levels now encourage critical analysis and not just a summarising of content. At dissertation level, the depth of analysis will be paramount and the research knowledge of the student should be clearly demonstrated. The dissertation will also concentrate on a far greater conceptual or abstract level of analysis, often relating the literature to a theoretical or conceptual framework. In the clinical setting, the review will seek best practice for an activity or choice of intervention. In the research context, reviews are produced for a number of reasons, listed by Holloway and Wheeler (2010: 36) as:
• to find out what is already known about the subject and acknowledge those who have worked in this area,
• to identify gaps in the knowledge,
• to describe how the study contributes to existing knowledge of a topic area,
• to avoid duplicating other people’s work,
• to assist in defining the research question,
• to place the research in the context of other studies,
• to show that the researcher has reflected on the research question.
The process of reviewing the literature
Producing a rigorous review of the literature consists of the following three stages, each with its own demands and skills required to accomplish them:
• sourcing, or searching for and locating appropriate literature,
• evaluating the results of the search and extracting relevant detail,
• writing the review based on the synthesis and evaluation of the material.
There are surprising similarities between conducting a review of the literature and a research project; both start with a precise question, and maximum effort must go into the planning stage. A statement such as: ‘I want to find out about women who have twins’ is unlikely to be successful. Try to be clear on the question you want the review to answer. A more suitable wording would be ‘What are the main physical, psychological and social problems faced by women who have twins?’ Even this may be too ambitious for one assignment or review and just one of those three aspects may be more appropriate.
The review, when written, will consist of a number of subheadings under which you will group or ‘cluster’ the literature. The key words that may prompt you to clarify the headings under which the review will be structured are listed in Box 6.1.
BOX 6.1
Key words that may help to identify suitable theme headings for structuring a review
What (definitions of key terms or concepts)
Why (what are the causes/influences of the key term/concept)
Who (is particularly affected/at risk/involved)
When (are there particular times when this might happen or action ought to be taken)
How (does it happen/take place/can we do something about it)
Problems
Solutions/recommendations
Advantages
Disadvantages
Implications for practice
Not all of these would be used for every subject. If we take the example of reviewing the literature on twins discussed above, we can see how they can be applied in practice. The process of planning the review may follow similar lines to that outlined in Box 6.2.
BOX 6.2
Planning a review of the literature
Aim of the review:
To consider the physical, psychological and social implications of the birth of twins on the mother and family, and to identify the implications of these factors for the midwife.
Possible theme headings:
What are twins – how is this clinically defined, what variations are there?
Why do twins occur – what are the factors associated with twin pregnancies?
Who is most likely to have twins?
When should some of the implications be considered?
How do twins influence physical, psychological, social factors related to the mother and family?
Problems – what problems are associated with twins in pregnancy, birth, and early months?
Solutions – how can some of the identified problems he reduced?
What are the implications for the midwife and maternity services?
If at this stage it is evident that the review is going to be large, the scope can be reduced to look at an aspect of it, such as the consequence of birthing twins in the first 3 months following birth. In this way the planning stage helps to clarify the question that the review will answer. It is also important to realise that some of the above questions will vary in emphasis. This will have implications for the amount of space devoted to exploring them. The answers to some questions will be discussed in a sentence or two; others will be several pages long.
The structure of the review may be reassessed as the material is gathered. For instance, it may be better to put some of the material such as the ‘what is meant by…’ in an introduction. The main body of the review may concentrate on the two headings of ‘the main problems faced by the mothers of twins’ and ‘ways in which problems can be reduced’. A final heading may then be ‘implications for practice’.
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