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Nursing: How to Write a Literature Review

  • Traditional or Narrative Literature Review

Getting started

1. start with your research question, 2. search the literature, 3. read & evaluate, 4. finalize results, 5. write & revise, brainfuse online tutoring and writing review.

  • RESEARCH HELP

The best way to approach your literature review is to break it down into steps.  Remember, research is an iterative process, not a linear one.  You will revisit steps and revise along the way.  Get started with the handout, information, and tips from various university Writing Centers below that provides an excellent overview.  Then move on to the specific steps recommended on this page.

  • UNC- Chapel Hill Writing Center Literature Review Handout, from the University of North Carolina at Chapel Hill.
  • University of Wisconsin-Madison Writing Center Learn how to write a review of literature, from the University of Wisconsin-Madison.
  • University of Toronto-- Writing Advice The Literature Review: A few tips on conducting it, from the University of Toronto.
  • Begin with a topic.
  • Understand the topic. 
  • Familiarize yourself with the terminology.  Note what words are being used and keep track of these for use as database search keywords. 
  • See what research has been done on this topic before you commit to the topic.  Review articles can be helpful to understand what research has been done .
  • Develop your research question.  (see handout below)
  • How comprehensive should it be? 
  • Is it for a course assignment or a dissertation? 
  • How many years should it cover?
  • Developing a good nursing research question Handout. Reviews PICO method and provides search tips.

Your next step is to construct a search strategy and then locate & retrieve articles.

  •  There are often 2-4 key concepts in a research question.
  • Search for primary sources (original research articles.)
  • These are based on the key concepts in your research question.
  • Remember to consider synonyms and related terms.
  • Which databases to search?
  • What limiters should be applied (peer-reviewed, publication date, geographic location, etc.)?

Review articles (secondary sources)

Use to identify literature on your topic, the way you would use a bibliography.  Then locate and retrieve the original studies discussed in the review article. Review articles are considered secondary sources.

  • Once you have some relevant articles, review reference lists to see if there are any useful articles.
  • Which articles were written later and have cited some of your useful articles?  Are these, in turn, articles that will be useful to you? 
  • Keep track of what terms you used and what databases you searched. 
  • Use database tools such as save search history in EBSCO to help.
  • Keep track of the citations for the articles you will be using in your literature review. 
  • Use RefWorks or another method of tracking this information. 
  • Database Search Strategy Worksheet Handout. How to construct a search.
  • TUTORIAL: How to do a search based on your research question This is a self-paced, interactive tutorial that reviews how to construct and perform a database search in CINAHL.

The next step is to read, review, and understand the articles.

  • Start by reviewing abstracts. 
  • Make sure you are selecting primary sources (original research articles).
  • Note any keywords authors report using when searching for prior studies.
  • You will need to evaluate and critique them and write a synthesis related to your research question.
  • Consider using a matrix to organize and compare and contrast the articles . 
  • Which authors are conducting research in this area?  Search by author.  
  • Are there certain authors’ whose work is cited in many of your articles?  Did they write an early, seminal article that is often cited?
  • Searching is a cyclical process where you will run searches, review results, modify searches, run again, review again, etc. 
  • Critique articles.  Keep or exclude based on whether they are relevant to your research question.
  • When you have done a thorough search using several databases plus Google Scholar, using appropriate keywords or subject terms, plus author’s names, and you begin to find the same articles over and over.
  • Remember to consider the scope of your project and the length of your paper.  A dissertation will have a more exhaustive literature review than an 8 page paper, for example.
  • What are common findings among each group or where do they disagree? 
  • Identify common themes. Identify controversial or problematic areas in the research. 
  • Use your matrix to organize this.
  • Once you have read and re-read your articles and organized your findings, you are ready to begin the process of writing the literature review.

2. Synthesize.  (see handout below)

  • Include a synthesis of the articles you have chosen for your literature review.
  • A literature review is NOT a list or a summary of what has been written on a particular topic. 
  • It analyzes the articles in terms of how they relate to your research question. 
  • While reading, look for similarities and differences (compare and contrast) among the articles.  You will create your synthesis from this.
  • Synthesis Examples Handout. Sample excerpts that illustrate synthesis.

Regis Online students have access to Brainfuse. Brainfuse is an online tutoring service available through a link in Moodle. Meet with a tutor in a live session or submit your paper for review.

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Literature Review Overview

What is a Literature Review? Why Are They Important?

A literature review is important because it presents the "state of the science" or accumulated knowledge on a specific topic. It summarizes, analyzes, and compares the available research, reporting study strengths and weaknesses, results, gaps in the research, conclusions, and authors’ interpretations.

Tips and techniques for conducting a literature review are described more fully in the subsequent boxes:

  • Literature review steps
  • Strategies for organizing the information for your review
  • Literature reviews sections
  • In-depth resources to assist in writing a literature review
  • Templates to start your review
  • Literature review examples

Literature Review Steps

literature review example nursing student

Graphic used with permission: Torres, E. Librarian, Hawai'i Pacific University

1. Choose a topic and define your research question

  • Try to choose a topic of interest. You will be working with this subject for several weeks to months.
  • Ideas for topics can be found by scanning medical news sources (e.g MedPage Today), journals / magazines, work experiences, interesting patient cases, or family or personal health issues.
  • Do a bit of background reading on topic ideas to familiarize yourself with terminology and issues. Note the words and terms that are used.
  • Develop a focused research question using PICO(T) or other framework (FINER, SPICE, etc - there are many options) to help guide you.
  • Run a few sample database searches to make sure your research question is not too broad or too narrow.
  • If possible, discuss your topic with your professor. 

2. Determine the scope of your review

The scope of your review will be determined by your professor during your program. Check your assignment requirements for parameters for the Literature Review.

  • How many studies will you need to include?
  • How many years should it cover? (usually 5-7 depending on the professor)
  • For the nurses, are you required to limit to nursing literature?

3. Develop a search plan

  • Determine which databases to search. This will depend on your topic. If you are not sure, check your program specific library website (Physician Asst / Nursing / Health Services Admin) for recommendations.
  • Create an initial search string using the main concepts from your research (PICO, etc) question. Include synonyms and related words connected by Boolean operators
  • Contact your librarian for assistance, if needed.

4. Conduct searches and find relevant literature

  • Keep notes as you search - tracking keywords and search strings used in each database in order to avoid wasting time duplicating a search that has already been tried
  • Read abstracts and write down new terms to search as you find them
  • Check MeSH or other subject headings listed in relevant articles for additional search terms
  • Scan author provided keywords if available
  • Check the references of relevant articles looking for other useful articles (ancestry searching)
  • Check articles that have cited your relevant article for more useful articles (descendancy searching). Both PubMed and CINAHL offer Cited By links
  • Revise the search to broaden or narrow your topic focus as you peruse the available literature
  • Conducting a literature search is a repetitive process. Searches can be revised and re-run multiple times during the process.
  • Track the citations for your relevant articles in a software citation manager such as RefWorks, Zotero, or Mendeley

5. Review the literature

  • Read the full articles. Do not rely solely on the abstracts. Authors frequently cannot include all results within the confines of an abstract. Exclude articles that do not address your research question.
  • While reading, note research findings relevant to your project and summarize. Are the findings conflicting? There are matrices available than can help with organization. See the Organizing Information box below.
  • Critique / evaluate the quality of the articles, and record your findings in your matrix or summary table. Tools are available to prompt you what to look for. (See Resources for Appraising a Research Study box on the HSA, Nursing , and PA guides )
  • You may need to revise your search and re-run it based on your findings.

6. Organize and synthesize

  • Compile the findings and analysis from each resource into a single narrative.
  • Using an outline can be helpful. Start broad, addressing the overall findings and then narrow, discussing each resource and how it relates to your question and to the other resources.
  • Cite as you write to keep sources organized.
  • Write in structured paragraphs using topic sentences and transition words to draw connections, comparisons, and contrasts.
  • Don't present one study after another, but rather relate one study's findings to another. Speak to how the studies are connected and how they relate to your work.

Organizing Information

Options to assist in organizing sources and information :

1. Synthesis Matrix

  • helps provide overview of the literature
  • information from individual sources is entered into a grid to enable writers to discern patterns and themes
  • article summary, analysis, or results
  • thoughts, reflections, or issues
  • each reference gets its own row
  • mind maps, concept maps, flowcharts
  • at top of page record PICO or research question
  • record major concepts / themes from literature
  • list concepts that branch out from major concepts underneath - keep going downward hierarchically, until most specific ideas are recorded
  • enclose concepts in circles and connect the concept with lines - add brief explanation as needed

3. Summary Table

  • information is recorded in a grid to help with recall and sorting information when writing
  • allows comparing and contrasting individual studies easily
  • purpose of study
  • methodology (study population, data collection tool)

Efron, S. E., & Ravid, R. (2019). Writing the literature review : A practical guide . Guilford Press.

Literature Review Sections

  • Lit reviews can be part of a larger paper / research study or they can be the focus of the paper
  • Lit reviews focus on research studies to provide evidence
  • New topics may not have much that has been published

* The sections included may depend on the purpose of the literature review (standalone paper or section within a research paper)

Standalone Literature Review (aka Narrative Review):

  • presents your topic or PICO question
  • includes the why of the literature review and your goals for the review.
  • provides background for your the topic and previews the key points
  • Narrative Reviews: tmay not have an explanation of methods.
  • include where the search was conducted (which databases) what subject terms or keywords were used, and any limits or filters that were applied and why - this will help others re-create the search
  • describe how studies were analyzed for inclusion or exclusion
  • review the purpose and answer the research question
  • thematically - using recurring themes in the literature
  • chronologically - present the development of the topic over time
  • methodological - compare and contrast findings based on various methodologies used to research the topic (e.g. qualitative vs quantitative, etc.)
  • theoretical - organized content based on various theories
  • provide an overview of the main points of each source then synthesize the findings into a coherent summary of the whole
  • present common themes among the studies
  • compare and contrast the various study results
  • interpret the results and address the implications of the findings
  • do the results support the original hypothesis or conflict with it
  • provide your own analysis and interpretation (eg. discuss the significance of findings; evaluate the strengths and weaknesses of the studies, noting any problems)
  • discuss common and unusual patterns and offer explanations
  •  stay away from opinions, personal biases and unsupported recommendations
  • summarize the key findings and relate them back to your PICO/research question
  • note gaps in the research and suggest areas for further research
  • this section should not contain "new" information that had not been previously discussed in one of the sections above
  • provide a list of all the studies and other sources used in proper APA 7

Literature Review as Part of a Research Study Manuscript:

  • Compares the study with other research and includes how a study fills a gap in the research.
  • Focus on the body of the review which includes the synthesized Findings and Discussion

Literature Reviews vs Systematic Reviews

Systematic Reviews are NOT the same as a Literature Review:

Literature Reviews:

  • Literature reviews may or may not follow strict systematic methods to find, select, and analyze articles, but rather they selectively and broadly review the literature on a topic
  • Research included in a Literature Review can be "cherry-picked" and therefore, can be very subjective

Systematic Reviews:

  • Systemic reviews are designed to provide a comprehensive summary of the evidence for a focused research question
  • rigorous and strictly structured, using standardized reporting guidelines (e.g. PRISMA, see link below)
  • uses exhaustive, systematic searches of all relevant databases
  • best practice dictates search strategies are peer reviewed
  • uses predetermined study inclusion and exclusion criteria in order to minimize bias
  • aims to capture and synthesize all literature (including unpublished research - grey literature) that meet the predefined criteria on a focused topic resulting in high quality evidence

Literature Review Examples

  • Breastfeeding initiation and support: A literature review of what women value and the impact of early discharge (2017). Women and Birth : Journal of the Australian College of Midwives
  • Community-based participatory research to promote healthy diet and nutrition and prevent and control obesity among African-Americans: A literature review (2017). Journal of Racial and Ethnic Health Disparities

Restricted to Detroit Mercy Users

  • Vitamin D deficiency in individuals with a spinal cord injury: A literature review (2017). Spinal Cord

Resources for Writing a Literature Review

These sources have been used in developing this guide.

Cover Art

Resources Used on This Page

Aveyard, H. (2010). Doing a literature review in health and social care : A practical guide . McGraw-Hill Education.

Purdue Online Writing Lab. (n.d.). Writing a literature review . Purdue University. https://owl.purdue.edu/owl/research_and_citation/conducting_research/writing_a_literature_review.html

Torres, E. (2021, October 21). Nursing - graduate studies research guide: Literature review. Hawai'i Pacific University Libraries. Retrieved January 27, 2022, from https://hpu.libguides.com/c.php?g=543891&p=3727230

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Literature Reviews for Education and Nursing Graduate Students

(13 reviews)

literature review example nursing student

Linda Frederiksen, Washington State University Vancouver

Sue F. Phelps, Washington State University Vancouver

Copyright Year: 2017

Publisher: Rebus Community

Language: English

Formats Available

Conditions of use.

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Learn more about reviews.

Reviewed by Yolanda Griffiths, Professor of Occupational Therapy, Drake University on 12/15/21

The authors were thorough and very organized in stepping readers through the process of conducting and writing a literature review. Each area is appropriately indexed and examples are provided in a variety of ways. The synthesis section is... read more

Comprehensiveness rating: 5 see less

The authors were thorough and very organized in stepping readers through the process of conducting and writing a literature review. Each area is appropriately indexed and examples are provided in a variety of ways. The synthesis section is especially useful as students often do not understand what this means. Perhaps some content on plagiarism would benefit this section as well. The flow of the material easily guides users logically through each topic.

Content Accuracy rating: 5

The content is accurate and unbiased. The content is presented in an easy to understand way with videos, and examples.

Relevance/Longevity rating: 5

The relevance of the content is classic and the text should be pertinent for many years. The links included in the text are very useful and should be easy for authors to check periodically. Using a digital media is more relevant to today's students than print textbooks. Each section addresses a reasonable chunk of information.

Clarity rating: 5

The book is user friendly, written in an easy to understand manner, and graphics or links add to the understanding of the content. Definitions are clearly written. Such as clarifying the types of literature reviews will be useful for students. Providing a test yourself section at the end of sections allows the reader to check if any content was confusing or not clear.

Consistency rating: 5

The text is consistently laid out in a logical manner which helps to unpack content which may be new or unfamiliar to the reader/student.

Modularity rating: 5

The amount of content allocated to each chapter is appropriate and will be easy to assign readings. The chapter headings are clear and the embedded videos, charts and test questions enlighten each subunit. The hyperlinking in the table of contents helps to navigate the chapters well.

Organization/Structure/Flow rating: 5

The organization of the content is logical and easy to understand the process of completing a literature review. The book is laid out much like a road map where students can see the big picture as well as the supporting parts to the process. The references by chapter are very useful.

Interface rating: 5

The graphics were clear, and the non-serif font aids in eye fatigue. One recommendation is to lower the brightness of the bold blue text in the table of contents to reduce eye fatigue. There was no problem to play the videos and the audio was clear. All links worked well.

Grammatical Errors rating: 5

There were no grammatical errors. There were a few typos such as 1.3.1.8 needs a space between "A specific", 2.3 in the phrase "Articles by the type of periodical in which an article it is published" perhaps remove the word "it", in the table on page 41. under Nursing , the word clinical is spelled "Cclinical", remove the capital C.

Cultural Relevance rating: 5

No evidence of cultural bias or insensitivity.

I am very excited to use this textbook in my doctoral level occupational therapy class. The inclusion of concise explanations of PICO and SPICE will be very useful. This will be a wonderful resource for graduate students and being mindful of costs for textbooks is compassionate.

Reviewed by Susan Bassett, Instructor, Nursing Graduate Program, Eastern New Mexico University on 11/9/21

Each chapter presented a different aspect of doing a literature review. This was organized and orderly. The index/table of contents was very detailed which allowed the reader to easily use this book as a reference while conducting a literature... read more

Each chapter presented a different aspect of doing a literature review. This was organized and orderly. The index/table of contents was very detailed which allowed the reader to easily use this book as a reference while conducting a literature review.

The content appeared to be entirely accurate. It did a good job of combining information for both education and nursing students. The authors addressed pertinent points of research study development as well as the specific methodology of approaching a research-focused literature review.

The text was up-to-date in methodology, which should not change frequently. The many links to websites were very helpful and yet were basic enough that they should be relevant for years. If they do need updating, the are clearly presented and should be easily updated. The breakdown to very small "chunks" of information per section will help in easily updating specific parts of information.

The book presented a rather complex topic in an extremely straight-forward, easy to read, clear manner. Each small "chunk" of information was identified per section numbering which correlated with movement through the content. The writing was professional and yet not overwhelmed with discipline-specific terminology. Where potentially new terminology was presented, it was immediately followed with definitions and examples.

The book was well-organized and moved along the structure set out early in the book. Content was gradually unfolded, as divided per chapter. There was a bit of repetition (probably about three examples) where the authors attempted to tie information together. Although this stood out to a reader, it seemed more useful in organizing than detrimental in repetition.

The book was subdivided into chapters and then into many small modules of discrete information. It could easily be assigned in part. It could also readily be used as a reference for students to go back and easily find processes or pieces of information they might need later.

I found the continual clear and succinct organization of information to be a defining highlight of this book. When presenting early steps of the research process and then linking these steps with how to conduct a literature review and subsequenty organize and write a literature review, this book is presenting numerous procews steps that must work in tandem. This book did that in a clear and easily readable fashion.

The one feature that did distract me was within the bullet points of 1.3.1. "Types of Reviews". There was a mix of complete and incomplete sentences that worked to convey information succinctly, but distracted me as a reader.

Grammatical Errors rating: 4

I did find several spelling and grammaticl errors (1.3.1.8, , 1.3.1.9, 2.1.1, 2.3, 2.3.1.1, , 2.3.1.4, 2.3 Table A., p. 41, p. 53, p. 54). Although small errors (a few letters or spacing) they should be corrected.

I did not find any mistakes in cultural appropriateness The content did repeatedly talk about bias reduction in the process of writing a literature review

I thought this book was very well-written and contained great information for my students. The links provided were very appropriate and helpful. The Table "Guide to searching for literature at various stages of the scholarly communication process” was particularly helpful. I will immediately begin using portions of the content in this book to support my research class. Additionally, I will recommend the entire book as a reference for the dedicated student (or one intending to go forward to a doctoral level of education in nursing). Thank you for collating all this information and helpful links into one clear, easily readable and understandable document.

Reviewed by Leah Nillas, Associate Professor, Illinois Wesleyan University on 9/6/21

This book addresses the basic steps in the process of writing a literature review research. Chapter 2 (What is a Literature Review?) needs to be retitled. I think Chapter 1 (Introduction) clearly defines and characterizes literature review as a... read more

Comprehensiveness rating: 4 see less

This book addresses the basic steps in the process of writing a literature review research. Chapter 2 (What is a Literature Review?) needs to be retitled. I think Chapter 1 (Introduction) clearly defines and characterizes literature review as a research category. Chapter 2 focuses more on the creation of information, information cycle, and selecting appropriate sources. Chapter 7 (Synthesizing Sources) and Chapter 8 (Writing the Lit Review) can still be improved to incorporate specific strategies in synthesizing research literature and examples of writing styles through analysis of a variety of published examples. Writing a synthesis is a challenging skill for most novice researchers.

Information shared is accurate. I did not notice any content error.

Relevance/Longevity rating: 4

Main content is up-to-date. A few citations maybe dated but they are necessary in illustrating different examples of literature reviews. It will be easy to include additional relevant examples of research work that are published recently.

I like how this text is written. Tone is reader friendly and narrative is accessible to novice researchers.

Clearly consistent throughout the chapters.

Clear and purposeful "chunking" of information per chapter.

Readers can easily follow the organization of topics and content.

No obvious interface issues. Appropriate use of multimedia tools.

No grammatical errors.

Text is culturally sensitive. Additional readings, references, or examples can easily be added to incorporate research conducted by diverse authors or literature reviews which focus on diversity and inclusion issues in education and nursing.

This is a good introductory literature review text even for undergraduate education students. Clear discussion of the nature of the research and the writing process. The use of videos and images is helpful in providing multimodal approach in explaining topics or processes. Writing style and tone make the text accessible to novice researchers.

Reviewed by Rebecca Scheckler, Assistant Professor, Radford University on 7/6/20

Two missing topics were inter-library loan and how to avoid plagiarism in writing up the literature review. This second is such an important topic that it deserves its own chapter. read more

Two missing topics were inter-library loan and how to avoid plagiarism in writing up the literature review. This second is such an important topic that it deserves its own chapter.

It is accurate. I found no inaccuracies.

