Purpose of the Literature Review in Quantitative Research

The review of literature in quantitative research is conducted to direct the planning and execution of a study. The major literature review is performed at the beginning of the research process (before the study is conducted). A limited review is conducted after the study is completed to identify studies published since the original literature review, especially if it has been 1 year or longer since the study began. Additional articles may be retrieved to find information relevant to interpreting the findings. The results of both reviews are included in the research report. The purpose of the literature review is similar for the different types of quantitative studies—descriptive, correlational, quasi-experimental, and experimental.

Quantitative research reports may include citations to relevant sources in all sections of the report. The researchers include sources in the introduction section to summarize the background and significance of the research problem. Citations about the number of patients affected, cost of treatment, and consequences in terms of human suffering and physical health may be included. The review of literature section may not be labeled but be integrated into the introduction. The review includes theoretical and research references that document current knowledge about the problem studied.

A quantitative study develops its framework section (not always so labeled) from the theoretical literature and sometimes from research reports, depending on the focus of the study. The methods section of the research report describes the design, sample and the process for obtaining the sample, measurement methods, treatment, and data collection process. References may be cited in various parts of the methods section as support for the appropriateness of the methods used in the study. The results section includes the results of the statistical analyses, but also includes sources to validate the analytical techniques that were used to answer the research questions. Sources might also be included to compare the analysis of the data in the present study with the results of previous studies. The discussion section of the research report provides the comparison of the findings to other studies’ findings, if not already included in the results section. The discussion section also incorporates conclusions that are a synthesis of the findings from previous research and those from the present study.

Purpose of the Literature Review in Qualitative Research

In qualitative research reports, the introduction will be similar to the same section in the quantitative study report because the researchers document the background and significance of the research problem. Researchers often include citations to support the need to study the selected topic (Creswell, 2013). However, additional review of the literature may not be cited for two reasons. One reason is that qualitative studies are often conducted on topics about which we know very little, so little literature is available to review. The other reason is that some qualitative researchers deliberately do not review the literature deeply prior to conducting the study because they do not want their expectations about the topic to bias their data collection, data analysis, and findings (Munhall, 2012). This is consistent with the expectation that qualitative researchers remain open to the perspectives of the participants. In the methods, results, and discussion sections, qualitative researchers will incorporate literature to support the use of specific methods and place the findings in the context of what is already known.

The purpose, extent, and timing of the literature review vary across the different qualitative approaches (Grove, Burns, & Gray, 2013). Phenomenologists are among those who are likely to delay literature review until after data collection and initial analysis have been completed (Munhall, 2012). These researchers will review the literature in the later stages of the analysis and as they interpret the findings in the larger context of theoretical and empirical knowledge. Grounded theory researchers include a minimal review of relevant studies at the beginning of the research process. This review is merely a means of making the researcher aware of what studies have been conducted and that a research problem exists (Corbin & Strauss, 2008), but the information from these studies is not used to direct data collection or theory development for the current study (Walls, Pahoo, & Fleming, 2010). The researcher uses the literature primarily to explain, support, and extend the theory generated in the study (Wuerst, 2012).

The review of literature in ethnographic research is similar to that in quantitative research. In early ethnographies of unexplored groups of people in distant locations, culture-specific literature was not available to review prior to data collection. Theoretical and philosophical literature, however, was and continues to be used to provide a framework or perspective through which researchers approach data collection. The research problem for an ethnography is based on a review of the literature that identifies how little is known about the culture of interest (Wolf, 2012). The review also informs the research process by providing a general understanding of the cultural characteristics to be examined. For example, the literature review for an ethnography of nursing in Uganda would reveal that the healthcare system has referral hospitals, district hospitals, and health centers. With this information, the researcher might decide to develop a data collection plan to observe nurses in each setting, or the researcher might decide to narrow the ethnography to health centers. Another example would be the ethnographer studying health behaviors of Burmese refugees in a specific neighborhood. From the literature, the researcher learned that older community members are highly respected and, as a result, the researcher would seek support of older refugees to facilitate access to others in the community. Ethnographers return to the literature during analysis and interpretation of the data to expand the readers’ understanding of the culture.

