1. Review of Literature & Theoretical Frameworks
Nursing 200W

2. Learning Objectives Describe reviews of literature (ROL)
Discuss process of completing a ROL
Identify the purpose of theories and frameworks in nursing research
Compare conceptual models and differing levels of theories

3. Review of Literature (ROL)
Critical summary of published literature about a particular topic or practice problem
Empirical (a.k.a. research) literature
Theoretical literature
Determine what is known and not known
Provide a background or basis for the current research study

4. Purposes of ROL - General
Direct the development and implementation of a study
Document background and significance of study
Identify theories that can provide a framework for studying a particular topic

5. Purposes of ROL by Research Type
Quantitative
Qualitative
Identify research problem
Understand previous research
Plan the study
During the interpretation of findings, the ROL may help determine if any additional relevant studies have been published.
Provides background for the study
Provides significance of the study
Additional literature may be reviewed after the data are collected to compare and contrast finding to the literature.

6. Types of Sources
Primary sources – original research or ideas, written by the person who generated the information
Secondary sources – books or articles that paraphrase or summarize the works of others

7. Tips for Searching Determine topic Choose database Select keywords
Locate relevant sources
Limit or refine the search

8. Example
How would you begin a literature review for studies examining the effects of an exercise program on the emotional well-being of women with breast cancer?
Databases
CINAHL
MEDLINE
ProQuest

9. Electronic Nursing/ Medical Journals
Increasing number
Targeted to small specialty audiences
More current information
Check health sciences libraries’ web-sites for print and e-journals

10. Web-based Information
Advantages?
Disadvantages
No screening/filter
Misinformation
Out-of-date information
Check the source of any information obtained on the Web

11. Integrative Reviews of Literature
Purpose: identify, analyze, & synthesize results from many independent studies to determine the current knowledge in a particular area.
Support EBP in nursing
Used to develop protocols and critical pathways.
Studies are selected based on their quality and their relationship to a selected practice problem.

12. Sources of Integrated Reviews
Annual Review of Nursing Research
Journal: Evidence-Based Nursing
Sigma Theta Tau Online Journal of Nursing Synthesis
The Cochrane Collaboration (
The Agency for Health Care Research and Quality (

13. Writing a Review of Literature
Purposes
Document current knowledge of a topic or gaps in knowledge
Identify findings that are ready for use in practice
Outline
Introduction
Review relevant studies
Critique and Summary

14. Introduction Indicate focus or purpose of review
Provide background information
Describe organization of studies included
Most to least important
Earliest to most recent
By relevance
Make it brief and interesting!

15. Review of Relevant Studies
For each study:
Summarize purpose, research design, sample, methods, and important findings
Concisely critique strengths/weaknesses
Ethical writing
Restricted use of direct quotes
Cite/reference studies accurately

16. Synthesizing Studies for the ROL
Author, Year
Purpose
Sample
Data Collection
Findings
App. To Practice
ABC, 2011
DEF, 2014
HIJ, 2013
WXY,
2014

17. Summary/Discussion
Summarize what is known and not known about the topic
Evaluate whether there is adequate knowledge to support a change in clinical practice,
and/or evaluate the need for further research on this topic

18. Theories/Frameworks Theories Frameworks Abstract models
Testable portions of theories

19. Theory Integrated set of defined concepts and statements
present a view of a phenomenon
used to describe, explain, predict, or control the phenomenon
Where do theories come from?
Theories are NOT…

20. Purposes of Theory Make scientific findings meaningful and useful
Summarize and organize information
Generalize findings
Tested and refined by research
Guide practice
Research
Practice
Theory

21. Components of Theory 1. Concepts – Building blocks
Construct (Abstract)
Concept
Variable (Concrete)

22. Example Emotional Response ANXIETY Anger  HR, cortisol level Abstract
Concrete

23. Examples of Nursing Concepts
Human Beings (across the lifespan)
Environment
Health
Nursing/nursing process

24. Components of Theory 2. Relational Statements (Propositions)
Indicate relationships among concepts
Expressed at various levels of abstraction
Logically interrelated

25. Examples of Statements
Outbursts of anger may lead to high levels of cortisol
High levels of cortisol are a precursor of atherosclerosis
Atherosclerosis increases the risk of CAD
CAD may lead to early mortality

26. Operationalizing Variables
Identify variables used to represent concepts
Develop operational definitions
How variables will be measured or manipulated in the study
For example: Pain

27. Defining “Pain”
Conceptual definition: “Pain is a sensation of discomfort caused by tissue damage and inflammatory response”
Operational definition: “Pain will be measured with the Analog Chromatic Continuous Scale (ACCS)”

28. Theories Types of theories Most nursing theories are middle-range
Meta-theory (theories about theories)
Grand theories (conceptual models)
Middle-range theories (limited # concepts)
Practice theories (very specific)
Most nursing theories are middle-range

29. Conceptual Models May be based on several theories
Broad, abstract explanation of a phenomenon
Reflect a philosophy (set of beliefs)

30. Nursing Conceptual Models
Orem’s Self-Care Model
Rogers’ Science of Unitary Human Beings
Roy’s Adaptation Model
Watson’s Caring Model

31. Roy’s Adaptation Model
People are in constant interaction with a changing environment.
Nurses can promote adaptation in situations of health and illness
Environment
(health/illness)
Person
Nursing
Adaptation
(health/illness)
(Fawcett, 1984, p. 259)

32. Middle-range Theories
Narrower scope
Contains limited number of concepts
Focus on limited aspects of relationship
Examples:
Theory of Health Promotion (Pender, 1987)
Theory of Becoming a Mother (Mercer, 2004)
Social Cognitive Theory (Bandura, 1986)

33. Practice Theory Least complex theory Very specific
Emphasis is clinical situations
Examples:
Comfort Theory
Wellness MotivationTheory

34. Research Framework Every study should have a framework
A brief explanation of a theory or those portions of a theory to be tested in a study
Every study should have a framework
Well-developed studies will have a clearly identified framework
Some are implied, not explicitly described
As knowledge about topic increases, development of framework gets easier

35. Framework Example General Adaptation Syndrome (Selye, 1946)
Increased HR, RR
Decreased HRV
Stress
Sympathetic NS
Decreased HR, RR
Increased HRV
Relaxation
Parasympathetic NS
Hypnosis
(VandeVusse et al., 2010)

36. Critiquing How extensive is the ROL?
Is it clearly and logically organized?
Is the literature current and relevant?
Does the author evaluate, as well as summarize, the literature?
Can you determine what is known and not known about the topic?

37. Critiquing Is a framework identified?
Is it based on theory?
Is it appropriate for study?
Are relationships among concepts stated?
Are conceptual and operational definitions provided?
Does researcher connect research findings to framework?