This book is very relevant. Every advanced undergraduate or graduate students requires such a book

I found the book clear. The videos interspersed within the book added much to the clarity. There are lots of good diagrams that add to the clarity. They are not all original but their sources are all cited. The section on boolean searches, usage of asterisks and quotes in searches is very helpful and appropriate although often left out of discussion of searches.

The book is consistent in terminology and framework.

The chapters were cohesive.

Organization/Structure/Flow rating: 4

I like the links to within the text to the references and other matter. What is needed are back links to the text from the references. I also would have liked links from the exercises to the answers of the exercises.

Interface rating: 4

See navigation links mentioned above. The grey literature link is broken.

I saw no grammatical problems. There are many bulleted lists rather than text which is appropriate to this topic.

There could be more attention to cultural context in the frequent examples.

I wondered why nursing and education were combined. They are similar in nature but not identical. separation them out into two books might be appropriate.

Reviewed by Lisa Shooman, Associate Professor, Worcester State University on 6/29/20

Overall, this book provides a very comprehensive and thorough roadmap for creating a literature review. The videos assist the reader in crystallizing the information presented in the text. There is an effective index and glossary that provide... read more

Overall, this book provides a very comprehensive and thorough roadmap for creating a literature review. The videos assist the reader in crystallizing the information presented in the text. There is an effective index and glossary that provide helpful navigation to the reader.

The content is detailed, clearly explained, error-free, and unbiased. My students would greatly benefit from the lucid information presented in this text to guide them with developing a literature review. I would be eager to adopt this book for my students.

The content is timely and will not be quickly out-of-date. The quiz questions at the end of each chapter are relevant and will aid students with the consolidation of the material. The online format allows for updating, and the version history at the end of the text clearly indicated that the book was updated recently.

The text is clear and not ridden with any excess jargon /technical terminology. Pictures, graphics, and videos further elucidate the text. There are helpful questions that stimulate thought and lists that help to organize information.

The internal consistency in the text is excellent. However, Chapter 1.1 and Chapter 2 have the same title and it would benefit the reader to have different titles that would highlight the differences between these two sections. Chapter 1.1 is an overview and Chapter 2 dives into more depth.

The text is efficiently divided into smaller reading sections that are demarcated by numbers. The subsections in each chapter can be assigned at different points in the course. The text is organized logically and systematically that assists the reader with comprehension and provides a roadmap for creating an effective literature review.

The entire text is presented coherently and concisely. The organization of the text takes the reader through the process of creating an effective literature review. It can be used by multiple health professions, although the length of the text is relatively short it includes a considerable depth of the material. Other disciplines that would benefit from using this test in their courses may include occupational therapy, physical therapy, and speech and language pathology students.

The interface of the text is simple and easy to follow. The cover of the text would benefit from photos, color, and graphic design to appeal to the modern digital reader.

No grammatical or spelling errors are noted.

No cultural biases existed in the text in any way. There are no individuals highlighted in the book, and due to the technical nature of the subject matter, the text is inclusive to a variety of races, ethnicities, and backgrounds. No offensive statements are included in this book.

The authors should consider including other health professionals in the title and provide examples that can relate to other health professionals throughout the text. Other health professionals that can benefit from reading this text include occupational therapy, physical therapy, and speech and language pathology students. Literature reviews are relevant for many health professionals in their master's and doctorate programs and the text could serve a wider audience.

Reviewed by Ellen Rearick, Assistant Professor, Framingham State University on 6/1/20

This text covers all areas and the process of the integrative review appropriately. It is an engaging text for graduate students new to these assignments. read more

This text covers all areas and the process of the integrative review appropriately. It is an engaging text for graduate students new to these assignments.

This text is well done, very accurate

This text is relevant. The updates needed regarding APA format should be relatively easy to implement.

This text is clear and provides users with definitions and examples of the variety of reviews.

Very well written using consistent terminology throughout.

The text's reading sections are easily accessible and users will find them organized. Each chapter and its sections are presented in the sequence of the process of an integrative review.

Very clear and logical order.

The navigation of this text was problem-free.

No grammatical errors noted.

No issues with cultural insensitivity noted.

This was a well-organized text using videos to reinforce content that would benefit any education or nursing graduate student new to the integrative review process.

Reviewed by Ruth Stoltzfus, Professor of Nursing; Dir., Grad Programs in Nursing, Goshen College on 6/1/19

This text provides everything a graduate student needs to write a literature review in a concise manner. If you look at the digital pdf, there are many strategies to help the reader learn the process - videos, diagrams, and also text. read more

This text provides everything a graduate student needs to write a literature review in a concise manner. If you look at the digital pdf, there are many strategies to help the reader learn the process - videos, diagrams, and also text.

I found no evidence of bias and no errors.

This book has long-term relevance. The content will not quickly out-date.

I really liked the way the textbook is structured. The author is concise which makes the textbook easy to read.

I found no inconsistencies in terminology or other aspects related to the content.

I will adopt this text for a research course I use and will likely assign only specific chapters. I plan to recommend the textbook to another faculty who teaches a comprehensive research course with the idea of assigning only specific sections to read..

The textbook begins with an introduction to the subject matter. Subsequent chapters develop specific aspects related to lit reviews. The textbook provides a nice "how to" for each element of a lit review. Chapters are also organized in a smooth, easy to follow format.

I only looked at the digital pdf and print pdf versions. The print pdf indicates that there are videos to watch, but of course since it is a print pdf, there is no linkage. I think this would be obvious to a savvy reader - that a print pdf will be limited in what the reader can access.

I found no grammatical errors in my quick read.

I found no evidence of cultural bias or insensitivity.

This is the first open textbook that I have encountered. I was expecting it to be flat and boring! However, it was neither of those. There were color diagrams, color photos, and even videos embedded in the textbook.

I have adopted this book for the Research Lit Review course that I am teaching soon. I am impressed!

Reviewed by Melissa Wells, Assistant Professor, University of Mary Washington on 5/1/19

This book helps students in education and nursing complete a literature review, which may be the first time these students are tackling such a task. The chapters break down the process into defining the special genre of a literature review;... read more

This book helps students in education and nursing complete a literature review, which may be the first time these students are tackling such a task. The chapters break down the process into defining the special genre of a literature review; providing tips to get started; suggesting where students can find literature to review; explaining how to evaluate sources; detailing the process of documenting sources; giving advice for synthesizing sources; and finally, putting all of these pieces together into a final literature review. Most significantly, the text provides specific examples of ideas presented in the context of both nursing and education, which makes the content directly relatable to the student's course of study. The conclusion recaps the main points of each chapter in bullet form. The text is lacking both an index and a glossary, which would be additions that could strengthen the text.

Content Accuracy rating: 4

The text explains 11 different types of literature reviews that students may encounter or be asked to create. Also, the text is framed to work with multiple methodologies; for example, steps for writing a research question or a hypothesis to frame the literature review are provided. One inconsistency I noted was in diagram 6.2: the APA citation is incorrectly capitalized for the journal title (which should use sentence, not title, capitalization).

The text also includes external links to sources, such as a videos, which provide students with multiple modalities in which to digest the information. An example of a literature review for both education and nursing is provided at the end of the book; instead of embedding these in the text, the hyperlinks refer the reader to the external site. This will be easy to change to a new example in the future, but checks will need to be done to ensure that all such external sources remain actively accessible.

Each chapter opens with learning objectives to help frame the content with which the reader is about to engage. Throughout the text, the language is approachable and reader-friendly. For example, when the text explains more factual components (i.e., what makes a literature review or what the basics of an effective literature review include), this information is presented in bullet points with hyperlinks to the original sources.

Each chapter follows a similar construction, which makes it accessible to the reader. For example, chapters end with a "Practice" and "Check Yourself" section to apply new learning and self-check responses (an answer key is provided in an appendix). Examples in these exercises are either related to nursing or education, continuing with the stated theme of the text.

When I used this text with my own students, I assigned chapters in isolation, since they had already taken a research methods course and were applying that knowledge to create a research proposal in a specific area of study in my course.

The book is organized in such a way that logically walks the reader through the literature review writing process. Clear headings (which are hyperlinked in the table of contents) also allow the reader to jump to specific parts with which they need additional support.

The interface of this document offered a lot of flexibility. Options allowed users to access the text online, or as a download in multiple file types (EPUB, Digital PDF, MOBI, XHTML, Pressbooks XML, Wordpress XML, and Open Document). These formats provide the reader with an opportunity to pick the interface that works best for them.

I did not see any grammatical errors in the text.

Cultural Relevance rating: 4

No culturally insensitive/offensive content was noted. A variety of examples of research topics were included from both nursing and education. Of the images/video thumbnails embedded in the text that involved people, all depicted White people except for 2 images; therefore, more intentional selection of culturally diverse visuals would be helpful in future versions of this text.

I feel this text was helpful to my students as they wrote their own literature reviews. The only weakness in their papers that I noted was their organization of their literature review based on themes/topic, which was addressed in Chapters 7- 8. I now know to focus more on this part of literature review writing with future students. This text is approachable and field-specific, and I will be using it again!

Reviewed by Bernita (Bernie) Missal, Professor, Bethel University on 12/14/18

This book includes all areas that a graduate student needs to begin a literature review. However metasynthesis could have also been included in types of literature review. read more

This book includes all areas that a graduate student needs to begin a literature review. However metasynthesis could have also been included in types of literature review.

This book is accurate although missing qualitative research.

Although content is up to date, some of the article examples need to be updated. (Example: articles published in 1981 and 1992 need to be updated to more recent articles.)

The book is clear and easy to follow. Bullet points were used throughout the book with short paragraphs which helps the student.

Each chapter follows the same format with narrative followed by practice and test questions.

Clear subheadings are used throughout the book.

This book is presented in a logical way and easy for the student to follow.

Images are clear and appropriate for the content.

No specific grammar issues were seen.

It would be helpful for students to include additional examples of cultural studies throughout the book

This book is an excellent resource for graduate students. It has helpful information for the preparation and process for a literature review. Examples of written literature reviews in chapter 8 or in an appendix would be helpful for students.

Reviewed by Nancyruth Leibold, Associate Professor, Southwest Minnesota State University on 6/19/18

The text is overall comprehensive, yet it breaks the information up into manageable parts. See the table of contents for an overview of the topics. The text is very quantitative driven in that the focus is on reviewing quantitative studies. The... read more

The text is overall comprehensive, yet it breaks the information up into manageable parts. See the table of contents for an overview of the topics. The text is very quantitative driven in that the focus is on reviewing quantitative studies. The book included information about PICO statements, but did not include PICO(T) or the time variable, which is not always used in every case. Population was included in the PICO explanation, but a bit more information on the population or aggregate narrowing could improve the PICO section. These items do not hinder use of the book, but these items would need further inclusion by the faculty member using the text as specific to the discipline.

The content in the book is very accurate.

The content in the book is current and should not be obsolete within a short period of time. Any updates would be easy to add.

The text is clear and easy to understand.

The internal organization and terminology of the book is consistent and logical

The text is set up in small reading sessions. The videos and learning activities are well done and break up some of the content, so there is a variety of presentation. The tutorials, figures, practice and self-test areas are also fantastic in that they are quality and sprinkled throughout the text.

The topics in the book are presented in clear and organized fashion. I particularly like the upbeat and personal writing tone of the book. This tone makes it seem like the authors are speaking to me.

The text is free of any significant interface issues. The book is available in many formats. I used the book online and I did have one navigational problem and that is when clicking on a video, it does not open in a new tab and so the book is lost and have to start over going in the start to the book. One easy solution to this is to right click your mouse and then select open in new tab to watch videos. That way, your place in the book is not lost.

No grammar problems present.

The book is not culturally insensitive or offensive in any way.

Overall, this is a well written textbook and I recommend it!

Reviewed by Marjorie Webb, Professor, Metropolitan State University on 6/19/18

From the Introduction to the Conclusion, the text covers the step-by-step process of conducting a literature review. The text includes topics such as, “Where to find the Literature” and “Synthesizing Sources” that will be useful to graduate... read more

From the Introduction to the Conclusion, the text covers the step-by-step process of conducting a literature review. The text includes topics such as, “Where to find the Literature” and “Synthesizing Sources” that will be useful to graduate nursing students.

The content in the text, including texts, links, and diagrams, is accurate and unbiased. Again, it will aid the graduate nursing student in the long process of conducting a literature review.

The text is current and this type of material does not become dated quickly. The authors did use internet links in the text which will need to be monitored periodically to ensure they are still available. Updates to the text will be relatively easy and straightforward. If media styles change, there may be some challenges to updating.

The text is clear and easy to read. Technical terminology is defined and/or explained.

The text is internally consistent.

The text is organized in sections which facilitates assigning readings based on the subject matter for the class time. It would be pretty easy to divide up this text into easily readable units based on headings and subheadings.

This text is structured well. The topics flow in an organized manner and really help the student see the process of a literature review. The authors discuss the both theory and purpose of the review and the day-to-day logistics of actually performing the review. The day-today organization is not always included in other texts.

The interface is well-done with no distractions.

There was no indication of cultural bias.

I think this text is appropriate for graduate nursing students. Some students struggle with the difference between writing about a topic (generally undergraduate writing) and synthesizing literature on a given topic (generally graduate writing). Chapters seven and eight focus on preparing the graduate student to make the jump to graduate-level writing and should really benefit new graduate students.

Reviewed by Susanna Thornhill, Associate Professor , George Fox University on 3/27/18

This book is fairly comprehensive and offers step-by-step instructions for conceptualizing/researching a literature review. The Table of Contents is well-organized to reflect the book's progression, from establishing the basics of why to write a... read more

This book is fairly comprehensive and offers step-by-step instructions for conceptualizing/researching a literature review. The Table of Contents is well-organized to reflect the book's progression, from establishing the basics of why to write a literature review and the various types of literature reviews, to getting started with formulating a research idea/question, finding and evaluating sources, synthesizing sources, and guidelines on writing the literature review, itself. I found this text to be a straightforward guide for my graduate students in education, and while I worried at first that the merging of education and nursing topics would prove distracting to my education students, I don't believe this was the case.

One thing that was not comprehensive in this book was discussion of qualitative research and methodologies as a valid means of conceptualizing research aims. I hoped for a more balanced discussion between methodological branches as it applied to literature reviews; this book overly favored quantitative methodologies and studies in terms of its direction to readers about how to conceptualize/choose a topic and design a research question in relation to it. Variables that cannot be measured are not inherently un-researchable, which is the conclusion put forth in this textbook. This might serve nursing students better than education students in terms of their discipline's requirements, but it still represents an element that could be improved.

Finally, while the background on what a literature review is, how to conceptualize research, and how to search for and synthesize research was all valuable, the chapter on actually writing the literature review was a bit thin, simply offering tips for introduction, body, and conclusion and some questions for self-evaluation. Some of the most difficult work for students writing a literature review is achieving proper focus, organization, hierarchy of themes, balance in treatment of related topics, etc. None of these issues were discussed in the chapter pertaining to the writing of a literature review.

I did not have any concerns about the book's accuracy. Content was accurate, albeit biased to quantitative and positivist views of research. I would have liked to see it include additional prompts to support students in conceptualizing and valuing qualitative research; this is an area where I had to supplement course readings with additional texts.

The only significant error I could discern in the text was a lack of an Answer Key corresponding to the questions posed at the end of each chapter.

Content is up-to-date and seems like it will hold meaning well over the next few years. The only things I anticipate might go out-of-date is technological information on things like citation managers, search guidelines, and database information. This is easily updatable with future versions of the text. In my view, ERIC is not the best database for educational research and I have confirmed this with educational librarians who support my students, yet it is the only one identified in this text as the best subject-specific source of educational research; this could be revised for additional relevance.

I noticed no issues with the book's clarity. The authors write in a clear and straightforward style, making the text easy to read. Overall, they did well writing for students across two disciplines by avoiding nursing or education-specific terms that would have been problematic to readers in the other discipline.

The book is internally consistent and did not have issues with terminology or framework.

No issues with the book's modularity. Chapter headings and sub-headings were appropriately paced and spaced. I assigned this textbook to my graduate students as a whole text that I wanted them to read at the beginning of a course, but it has been easy to refer them back to particular topics as the course has continued.

In future iterations of the book, I suggest hyperlinking the Answer Key to the exercises at the end of each chapter and/or listing the Answer Key in the Table of Contents for easy referral.

I found the book's organization to be straightforward and sensible. The Table of Contents offers a helpful snapshot of the scope of the book and the authors write in a direct and clear style, which contributes to an appropriate flow for the text.

I did not note any navigation problems with any links. All charts/images loaded well in my iBook app. The authors did a nice job of pulling relevant content and links in to support their ideas; it provided an easy way to seek more information if I wanted it, without feeling like the text was loaded down with unnecessary information.

I only found a few small typos in the text, with no grammar issues. The book is obviously written by two very detail-oriented librarians. I appreciated the clarity of the text and lack of errors.

The text was not culturally insensitive; a variety of topics across nursing and education were discussed as examples, which yielded a fairly balanced text regarding cultural considerations.

Reviewed by Alicia Rossiter, Assistant Professor, University of South Florida on 3/27/18

I believe the book gives a comprehensive overview on how to complete a literature view at the graduate level. It begins with an overview of the purpose of a literature review and moves through the steps to completing the review process. read more

I believe the book gives a comprehensive overview on how to complete a literature view at the graduate level. It begins with an overview of the purpose of a literature review and moves through the steps to completing the review process.

I believe the book was accurate and unbiased. It was easy to read but comprehensive.

Content within the text is relevant and supports the literature view process. It did discuss the various databases for searches which may need updating to include new sites, search engines but otherwise relevant and useful information.

The text is easy to read, provides appropriate examples, includes a section on putting the process into practice as well as a "test yourself" section to ensure the content is understood.

The text is consistent throughout in regards to terminology, framework, and set up.

The text is easy to read and content is leveled for the reader but not over simplified. Content is chunked into sections making it easy for the reader to digest the content. The chapters are well laid out and flow from chapter to chapter. Each chapter contains learning objectives, content sections, practice section, and test yourself section. Well organized and great visuals.

Topics are presented in a logical, clear fashion that flow from chapter to chapter and build as the reader moves through the process.

The text is free of interface issues. I could not get the videos to play but other visuals were appropriate and useful to support content.

The text contains no grammatical errors.

The text is not culturally offensive. There was no evidence of bias or cultural insensitivity.

I think this would be a great resource for graduate student learning to navigate the literature review process. It is easy to read, straightforward, and guides the individual through the process from start to finish. I will recommend this text to my graduate students in evidence-based practice and research courses as a recommended reference.

Table of Contents

  • Chapter 1: Introduction
  • Chapter 2: What is a Literature Review?
  • Chapter 3: How to Get Started
  • Chapter 4: Where to Find the Literature
  • Chapter 5: Evaluating Sources
  • Chapter 6: Documenting Sources
  • Chapter 7: Synthesizing Sources
  • Chapter 8: Writing the Literature Review

Ancillary Material

About the book.

Literature Reviews for Education and Nursing Graduate Students is an open textbook designed for students in graduate-level nursing and education programs. Its intent is to recognize the significant role the literature review plays in the research process and to prepare students for the work that goes into writing one. Developed for new graduate students and novice researchers just entering into the work of a chosen discipline, each of the eight chapters covers a component of the literature review process. Students will learn how to form a research question, search existing literature, synthesize results and write the review. The book contains examples, checklists, supplementary materials, and additional resources. Literature Reviews for Education and Nursing Graduate Students is written by two librarians with expertise guiding students through research and writing assignments, and is openly licensed.

About the Contributors

Linda Frederiksen is the Head of Access Services at Washington State University Vancouver.  She has a Master of Library Science degree from Emporia State University in Kansas. Linda is active in local, regional and national organizations, projects and initiatives advancing open educational resources and equitable access to information.

Sue F. Phelps is the Health Sciences and Outreach Services Librarian at Washington State University Vancouver. Her research interests include information literacy, accessibility of learning materials for students who use adaptive technology, diversity and equity in higher education, and evidence based practice in the health sciences

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Nursing: Literature Review

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Good Place to Start: Citation Databases

Interdisciplinary Citation Databases:

A good place to start your research  is to search a research citation database to view the scope of literature available on your topic.

TIP #1: SEED ARTICLE Begin your research with a "seed article" - an article that strongly supports your research topic.  Then use a citation database to follow the studies published by finding articles which have cited that article, either because they support it or because they disagree with it.

TIP #2: SNOWBALLING Snowballing is the process where researchers will begin with a select number of articles they have identified relevant/strongly supports their topic and then search each articles' references reviewing the studies cited to determine if they are relevant to your research.

BONUS POINTS: This process also helps identify key highly cited authors within a topic to help establish the "experts" in the field.

Begin by constructing a focused research question to help you then convert it into an effective search strategy.