Researchers using the exploratory-descriptive qualitative and historical approaches may be conducting the study because they have reviewed the literature and found that little knowledge is available. Exploratory-descriptive qualitative researchers want to understand a situation or practice problem better so solutions can be identified (Grove et al., 2013). Historical researchers conduct an initial review of current literature and identify an event or time in history about which little is known and that has possible implications for nursing and health care today. Publications contemporary to the event or time are the sources of data. The researchers develop an inventory of sources, locate these sources, and examine them (Lundy, 2012). Because historical research requires an extensive review of literature that is sometimes difficult to locate, the researcher can spend months and even years locating and examining sources. Chapter 3 contains additional information about literature reviews in qualitative studies.

Types of Publications

An article is a paper about a specific topic and may be published together with other articles on similar themes in journals (periodicals), encyclopedias, or edited books. As part of an edited book, articles may be called chapters. A periodical such as a journal is published over time and is numbered sequentially for the years published. This sequential numbering is seen in the year, volume, issue, and page numbering of a journal. A monograph, such as a book on a specific subject, a record of conference proceedings, or a pamphlet, usually is a one-time publication. Periodicals and monographs are available in a variety of media, including online and in print. An encyclopedia is an authoritative compilation of information on alphabetized topics that may provide background information and lead to other sources, but is rarely cited in academic papers and publications. Some online encyclopedias are electronic publications that have undergone the same level of review as published encyclopedias. Other online encyclopedias, such as Wikipedia, are in an open, editable format and, as a result, the credibility of the information is variable. Using Wikipedia as a professional source is controversial (Luyt, Ally, Low, & Ismail, 2010; Younger, 2010).When you are writing a review of the literature, Wikipedia may provide ideas for other sources that you may want to find but check with your faculty about whether Wikipedia or any other encyclopedia may be cited for course assignments.

Major professional organizations may publish papers selected by a review process that were presented at their conference, called conference proceedings. These publications may be in print or online. Conference proceedings may include the findings of pilot studies and preliminary findings of ongoing studies. A thesis is a report of a research project completed by a postgraduate student as part of the requirements for a master’s degree. A dissertation is a report of an extensive, sometimes original, research project that is completed as the final requirement for a doctoral degree. Theses and dissertations can be cited in a literature review. In some cases, an article may be published based on the student’s thesis or dissertation. Clinical journals are periodicals that include research reports and non-research articles about practice problems and professional issues. You are familiar with textbooks as a source of information for academic courses. Other books on theories, methods, and events may also be cited in a literature review. To evaluate the quality of a book, consider the qualifications of the author related to the topic, and review the evidence that the author provides to support the book’s premises and conclusions. With textbooks and other books, chapters in an edited book might have been written by different people, which are cited differently than the book as a whole. This is important to note when checking citations and writing your own literature reviews.

Electronic access to articles and books has increased dramatically, making many types of published literature more widely available. In addition, websites are an easily accessible source of information. Not all websites are valid and appropriate, however, for citation in a literature review. The website of a company that sells diuretic medications may not be an appropriate source for hypertension statistics. In contrast, websites prepared and sponsored by government agencies and professional organizations are considered appropriate references to cite.

Content of Publications

References cited in literature reviews contain two main types of content, (1) theoretical and (2) empirical. Theoretical literature includes concept analyses, models, theories, and conceptual frameworks that support a selected research problem and purpose. Theoretical sources can be found in books, periodicals, and monographs. Nursing theorists have written books to describe the development and content of their theories. Other books contain summaries of several theories. In a published study, theoretical and conceptual sources are described and summarized to reflect the current understanding of the research problem and provide a basis for the study framework.

