Review of Literature &

Theoretical Frameworks

Nursing 200W
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
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
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
Purposes of ROL by Research Type
Quantitative Qualitative
 Identify research problem  Provides background for

 Understand previous the study

research  Provides significance of

 Plan the study the study

 During the interpretation  Additional literature may

of findings, the ROL may be reviewed after the

help determine if any data are collected to
additional relevant compare and contrast
studies have been finding to the literature.
published.
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
Tips for Searching
 Determine topic
 Choose database
 Select keywords
 Locate relevant sources
 Limit or refine the search
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
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
Web-based Information
 Advantages?
 Disadvantages
• No screening/filter
• Misinformation
• Out-of-date information
 Check the source of any information
obtained on the Web
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.
Sources of Integrated Reviews
 Annual Review of Nursing Research
 Journal: Evidence-Based Nursing
 Sigma Theta Tau Online Journal of
Nursing Synthesis
 The Cochrane Collaboration
(http://www.cochrane.org)
 The Agency for Health Care Research
and Quality (http://www.ahrq.gov)
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
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!
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
Synthesizing Studies for the ROL
Author, Purpose Sample Data Findings App. To Practice
Year Collection
ABC,
2011
DEF,
2014
HIJ,
2013
WXY,
2014
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
Theories/Frameworks
 Theories
• Abstract models

 Frameworks
• Testable portions of theories
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…
Purposes of Theory
 Make scientific
findings meaningful
Research
and useful
• Summarize and
organize information Practice

• Generalize findings
 Tested and refined Theory
by research
 Guide practice
Components of Theory
1. Concepts – Building blocks

Construct (Abstract)

Concept

Variable (Concrete)
Example

Emotional Abstract
Response

ANXIETY
Anger
ANXIETY

 HR, cortisol level Concrete

Examples of Nursing Concepts
 Human Beings (across the lifespan)
 Environment
 Health
 Nursing/nursing process
Components of Theory
2. Relational Statements (Propositions)
 Indicate relationships among concepts

 Expressed at various levels of

abstraction
 Logically interrelated
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
Operationalizing Variables
 Identify variables used to represent
concepts
 Develop operational definitions
• How variables will be measured or
manipulated in the study
 For example: Pain
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)”
Theories
 Types of theories
• Meta-theory (theories about theories)
• Grand theories (conceptual models)
• Middle-range theories (limited # concepts)
• Practice theories (very specific)
 Most nursing theories are middle-range
Conceptual Models
 May be based on several theories
 Broad, abstract explanation of a
phenomenon
 Reflect a philosophy (set of beliefs)
Nursing Conceptual Models
 Orem’s Self-Care Model
 Rogers’ Science of Unitary Human Beings
 Roy’s Adaptation Model
 Watson’s Caring Model
Roy’s Adaptation Model
 People are in Environment
(health/illness)
constant interaction
with a changing
environment. Person
 Nurses can promote
Nursing
adaptation in
situations of health Adaptation
and illness (health/illness)

(Fawcett, 1984, p. 259)

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)
Practice Theory
 Least complex theory
 Very specific
 Emphasis is clinical situations
 Examples:
• Comfort Theory
• Wellness MotivationTheory
Research 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
 Framework Example
General Adaptation Syndrome (Selye, 1946)

Stress Sympathetic NS Increased HR, RR

Decreased HRV

Decreased HR, RR
Relaxation Parasympathetic NS
Increased HRV

Hypnosis
(VandeVusse et al., 2010)
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?
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?