  • Identify keywords or synonyms
  • Type of study/resources
  • Which database(s) to search
  • Asking a Good Question (PICO)
  • PICO - AHRQ
  • PICO - Worksheet
  • What Is a PICOT Question?

Seminal Works: Search Key Indexing/Citation Databases

  • Google Scholar
  • Web of Science

TIP – How to Locate Seminal Works

  • DO NOT: Limit by date range or you might overlook the seminal works
  • DO: Look at highly cited references (Seminal articles are frequently referred to “cited” in the research)
  • DO: Search citation databases like Scopus, Web of Science and Google Scholar

Web Resources

What is a literature review?

A literature review is a comprehensive and up-to-date overview of published information on a subject area. Conducting a literature review demands a careful examination of a body of literature that has been published that helps answer your research question (See PICO). Literature reviewed includes scholarly journals, scholarly books, authoritative databases, primary sources and grey literature.

A literature review attempts to answer the following:

  • What is known about the subject?
  • What is the chronology of knowledge about my subject?
  • Are there any gaps in the literature?
  • Is there a consensus/debate on issues?
  • Create a clear research question/statement
  • Define the scope of the review include limitations (i.e. gender, age, location, nationality...)
  • Search existing literature including classic works on your topic and grey literature
  • Evaluate results and the evidence (Avoid discounting information that contradicts your research)
  • Track and organize references
  • How to conduct an effective literature search.
  • Social Work Literature Review Guidelines (OWL Purdue Online Writing Lab)

What is PICO?

The PICO model can help you formulate a good clinical question. Sometimes it's referred to as PICO-T, containing an optional 5th factor. 

Search Example

literature review example nursing student

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What is a Literature Review?

Key questions for a literature review, examples of literature reviews, useful links, evidence matrix for literature reviews.

  • Annotated Bibliographies

The Scholarly Conversation

A literature review provides an overview of previous research on a topic that critically evaluates, classifies, and compares what has already been published on a particular topic. It allows the author to synthesize and place into context the research and scholarly literature relevant to the topic. It helps map the different approaches to a given question and reveals patterns. It forms the foundation for the author’s subsequent research and justifies the significance of the new investigation.

A literature review can be a short introductory section of a research article or a report or policy paper that focuses on recent research. Or, in the case of dissertations, theses, and review articles, it can be an extensive review of all relevant research.

  • The format is usually a bibliographic essay; sources are briefly cited within the body of the essay, with full bibliographic citations at the end.
  • The introduction should define the topic and set the context for the literature review. It will include the author's perspective or point of view on the topic, how they have defined the scope of the topic (including what's not included), and how the review will be organized. It can point out overall trends, conflicts in methodology or conclusions, and gaps in the research.
  • In the body of the review, the author should organize the research into major topics and subtopics. These groupings may be by subject, (e.g., globalization of clothing manufacturing), type of research (e.g., case studies), methodology (e.g., qualitative), genre, chronology, or other common characteristics. Within these groups, the author can then discuss the merits of each article and analyze and compare the importance of each article to similar ones.
  • The conclusion will summarize the main findings, make clear how this review of the literature supports (or not) the research to follow, and may point the direction for further research.
  • The list of references will include full citations for all of the items mentioned in the literature review.

A literature review should try to answer questions such as

  • Who are the key researchers on this topic?
  • What has been the focus of the research efforts so far and what is the current status?
  • How have certain studies built on prior studies? Where are the connections? Are there new interpretations of the research?
  • Have there been any controversies or debate about the research? Is there consensus? Are there any contradictions?
  • Which areas have been identified as needing further research? Have any pathways been suggested?
  • How will your topic uniquely contribute to this body of knowledge?
  • Which methodologies have researchers used and which appear to be the most productive?
  • What sources of information or data were identified that might be useful to you?
  • How does your particular topic fit into the larger context of what has already been done?
  • How has the research that has already been done help frame your current investigation ?

Example of a literature review at the beginning of an article: Forbes, C. C., Blanchard, C. M., Mummery, W. K., & Courneya, K. S. (2015, March). Prevalence and correlates of strength exercise among breast, prostate, and colorectal cancer survivors . Oncology Nursing Forum, 42(2), 118+. Retrieved from http://go.galegroup.com.sonoma.idm.oclc.org/ps/i.do?p=HRCA&sw=w&u=sonomacsu&v=2.1&it=r&id=GALE%7CA422059606&asid=27e45873fddc413ac1bebbc129f7649c Example of a comprehensive review of the literature: Wilson, J. L. (2016). An exploration of bullying behaviours in nursing: a review of the literature.   British Journal Of Nursing ,  25 (6), 303-306. For additional examples, see:

Galvan, J., Galvan, M., & ProQuest. (2017). Writing literature reviews: A guide for students of the social and behavioral sciences (Seventh ed.). [Electronic book]

Pan, M., & Lopez, M. (2008). Preparing literature reviews: Qualitative and quantitative approaches (3rd ed.). Glendale, CA: Pyrczak Pub. [ Q180.55.E9 P36 2008]

  • Write a Literature Review (UCSC)
  • Literature Reviews (Purdue)
  • Literature Reviews: overview (UNC)
  • Review of Literature (UW-Madison)

The  Evidence Matrix  can help you  organize your research  before writing your lit review.  Use it to  identify patterns  and commonalities in the articles you have found--similar methodologies ?  common  theoretical frameworks ? It helps you make sure that all your major concepts covered. It also helps you see how your research fits into the context  of the overall topic.

  • Evidence Matrix Special thanks to Dr. Cindy Stearns, SSU Sociology Dept, for permission to use this Matrix as an example.
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Doing a Literature Review in Nursing, Health and Social Care

Doing a Literature Review in Nursing, Health and Social Care

  • Michael Coughlan - Trinity College Dublin, Ireland
  • Patricia Cronin - Trinity College Dublin, Ireland
  • Description

A clear and practical guide to completing a literature review in nursing and healthcare studies.

Providing students with straightforward guidance on how to successfully carry out a literature review as part of a research project or dissertation, this book uses examples and activities to demonstrate how to complete each step correctly, from start to finish, and highlights how to avoid common mistakes.

The third edition includes:

  • Expert advice on selecting and researching a topic
  • A chapter outlining the different types of literature review
  • Increased focus on Critical Appraisal Tools and how to use them effectively
  • New real-world examples presenting best practice
  • Instructions on writing up and presenting the final piece of work

Perfect for any nursing or healthcare student new to literature reviews and for anyone who needs a refresher in this important topic.

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

For assistance with your order: Please email us at [email protected] or connect with your SAGE representative.

SAGE 2455 Teller Road Thousand Oaks, CA 91320 www.sagepub.com

Praise for the previous edition:

'This book is an excellent resource for practitioners wishing to develop their knowledge and understanding of reviewing literature and the processes involved. It uses uncomplicated language to signpost the reader effortlessly through key aspects of research processes. Practitioners will find this an invaluable companion for navigating through evidence to identify quality literature applicable to health and social care practice.' 

'Students often struggle with writing an effective literature review and this invaluable guide will help to allay their concerns. Key terms are clearly explained, and the inclusion of learning outcomes is a helpful feature for students and lecturers alike.  The examples are also very helpful, particularly for less confident students.  This is an accessible yet authoritative guide which I can thoroughly recommend.' 

'A must have - this book provides useful information and guidance to students and professionals alike. It guides the reader through various research methods in a theoretical and pragmatic manner.' 

' It's a very readable, concise, and accessible introduction to undertaking a literature review in the field of healthcare. The book’s layout has a logical format which really helped me to think methodically about my research question. An excellent reference for undergraduates who are about to undertake their first literature review.' 

'This book is an essential resource for students. Clearly written and excellently structured, with helpful study tools throughout, it takes the reader step by step through the literature review process in an easy, informative and accessible manner. This text gives students the skills they need to successfully complete their own review.' 

'The updating of the chapters will be exceptionally helpful given the rapid changes in online availability of resources and open-access literature.'  

Excellent text for masters and doctoral level students

An excellent primer to help the level 7 students write their systemised review for the assignment.

This book provides a comprehensive overview of the practical process of literature review in healthcare. It contains all details required to conduct a review by students.

This is an excellent clear and concise book on undertaking literature reviews being particularly good at demystifying jargon. It is timely given the move to student dissertations being primarily literature reviews in the current Covid pandemic. However nearly all the examples are drawn from nursing and health making the text less useful for social care and social work. A little disappointing given the title. SW students are likely to gravitate to texts where their subject is more prominent for a primary text.

Accessible, informative, step to step guide

This is a really helpful, accessible text for students and academic staff alike.

A really good addition to the repertoire of skills and techniques for understanding the essential process of literature reviewing.

Preview this book

For instructors, select a purchasing option, related products.

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Doing a Literature Review in Nursing, Health and Social Care

Doing a Literature Review in Nursing, Health and Social Care

  • Michael Coughlan - Trinity College Dublin, Ireland
  • Patricia Cronin - Trinity College Dublin, Ireland
  • Description

A clear and practical guide to completing a literature review in nursing and healthcare studies.

Providing students with straightforward guidance on how to successfully carry out a literature review as part of a research project or dissertation, this book uses examples and activities to demonstrate how to complete each step correctly, from start to finish, and highlights how to avoid common mistakes.

The third edition includes:

  • Expert advice on selecting and researching a topic
  • A chapter outlining the different types of literature review
  • Increased focus on Critical Appraisal Tools and how to use them effectively
  • New real-world examples presenting best practice
  • Instructions on writing up and presenting the final piece of work

Perfect for any nursing or healthcare student new to literature reviews and for anyone who needs a refresher in this important topic.

Praise for the previous edition:

'This book is an excellent resource for practitioners wishing to develop their knowledge and understanding of reviewing literature and the processes involved. It uses uncomplicated language to signpost the reader effortlessly through key aspects of research processes. Practitioners will find this an invaluable companion for navigating through evidence to identify quality literature applicable to health and social care practice.' 

'Students often struggle with writing an effective literature review and this invaluable guide will help to allay their concerns. Key terms are clearly explained, and the inclusion of learning outcomes is a helpful feature for students and lecturers alike.  The examples are also very helpful, particularly for less confident students.  This is an accessible yet authoritative guide which I can thoroughly recommend.' 

'A must have - this book provides useful information and guidance to students and professionals alike. It guides the reader through various research methods in a theoretical and pragmatic manner.' 

' It's a very readable, concise, and accessible introduction to undertaking a literature review in the field of healthcare. The book’s layout has a logical format which really helped me to think methodically about my research question. An excellent reference for undergraduates who are about to undertake their first literature review.' 

'This book is an essential resource for students. Clearly written and excellently structured, with helpful study tools throughout, it takes the reader step by step through the literature review process in an easy, informative and accessible manner. This text gives students the skills they need to successfully complete their own review.' 

'The updating of the chapters will be exceptionally helpful given the rapid changes in online availability of resources and open-access literature.'  

Excellent text for masters and doctoral level students

An excellent primer to help the level 7 students write their systemised review for the assignment.

This book provides a comprehensive overview of the practical process of literature review in healthcare. It contains all details required to conduct a review by students.

This is an excellent clear and concise book on undertaking literature reviews being particularly good at demystifying jargon. It is timely given the move to student dissertations being primarily literature reviews in the current Covid pandemic. However nearly all the examples are drawn from nursing and health making the text less useful for social care and social work. A little disappointing given the title. SW students are likely to gravitate to texts where their subject is more prominent for a primary text.

Accessible, informative, step to step guide

This is a really helpful, accessible text for students and academic staff alike.

A really good addition to the repertoire of skills and techniques for understanding the essential process of literature reviewing.

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Nursing Literature Reviews

What is a Literature (Lit) Review? 

A Literature Review is Not: 

  • a quick summary of sources
  • a grouping of broad, unrelated sources
  • a compilation of everything that has ever been written on a topic
  • a literature criticism or book review

So, what is it then?

A literature review is an integrated analysis-- not just a summary-- of scholarly writings that are related directly to your research question.  That is, it represents the literature that provides background information on your topic and shows a correspondence between those writings and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

  • Explains the background of research on a topic.
  • Demonstrates why a topic is significant to a subject area.
  • Discovers relationships between research studies/ideas.
  • Identifies major themes, concepts, and researchers on a topic.
  • Identifies critical gaps and points of disagreement.
  • Discusses further research questions that logically come out of the previous studies.

Adapted from:  https://libguides.uwf.edu/c.php?g=215270&p=4439026  by Hillary Fox, University of West Florida,  hfox @uwf.edu.

Creating a Literature Review using the Matrix Method: 

A matrix review allows you to quickly compare and contrast articles in an easy to read format. It can help you to easily spot differences and similarities between journal articles and your nursing research topic. Review matrices are especially helpful for health sciences literature reviews that cover the scope of research over a given amount of time. 

Most literature reviews are set up in this format: 

Chart adapted from the book below: 

Health Sciences Literature Review Made Easy

  • Check out the e-book above for more help in creating a literature review matrix. 

Steps for Conducting a Literature Review

1. Choose Your Topic

  • Review your PICO question and think about your central research question. To review the PICO process, please see Kerry Sewell's LibGuide on this subject. 

2. Decide on the scope of your review

  • How many studies do you need to look at? 
  • How comprehensive should it be? 
  • How many years should it cover? (Dr. Larson usually prefers articles no older than 5 years)

3. Select the databases you want to use to conduct your searches (See the Databases Tab Above!)

4. Conduct your searches and find the literature. (Keep track of your searches)

  • Review the abstracts and conclusions carefully. This will help you decide which articles actually fit the criteria you are looking for. 
  • Write down the keywords you used and where you found them. 
  • Use RefWorks to keep track of your citations. (Email me  - [email protected] -  if you need help!) 

5. Review the Literature (This will probably be the most time consuming part)

  • What was the research question of the study you are reviewing?  What were the authors trying to discover? 
  • Was the research funded by a company or source that could influence the findings? (Such as Colgate® sponsoring a toothpaste study?)
  • What were the research methodologies? Analyze the paper's literature review, the samples and variables used, the results and conclusions. Does the research seem to be complete? Could it have been conducted more soundly? What questions does it raise? 
  • If there are conflicting studies, why do you think that is? 
  • How are the authors of the paper viewed in the field? Has this study been cited by other publications? 

Literature Review Examples

Remember, a lit review provides an intelligent overview of the topic. There may or may not be a method for how studies are collected or interpreted. Lit reviews aren't always labeled specifically as "literature reviews," they may often be embedded with other sections such as an introduction or background. 

  • Mentes, J.C., Salem, N., & Phillips, L.R. (2017). Ethnocultural gerontological nursing. An integrative literature review. Journal of Transcultural Nursing, 28(1), 79-97.  https://journals.sagepub.com/doi/pdf/10.1177/1043659615601483
  • Rosa, D.F., Carvalho, M.V., & Pereira, N.R, et al. (2019). Nursing care for the transgender population: genders from the perspective of professional practice. Revista Brasilerira de Enfermagem, 72 (Suppl 1), 299-306.  http://www.scielo.br/pdf/reben/v72s1/0034-7167-reben-72-s1-0299.pdf
  • Dahlke, S.A., Hunter, K.F., Negrin, K. (2019). Nursing practice with hospitalized older people: Safety and harm. International Journal of Older People Nursing, 14 (1), e1220.  https://onlinelibrary.wiley.com/doi/full/10.1111/opn.12220

Adapted from:  https://libguides.uwf.edu/c.php?g=215270&p=4439026  by Hillary Fox, University of West Florida, [email protected].

Carrie Forbes, MLS

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Congratulations! You applied and were accepted into a graduate-level program at [fill in the blank] university. In your first research methods class, your assignment is to do a comprehensive literature review on a topic of your choice. It sounds easy enough – just find a few articles related to your topic and summarize, right? You probably did this type of annotated bibliography as an undergraduate and are pretty optimistic about doing another one. As the professor and other classmates talk more about the demands and expectations for this literature review, however, you may begin to feel less confident. If it’s any consolation, you are not alone.

Writing a literature review involves a synthesis of a complex range of analytical and rhetorical skills as well as academic writing skills, and an understanding of what is meant by critical analysis and argument.(Turner & Bitchener, 2008).

At the same time, there is often a disconnect between what faculty expect in terms of research and writing skills and what incoming graduate students understand about how to conduct a literature review. At the graduate level, and especially when preparing a thesis or dissertation, the literature review is a high-stakes document that introduces the novice researcher to the scholarly conversation of his/her discipline for the first time. Students are often surprised that the specific research and writing skills needed to do a graduate-level literature review aren’t taught in class, while faculty may assume students already have these skills (Harris, 2011). As a result, “most graduate students receive little or no formal training in how to analyze and synthesize the research literature in their field” (Boote & Beile, 2005, p. 5). It is for these students that we write this book.

Literature Reviews for Education and Nursing Graduate Students introduces you to the components of the stand-alone literature review and prepares you to write one of your own. This open textbook is designed to help students in graduate-level nursing and education programs recognize the significant role the literature review plays in the research process and synthesize and cite key sources with confidence. Although specific examples are generally nursing or education related, most of the content is also applicable to other students in the social sciences. Likewise, this textbook is openly licensed, meaning it is available at no cost to anyone in the world who would like to use it. Instructors (and others) may freely edit or modify it and assign as much or as little as needed.

Literature Reviews for Education and Nursing Graduate Students is written for new graduate students and novice researchers just entering the work of their chosen discipline. It is meant to assist “students who can complete course assignments to scholars who can make a contribution to their respective fields.” (Switzer & Perdue, 2011, p. 12). The book was written by two librarians with expertise guiding nursing and education graduate students through the literature review research and writing process. We include in the book examples from the literature of nursing and education to facilitate a greater understanding of what it means to be a successful graduate student. Our intent is to promote the idea that the literature review is a dynamic and complex synthesis of research and writing that is quite different than an annotated bibliography.

Literature Reviews for Education and Nursing Graduate Students covers topics related to literature review research and writing. Chapter 1 provides an overview of literature reviews and their purpose. Chapters 2 and 3 relate to getting started with the review, including how to develop a research question or hypothesis. Chapters 4 and 5 deal with the research process, that is, where to find relevant sources and how to evaluate their credibility. Chapters 6 and 7 discuss how to document sources and, one of the most difficult tasks novice researchers face, how to synthesize information. Chapter 8 is focused on writing your own literature review. A short conclusion and an answer key to questions asked in previous chapters complete the text. Each chapter begins with a summary of learning objectives for that chapter and concludes with a set of questions to assess your understanding of the topics covered. Examples, tutorials, videos, additional resources, websites and/or activities are provided. Finally, at the end of each chapter you will find a list of works cited as well as image attributions.

Although this textbook does not contain all of the answers you will need to successfully write a literature review, the authors hope that when used in combination with all of the other experiences you will have as a graduate student, it will help you to become the researcher and scholar you want to be.

Boote, D.N., & Beile, P. (2005). Scholars before researchers: On the centrality of the dissertation literature review in research preparation. Educational Researcher 34(6), 3-15.

Harris, C.S. (2011). The case for partnering doctoral students with librarians: A synthesis of the literatures. Library Review 60(7), 599-620.

Switzer, A., & Perdue, A.S. (2011). Dissertation 101: A research and writing intervention for education graduate students. Education Libraries 34(1), 4-14.