Empirical literature in this context refers to knowledge derived from research. In other words, the knowledge is based on data from research (data-based). Data-based literature consists of reports of research and includes published studies, usually in journals, on the Internet, or books, and unpublished studies, such as master theses and doctoral dissertations.

Quality of Sources

Most references cited in quality literature reviews are primary sources that are peer-reviewed. A primary source is written by the person who originated or is responsible for generating the ideas published. A research report written by the researchers who conducted the study is a primary source. A theorist’s development of a theory or other conceptual content is a primary source. A secondary source summarizes or quotes content from primary sources. Authors of secondary sources paraphrase the works of researchers and theorists and present their interpretation of what was written by the primary author. As a result, information in secondary sources may be misinterpretations of the primary authors’ thoughts. Secondary sources are used only if primary sources cannot be located, or the secondary source provides creative ideas or a unique organization of information not found in a primary source. Peer-reviewed means that the author of the research report, clinical description, or theoretical explanation has submitted a manuscript to a journal editor, who identified scholars familiar with the topic to review the manuscript. These scholars provide input to the editor about whether the manuscript in its current form is accurate, meets standards for quality, and is appropriate for the journal. A peer-reviewed paper has undergone significant scrutiny and is considered trustworthy.

Quality literature reviews include relevant and current sources. Relevant studies are those with a direct bearing on the problem of concern. Current sources are those published within 5 years before publication of the manuscript. Sources cited should be comprehensive as well as current. Some problems have been studied for decades, and the literature review often includes seminal and landmark studies that were conducted years ago. Seminal studies are the first studies on a particular topic that signaled the beginning of a new way of thinking on the topic and sometimes are referred to as classical studies. Landmark studies are significant research projects that have generated knowledge that influences a discipline and sometimes society as a whole. Such studies frequently are replicated or serve as the basis for the generation of additional studies. Some authors may describe a landmark study as being a groundbreaking study. Citing a few older studies significant to the development of knowledge on the topic being reviewed is appropriate. Most publications cited, however, should be current. Replication studies are reproductions or repetitions of a study that researchers conduct to determine whether the findings of the original study could be found consistently in different settings and with different subjects. Replication studies are important to build the evidence for practice. A replication study that supports the findings of the original study increases the credibility of the findings and strengthens the evidence for practice. A replication that does not support the original study findings raises questions about the credibility of the findings.

Syntheses of research studies, another type of data-based literature, may be cited in literature reviews. A research synthesis may be a systematic review of the literature, meta-analysis of quantitative studies, meta-synthesis of qualitative studies, or a mixed-method systematic review. These publications are valued for their rigor and contributions to evidence-based practice (see Chapters 1 and 13).

Critical Appraisal of a Literature Review in a Quantitative Study

The anxiety related to having a surgical or diagnostic procedure can have adverse effects. Brand, Munroe, and Gavin (2013, p. 708) conducted a quasi-experimental study to “determine the effects of hand massage on patient anxiety in the ambulatory surgical setting.” The section entitled “Literature Review” (pp. 709-710) is included as an example and is critically appraised. In addition to the references included in the review of the literature, these authors cited references throughout the research report. The reference list, previously formatted in the style of medical literature, is included in APA format in this chapter. All the cited references are considered in the critical appraisal.

Research Example

Literature Review

“Anxiety is considered a normal part of the preoperative experience (Bailey, 2010). Because it is common, however, does not mean it should be ignored. Part of the nurse’s role in the perioperative setting is to manage patient anxiety to support positive surgical outcomes and satisfaction with the surgical experience. The shift from inpatient hospital stays for surgery to same-day surgery has been monumental; most patients undergoing surgeries that once required an overnight hospital stay now go home within hours of surgery (Mitchell, 2003). Unfortunately, nurses and physicians have a fraction of the time they once had to achieve all of the postoperative goals and outcomes, including, but not limited to, pain management and postoperative education (Mitchell, 2003).