Turner, E., & Bitchener, J. (2008). An approach to teaching the writing of literature reviews. Zeitschrift Schreiben. https://zeitschrift-schreiben.eu/globalassets/zeitschrift-schreiben.eu/2008/turner_approach_teaching.pdf

Literature Reviews for Education and Nursing Graduate Students Copyright © by Linda Frederiksen is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Bashir Y, Conlon KC. Step by step guide to do a systematic review and meta-analysis for medical professionals. Ir J Med Sci. 2018; 187:(2)447-452 https://doi.org/10.1007/s11845-017-1663-3

Bettany-Saltikov J. How to do a systematic literature review in nursing: a step-by-step guide.Maidenhead: Open University Press; 2012

Bowers D, House A, Owens D. Getting started in health research.Oxford: Wiley-Blackwell; 2011

Hierarchies of evidence. 2016. http://cjblunt.com/hierarchies-evidence (accessed 23 July 2019)

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2008; 3:(2)37-41 https://doi.org/10.1191/1478088706qp063oa

Developing a framework for critiquing health research. 2005. https://tinyurl.com/y3nulqms (accessed 22 July 2019)

Cognetti G, Grossi L, Lucon A, Solimini R. Information retrieval for the Cochrane systematic reviews: the case of breast cancer surgery. Ann Ist Super Sanita. 2015; 51:(1)34-39 https://doi.org/10.4415/ANN_15_01_07

Dixon-Woods M, Cavers D, Agarwal S Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol. 2006; 6:(1) https://doi.org/10.1186/1471-2288-6-35

Guyatt GH, Sackett DL, Sinclair JC Users' guides to the medical literature IX. A method for grading health care recommendations. JAMA. 1995; 274:(22)1800-1804 https://doi.org/10.1001/jama.1995.03530220066035

Hanley T, Cutts LA. What is a systematic review? Counselling Psychology Review. 2013; 28:(4)3-6

Cochrane handbook for systematic reviews of interventions. Version 5.1.0. 2011. https://handbook-5-1.cochrane.org (accessed 23 July 2019)

Jahan N, Naveed S, Zeshan M, Tahir MA. How to conduct a systematic review: a narrative literature review. Cureus. 2016; 8:(11) https://doi.org/10.7759/cureus.864

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1997; 33:(1)159-174

Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S. PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res. 2014; 14:(1) https://doi.org/10.1186/s12913-014-0579-0

Moher D, Liberati A, Tetzlaff J, Altman DG Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6:(7) https://doi.org/10.1371/journal.pmed.1000097

Mueller J, Jay C, Harper S, Davies A, Vega J, Todd C. Web use for symptom appraisal of physical health conditions: a systematic review. J Med Internet Res. 2017; 19:(6) https://doi.org/10.2196/jmir.6755

Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016; 21:(4)125-127 https://doi.org/10.1136/ebmed-2016-110401

National Institute for Health and Care Excellence. Methods for the development of NICE public health guidance. 2012. http://nice.org.uk/process/pmg4 (accessed 22 July 2019)

Sambunjak D, Franic M. Steps in the undertaking of a systematic review in orthopaedic surgery. Int Orthop. 2012; 36:(3)477-484 https://doi.org/10.1007/s00264-011-1460-y

Siddaway AP, Wood AM, Hedges LV. How to do a systematic review: a best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses. Annu Rev Psychol. 2019; 70:747-770 https://doi.org/0.1146/annurev-psych-010418-102803

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008; 8:(1) https://doi.org/10.1186/1471-2288-8-45

Wallace J, Nwosu B, Clarke M. Barriers to the uptake of evidence from systematic reviews and meta-analyses: a systematic review of decision makers' perceptions. BMJ Open. 2012; 2:(5) https://doi.org/10.1136/bmjopen-2012-001220

Carrying out systematic literature reviews: an introduction

Alan Davies

Lecturer in Health Data Science, School of Health Sciences, University of Manchester, Manchester

View articles · Email Alan

Systematic reviews provide a synthesis of evidence for a specific topic of interest, summarising the results of multiple studies to aid in clinical decisions and resource allocation. They remain among the best forms of evidence, and reduce the bias inherent in other methods. A solid understanding of the systematic review process can be of benefit to nurses that carry out such reviews, and for those who make decisions based on them. An overview of the main steps involved in carrying out a systematic review is presented, including some of the common tools and frameworks utilised in this area. This should provide a good starting point for those that are considering embarking on such work, and to aid readers of such reviews in their understanding of the main review components, in order to appraise the quality of a review that may be used to inform subsequent clinical decision making.

Since their inception in the late 1970s, systematic reviews have gained influence in the health professions ( Hanley and Cutts, 2013 ). Systematic reviews and meta-analyses are considered to be the most credible and authoritative sources of evidence available ( Cognetti et al, 2015 ) and are regarded as the pinnacle of evidence in the various ‘hierarchies of evidence’. Reviews published in the Cochrane Library ( https://www.cochranelibrary.com) are widely considered to be the ‘gold’ standard. Since Guyatt et al (1995) presented a users' guide to medical literature for the Evidence-Based Medicine Working Group, various hierarchies of evidence have been proposed. Figure 1 illustrates an example.

literature review example nursing student

Systematic reviews can be qualitative or quantitative. One of the criticisms levelled at hierarchies such as these is that qualitative research is often positioned towards or even is at the bottom of the pyramid, thus implying that it is of little evidential value. This may be because of traditional issues concerning the quality of some qualitative work, although it is now widely recognised that both quantitative and qualitative research methodologies have a valuable part to play in answering research questions, which is reflected by the National Institute for Health and Care Excellence (NICE) information concerning methods for developing public health guidance. The NICE (2012) guidance highlights how both qualitative and quantitative study designs can be used to answer different research questions. In a revised version of the hierarchy-of-evidence pyramid, the systematic review is considered as the lens through which the evidence is viewed, rather than being at the top of the pyramid ( Murad et al, 2016 ).

Both quantitative and qualitative research methodologies are sometimes combined in a single review. According to the Cochrane review handbook ( Higgins and Green, 2011 ), regardless of type, reviews should contain certain features, including:

  • Clearly stated objectives
  • Predefined eligibility criteria for inclusion or exclusion of studies in the review
  • A reproducible and clearly stated methodology
  • Validity assessment of included studies (eg quality, risk, bias etc).

The main stages of carrying out a systematic review are summarised in Box 1 .

Formulating the research question

Before undertaking a systemic review, a research question should first be formulated ( Bashir and Conlon, 2018 ). There are a number of tools/frameworks ( Table 1 ) to support this process, including the PICO/PICOS, PEO and SPIDER criteria ( Bowers et al, 2011 ). These frameworks are designed to help break down the question into relevant subcomponents and map them to concepts, in order to derive a formalised search criterion ( Methley et al, 2014 ). This stage is essential for finding literature relevant to the question ( Jahan et al, 2016 ).

It is advisable to first check that the review you plan to carry out has not already been undertaken. You can optionally register your review with an international register of prospective reviews called PROSPERO, although this is not essential for publication. This is done to help you and others to locate work and see what reviews have already been carried out in the same area. It also prevents needless duplication and instead encourages building on existing work ( Bashir and Conlon, 2018 ).

A study ( Methley et al, 2014 ) that compared PICO, PICOS and SPIDER in relation to sensitivity and specificity recommended that the PICO tool be used for a comprehensive search and the PICOS tool when time/resources are limited.

The use of the SPIDER tool was not recommended due to the risk of missing relevant papers. It was, however, found to increase specificity.

These tools/frameworks can help those carrying out reviews to structure research questions and define key concepts in order to efficiently identify relevant literature and summarise the main objective of the review ( Jahan et al, 2016 ). A possible research question could be: Is paracetamol of benefit to people who have just had an operation? The following examples highlight how using a framework may help to refine the question:

  • What form of paracetamol? (eg, oral/intravenous/suppository)
  • Is the dosage important?
  • What is the patient population? (eg, children, adults, Europeans)
  • What type of operation? (eg, tonsillectomy, appendectomy)
  • What does benefit mean? (eg, reduce post-operative pyrexia, analgesia).

An example of a more refined research question could be: Is oral paracetamol effective in reducing pain following cardiac surgery for adult patients? A number of concepts for each element will need to be specified. There will also be a number of synonyms for these concepts ( Table 2 ).

Table 2 shows an example of concepts used to define a search strategy using the PICO statement. It is easy to see even with this dummy example that there are many concepts that require mapping and much thought required to capture ‘good’ search criteria. Consideration should be given to the various terms to describe the heart, such as cardiac, cardiothoracic, myocardial, myocardium, etc, and the different names used for drugs, such as the equivalent name used for paracetamol in other countries and regions, as well as the various brand names. Defining good search criteria is an important skill that requires a lot of practice. A high-quality review gives details of the search criteria that enables the reader to understand how the authors came up with the criteria. A specific, well-defined search criterion also aids in the reproducibility of a review.

Search criteria

Before the search for papers and other documents can begin it is important to explicitly define the eligibility criteria to determine whether a source is relevant to the review ( Hanley and Cutts, 2013 ). There are a number of database sources that are searched for medical/health literature including those shown in Table 3 .

The various databases can be searched using common Boolean operators to combine or exclude search terms (ie AND, OR, NOT) ( Figure 2 ).

literature review example nursing student

Although most literature databases use similar operators, it is necessary to view the individual database guides, because there are key differences between some of them. Table 4 details some of the common operators and wildcards used in the databases for searching. When developing a search criteria, it is a good idea to check concepts against synonyms, as well as abbreviations, acronyms and plural and singular variations ( Cognetti et al, 2015 ). Reading some key papers in the area and paying attention to the key words they use and other terms used in the abstract, and looking through the reference lists/bibliographies of papers, can also help to ensure that you incorporate relevant terms. Medical Subject Headings (MeSH) that are used by the National Library of Medicine (NLM) ( https://www.nlm.nih.gov/mesh/meshhome.html) to provide hierarchical biomedical index terms for NLM databases (Medline and PubMed) should also be explored and included in relevant search strategies.

Searching the ‘grey literature’ is also an important factor in reducing publication bias. It is often the case that only studies with positive results and statistical significance are published. This creates a certain bias inherent in the published literature. This bias can, to some degree, be mitigated by the inclusion of results from the so-called grey literature, including unpublished work, abstracts, conference proceedings and PhD theses ( Higgins and Green, 2011 ; Bettany-Saltikov, 2012 ; Cognetti et al, 2015 ). Biases in a systematic review can lead to overestimating or underestimating the results ( Jahan et al, 2016 ).

An example search strategy from a published review looking at web use for the appraisal of physical health conditions can be seen in Box 2 . High-quality reviews usually detail which databases were searched and the number of items retrieved from each.

A balance between high recall and high precision is often required in order to produce the best results. An oversensitive search, or one prone to including too much noise, can mean missing important studies or producing too many search results ( Cognetti et al, 2015 ). Following a search, the exported citations can be added to citation management software (such as Mendeley or Endnote) and duplicates removed.

Title and abstract screening

Initial screening begins with the title and abstracts of articles being read and included or excluded from the review based on their relevance. This is usually carried out by at least two researchers to reduce bias ( Bashir and Conlon, 2018 ). After screening any discrepancies in agreement should be resolved by discussion, or by an additional researcher casting the deciding vote ( Bashir and Conlon, 2018 ). Statistics for inter-rater reliability exist and can be reported, such as percentage of agreement or Cohen's kappa ( Box 3 ) for two reviewers and Fleiss' kappa for more than two reviewers. Agreement can depend on the background and knowledge of the researchers and the clarity of the inclusion and exclusion criteria. This highlights the importance of providing clear, well-defined criteria for inclusion that are easy for other researchers to follow.

Full-text review

Following title and abstract screening, the remaining articles/sources are screened in the same way, but this time the full texts are read in their entirety and included or excluded based on their relevance. Reasons for exclusion are usually recorded and reported. Extraction of the specific details of the studies can begin once the final set of papers is determined.

Data extraction

At this stage, the full-text papers are read and compared against the inclusion criteria of the review. Data extraction sheets are forms that are created to extract specific data about a study (12 Jahan et al, 2016 ) and ensure that data are extracted in a uniform and structured manner. Extraction sheets can differ between quantitative and qualitative reviews. For quantitative reviews they normally include details of the study's population, design, sample size, intervention, comparisons and outcomes ( Bettany-Saltikov, 2012 ; Mueller et al, 2017 ).

Quality appraisal

The quality of the studies used in the review should also be appraised. Caldwell et al (2005) discussed the need for a health research evaluation framework that could be used to evaluate both qualitative and quantitative work. The framework produced uses features common to both research methodologies, as well as those that differ ( Caldwell et al, 2005 ; Dixon-Woods et al, 2006 ). Figure 3 details the research critique framework. Other quality appraisal methods do exist, such as those presented in Box 4 . Quality appraisal can also be used to weight the evidence from studies. For example, more emphasis can be placed on the results of large randomised controlled trials (RCT) than one with a small sample size. The quality of a review can also be used as a factor for exclusion and can be specified in inclusion/exclusion criteria. Quality appraisal is an important step that needs to be undertaken before conclusions about the body of evidence can be made ( Sambunjak and Franic, 2012 ). It is also important to note that there is a difference between the quality of the research carried out in the studies and the quality of how those studies were reported ( Sambunjak and Franic, 2012 ).

literature review example nursing student

The quality appraisal is different for qualitative and quantitative studies. With quantitative studies this usually focuses on their internal and external validity, such as how well the study has been designed and analysed, and the generalisability of its findings. Qualitative work, on the other hand, is often evaluated in terms of trustworthiness and authenticity, as well as how transferable the findings may be ( Bettany-Saltikov, 2012 ; Bashir and Conlon, 2018 ; Siddaway et al, 2019 ).

Reporting a review (the PRISMA statement)

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) provides a reporting structure for systematic reviews/meta-analysis, and consists of a checklist and diagram ( Figure 4 ). The stages of identifying potential papers/sources, screening by title and abstract, determining eligibility and final inclusion are detailed with the number of articles included/excluded at each stage. PRISMA diagrams are often included in systematic reviews to detail the number of papers included at each of the four main stages (identification, screening, eligibility and inclusion) of the review.

literature review example nursing student

Data synthesis

The combined results of the screened studies can be analysed qualitatively by grouping them together under themes and subthemes, often referred to as meta-synthesis or meta-ethnography ( Siddaway et al, 2019 ). Sometimes this is not done and a summary of the literature found is presented instead. When the findings are synthesised, they are usually grouped into themes that were derived by noting commonality among the studies included. Inductive (bottom-up) thematic analysis is frequently used for such purposes and works by identifying themes (essentially repeating patterns) in the data, and can include a set of higher-level and related subthemes (Braun and Clarke, 2012). Thomas and Harden (2008) provide examples of the use of thematic synthesis in systematic reviews, and there is an excellent introduction to thematic analysis by Braun and Clarke (2012).

The results of the review should contain details on the search strategy used (including search terms), the databases searched (and the number of items retrieved), summaries of the studies included and an overall synthesis of the results ( Bettany-Saltikov, 2012 ). Finally, conclusions should be made about the results and the limitations of the studies included ( Jahan et al, 2016 ). Another method for synthesising data in a systematic review is a meta-analysis.

Limitations of systematic reviews

Apart from the many advantages and benefits to carrying out systematic reviews highlighted throughout this article, there remain a number of disadvantages. These include the fact that not all stages of the review process are followed rigorously or even at all in some cases. This can lead to poor quality reviews that are difficult or impossible to replicate. There also exist some barriers to the use of evidence produced by reviews, including ( Wallace et al, 2012 ):

  • Lack of awareness and familiarity with reviews
  • Lack of access
  • Lack of direct usefulness/applicability.

Meta-analysis

When the methods used and the analysis are similar or the same, such as in some RCTs, the results can be synthesised using a statistical approach called meta-analysis and presented using summary visualisations such as forest plots (or blobbograms) ( Figure 5 ). This can be done only if the results can be combined in a meaningful way.

literature review example nursing student

Meta-analysis can be carried out using common statistical and data science software, such as the cross-platform ‘R’ ( https://www.r-project.org), or by using standalone software, such as Review Manager (RevMan) produced by the Cochrane community ( https://tinyurl.com/revman-5), which is currently developing a cross-platform version RevMan Web.

Carrying out a systematic review is a time-consuming process, that on average takes between 6 and 18 months and requires skill from those involved. Ideally, several reviewers will work on a review to reduce bias. Experts such as librarians should be consulted and included where possible in review teams to leverage their expertise.

Systematic reviews should present the state of the art (most recent/up-to-date developments) concerning a specific topic and aim to be systematic and reproducible. Reproducibility is aided by transparent reporting of the various stages of a review using reporting frameworks such as PRISMA for standardisation. A high-quality review should present a summary of a specific topic to a high standard upon which other professionals can base subsequent care decisions that increase the quality of evidence-based clinical practice.

  • Systematic reviews remain one of the most trusted sources of high-quality information from which to make clinical decisions
  • Understanding the components of a review will help practitioners to better assess their quality
  • Many formal frameworks exist to help structure and report reviews, the use of which is recommended for reproducibility
  • Experts such as librarians can be included in the review team to help with the review process and improve its quality

CPD reflective questions

  • Where should high-quality qualitative research sit regarding the hierarchies of evidence?
  • What background and expertise should those conducting a systematic review have, and who should ideally be included in the team?
  • Consider to what extent inter-rater agreement is important in the screening process

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How to Search

Need more articles, but can't seem to find the right ones? Try these techniques!

Backwards searching: Once you find a relevant article, check the reference list at the end of the article. This will help you find other pertinent articles. 

Forward searching : Once you find a relevant article, look at whether it has been cited in more-recent research. If a researcher cited it, it is likely that their paper will also relate to your topic. ResearchGate is a community for students and researchers. It lists where each of their publications have been cited, if at all. This can be found under the "citations" tab that pops up when you click on any publication. 

When stuck, ask yourself, "What else is related to my topic?"

Get creative! You might find useful literature that you did not initially anticipate.

Fonseca, M. (2013, November 4) 5 tips to write a great literature review. https://www.editage.com/insights/5-tips-to-write-a-great-literature-review?refer=scroll-to-1-article&refer-type=article

What is a Literature Review?

"A literature review is a critical summary of all the published works on a particular topic" (Fonseca, 2013). A literature review provides background for your paper by quickly bringing the reader up-to-date on relevant findings, controversies, and dilemmas. It is the author's chance to "set the scene" and demonstrate why their topic is of interest to academia. In your literature review, you will describe "where your project comes from and how it fits in with existing knowledge" (Lloyd, 2017-2018). Further, you will provide "an argument for why your project makes a valuable contribution" (Lloyd, 2017-2018).

References: 

Lloyd, C.(2017-2018). Literature reviews for sociology senior theses . [PowerPoint Slides]. https://socthesis.fas.harvard.edu/files/socseniorthesis/files/pres-litreview.pdf

Step One: Define Your Research Question

What are you trying to determine for your literature review? What specifically do you want to learn more about? Choose a topic that you are genuinely interested in. Next, conduct a broad search on it. Determine what trending and popular research is available, then narrow your topic down. You can refine it by one or more of the following:

  • Geographic location
  • Time period
  • Discipline/field of study, etc.

Research terms will help define your question.

  • A broad question might be something like: What is the homeless population like?
  • A narrow and specific question may include: What social and political factors have affected the growth of the middle-aged homeless population in Toronto within the past five years?

Once you have determined an appropriate research question/topic, move on to planning your approach.

Dermody, K., Literature Reviews. (2020, January 23). Retrieved from https://learn.library.ryerson.ca/literaturereview.

Step Two: Plan Your Approach 

After you have landed a research question, ask yourself "Which specific terms will I use, and where am I going to begin?" Determine what kind of literature you want to look at, whether it be journal articles, books, electronic resources, newspapers, or even other literature reviews on similar topics.

Boolean Search Terms Image

Your keywords are the main concepts or ideas of your paper.  For example, the keywords for a paper on “youth employment in Canada” would be:

Use synonyms: Often there are multiple ways to express the same concept. Make sure to use synonyms in your research. For instance, "employment" can be researched as:

Lastly, use “ AND ” and “ OR .” By bridging your truncated keywords and synonyms with the capitalized search words “AND” and “OR” (known as Boolean operators), you can search for multiple concepts effectively. For more information, visit the "electronic resources" tab of this research guide. There is a box on Boolean operators. 

Step Four: Analyze Material

When searching for material, it is important to analyze your sources for credibility, accuracy, currency, and authenticity. Ask these questions when analyzing a source:

  • What is the purpose of the work?
  • How current is it?
  • Who is the author? 
  • What are the author's biases?
  • Is this work peer reviewed? 
  • How accurate is this information? What facts/empirical evidence support it?
  • What time frame are you looking at for your literature review, and does the work fall within that range?

Step Five: Manage Your Results 

After analyzing your research and determining what sources you want to use, it's important to keep track of what you have looked through. Keep a list of the following:

  • What searches you have completed.
  • Which ones were successful and unsuccessful.
  • What databases you used.
  • What sources you want to use for your literature review.
  • What else you may want to search for next.

You can do this using software such as Zotero , Mendeley , and EndNote .

Congratulations! You are making progress towards an exceptional literature review.

Literature Review vs. Annotated Bibliography  Both a literature review (A.K.A. literature synthesis) and an annotated bibliography summarize the existing body of knowledge on a given topic.

What is the difference between a literature review and an annotated bibliography?  Unlike literature reviews, annotated bibliographies summarize entire research articles. An annotated bibliography looks like this:

Annotated Bibliography

•    Summarizes each article separately.

o    First, students discuss article one, then two, etc.  o    Topic: Blood Donation

  • Paragraph 1: Bonnie and Clyde (2019) wrote "this" on blood donation.
  • Paragraph 2: Rose and Jack (1997) wrote "this" on blood donation.
  • Paragraph 3: Mary-Kate and Ashley (2001) wrote "this" on blood donation.
  • Result: Multiple summaries of individual research articles (Lloyd, 2017-2018).

•    Describes the existing body of knowledge by integrating and synthesizing the literature to create something new.

o     Topic: Blood Donation

  • Paragraph 1: Information/research findings on red blood cells pulled from multiple sources.
  • Paragraph 2: Information/research findings on platelets pulled from multiple sources.
  • Paragraph 3: Information/research findings on white blood cells pulled from multiple sources.
  • Paragraph 4: Information/research findings on the drawbacks of donating blood from multiple sources (Lloyd, 2017-2018).
  • Result: The author points out "themes, concepts, gaps and disagreements" between articles (Hofer, Hanick & Townsend, 2019, p. 216). Students use these to describe the existing body of knowledge on their topic one concept at a time. 

References:

Hofer, A. R., Hanick S. L., & Townsend, L. (2019). Designing activities for conceptual teaching. Transforming information literacy instruction: Threshold concepts in theory and practice. (p. 209-224). Libraries Unlimited.

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What type of review, how to conduct a review, find articles, evaluating articles, full text access tool.

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Researchers, academics and librarians all use various terms to describe different types of literature reviews. Indeed there is often inconsistency between the ways the types are discussed. Here are a couple of simple explanations.

The image below describes common review types in terms of speed, detail, risk of bias and comprehensiveness:

Comparison table of types of reviews

"Schematic of the main differences between the types of literature review" by Brennan, M. L., Arlt, S. P., Belshaw, Z., Buckley, L., Corah, L., Doit, H., Fajt, V. R., Grindlay, D., Moberly, H. K., Morrow, L. D., Stavisky, J., & White, C. (2020). Critically Appraised Topics (CATs) in veterinary medicine: Applying evidence in clinical practice. Frontiers in Veterinary Science, 7 , 314. https://doi.org/10.3389/fvets.2020.00314 is licensed under CC BY 3.0

The table below has been adapted from a widely used typology of fourteen types of reviews, (Grant & Booth, 2009).  Here are four of the most common types:

For a more detailed list of review types, see:

Grant, M.J. & Booth, A. (2009).  A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26 (2), 91-108.  DOI: 10.1111/j.1471-1842.2009.00848.x

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) outlines standards of practice completing a systematic review to ensure consistency and high-quality results.

  • PRISMA 2020 Explanations
  • PRISMA 2020 Checklist
  • PRISMA 2020 Flow Diagram
  • PRISMA Flow Diagram Generator
  • PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews

Techniques from the PRISMA process can also be used with other types of reviews to have a systematic process for searching and evaluating results.

Access provided by JMU

  • Article Evaluation Handout Key questions to evaluate each section of original research studies (RCTs, cohort studies, etc)

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LibKey Nomad is a browser extension that connects you with articles that are library-licensed or open access. LibKey Nomad is available for Google Chrome, Firefox, Safari, Microsoft Edge, Brave, and Vivaldi.

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When using LibKey Nomad, you will automatically be directed to the best available version of an article so you don't need to search in multiple places. When the full text of an article is not available, you will be provided with options to request the article through  Interlibrary Loan (ILL).

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100+ Current Nursing literature review topics + Examples to Write About

Nursing literature review is an important part of the nursing profession. It allows nurses to learn from the best studies and research on a particular topic. In this article, we will provide you with 100 good nursing literature review topics that you can use to help you write your nursing literature review.

Current Nursing literature review topics to Write About – topics for literature review in nursing

Nursing literature review is an essential component of any nursing program. Nurses need to have a comprehensive understanding of the latest nursing research in order to provide optimal care for their patients .

Here are current nursing literature review topics that you can explore:

  • The Role of Nursing Research in Clinical Practice
  • Enhancing Patient Outcomes through Nursing Research
  • Applications of evidence-based Practice in Nursing
  • The Relationship between Nursing Theory and Practice
  • Issues in Implementation and Translation of Research Evidence into Clinical Practice
  • Cultural Competence in Nursing: Perspectives from the Global South
  • Nursing Perspective on Genetics and Genetics in Nursing
  • Advances in Geriatric Nursing: From Theory to Practice
  • Transforming Pediatric Nursing Care through EvidenceBased Practice
  • Health Technology Assessment: A Critical Appraisal from a Nursing Perspective
  • Promoting Collaborative Care through Effective Communication Practices within the Health System
  • Nurses, Technology, and Innovation: Implications for Quality Improvement and Patient Safety
  • Nursing Ethics: A Multidisciplinary Perspective
  • Nursing in an Era of Health Care Reform
  • The Role of Nursing Research in Evaluating Nursing Practice
  • Nursing Research and Quality Improvement: Strategies for conducting systematic reviews
  • Collaborative Care in Nursing: Theory, Research, and Practice
  • The Impact of Nursing on Patient Safety
  • The Role of Nursing Ethics in Patient Safety
  • Nursing Informatics: A Critical Appraisal
  • What Nurses Should Know About the National Minimum Data Set (NMDS)
  • Assessing Electronic Health Records: Challenges and Opportunities
  • Nursing in the Era of the Affordable Care Act
  • The Influence of Nursing on Patient Outcomes
  • The Effects of Culture on Nursing Practice
  • Nursing in a Time of Economic Turmoil
  • Challenges Facing Nursing Education in the Context of Healthcare Reform
  • The Use of Technology by Nurses in the Delivery of Nursing Care
  • Creating an Effective Learning Environment for Nursing Students

Here’s How to write a Strong Literature Review for Nursing | Guide, Outlines & Examples

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20 Mental health nursing literature review topics

  • Introduction to mental health nursing literature review: This literature review will introduce the reader to the field of mental health nursing and provide an overview of 20 different mental health nursing literature review topics.
  • Psychiatric assessment: This literature review will focus on the psychiatric assessment process, including topics such as history taking and diagnostic procedures.
  • Assessing for suicide risk: This literature review will discuss methods for assessing for suicide risk in patients, including coding criteria and risk assessment tools.
  • Cultural competency in mental health nursing: This literature review will explore ways to be culturally competent when providing care to patients with mental illness, such as understanding cultural norms and beliefs.
  • Therapeutic interventions for depression: This literature review will focus on therapeutic interventions for treating depression, such as pharmacological and psychological treatments.
  • Psychotherapy for anxiety disorders: This literature review will discuss psychotherapy options for treating anxiety disorders, including cognitive-behavioral therapy and group therapies.
  • Psychosocial rehabilitation interventions for addiction: This literature review will focus on psychosocial rehabilitation interventions designed to help patients recovering from addiction. Topics covered include relapse prevention and counseling techniques.
  • Care of childrenand adolescents with mental health issues: This literature review will discuss the care of children and adolescents with mental health issues, including pediatric mental health disorders and psychosocial interventions for children and adolescents.
  • Care of older adults with mental illness: This literature review will focus on the care of older adults with mental illness, including interventions for dementia-related psychosis and falls prevention.
  • Complementary and alternative medicine in mental health nursing: This literature review will explore complementary and alternative medicine (CAM) therapies used to treat mental illness, such as acupuncture and meditation.
  • Ethics in mental health nursing: This literature review will discuss ethical considerations in providing care to patients with mental illness, such as cross-cultural competency and ensuring patient safety.
  • Mental health literacy: This literature review will focus on how to improve mental health literacy among nurses, including teaching strategies and clinical applications.
  • Research methods in mental health nursing: This literature review will discuss research methods used in the study of mental health Nursing, including qualitative methods and quantitative methods.
  • The role of nursing research in advancing mental health nursing: This literature review will discuss the role of nursing research in advancing the field of mentalhealth nursing, including the importance of randomized controlled trials.
  • The role of advocacy in mental health nursing: This literature review will discuss the role of advocacy in mental health nursing, including advocacy for better access to mental health care and insurance coverage for mental health services.
  • Patient safety in mental health nursing: This literature review will discuss patient safety issues in mental health nursing , including safe practices for handling psychiatric medications and preventing falls in elderly patients with dementia.
  • The role of social work in mental health nursing: This literature review will discuss the role of social work in mental health nursing, including providing support to patients and their families.
  • Geriatric psychiatry: This literature review will focus on the impact of aging on the brain and psychiatric disorders, including geriatric bipolar disorder and dementia-related psychosis.
  • Rehabilitation interventions for people with mental illness: This literature review will focus on rehabilitation interventions designed to help people with mental illness recover from their illnesses. Topics covered include cognitive-behavioral therapy and peer support groups.
  • Future research in mental health nursing: This literature review will discuss future research directions in mental health nursing, including innovative treatments and new approaches to understanding psychiatric disorders.

Here’s the process of Evaluating sources for a nursing literature review | Guide

List of 7 Nursing Literature Review Examples

  • Here’s a  sample Capstone project
  • Make use of this  Nursing Literature Review Sample | Benchmark – Part B: Literature Review
  • More resources for your study  Capstone Literature Review
  • Here’s the best  Capstone Project Literature Review – Solved Example
  • Working with a PICOT question, here’s a  Literature Review For The PICOT Question – Solved Essay
  • Make use of this  Grand Canyon Literature Review PICOT Statement Paper
  • Taking MSN, here’s a sample nursing literature review example that you should read  Literature Review: The Use Of Clinical Systems To Improve Outcomes And Efficiencies

40 Ideas for nursing literature review topics

Nursing literature review is an important practice that nurses use to learn about new concepts and research studies. It can also be used to evaluate the quality of nursing care.

Here are forty ideas for nursing literature review topics:

  • Nursing care of patients with dementia
  • Effect of bed rest on nurses’ health
  • Use of complementary and alternative medicine in nursing care
  • Impact of technology on nurses’ work
  • Role of nurses in disaster preparedness
  • Effectiveness of patient safety programs
  • Assessment and management of chronic diseases in the elderly
  • Developing culturally competent nursing care plans
  • Care of hospitalized pediatric patients
  • Nursing interventions for preventing falls in the elderly
  • Effectiveness of home health services for persons with disabilities
  • Strategies to improve communication between nurses and patients with dementia
  • Health promotion in hospitals: an evidence-based approach
  • Nursing care for critically ill patients
  • Promoting safe sleep for children
  • A qualitative exploration into transitional learning experiences in nursing
  • The intersection of race, ethnicity, and gender with nursing
  • Ethics education for nurses
  • Nurses’ experience working with migrant patients
  • The impact of social media on nurses’ work
  • Nurses’ perceptions of work stress and burnout
  • Nursing management of chronic pain in adults
  • Implementation and evaluation of nurse-led interventions for promoting oral health in older adults
  • The role of nurses in the transition to palliative care
  • Assessment and management of postoperative pain in adults
  • Effects of sleep deprivation on nurses’ performance
  • Nurse-led interventions for preventing falls in the elderly: a systematic review
  • Nursing care in intensive care units: an overview
  • Psychiatric nursing: an introduction
  • Impact of burnout on nurses’ quality of life
  • Nursing research: a critical perspective
  • The influence of culture on maternal nursing
  • Assessment and management of chronic diseases in children
  • Caregiving trajectories among migrant mothers in Canada
  • Development and evaluation of an evidence-based electronic health record for pediatric patients with chronic conditions (CHILD-EHR)
  • Research methods for studying nursing practices: a qualitative exploration
  • Cultural competency among hospital workers: implications for patient safety
  • Nursing interventions for managing postoperative pain
  • The role of nurses in disaster preparedness
  • A qualitative exploration of the experience of work-life balance in nurses

Pediatric nursing literature review topics

There are many nursing literature review topics that could be covered when studying pediatric nursing. A few possible topics include:

  • Acute care of the pediatric patient
  • Assessment and diagnosis of pediatric patients
  • Vital signs in pediatric patients
  • Nutrition in the pediatric patient
  • Pharmacology in the pediatric patient
  • Palliative care of the pediatric patient
  • Sleep patterns in the pediatric patient
  • Infectious diseases of the pediatric population
  • Child abuse and neglect in the pediatric population
  • Medications and their effects in pediatrics

Nursing dissertation topics literature review

Nursing dissertation topics can be incredibly diverse, and there are many different ways to approach them. Below is a list of thirty possible topics that could be used as a starting point for your literature review. This is by no means an exhaustive list – you may want to explore additional topics that you feel would be relevant to your project.

  • Care of the Elderly
  • Care of Patients with Chronic Conditions
  • Care of Pregnant Women
  • Developmental Nursing
  • Geriatric Nursing
  • Healthcare Ethics
  • Healthcare Leadership and Management
  • Industrial/Organizational Nursing
  • Neonatal/Pediatric Nursing
  • Patient Safety and Welfare
  • Primary Health care nursing
  • Public Health nursing
  • Women’s health nursing
  • Youth health nursing
  • Nursing Research Methods
  • Nursing Care of Children with Special Health Needs
  • Nursing Care of Patients with Developmental Disabilities
  • Nursing Care of the Elderly with Memory Loss
  • Nursing Research on Pediatric Populations
  • Nursing Research on Chronic Illness
  • Nursing Care of the Obese Patient
  • Nursing Research on Palliative Care
  • Nurse Anesthetists
  • Nurse Midwives
  • Nurse Practitioners
  • Nurses in Critical Care Settings
  • Nurses in Psychiatric Settings
  • Nurses in Geriatric Settings
  • Advanced Practice Registered Nurses
  • Collaborative Practice

Nursing literature review is an important part of the nursing profession. It allows nurses to learn from the best studies and research on a particular topic. In this article, we will provide you with 100 good nursing literature review topics that you can use to help you write your nursing literature review.

Other Nursing Dissertation Topic Areas include

  • The impact of technology on nursing
  • Global health nursing
  • Nursing care in the aged population
  • Geriatric psychiatry
  • Nursing research methods Nursing care of developmental disabilities
  • Nursing research with multicultural populations
  • Palliative care in nursing
  • Nursing leadership
  • Nursing care of hospitalized patients
  • Nursing research on pediatric populations
  • Nursing care of patients with chronic conditions
  • Nursing care for pediatric cancer patients
  • Nursing research on chronic illness
  • Nursing care of the obese patient
  • Nursing research on geriatric populations
  • Nursing care of the medically ill patient
  • Nursing care of the chronically ill patient
  • Nursing care of the postoperative patient
  • Nursing care of the pediatric patient in critical condition
  • Nursing research on perinatal and neonatal patients
  • Nursing care of the pediatric patient with cerebral palsy
  • Nursing research on palliative care

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List of Literature review topics for nursing students

Nursing students need to be familiar with a wide variety of literature review topics in order to become well-rounded professionals . Here are fifty of the most common nursing literature review topics.

  • Nursing care of people with disabilities
  • Advanced practice nurse practitioner roles and responsibilities
  • Infectious diseases in nurses and patients
  • Collaborative care: working together as a team in healthcare settings
  • Leadership concepts in nursing: decision making, planning, organizing, goal setting, communication, delegation, and problem solving
  • Nursing research: methods and applications in population-based studies
  • Violence against nurses:prevention, intervention and response
  • Nursing care of patients with chronic diseases
  • Health assessment in the clinical setting
  • Care of the elderly patient: principles and practice
  • Nursing care of persons with diabetes mellitus
  • Nursing care of the HIV-infected patient
  • Cardiovascular nursing
  • Advanced practice nurse roles in pediatric health nursing
  • Nursing care of the post-operative patient
  • Geriatric mental health nursing: a framework for practice
  • Critical care transport nursing
  • Community pharmacists in healthcare
  • Pediatric advanced practice nurse roles and responsibilities
  • Environmental health nursing
  • Nurse case managers: integrating evidence-based interventions into clinical practice
  • Mental health assessment tools for nurses
  • Acute renal failure: diagnosis and management
  • Nurses & social work collaboration in long-term care settings
  • Care of the homeless patient
  • Nursing care of the elderly at home
  • Palliative care for pediatric patients
  • Nursing care of older adults in assisted living facilities
  • Nurses & pharmacists: drug therapy interactions
  • Nursing care of cancer patients
  • Patient assessment
  • Care of the critically ill patient
  • Nursing interventions for acute care
  • Palliative care
  • Nursing assistantship and leadership development
  • Pharmacology for nursing students
  • Human growth and development
  • Community health nursing
  • Research methods in nursing
  • Nursing leadership and management
  • Mental health nursing
  • Nutrition for nurses
  • Psychiatric rehabilitation nursing
  • Nurse-midwife collaboration in obstetrics and gynecology
  • Pediatric infection control and prevention
  • Geriatric health teaching: a systematic approach
  • Palliative care for children and adolescents
  • Critical incident stress debriefing
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  • Volume 14, Issue 2
  • Nursing students’ Health Literacy skills: a scoping review protocol for driving research
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  • http://orcid.org/0000-0002-5299-3302 Giampiera Bulfone 1 ,
  • Valentina Bressan 2 ,
  • Irene Zerilli 3 ,
  • Rocco Mazzotta 3 ,
  • Giuliana Favara 1 ,
  • Roberta Magnano San Lio 1 ,
  • http://orcid.org/0000-0002-0905-5003 Martina Barchitta 1 ,
  • Antonella Agodi 1
  • 1 Department of Medical, Surgical Science and Advanced Technology "G. F. Ingrassia" , University of Catania , Catania , Italy
  • 2 Department of Specialistic Medicine , Azienda Sanitaria Universitaria Friuli Centrale , Udine , Italy
  • 3 Department of Biomedicine and Prevention , University of Rome Tor Vergata , Roma , Italy
  • Correspondence to Dr Giampiera Bulfone; giampiera.bulfone{at}unict.it

Introduction The healthcare systems in Europe are changing rapidly due to the increased complexity of healthcare needs, specifically for the ageing population with chronic diseases. Nurses play a key role in providing care for patients with chronic diseases, encouraging patients to take care of their own health improving their Health Literacy (HL) too. Previous works have highlighted the paucity of HL content in nursing curricula, and the need to prioritise the development of HL skills in academic teaching and assessment methods. The aim of this study is to analyse HL skills nursing literature to further develop scientific knowledge in this area of research.

Methods and analysis This scoping review will be conducted following Arksey and O’Malley’s framework. This study is based on the Joanna Briggs Institute manual. A systematic search will be performed by four researchers using the electronic databases of MEDLINE (via PubMed), the Education Resources Information Centre, the Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science and Google Scholar. We will include any paper that focuses on HL skills and undergraduate nursing students. We will select every primary study (quantitative, qualitative and mixed method design) published in peer-reviewed journals up until February 2023, in both Italian and English language, without any time limit.

Ethics and dissemination This scoping review is part of a large project of the University of Catania which aims at developing higher educational standards for nursing student. This project will not involve patients/public and does not require ethical committee approval. This scoping review will be submitted to international peer-reviewed journals.

Registration details The protocol was registered with the Open Science Framework on 20 April 2023 ( https://osf.io/cn8d7 ).

  • Nursing Care
  • Health Education
  • PUBLIC HEALTH

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2023-075682

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STRENGTHS AND LIMITATIONS OF THIS STUDY

To our knowledge, this will be the first scoping review on Health Literacy skills among nursing students.

The review will take a rigorous approach, adhering to the Joanna Briggs Institute manual.

Large searching strategies will be developed drawing on major databases and grey literature without any time limits.

A limit of this study is that articles in Italian and English only will be included and, being a scoping review, no quality of the chosen studies will be assessed.

Introduction

The Europe healthcare landscape is undergoing rapid transformations, driven by the growing complexities of healthcare needs, particularly among the ageing population affected by chronic diseases. It is essential to empower patients in order to improve their quality of life, well-being, health outcomes and self-management. 1 2 In order for patient to better manage self-care and exercise a more active involvement in decision-making regarding own care, they will have to be educated by healthcare professionals. 3 Nurses play a critical role in caring for patients with chronic diseases, managing symptoms and preventing disease progression. 4–7 Their work will include promoting patients’ self-care through improving Health Literacy (HL) skills. 6 7 HL means, on the part of the patient, to access, understand and use health-related information and services, enabling informed health decisions that help improve, protect and promote the quality of life for themselves, their families and communities. 8–10 Specifically, low HL is associated with adverse health outcomes, including increased emergency department visits, reduced chronic disease management, poor medication adherence, hospitalisation and elevated mortality risk. 11 12 Consequently, it is critical to prepare nurses to address the challenges posed by patients with limited HL skills. 13

Scholars must actively engage in HL research, education and promotion to address these critical needs. 14 Previous works by McCleary-Jones 15 and Toronto and Weatherford 16 have highlighted the paucity and inconsistency of HL content in nursing curricula, highlighting the need to prioritise the development of HL-related skills, specially teaching and assessment methods. 15 16 McCleary-Jones 15 and Toronto and Weatherford 16 stressed the urgency of rigorous research on methods and procedures to generate understanding the subject matter and develop the relevant skills. This knowledge might offer insight on existing research, at the same time identifying potential gaps and informing future investigations. Advances in this field of research could significantly benefit nursing education by adapting more effective models and strategies, ultimately ensuring that students’ proficiency in HL translates into professionals capable of addressing the current healthcare needs of chronic patients. 6 7 13

Despite the relevance of HL proficiency among nursing students, no synthesis has been conducted to summarise findings, identify gaps and guide scholars in further research. Therefore, this study aims to identify the primary sources and types of evidence available regarding HL skills in nursing students, contributing to the development of research in this critical field.