Grieve (2002) described causes of anxiety in the preoperative patient.… Yellen and Davis (2001) reviewed the effects of anxiety and found that it can be detrimental to physical and emotional recovery, and that anxiety can contribute to poor outcomes and longer hospitalizations. These researchers also learned that when patients felt valued and attained a high level of comfort, these beliefs were strong predictors of patient satisfaction.

Anxiety triggers the stress response, stimulating the release of epinephrine and norepinephrine, which raises blood pressure and increases heart rate, cardiac output, and blood glucose levels (Forshee, Clayton, & McCance, 2010). Poorly managed anxiety can be life-threatening in patients diagnosed with hypertension and coronary artery disease, increasing the chances for myocardial infarction or potential stroke (Forshee, Clayton, & McCance, 2010). Anxiety can also have a major effect on psychological symptoms and can inhibit learning, concentration, and routine tasks (Gilmartin & Wright, 2008; Vaughn, Wichowski, & Bosworth, 2007).… Armed with this knowledge, nurses in the perioperative setting should be concerned about how anxiety can affect the outcomes for all surgical patients.

There is a link between preoperative anxiety and postoperative pain. In their systematic review of predictors for postoperative pain, Ip et al. (2009) found that anxiety ranked as the highest predictor.… According to Lin and Wang (2005), unrelieved postoperative pain has a negative effect on patients and delays postoperative recovery. In their literature review, Vaughn et al. (2007) found studies that correlated anxiety and pain, and concluded that ‘preoperative planning for patients with high levels of anxiety should be implemented to obtain optimal postoperative pain control’ (p. 601).

In her review of studies for strategies to decrease patient anxiety, Bailey (2010) found that perioperative education and music therapy were successful. McRee et al. (2003) researched the use of music and massage as forms of improving postoperative outcomes.… The findings provided evidence that patients who received preoperative music or music with massage had reduced anxiety, stress, and pain (McRee et al., 2003).

In their review, Cooke et al. (2005) identified 12 studies that focused on the effect of music on anxiety in patients waiting for surgery or other procedures in the ambulatory setting.… The studies of the effects of music interventions in relation to anxiety and pain reduction have similar findings (Nilsson, 2008; Yung, Chui-Kam, French, & Chan, 2002).… The types of music that are relaxing to patients may need to be individualized, however, thus posing challenges to implementing this intervention.

Braden et al. (2009) studied the use of oil lavandin, which has relaxant and sedative effects, as a means to reduce preoperative anxiety in surgical patients.… Similar to music, olfactory and topical application of oil lavandin has a low risk of adverse effects and is a cost-effective intervention that has proven successful in lowering patient anxiety on OR transfer (Braden et al., 2009). However, the use of essential oils may pose challenges with infection control standards, which often specify the brand name (i.e., source) of lotion products that can be used in the healthcare facility.

Kim et al. (2001) researched the effects of preoperative hand massage on patient anxiety before and during cataract surgery.… The researchers concluded that hand massage decreased the psychological and physiological anxiety levels in patients having cataract surgery under local anesthesia (Kim et al., 2001).

Of all the alternative methods used to alleviate anxiety in preoperative patients, we identified hand massage as a strategy that was consistent with the time constraints in the perioperative setting. Massage can be readily learned by nursing personnel, surgical patients’ hands are easily accessible, and massage can be accomplished in 10 minutes. We were curious to see whether hand massage would improve patient outcomes and overall patient satisfaction. Results of previous research have shown that significant psychological and physiological changes take place after a hand massage (Kim et al., 2001). Hand massage is also a high-touch nursing care procedure that supports the concept of patients feeling valued and feeling the highest level of comfort during a time of stress and uncertainty.”

References

Bailey, L. (2010). Strategies for decreasing patient anxiety in the perioperative setting. AORN Journal, 92(4), 445–457.

Braden, R., Reichow, S., & Halm, M. A. (2009). The use of the essential oil lavandin to reduce preoperative anxiety in surgical patients. Journal of Perianesthesia Nursing, 24(6), 348–355.