Methods and analysis

Study design.

A scoping review will be conducted following Arksey and O’Malley’s 17 five-stage framework, which includes (1) identifying the research question based on the patient (P), concept (C) and context (C), (2) identifying relevant studies, (3) selecting the studies, (4) charting the data and (5) collating, summarising and reporting the results. 17 In developing this study, researchers will consult the Joanna Briggs Institute manual. 18 19 The protocol was registered with the Open Science Framework (OSF) on 20 April 2023 (LINK).

Identifying research questions

Given the aim/s of this study, our research questions are the following:

(1) What are the areas of research regarding HL skills among nursing students that have already been extensively studied? (2) Which areas require further investigation? (3) What are the methods used in the existing literature, and which of these could be more effective in future research?

The research questions will be formulated using key elements aligned with the Population, Concept and Context framework approach. 18 19 The population will be active undergraduate nursing students of every year of the programme, of any age, sex and nationality. The concept, focusing on interventions, phenomena of interest and outcomes, revolves around the development of HL skills throughout the undergraduate programme. HL skills are linked to Information Literacy, that is the ability to recognise any moment when information is needed. 8–10 The context is defined as the academic or educational setting, of every region, and cultural background they come from.

Search strategy

Four authors (GF, RM, RMSL and IZ) will undertake the article search in three sequential steps. Initially, they will review some studies on HL in nursing students to identify subject headings and keywords to narrow down the search strategy. In the second step, the researchers, under the supervision of a senior researcher (MB), will engage in discussions in order to reach a consensus on databases selection and search terms. The chosen online databases include MEDLINE (via PubMed), Education Resources Information Centre, the Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science and Google Scholar. The search terms include “ Nursing Students ” (Mesh), “ Health Literacy ” (Mesh), “ Information Literacy ” (Mesh) and “ Clinical Competence ” (Mesh), combined using Boolean operators ‘AND’ and ‘OR’ ( table 1 ). Each study will be imported into the RefWorks database manager to discard duplicates. In the third and final step, the reference lists of all identified reports will be analysed for additional studies.

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Eligibility criteria

Papers on HL skills will be selected, especially those that focus on nursing students pursuing a nursing-degree level. The inclusion criteria consist of primary studies employing diverse research designs, including quantitative, qualitative and mixed methods. Selected studies are those already published in peer-reviewed journals up until February 2023 and will be available in either Italian or English. Letters, comments, conference abstracts, editorials, books, any form of review and doctoral theses will not be included. Where sample details lack clarity, researchers will meticulously examine the full text to ensure the inclusion of nursing students related material and information capable of providing data. No time frame limitation will be imposed ( table 2 ).

Selection of sources of evidence, charting the data process

Selection of sources of evidence

Based on the inclusion and exclusion criteria, three researchers (BG, VB and RM) will first independently screen titles, abstracts for inclusion criteria and then their full text. When a full text is not available, the researchers will contact the authors. Every researcher will structure a table in excel with title, authors, publication data, journal and notes to share information in a meeting with the senior researcher. In the case of disagreement concerning the inclusion of a study, an independent assessment will be conducted by a senior researcher (MB) ( table 2 ).

The number of the records removed and reasons for their removal will be reported in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram for systematic reviews. 20

Charting the data

After selecting the final set of studies, each researcher (BG, VB and RM) will independently extract and chart the data for the first five studies. Then the team will discuss the findings together for problems related to this process and purposes of adding data to extract. The researchers then will continue the charting data independently with a final meeting in order to share their results. In the case of disagreement, an independent assessment will be conducted by a fourth author (MB) ( table 2 ).

The researchers (BG, VB and RM) will independently abstract their data with regard to authors, year of publication, country of origin, aim, study design and sample size. In the case of studies considering non-nursing undergraduate, only the nursing students’ sample size will be given. Researchers will also extract the instruments used for HL measurement as well as the author of the instrument, the concept of HL and findings related to the aim of the study. In the case of qualitative studies, the themes that will emerge will be analysed and synthesised ( table 2 ).

Critical appraisal of individual sources of evidence

Given the intent of the review, the quality of the included studies will not be assessed. 21

Synthesis and presentation of results

The results will be described through each of their research questions. The quantitative and qualitative results will be reported in the main text and tables. Qualitative results will be synthesised, adopting the content analysis method. 22 Content analysis as a research method is a systematic and objective way to describe and quantify phenomena; it is useful for making replicable and valid inferences from data. 22

Specifically, the results section will consist of two parts: the first will describe the results of the search strategy and selection process, including a PRISMA flow diagram, while the second part will provide key information regarding the characteristics of the selected studies (design of the study, country, year of publication, sample, instrument for assessing the HL skills and main finding).

Ethics and dissemination

This scoping review is part of a large project of the university of Catania aimed at developing higher quality educational approaches to nursing curricula. This project will not involve patients/students/public and will not require ethical committee approval. This scoping review will be submitted to international peer-reviewed journal. The protocol was registered with the OSF on 20 April 2023 (LINK).

Patient and public involvement

None. The patients and the public are not involved in this project neither in the dissemination plans.

Discussion and conclusion

The aim of this scoping review is to identify the main sources and types of available evidence regarding HL skills among nursing students to further develop knowledge and understanding in this area of research.

This could pave the way for innovative strategies in higher education to significantly enhance nursing students’ learning and clinical experience.

Furthermore, this scoping review will seek to both address some of the most important gaps in HL skills among nursing students and facilitate new approaches in healthcare practice, research and education.

Ethics statements

Patient consent for publication.

Not applicable.

  • World Health Organization Joint Governance Working Group
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Contributors AA and MB are the senior researchers. GF, RMSL, RM and IZ developed the search strategy. GB, VB and RM are the reviewers. All authors drafted the manuscript, contributed to the development of the selection criteria and data extraction criteria. All authors read, provided feedback and approved the final manuscript.

Funding STARTING GRANT, University of Catania, Catania, Italy—No 85194 of 20230222 (2023-UNCTCLE-0085194). Incentives PLAN for University RESEARCH 2020/2022 (C.o.A. of 04.29.2020)—Intervention line 3 "Starting Grant".

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

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  • Published: 20 February 2024

Educating the nurses of tomorrow: exploring first-year nursing students’ reflections on a one-week senior peer-mentor supervised inspiration practice in nursing homes

  • Daniela Lillekroken   ORCID: orcid.org/0000-0002-7463-8977 1 ,
  • Heidi M. Kvalvaag 1 ,
  • Katrin Lindeflaten 1 ,
  • Tone Nygaard Flølo 1 ,
  • Kristine Krogstad 1 &
  • Elisabeth Hessevaagbakke 1  

BMC Nursing volume  23 , Article number:  132 ( 2024 ) Cite this article

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Worldwide, the healthcare system stresses a severe deficit of nurses because of elevated levels of work-induced stress, burnout and turnover rates, as well as the ageing of the nursing workforce. The diminishing number of nursing students opting for a career in nursing older people has exacerbated this shortage. A determining factor in the choice of a career within the field of residential care for nursing students is educational institutions offering students learning opportunities with positive learning experiences. Therefore, educational institutions must develop programmes that employ student active learning methods during clinical periods. Although much focus has been given to the development of new educational programs, insufficient consideration has been given to the value of peer mentoring and students’ interactions during the clinical placement at nursing homes. The aim of the present study is to explore first-year nursing students’ perceptions and experiences with peer mentoring as an educational model during their inspiration practice week at nursing home.

The study employed a qualitative exploratory and descriptive research design. Data collection took place in October 2022 using focus group interviews. A total of 53 students in their first year of the bachelor’s programme at the Oslo Metropolitan University participated in eight focus group interviews. The data were analysed following the principles of inductive content analysis.

The analysis resulted in one main category, ‘Being inspired—keep learning and moving forward’, representing first-year nursing students’ common perceptions of being mentored by third-year students. The main category is supported by two categories: ‘Closeness to the mentor’ and ‘Confidence in mentors’ professional knowledge and teaching and supervision methods’, which are interpreted as the drivers that enabled first-year students to learn more about nurses’ roles and responsibilities in the nursing home.

Mentorship enhances the learning transfer from third-year nursing students over to first-year nursing students by providing them with real-world exposure and guidance from their more experienced peers. This hands-on approach allows them to bridge the gap between theory and practice more effectively, boosting first-year nursing students’ confidence and competence in nursing and caring for older people living in nursing homes.

Peer Review reports

Nursing is one of the main professions that provides care to older people [ 1 ]. To meet society’s challenges of providing quality healthcare to older people, knowledgeable and skilled future generations of nurses are needed [ 2 ]. International research reveals that one of the key challenges for nursing in residential care is recruiting and retaining knowledgeable and skilled nurses [ 3 ]. Although nursing students have positive [ 4 ], or moderately positive attitudes towards nursing older people [ 5 ], they generally do not see caring for older people as an interesting area of their future careers [ 6 ]. Students may lack the motivation to study and work in this field; therefore, it is necessary to increase the attractiveness of working within the gerontological nursing field [ 7 ].

Generation Z nurses, born 1995 or later (aged ≤ 24 years of age), have introduced new expectations and ideals of life and work into the nursing profession [ 8 ]. People belonging to generation Z exhibit traits such as tolerance, respect, social-change oriented, collaboration and confidence but with caution while embracing diversity and growing up with friends from various ethnic backgrounds [ 9 , 10 ]. To meet their expectations and retain them into the nursing profession, it is vital to design educational programmes and work conditions accordingly. Moreover, to ensure that graduating nurses possess the necessary levels of gerontological nursing competence, nursing education programmes must prepare future nurses accordingly. This implies that faculties must emphasise the importance of having gerontological nursing knowledge and competences among nursing students right from the early years of training [ 11 ]. This may contribute to providing comprehensive education to nursing students and instil a positive attitude towards nursing older adult patients [ 7 ].

Nursing education in Norway, as well as in other European countries, complies with the European Union’s (EU) directives [ 12 , 13 ], and is completed in accordance with the Bologna Process [ 14 ], requiring bachelor’s and master’s degrees as the norm. This means that it takes 180 ECTS (European Credit Transfer System) to obtain a bachelor’s degree and a further 120 ECTS to complete a master’s degree. In Norway, nursing education consists of at least 4,600 h, including theoretical knowledge and clinical practice, in which clinical practice represents half of the education period; therefore, clinical practice must cover a minimum of 2,300 h [ 12 ]. As required by the EU [ 12 , 13 ], theoretical and clinical studies alternate during these three years, and students intertwine theoretical and clinical knowledge during lectures, seminars, workshops and clinical periods conducted in different clinical contexts. After attending a three-year nursing education programme, the student achieves a bachelor’s degree in nursing as a registered nurse (RN) with competence at a general level. For students to obtain a nursing degree, they must demonstrate the knowledge and ability required in the national goals to become RNs at the end of their education, consisting of three main goals: knowledge, skills and general competence [ 15 ].

Since 2020, Oslo Metropolitan University [OsloMet], as well as other Norwegian universities, has implemented a new bachelor’s programme in nursing. The programme aims to qualify candidates for practicing professional nursing based on up-to-date evidence-based knowledge, professional suitability and respect for human autonomy and participation [ 16 ].

To educate knowledgeable and skilled nurses to meet Norwegian society’s healthcare challenges, knowledge and skills of how to provide better and safer fundamental care are part of the curriculum of the first year during the bachelor’s programme in nursing [ 15 ], and clinical placements in nursing homes where students learn to plan and provide fundamental care to older people are mandatory courses [ 12 , 17 ]. During the course ‘Theoretical Foundations of Nursing’ (SYK1000) that is taken in the students’ first term, the first-year students have a one-week clinical period (inspiration practice) in nursing homes. This one-week inspiration practice period is in addition to their six-week clinical placement during the second term. The focus of the inspiration practice is to observe and gain knowledge about the nurse’s role and responsibilities in nursing homes, including planning and participating in providing fundamental care to nursing home residents. During this period, the third-year nursing students attend the clinical period ‘Nursing Patients with Complex Health Challenges’ (SYKPRA60) in nursing homes. One of the learning outcomes of this course is related to students developing skills and knowledge about learning, mastering and changing processes, as well as supervising and teaching patients, next-of-kin, students and healthcare personnel. To pass the clinical period, as a mandatory learning activity, the third-year students will supervise, plan and carry out supervision for one or a group of two to three first-year students in cooperation with the nurse preceptor and nurse educator from the university [ 16 ], hence employing peer mentoring as a learning and teaching method during the clinical period at nursing home for both student groups.

Mentoring is an encouraging and supportive one-to-one relationship with a more experienced worker or peer student and is characterised by positive role modelling, promoting aspirations, positive reinforcement, open-ended counselling and joint problem-solving [ 18 ]. Peer mentoring is a relational process where a more experienced individual (mentor) contributes to the professional and personal development of a less experienced individual (mentee) [ 19 ]. This approach aligns with the educational philosophy of peer-assisted learning, which engages students in the teaching process [ 20 ]. However, it is worth noting that the term ‘peer mentoring’ lacks a consistent definition [ 21 ]; therefore, various interchangeable terms, such as ‘peer learning’, ‘peer coaching’ and ‘near-peer teaching’, are utilised in the literature [ 22 ]. In the present study, ‘peer mentors’ or ‘mentors’ refers to senior nursing students possessing more extensive experience than their junior counterparts, the ‘mentees’, and ‘peer mentoring’ refers to the process of learning transfer from mentors to their mentees.

The inspiration practice period has been implemented to provide first-year students with insights into the nurse’s role and responsibilities in nursing homes, hence, to prepare them for their first clinical placement period at nursing home and all subsequent clinical periods throughout their education. This preparation aims to prevent the occurrence of what is termed ‘reality shock’ [ 23 ], a phenomenon that may lead to negative consequences for their continuing nursing education and influence their choice of whether to pursue a career in nursing [ 24 ].

Despite the growing number of studies revealing the importance of the professional development of nursing students in clinical studies, little is known about the peer mentoring process used by students in learning from each other in higher education [ 25 ]. Results from previous studies reveal that peer mentoring increases mentees’ integration, academic success, class retention, self-esteem, psychosocial wellness, reduces anxiety in clinical setting, increases self-worth for both the mentee and the mentor [ 26 , 27 , 28 , 29 , 30 ]. Furthermore, positive outcomes for mentors have been observed, ranging from enhanced problem-solving abilities to heightened coping skills [ 31 , 32 ]. Recently, results from a longitudinal study indicate that a one-on-one mentorship program is beneficial for the retention of new graduate nurses, particularly during the first year [ 33 , 34 ].

Learning environment quality in clinical placement is vital for how nursing students achieve competence through reflection on their experiences [ 35 ]. Similarly, positive learning experiences in residential care are vital for their future choices regarding where to work and therefore crucial for employers striving to recruit newly qualified nurses. Facilitating optimal clinical mentoring is therefore of high priority in nursing education [ 36 ].

As shown above, although peer mentoring has been reviewed in many studies, several gaps on the effects the mentor program has in the context of nursing home as teaching and learning context remain. Specifically, no programs focus mentoring on a targeted discipline or degree of interest to cultivate specific gerontological professional development. Because of this, there is a lack of literature focusing on the first-year experience of a nursing student. Likewise, there is limited available research exploring the benefits of mentoring specifically for first-year nursing students during the clinical placement at nursing homes as a learning context. Therefore, the aim of the present study is to explore first-year nursing students’ perceptions and experiences with peer mentoring as an educational model during their inspiration practice week at nursing home.

Theoretical framework

To the best of the researchers’ knowledge, the application of peer mentoring as a learning and teaching strategy for first-year students within the context of nursing home learning is a novel approach. Therefore, the application of innovative and active learning strategies in clinical settings necessitates educational research. For the present study, the theory of learning transfer described by Wahlgren and Aarkrog [ 37 ] was chosen as the theoretical framework. The theory of transfer of learning is defined as the application or adaptation of previously learned knowledge, skills or understanding to new situations or contexts. Moreover, it involves the ability to make connections and use what a student has learned in one context to solve problems or understand concepts in different contexts. However, little is known about the processes used by students to transfer learning from each other and to apply or adapt knowledge to practice.

The theory of transfer of learning is influenced by three factors that may be seen as facilitators or barriers that promote or hinder students’ learning in clinical settings: (i) person-related transfer factors, which include motivation, the ability to set goals, having confidence and knowing how to apply the new knowledge and reflecting on how to apply the new knowledge [ 38 ]; (ii) teaching-related transfer factors, which refer to how the ‘teacher’ organises the learning situation, by, for example, giving theoretical and examples and demonstrating how to apply theoretical knowledge into real-life situations [ 38 ]; and (iii) factors related to the situation where the knowledge is applied [ 37 ], such as the context of where the knowledge is applied, that is, willingness to include the workers’ new knowledge and skills in the workplace, leadership characterised by openness to positive changes and willingness of using the necessary resources. During the analysis, the content of the processes described by students when learning from each other revealed similarities with the theory of transfer of learning [ 37 ]; therefore, the researchers decided to choose this theory as a framework for discussing the study’s findings.

Aim of the study

This study aims to explore first-year nursing students’ perceptions and experiences with peer mentoring as an educational model during their inspiration practice week at nursing homes.

Study design

The present study has a qualitative exploratory descriptive design [ 39 ]. The design was appropriate because it allowed the researchers to contextualise how the first-year students perceived peer mentoring and nursing home as learning environment and their role as mentees within the context of nursing home, thus providing a picture of what naturally occurred between the mentors and mentees.

Study setting

The study was conducted at Oslo Metropolitan University during the one-week inspiration practice at nursing homes for first-year nursing students.

Study population and sampling

All the students enrolled in the first year of the bachelor’s programme in nursing at the Department of Nursing and Health Promotion in the academic year 2022–2023 were informed about the study and invited to participate. All six researchers were engaged in providing information about the study and in the process of recruiting potential participants.

The students were provided with verbal and written information about the study during a face-to-face first meeting before and after inspiration practice week. For inclusion, the students should: (i) be enrolled in the academic year 2022–2023, (ii) voluntary to attend the study, (iii) agreed to be recorded during the interviews. If the students were interested and expressed their wish to participate, they were asked to contact the researchers by email and agree upon the date for the interview. When distributing the participants in focus groups, to make the participants feel confident and comfortable during the interviews, the researchers considered the students’ class affiliation and formed groups with students belonging to the same class, thus fostering a sense of familiarity and ease among the participants.

Of a total of 488 students enrolled in the academic year 2022–2023, only 53 expressed their interest and agreed to participate. The ages of the participants ranged between 19 and 54 years. Although most had no work experience in the field of healthcare/nursing, some had up to 13 years of clinical experience working in nursing homes or home care. The researchers strived to provide a gender balance among the participants; therefore, an equal proportion of female and male participants was encouraged to participate. Even so, only seven participants were males. As the research literature has demonstrated, nursing is a female-dominated profession with individuals still choosing gender role stereotypes for their careers [ 40 , 41 ] This may explain the large number of females among the participants.

Data collection

Data were collected during the fall semester of 2022, one week after the students conducted their inspiration practice week. Eight focus group interviews were conducted to collect data during October– November 2022. Focus groups involve people with similar characteristics coming together in a relaxed and permissive environment to share their thoughts, experiences and insights [ 42 ]. The choice of using focus group interviews as data collection methods was because allows participants share their own views and experiences, but also listen to and reflect on the experiences of other group members [ 42 ]. This synergistic process of group members interacting with each other promotes and refines participants’ viewpoints to a deeper and more considered level and produces data and insights that would not be accessible without the interaction found in a group [ 42 , 43 ]. Prior to conducting the interviews, a semistructured interview guide inspired by peer mentoring in nursing literature was developed and used to guide the interviews. The interview guide used in the present study was developed based on recommendations from previous studies for further research to achieve a comprehensive understanding of how peer mentoring can be effectively employed in the context of nursing home [ 22 , 23 , 26 ]. The themes and questions that were posed during the interviews are presented in Table  1 .

The number of participants in each focus group ranged between 3 and 12. Depending on the number of participants in each focus group and on their verbal dynamism during the interviews, each focus group interview lasted between 30 and 55 min. The focus group interviews were held in a quiet classroom after a seminar class. As recommended by Krueger and Casey [ 42 ], the researchers planned to conduct each focus group interview in pairs. However, because of the busy work schedules among researchers, only two focus group interviews were conducted by two researchers, one acting as a moderator and the other as a ‘secretary’. While the moderator’s role was to pose questions and follow up the answers, the secretary’s role was to take notes, observe the group dynamic and use the recording device. During the interviews, the participants were encouraged to talk openly, share their thoughts and experiences with one week of inspiration practice in a nursing home and offer suggestions for improvement for the course. Hence, the participants offered deep and rich answers that contributed to the detailed expression of opinions.

Data analysis

All eight focus group interviews were digitally recorded and transcribed verbatim by the researchers immediately after completion. Except for one researcher (KK) who transcribed four focus group interviews, all authors transcribed each one to two focus group interviews. However, depending on the length of the interviews and the richness of the dialogs, the transcription process lasted between 6 and 8 weeks. The data generated from eight focus group interviews consisted of 106 A4 pages taped with 1.5 line spacing and Times New Roman font size. The analysis process has additionally taken eight weeks.

When conducting a focus group interview, it is the group rather than the individual that is the focus of analysis because data generated from focus groups represents situated accounts that can provide in-depth insights into contextualised social interactions [ 43 ]. The transcripts from the interviews were analysed following the three steps of inductive content analysis outlined by Kyngäs [ 44 ]: preparation, organising and reporting the findings.

As part of the first step, data analysis began during data collection through careful group moderation. By following transcription, reflexive engagement with the data enabled researchers’ familiarity with it as a whole before the coding process. The empirical data generated from eight focus groups were analysed independently by two researchers (DL & HK) to identify the key categories coded onto transcripts. At this step, the coding process helped reduce the amount of data. These codes were subsequently subjected to a more detailed subcoding of meaningful content, such as one word or a shorter sentence. At this step, no theoretical understanding influenced the selection of the units of analysis. Unit selection was based on the themes from the interview guide and derived from the data. Both authors then met and discussed the similarities and differences between the coded data from each interview, sharing their overall understanding of the data. If discrepancies occurred, they were solved by discussing before making a final decision.

In the second step, the researchers discussed, analysed and decided which codes should be grouped together into subcategories and determining the hallmarks of the categories. Following a discussion about the open coding process, a coding tree was developed to facilitate comparisons within and between groups. To validate and maximise the trustworthiness of the initial findings, a descriptive overview of the final analysis was presented to the other researchers, that is, the coauthors of the present paper, to confirm that it was a realistic interpretation of their views. For example, the code ‘following the mentors everywhere’ has gradually been incorporated into the subcategory ‘Spending time with mentors.’ In this step, influenced by the learning transfer theory [ 37 ] this subcategory was further placed under a category labeled ‘Closeness to the Mentor.’ It was interpreted as a person-related factor that facilitates learning transfer, thereby inspiring first-year students to continue learning and moving forward.

The third step was to present the findings by describing the content of the subcategories and categories as supported by participant quotes. An example of the coding tree is shown in Table  2 .

Rigour of the study

Rigour was ensured by employing several strategies. First, to ensure trustworthiness and rigour, the criteria described by Lincoln and Guba [ 45 ], known as credibility, dependability, confirmability and transferability, were employed.

To ensure transferability and dependability, the researchers clearly described the study’s theoretical framework, the recruitment and the characteristics of the participants, the research context, data collection and analysis processes so that readers could assess whether findings were applicable to their specific contexts and, if desired, repeating the study.

The data analysis was iterative and continued until all members of the research team agreed on a relevant and trustworthy formulation of the categories. To enhance trustworthiness, the consistency and dependability of data analysis was optimised by researcher triangulation. Two members of the research team (DL & HK), who independently coded interview transcripts and managed the coding and developed categories and subcategories that were assessed, verified and amended by all the members of the research team. Discrepancies in the coding were resolved through discussions until a consensus for each interview transcript was reached.

Confirmability is ensured by researchers presenting quotes from the participants that support the findings. The researchers strived to accurately represent the information provided by the participants, hence indicating that the interpretations of the data were not invented or based on preconceived notions.

In qualitative research, reflexivity should be oriented towards personal, interpersonal, methodological and contextual issues in the research [ 46 ]. Personal reflexivity refers to researchers reflecting on and clarifying their expectations, assumptions, and conscious and unconscious reactions to contexts, participants, and data [ 46 ]. The research team was composed of six women, all of whom had teaching experience with and knowledge of the first-year curriculum. Five of the research team members had experience with designing and conducting qualitative studies and collecting and analysing qualitative data. Although the analysis was performed by two researchers, all the researchers brought important contextual knowledge and insights to the analysis discussion, thus strengthening the study’s dependability. However, the researchers’ professional backgrounds as nurse educators who had knowledge of the curriculum and the course’s expected learning outcomes could address certain topics or follow-up questions during the focus group interviews, thus influencing the answers. Therefore, to minimize bias, the researchers discussed their prior experiences with interviewing, reflected on how questions were asked, and simultaneously managed their assumptions around how participants thought about and experienced being in the one-week inspiration practice.

Interpersonal reflexivity refers to the existing relationships and power dynamics between researcher and participants [ 46 ]. The participants in this study were first-year students, and some of the researchers who conducted the interviews were their teachers. Consequently, during the interviews, the power balance between researchers and participants could result in participants feeling that they were being evaluated, potentially leading to a focus on more positive experiences. To avoid this, researchers reinforced to participants that their participation is voluntary and that their answers will not influence their study progression. Moreover, during the interviews, researchers encouraged quieter participants to answer and allowed for differences of opinion.

Methodological reflexivity refers to researchers critically consider the nuances and impacts of their methodological decisions [ 46 ]. To strengthen methodological reflexivity, researchers discussed whether the study’s aim aligns with the chosen design and whether the data collection method and interview guide will generate data to answer questions posed during the focus group interviews. Another method to enhance methodological reflexivity was discussing the theoretical framework’s relevance to the study. After considerable discussions, the researchers decided to choose the theory of learning transfer [ 37 ] as it was considered the best theory to inform the data.

Contextual reflexivity entails researchers understanding the unique setting of the study [ 46 ]. To strengthen the study’s contextual reflexivity, researchers discussed which aspects of the context could influence the research and people involved, as well as how the research impacts the context. The study was conducted at a Norwegian university, and participants were enrolled in the first year of the nursing bachelor’s program. Although the interview guide was inspired by previous literature on peer-mentoring, the questions posed were developed to gain knowledge about students’ experiences with a one-week inspiration practice at a nursing home. This means that the research was influenced by the curriculum and mandatory courses conducted at this university. During discussions, some researchers mentioned that most focus group participants reflected on their clinical development and were looking forward to their turn being a mentor for first-year students. It was evident that this study also had a positive impact on participants.

Ethical approval

The present study was granted approval to be conducted from the researchers’ institution, Department of Nursing and Health Promotion at Oslo Metropolitan University and from the Norwegian Agency for Shared Services in Education and Research (Sikt/Ref. number 334855). The study was conducted in accordance with the Helsinki Declaration [ 47 ]. Informed consent, consequences and confidentiality were all obtained and maintained. All participants received verbal and written information about the study and written informed consent was obtained from all the participants prior to data collection. The participants were also informed that they would not receive any financial or other benefits for participating in the study. All participants were assured that, should they choose to withdraw from the study at any time and for any reason, there would be no negative consequences for their education at the university. Nevertheless, the researchers were mindful of the students’ potential vulnerability due to their role as students, which might discourage them from withdrawing. However, despite no reported discomfort during interviews, the potential for discomfort or reluctance to express negative experiences exists. Therefore, before each focus group interview, the students were reminded of their option to withdraw from the interview, providing them with additional opportunities to assent to or withdraw from the study. None of the students who agreed to be interviewed reported any discomfort during the interviews, and none chose to withdraw.

Following data analysis, one main category was generated, ‘Being inspired—keep learning and moving forward’, which was interpreted as the first-year nursing students’ common perception of being supervised by third-year students for one week of inspiration practice at nursing homes. During the interviews, the first-year students mentioned several times that they perceived third-year students as their mentors. To differentiate between first-year students and those in their third year, the third-year students will be referred to as ‘mentors’ throughout the manuscript.

Two categories—(i) ‘Closeness to the mentor’ and (ii) ‘Confidence in mentors’ professional knowledge and teaching and supervision methods’—were interpreted as the drivers enabling first-year students to learn more about nurses’ roles and responsibilities in nursing homes. Each category is supported by several subcategories.

In the following section, the findings are presented with excerpts from the participants’ statements. The statements end with a number representing the code each participant (i.e., P1) and focus group (i.e., FG2) were given before conducting the focus group interviews, meaning participant 1 in focus group 2.

Closeness to the mentor

This category was supported by four subcategories: spending time with mentors, perceiving mentors as role models, feelings of insecurity and mutual learning– learning from each other.

Spending time with mentors

The first subcategory was related to the time first-year students spent with their mentors. Because the mentors could allocate more time to spending with the first-year students, this time allowed mentors to share formal and informal knowledge and create learning opportunities for first-year students. Being close to the mentor and spending time together was decisive for several first-year students to experience a positive relationship with their mentor. This positive mentor-first-year student relationship was highlighted as one of the participants’ positive experiences in the inspiration practice. They experienced that their mentors were aware of their own roles and responsibilities and encouraged first-year students to follow them everywhere to gain insights into how it is to be a nurse employed at a nursing home. One of the participants said the following:

We were following the mentors everywhere… They explained us everything… However, we were only six students at that nursing home, so we get one mentor each… and I followed my mentor all the time, and she explained me a lot about how to help the resident with personal hygiene or how to use a Hoyer lift to help the resident to move from bed to wheelchair. I feel that I learned a lot.… (P4, FG1).

Other first-year students were grateful that, by being with mentors, they had the opportunity to be introduced to more complicated procedures, such as changing a stoma bag or measurements of vital signs or even weighing the residents. One participant shared her experience:

Yes, we have experienced a lot! We contributed to making breakfast and served it, we helped residents with personal hygiene… we weighed the residents and documented in their journal, and we learned how to document everything we did to or with a resident, in generally… However, I learned a new word: stoma and… [stoma bag]. I observed how my mentor changed the stoma bag to a resident. You know, I get the opportunity to meet the residents face-to-face and the life at that ward. (P1, FG3)

The first-year students stated that, with this type of supervision, they would be much more likely to reach their learning outcomes for the inspiration practice. One of the participants stated the following:

I feel that, for me, everything was good. They [mentors] showed us that they have knowledge… they were very open and receptive if we had some questions: ‘Just ask me!’ and they were honest if they could not provide the answer. It wasn’t like at school: ‘Use the contact form’ [laughter]… we got the answer at once, so this was OK. They were also very creative. They made cases about things we already had knowledge about, and I learned to use several measurement instruments, such as QSOFA [Quick Sepsis Related Organ Failure Assessment] and this kind of thing.… (P1, FG8).

Perceiving mentors as role models

The second subcategory was related to first-year students perceiving the mentors as role models. Being close to the mentor, the first-year students could engage in informal discussions, hence finding that mentors were people who had been in their shoes, who had journeyed close to where they wanted to be and who had made their own mistakes in their learning but also gained practical knowledge. They perceived mentors as someone who was close enough to them, willing to share their wisdom and experience, and could help them avoid certain pitfalls. These perceptions contributed to developing a positive relationship with the mentors, which positively influenced their learning. One of the participants said the following:

I am happy that my first encounter with practice was through third-year students. It is not a long time since they were in our situation, so they know how it feels. They explain in an easier way… and you get a kind of insider information… yes, they provide us with information that nurses don’t say because they believe that we already know things… I think that because they were in this situation, they explain or teach us things in the same way they wish they have been told… They have established good routines for learning to achieve learning outcomes.… (P3, FG5).

Feelings of insecurity

The third subcategory was related to feelings of insecurity among first-year students. Several first-year students asserted that they were not confident when they had to help the residents with their fundamental needs, such as toileting, changing diapers, personal hygiene or eating and drinking. One of the participants shared her experience:

I have never assisted someone with personal hygiene before… It was quite an experience…I felt hesitant, but I had to manage somehow… (P4, FG2).

Being close to the mentor offered opportunities to seek support. They appreciated that mentors accepted their insecurity, lack of experience and theoretical knowledge limitations. One of the participants said the following:

Going together with my mentor, I felt safe to fail… [laughter]. I am happy that I gained the opportunity to try and experience the challenges that came with… They asked questions and they sensed that we were not sure about the answer, but we gradually became confident when they ‘pushed’ us to try it on our own.… (P3, FG6).

Mutual learning– learning from each other

The last subcategory was related to the learning process as a mutual process. Some of the first-year students had clinical experience in healthcare services as healthcare assistants. This placed expectations on the inspiration practice period, and although these students knew the field very well, they were impressed by the amount of practical knowledge they gained during this week. However, being close to the mentor offered opportunities to learn from each other. When the mentors could not answer their questions, they experienced that they searched for knowledge and together agreed about the correct answer for the given situation. The participants experienced that learning was a mutual process, and it did not happen only from mentors to them but also vice versa, as one of the participants said:

Yes, we had a positive dialogue about knowledge… sometimes it was funny to see… I think that it was a positive experience for both of us [to share knowledge], that when we asked questions, they had to search for the answer… and figure it out together… This would not happen with a nurse that has 20 years’ experience that knows the answer: ‘that is it!’… (P1, FG4).

Confidence in mentors’ professional knowledge and teaching and supervision methods

This category was supported by two subcategories: mentors’ theoretical and practical knowledge and skills, and mentors’ ability to apply diversity in didactical and pedagogical methods.

Mentors’ theoretical and practical knowledge

The first subcategory relates to the first-year students’ perceptions of mentors’ professional competence, which can be defined in theoretical knowledge, skills and general competence. The first-year students were positively surprised about their mentors’ amount of theoretical and practical knowledge. This contributed to motivating first-year students to be curious and wanting to learn more. Several first-year students asserted that their expectations for the inspiration practice week were fulfilled because of the supervision they gained from mentors, hence assessing mentors as ‘competent’, meaning ‘knowledgeable and skilled’. One of the participants said the following:

I was quite content with my mentor… She [the mentor] had so much knowledge… it seemed that she worked there [at nursing home] for 10 years… I was motivated by that because I noticed how much they [mentors] have learned during these three years.… (P3, FG6).

Other first-year students reported that they got answers no matter what they asked. They were surprised by the mentors’ theoretical knowledge and how they could provide them with examples of the application of theory in real patient situations. This contributed to an increase in first-year students’ self-confidence. One of the participants described his experience as follows:

Our mentors were very knowledgeable and skilled… They provide us with answers… I was surprised how much knowledge a third-year student could gain through education… As third-year students, they were so well prepared to work and to meet patients in the clinical field.… (P10, FG5).

Other participants were impressed by mentors using professional language during formal and informal conversations and by the clinical gaze they developed. One participant stated the following:

… and they communicate with us by using professional terms… such as… I don’t remember all of them now, but they [mentors] mentioned frontal lobe, and other [laughter]… and yes, ‘she’s got Alzheimer’s [referring to a nursing home resident]… it’s only a name for me… but, you know, Alzheimer’s means that the woman has dementia… (P5, FG7).

The mentors’ practical skills were also praiseworthy among first-year students. They observed and learned from mentors how to use different medical instruments and measure vital signs/National Early Warning Score (NEWS) or the level of haemoglobin or insulin on real patients and then documenting the results. One participant said the following:

I could see that they [the mentors] were knowledgeable and skilled… when they presented and demonstrated for us, they knew what they were doing and talking about… They taught us and demonstrated different measures, and when we asked them, they answered us… yes, they were professional.… (P2, FG7).

A skill that first-year students could easily perceive as a challenge was communication with residents who had a cognitive impairment. However, several first-year students were impressed by the mentors’ communication skills. Many were surprised by the ethical challenges imposed by communication with people with dementia. Others noticed how respectful mentors were when asking the residents for permission to bring into the resident’s room another person who would assist the resident with personal hygiene or toileting. One of the participants expressed this as follows:

He [the mentor] I had was very good at communicating with the residents… he always asked them if we could enter the room to observe or help with the provision of personal hygiene.… (P2, FG8).

Mentors’ ability to apply diversity in didactical and pedagogical methods

The second subcategory was related to first-year students’ perceptions of the mentors’ ability to teach and supervise them and the diversity in didactical and pedagogical methods employed. The participants were content with the mentors’ explanations and demonstrations of all the work tasks a nurse has during a working day at a nursing home. Because the first-year students were not aware of what they should ask about, they particularly liked when their mentors provided them with knowledge without being asked for it or just demonstrated how the medical instruments or personal lift-assist device functioned. For most of them, this was perceived as the most appreciated first-hand knowledge, which mentors ‘just shared’ with them. They were also encouraged to ask questions and eventually provided additional answers if they could. One of the participants explained this as follows:

When we asked the mentors ‘Why are doing in this way and not in another…’, they always had good answers grounded in theory or in their prior clinical experiences… They acted very confident, so we also felt confident in what we were doing.… (P5, FG1).

Most of the participants were content with mentors’ methods of teaching or supervising them and giving feedback. They appreciated when mentors supported and encouraged them to learn things and become independent, but also to try new things and teach them how to do it. They appreciated being told what and how to help the resident prior to entering the resident’s room, not just being told what they had to do while the resident observed and listened, thus making them uncomfortable (i.e., during the provision of personal hygiene for a resident). One participant shared his less positive experience with providing personal hygiene to a female resident:

I had to ask my mentor how I should wash her body, and when I came to her breasts, I became very uncomfortable, but the mentor said to me, ‘Just lift her breasts and wash under and dry gently… it is OK’, and then I did it, but it was a strange experience.… (P3, FG7).

Another participant gladly shared her positive experience of being taught different procedures and routines regarding hygiene routines:

We had an interesting overview of hygiene routines at the ward, and then, we went through infection control equipment, and we had to take on and off, to learn these routines… We also learned how many times, how and when we had to use disinfecting alcohol on our hands and the order of taking on and off all that infection control equipment… a kind of ‘learning by doing’… (P1, FG2).

Another learning method that was much appreciated by first-year students was mentors asking questions during a procedure that engaged first-year students to reflect on knowledge before answering. One participant said the following:

When we got out of the resident’s room, they [mentors] asked us if we would do anything different.… (P3, FG7).

Because of the limited number of nursing homes that could have both first- and third-year students at the same time in the clinical field, a few of the first-year students had to complete their inspiration practice week by being two or three days at school or/and the department’s simulation learning environment and only one or two days in the nursing home. Although these students expressed that they learned a lot from their mentors, their expectations for inspiration practice week were not as positive as they expected to be. Some asserted that they got limited or almost no insights into the nurse’s role and responsibilities in the nursing home. One of the participants revealed her experiences in the department’s simulation learning environment:

Together with a few other students from my group, we were at the school’s simulation environment… They [mentors] had a good plan for us. The first day began with measuring vital signs on each other. and we could do it many times. They created several patient cases where we could measure and document NEWS for each case… Then, we learned to change the sheets on the bed while a ‘patient’ was lying there… I felt that I learned a lot, and I am content with how mentors taught us different procedures; however, I wish I could have been at a nursing home because, personally, I have no clinical experience; it would have been useful to get insights into the nurse’s role and responsibilities at nursing home before we start the clinical period at nursing home.… (P3, FG6).

During the focus group interviews, those first-year students who completed the inspiration practice week at the school’s simulation learning environment revealed some learning and teaching methods employed by their mentors, asserted as being very creative. The mentors could not offer learning activities regarding some procedures that could be done in real life (i.e., changing wound dressing on a resident’s leg ulcer); therefore, they had to think outside the box and create situations that could contribute to learning. One of the participants explained this as follows:

They [mentors] drew a ‘wound’ on their own leg and, by following the procedure, they changed the wound dressing on each other to demonstrate us how to change a leg ulcer dressing. I have to say that I learned a lot, although the wound was ‘fake’… [laughter]. (P2, FG7)

The aim of the present study was to explore first-year nursing students’ perceptions and experiences with peer mentoring as an educational model during their inspiration practice week at nursing homes. The analysis of the empirical data revealed that first-year students were inspired by their mentors, an inspiration that contributed to their learning progression.

As the findings have revealed, as a learning process, peer mentoring facilitates the transfer of learning by mentors designing instructional activities, thus encouraging first-year students to make connections between the theoretical knowledge they gained at school and the simulation learning environment and practical knowledge within new and real patient situations.