Chlan, L. L. (2004). Relationship between two anxiety instruments in patients receiving mechanical ventilatory support. Journal of Advanced Nursing, 48(5), 493–499.

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Cooke, M., Chaboyer, W., Schluter, P., & Hiratos, M. (2005). The effect of music on preoperative anxiety in day surgery. Journal of Advanced Nursing, 52(1), 47–54.

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Forshee, B. A., Clayton, M. F., & McCance, K. L. (2010). Stress and disease. In K. L. McCance, S. E. Huether, V. L. Brashers & N. S. Rote (Eds.), Pathophysiology: The biologic basis for disease in adults and children (6th ed., pp. 336–358). St. Louis, MO: Mosby.

Gilmartin, J., & Wright, K. (2008). Day surgery: Patients felt abandoned during the preoperative wait. Journal of Clinical Nursing, 17(18), 2418–2425.

Grieve, R. J. (2002). Day surgery preoperative anxiety reduction and coping strategies. British Journal of Nursing, 11(10), 670–678.

Ip, H. Y., Abrishami, A., Peng, P. W., Wong, J., & Chung, F. (2009). Predictors of postoperative pain and analgesic consumption. Anesthesiology, 111(3), 657–677.

Kim, M. S., Cho, K. S., Woo, H. M., & Kim, J. H. (2001). Effects of hand massage on anxiety in cataract surgery using local anesthesia. Journal of Cataract and Refractive Surgery, 27(6), 884–890.

Leach, M., Zernike, W., & Tanner, S. (2000). How anxious are surgical patients? ACORN Journal, 13(1), 30–31, 34–35.

Lin, L. Y., & Wang, R. H. (2005). Abdominal surgery, pain and anxiety: Preoperative nursing intervention. Journal of Advanced Nursing, 51(3), 252–260.

McRee, L. D., Noble, S., & Pasvogel, A. (2003). Using massage and music therapy to improve postoperative outcomes. AORN Journal, 78(3), 433–447.

Mitchell, M. (2003). Patient anxiety and modern elective surgery: A literature review. Journal of Clinical Nursing, 1(6), 806–815.

Nilsson, U. (2008). The anxiety- and pain-reducing effects of music interventions: A systematic review. AORN Journal, 87(4), 780–807.

Oshodi, T. O. (2007). The impact of preoperative education on postoperative pain. British Journal of Nursing, 16(3), 790–797.

Quattrin, R., Zanini, A., & Buchini, S., et al. (2006). Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: Methodology and outcomes. Journal of Nursing Management, 14(2), 96–105.

Salmore, R. G., & Nelson, J. P. (2000). The effect of preprocedure teaching, relaxation instruction and music on anxiety as measured by blood pressures in an outpatient gastrointestinal endoscopy laboratory. Gastroenterology Nursing, 23(3), 102–110.

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Vaughn, F., Wichowski, H., & Bosworth, G. (2007). Does preoperative anxiety level predict postoperative pain? AORN Journal, 85(3), 589–604.

Wang, S. M., Caldwell-Andrews, A., & Kain, Z. N. (2003). The use of complementary and alternative medicines by surgical patients: A follow-up survey study. Anesthesia and Analgesia, 97(4), 1010–1015.

Wagner, D., Byrne, M., & Kolcaba, K. (2003). Effects of comfort warming on perioperative patients. AORN Journal, 84(3), 427–448.

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Williams, V. S., Morlock, R. J., & Feltner, D. (2010). Psychometric evaluation of a visual analog scale for the assessment of anxiety. Health and Quality of Life Outcomes, 8, 57. Available from http://www.hqlo.com/content/8/1/57.

Yellen, E., & Davis, G. (2001). Patient satisfaction in ambulatory surgery. AORN Journal, 74(4), 483–498.

Yung, P. M., Chui-Kam, S., French, P., & Chan, T. (2002). A controlled trial of music and pre-operative anxiety in Chinese men undergoing transurethral resection of the prostate. Journal of Advanced Nursing, 39(4), 352–359.

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