The findings from the current study have revealed first-year students’ descriptions of how mentors provided them with explicit instructions on how to apply knowledge or skills, thus engaging them in problem-solving activities that required learning transfer. Through these instructions, the mentors transferred learning over to first-year students, hence enabling their reflective thinking within the context of a nursing home. Moreover, acting as role models, being available and allocating time to be together with first-year students, the mentors were perceived as knowledgeable and skilled, features that contributed to enhancing first-year students’ motivation to search for new and more knowledge and, thus, to achieve learning outcomes. These features can be understood as person-related factors, which Wahlgren and Aarkrog [ 37 ] described as one of the factors facilitating learning transfer. Moreover, a person-related transfer factor was positively related to those participants who had previous clinical experience. As the findings have revealed, if the mentors could not answer the questions, the experienced participants, based on their previous clinical experience, suggested solutions; thus, learning was transferred the other way around, from the first-year students to mentors, with learning perceived as a mutual process [ 48 ].

In the present study, the first-year students showed receptiveness to acquiring knowledge and were concerned with making the most of the inspiration practice week. Their interest in learning was strengthened by mentors’ knowledge and abilities in providing instructions. This finding is similar to and supports the findings from previous studies demonstrating that peer mentoring contributes to students’ engagement and increases their cognitive skills, self-confidence, autonomy, clinical skills and reasoning [ 22 , 49 , 50 ].

The mentors’ specific knowledge about nurses’ roles and responsibilities in nursing homes, different procedures and communication challenges with people with cognitive impairment enhanced trust and the credibility of mentors’ preparedness for inspiration practice week. This led to first-year students’ trust in mentors’ ability to transfer learning. The participants’ curiosity and desire to gain insights into real-life patient situations have enabled their willingness to engage in learning activities. In the current study, the mentors adopted an active role when teaching and supervising first-year students. As the participants described, the mentors gladly shared their knowledge, demonstrated how to perform procedures and had informal and formal discussions about how first-year students could implement theory into practice. Similar to previous studies, which have demonstrated that learning with an equal peer facilitates making friends and developing relationships [ 25 ], hence reducing nursing student anxiety in the clinical setting [ 29 ] and promoting learning, the findings from the current study have revealed that the participants leaned on their mentors and felt safe and could trust their mentors. Although a few felt uncomfortable being exposed to new challenges (i.e., providing personal hygiene or helping residents with toileting), most of the participants stated that the mentors’ feedback given both during and postprocedure performance contributed to increasing their self-confidence when performing measures of vital signs or other procedures. These features resonate with Wahlgren and Aarkrogs’ [ 37 ] teacher-related transfer factor which emphasises the mentor’s ability to organise learning situations by including demonstrations, providing examples from theory and practice and reflecting on possible applications in real-life patient situations.

As suggested above, although person- and teacher-related transfer factors facilitated transfer learning, the situation-related factor raised some challenges. Despite the results from one study [ 51 ] demonstrating that nursing homes as a clinical placement will not add something new to students’ skills and competencies required for their future practice, other studies [ 35 , 52 ] have demonstrated that, in general, learning in a clinical context can affect nursing students’ learning outcomes and satisfaction, as well as influence their choice of future career. Although simulation may prepare students for clinical learning environments, there is no comparison to the learning that comes from nursing patients in a real clinical context and from a simulation learning environment at school [ 53 ].

The findings from the current study revealed that not all the students were content with the learning context during their inspiration practice week. Some first-year students, together with their mentors, used the department’s simulation learning environment and even classrooms as a learning context for two or three days or even for the entire week. In this situation, it is reasonable to think that situation-related transfer factors [ 37 ] posed some challenges, and they were not related only to mentors’ pedagogical methods, but also to the programme’s readiness to inspiration practice week and the leadership of the related factors of the nursing home (i.e., not being able to provide enough placements). If the first-year students and their mentors had the necessary theoretical knowledge but could not apply it in a real-life patient situation, the person-related transfer factors could also be challenged. Although none of the participants expressed that using the department’s simulation learning environment as a learning environment was worthless, some hinted at their disappointment. The lack of situational transfer factors seemed to negatively affect the participants’ motivation to gain knowledge. However, as the participants asserted, their mentors’ creativity contributed to creating potential patient situations similar to those in real life. They also encouraged first-year students to simulate different patient conditions and perform different procedures, thus creating opportunities for first-year students to apply theoretical knowledge and improve their skills. This supports the idea that, despite a lack of situational transfer factors, the transfer of learning was supported by mentors’ teacher-related transfer factors rather than situational transfer factors.

Finally, being a first-year student supervised by knowledgeable and skilled third-year students can contribute to first-year students mirroring themselves and their knowledge with their peers. Thus, first-year students can become more aware of themselves as professionals and develop an understanding of the nurse’s role and responsibilities in the nursing home. Consistent with results from previous studies, the results of the present study suggest that peer mentoring facilitates the development of self-understanding in students [ 25 , 26 , 32 , 36 ], which is essential for first-year students to gain a positive attitude towards nursing older people. The findings from the present study have suggested the use of peer mentoring in nursing education with structured training and supervision. Moreover, as the findings have indicated, peer mentoring facilitates learning transfer from mentors to mentees and provides valuable leadership experience for third-year students as mentors. In addition, mentoring may enhance a first-year student’s opportunity to be mentored and provide mentoring in the future.

Implications for nursing education and clinical practice

Peer mentoring, as a teaching and learning method, can be applied to enhance nursing curricula and clinical practice in several ways. Firstly, incorporating successful peer mentoring strategies into the curriculum can foster a collaborative and supportive learning environment among nursing students. The perceived closeness between mentors and first-year students suggests that fostering strong mentor– first year student relationships can serve as a driver for effective learning in the context of nursing homes. This closeness may create an environment that facilitates open communication, trust, and a sense of support, which are essential elements in the field of nursing. Additionally, the confidence instilled in first year students regarding their mentors’ professional knowledge and teaching and supervision methods can directly impact the students’ understanding of nurses’ roles and responsibilities in nursing homes. In clinical practice, the findings from the study can be used to promote mentorship programs that facilitate knowledge transfer and skill development among nurses and among senior and novice students during their clinical periods. Lastly, the study highlights first-year students’ overall positive experiences with peer mentoring program. This positive experience can help change students’ attitudes towards nursing older people, making it an interesting aspect of their future careers.

Strengths and limitations

The present study has several limitations that must be considered when interpreting the findings. First, although many students were invited to participate, the study was limited by a relatively small sample size restricted to students from Oslo Metropolitan University, hence limiting the findings’ national and international transferability. However, one strength may be that the findings and issues raised are relevant for both national and international nursing education programmes that apply the peer mentoring teaching and learning model in clinical placements. Another limitation may be the sample size and data saturation. As a concept, data saturation in qualitative research has been subject to several discussions arising from a variety of conceptual understandings [ 54 ]. Although the sample size posed some limitations, the richness in the participants’ descriptions was a strength, thus contributing to enhancing the information power [ 55 ]. Another limitation may be related to the researchers not being able to conduct member checks to improve the credibility of the data. For practical reasons, it was impossible to gather the same sample of students to validate their statements. However, during the focus group interviews, the participants were asked to provide detailed answers and were given the necessary time to reflect and express their experiences, thus confirming and or disagreeing with each other’s perceptions. Furthermore, potential research biases should be acknowledged given that the data collection and analysis were conducted by all researchers who were nurse educators employed at the same university as the students, hence entailing a prior understanding of the research context. However, the researchers were not involved in the students’ inspiration practice period, which may have limited the research bias regarding data collection. Another limitation may be its specific theoretical framework [ 37 ]. We are aware that other researchers, by using another theoretical framework, would probably discuss the findings accordingly and, hence, interpret the findings differently.

To the best of the researchers’ knowledge, this is the first study exploring first-year nursing students’ experiences with one week of inspiration practice at a nursing home by employing peer mentoring as a teaching and learning method. The findings revealed that first-year students were inspired by their senior peers to keep learning and moving forward. By being close to their mentors and having confidence in their professional knowledge and teaching and supervision methods’, learning was easily transferred from the third-year students to first-year students. Moreover, person-related, teaching-related and situation-related factors were perceived as drivers that positively influenced students’ learning in nursing homes.

The findings have indicated that first-year students had both positive and less positive experiences with attending a one-week inspiration practice at nursing homes. The challenges with inspiration practice were related to situation-related learning transfer factors, such as clinical field not providing enough placements; therefore, the third-year students had to improvise and be creative. However, despite some challenges, mentorship during the one-week inspiration practice offered significant advantages to both mentors and mentees. To fully harness these advantages, we recommend that first-year educational programmes implement person-centred care for older people into the educational curriculum. This should include a one-week compulsory inspiration practice placement in settings exclusive to older people, such as nursing homes. Moreover, peer mentoring as a teaching and learning method, with themes especially designed to focus on nursing and caring for and with older people, offers first-year students insights into nurses’ roles and responsibilities at nursing homes. We believe that such a programme can prevent ‘reality shock’, reduce dropout rates, enhance academic achievements and cultivate personal and professional qualities in students at all levels of their education programmes. More research is needed to explore how peer mentoring is experienced by students enrolled at different levels of Bachelor of Nursing Education and may contribute to their preparation to care for older people in nursing homes.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

Participant (followed by a number indicating the number of participants in the focus group)

Focus Group (followed by a number indicating the number of the focus group)

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Acknowledgements

We would like to thank all the students who participated in the focus group interviews, thus contributing to data collection. We further thank the Department of Nursing and Health Promotion at Oslo Metropolitan University and the University Library for giving their approval and for supporting the publication fee of this article.

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D.L. contributed to study conception, data collection, analysis and wrote the main manuscript text; H.K., K.L., T.N.F., K.K., & E.H. contributed to data collection and analysis. All authors reviewed the manuscript.

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Lillekroken, D., Kvalvaag, H.M., Lindeflaten, K. et al. Educating the nurses of tomorrow: exploring first-year nursing students’ reflections on a one-week senior peer-mentor supervised inspiration practice in nursing homes. BMC Nurs 23 , 132 (2024). https://doi.org/10.1186/s12912-024-01768-5

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  • Clinical practice
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Prerequisites for entry to advanced nurse practitioner studies- a qualitative study of Norwegian nurse anesthetist students’ experiences

  • Cecilie Aanderud-Larsen 1   na1 ,
  • Sara Østlien 2   na1 &
  • Ann-Chatrin Linqvist Leonardsen 3 , 4   na1  

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Nurse anesthesia is acknowledged as advanced practice nursing, and requires independency in patient monitoring and clinical decision-making. In Norway, 2022, a prerequisite to nurse anesthesia education programs of at least two years of clinical nursing experience prior to entry, was removed. The consequences of removing the prerequisite of clinical nursing experience prior to entering the nurse anesthetist education program on academic progression or on students’ qualifications after completion of the program remain unexplored. Hence, the purpose of the current study was to explore nurse anesthetist students’ experiences of the impact their previous clinical nursing experience had on their academic progression.

A qualitative design with semi-structured individual interviews was used. The sample consisted of 12 nurse anesthetist students at the end of the education program. The data were analyzed using thematic analysis in-line with recommendations from Braun & Clarke.

Two main themes with in total six subthemes were identified, namely 1) Experience develops non-technical skills, with subthemes (a) feeling secure in task management, (b) recognizing different situations, (c) understanding my role in teamwork, and 2) Integration of non-technical and technical skills, with subthemes (a) possessing procedural competence, (b) taking responsibility in medication administration, and (c) including a patient-centred approach. Previous clinical experience as a nurse prior to entry to a NA education program had provided a basis of non-technical and technical competencies, that supported further learning and development of advanced level competencies that are needed for NAs.

Non-technical and technical nursing competence represented a solid base for achievement of anesthesia competence within the same areas, also ensuring patient-centred practice. Hence, the change in prerequisites to the NA education program must be followed by evaluations of consequences on students’ academic progress and competence at the end of the program, as well as a possible increased need for supervision throughout.

Peer Review reports

In 2021, the International Council of Nurses (ICN) [ 1 ] acknowledged Nurse Anesthetists (NAs) as Advanced Practice Nurses (APNs), and recommended education programs at a minimum of masters’ degree level (120 European Credit Transfer and Accumulation System, (ECTS)). To date, NA education programs vary in length and contents globally, directed by national legislations and needs [ 2 ]. Despite similarities in NAs’ role and responsibilities in the Nordic countries, there are great variations in education programs, comprising from 30 to 120 ECTS [ 3 ]. In Norway, NA education programs previously comprised 90 ECTS [ 4 ]. One of the prerequisites for entry to the program was a minimum of two years of relevant, full-time, clinical experience as a nurse. From 2012, masters’ degree programs have been established, and in 2022 a national guideline for NA education programs was implemented [ 5 ]. The guideline specifies that all NA education programs must as a minimum include 30 weeks of clinical practice of 30 h each. Prerequisites are having a bachelor degree in nursing, and a Norwegian authorization as a nurse. ICN states that a prerequisite for entry to NA education programs is a minimum of one-year nursing experience, preferably in acute care [ 1 ]. However, as a consequence of the national guideline, several Norwegian universities have discarded the prerequisite of nursing experience, allowing for students to enter directly from the nursing bachelor program to the NA education program.

Summary of existing literature

Only two studies focusing on the impact of clinical nursing experience as a prerequisite to NA education programs have, as far as we know, been conducted the last 12 years. In 2011, Burns [ 6 ] identified a statistically significant positive relationship between prerequisites such as grades and critical care experience, and academic progression for NA students. In 2014, Collins & Callahan [ 7 ] claimed that prerequisites in general do not ensure positive progression and graduation for NA students. However, the aim of their study was to demonstrate the need for valid clinical evaluation tools.

In Norway, NAs traditionally have been qualified to independently administer general anesthesia for minor operations on otherwise healthy patients, and to work in a team with an anesthesiologist on anesthesia for major operations and patients with more complex illnesses [ 8 ]. The aim of the current study was to explore NA students’ experiences of the impact their previous clinical nursing experience had on their academic progression towards the independent role as a NA.

Materials and methods

Study design.

The study had a qualitative design, using semi-structured, individual interviews to explore NA students’ experiences. A qualitative approach is appropriate when aiming to explore how individuals experience a phenomenon, dependent on their background, interests and interpretation [ 9 ]. The study is reported in-line with the Consolidated criteria for reporting qualitative research– COREQ [ 10 ].

Participants

NA students were invited to participate at the end of a 90 ECTS NA education program from one university in Southeastern-Norway, which allows a variation from at least nine hospitals in the region. A purposive sampling strategy was used, selecting information rich cases for in-depth study [ 9 ]. Maximum variation sampling was sought [ 11 ], focusing on inviting participants of both gender, a range in age, from different geographical areas and with a variation in years and sort of previous working experience as a nurse. The inclusion criteria to participate in the study were NA students who were to complete 90 ECTS of the NA education, with at least to years of clinical experience prior to NA education start.

An open invitation was sent out through the program coordinator at the university. NA students in their third semester were invited to participate. Participants were asked to contact one of the first authors to agree on an interview. Pragmatically, the sample was set to 12 participants. This was assumed purposive, due to the narrow research aim, to ensure sufficient information power [ 12 ].

Interview guide

An interview guide was developed based on several discussions within the research group until consensus was reached (Table  1 ).

The interview guide was piloted in one (female) NA, to ensure that the guide was understandable, logic, and relevant. Some of the questions were shortened, using fewer words, two questions were deleted, and the final question was added to the interview guide.

Data collection

Due to the Covid-19 pandemic, interviews were conducted remotely, through the safe digital platform Zoom, in the period May-June 2022. The interviews lasted from 25 to 55 min. In the first interview, all authors were present, to validate the interview guide and data collection procedure. Remaining interviews were conducted by the two first authors together (CAL, SØ), one of them being the most active part, and the other one taking notes and posing follow-up questions if needed. Repeatedly during the interviews, the least active author orally summarized the participants’ responses as a validation of the participants’ statements [ 9 ]. Interviews (sound only) were digitally recorded and transcribed verbatim by one of the authors respectively (CAL, SØ, ACLL).

Reflexivity

ACLL is a professor and NA, with nine years of clinical experience as a nurse prior to partaking the NA education, and over ten years of NA experience. She is well experienced with qualitative research methods. CAL and SØ are both NAs with 2.5 and 3 years of experience as nurses respectively, prior to partaking the NA education. The study was conducted as part of CAL and SØ’s masters’ degree. Hence, participants were students at the same program as the two first authors. However, in recruitment of participants, the focus was on avoiding inclusion of students familiar to the authors. Also, the last author contributed throughout with critical reflections and input, both during data collection, analysis, and interpretation of findings.

Thematic, inductive analysis in five steps, in-line with recommendations from Braun & Clarke [ 13 ], was used to analyze the data. In step one, the two first authors read and re-read the transcripts to get an impression of the whole, and to familiarize with the data. Then, each transcript was coded inductively, by manually marking central key words (CAL, SØ). The codes were then reviewed by the last author (ACLL). In step two, codes across all interviews were collated, and CAL/SØ searched for aspects that were related, and that could be identified as initial sub-themes. Here, all sub-themes were marked with different colors on paper-sheets. In step three, the codes and sub-themes were then assessed and discussed by all authors, until consensus was reached. In step four, the sub-themes were reviewed, and in step five, the final themes and sub-themes were identified and named through iterative discussions among the three authors until consensus was reached.

Ethics approval and consent for participation

The study was approved by the Norwegian Center for Research Data (NSD) (Ref. no. 267,130), with regards to confidentiality issues. According to Norwegian legislations, no ethics approval is needed when interviewing healthcare personnel [ 14 ]. The study was conducted in-line with the Declaration of Helsinki [ 15 ]. Participants gave their written, informed consent to participate, and were informed that they could withdraw the consent at any point without any negative consequences. The data was handled confidentially and anonymously, and it is not possible to recognize individuals in the presentation of results.

In total 12 NA students participated (two male) in semi-structured interviews. The participants had from 3.5 to 20 years (mean 10 years) of experience as a nurse prior to entry to the NA education program. They were recruited from four different hospitals.

All the participants thought that the NA education would have been even more demanding if they hadn’t had previous experience as a nurse, supporting their learning of new theory and skills. With this as a basis, they did not have to learn basic nursing skills and could focus on the anesthesia-specific theory and practice. Through analysis, two main themes with a total of six subthemes were identified. Table  2 gives and overview of the relation between themes and subthemes.

Experience develops non-technical skills

All participants reflected on that previous nursing experience had developed their non-technical skills within different areas.

Feeling secure in task management

Several of the participants described being used to meeting unforeseen events as a nurse. Several of the participants emphasized their ability to prioritize and work systematically, seeing the whole picture and continuously being prepared for a «worst case scenario». Some stated that, as a new nurse, it is difficult to focus on several things at the same time. Moreover, being used to a high workload and hectic days was seen as useful when meeting new challenges as a NA. Participant 3 stated that experience developed an ability to focus on the work tasks also in chaotic situations. Participant 9 said: «Having experienced chaotic situations- I think it is an advantage. To avoid contributing to the chaos yourself».

However, entering the new role as a NA student had been challenging. Several of the participants underlined the NA’s independent role, making it essential to feel secure on alternative actions, be able to assess the situation and decide what to do. To several of the participants, this felt overwhelming. But, as stated by participant 1, previous experience made this somewhat less overwhelming: «Even only four or five years of experience will make you more prepared and ready for taking action than having no experience as a nurse at all».

Recognizing different situations

All the participants referred to ‘tacit knowledge’ as being integrated through their previous experience. This was related to being able to recognize complex symptoms based on clinical observations, and being able to identify deterioration in patients’ condition, without being dependent on medical technical equipment. Participant 8 described this as «being able to identify deterioration before it becomes visible at the monitor». All of the participants linked this skill to having several years of clinical nursing experience. Participant 6 underlined: «It takes years to develop tacit knowledge. You must have seen very ill patients enough times before you can be able to recognize them».

Moreover, several of the participants described how previous clinical experience had provided them with a «bank of experiences», that they could add to during the NA education. For example, participant 1 elaborated:

«You know that if the patient gets nauseous, you think blood pressure decrease instead of just.if you’re nauseous you need Afipran».

Understanding my role in teamwork

Even if being a NA student was a new role for all of the participants, nine of the participants found previous experience with being part of teams as a nurse as a strength when taking their role in new team constructions. Participant 7 stated:

«From the emergency department, I’m used to gather the team if things flow… It’s the nurse’s role to collect the loose threads. Raising my voice is something I’ve learnt in the emergency department, and this has been useful».

Several of the other participants also emphasized having extensive experience with team communication, and that this had made them used to taking their place in the team. Participant 5 underlined the importance of not being afraid to ask if something is unclear, and to create a dialogue. For example, participant 6 thought this had made her not afraid of making the surgeon aware of changes in the patients’ condition during surgery. Specifically, this experience was found to be useful in the collaboration with the anesthesiologist. Previously, the participants had experienced being exposed to authoritarian physicians and reprisals, especially early in the nursing career. Having learnt how to deal with this was seen as a strength when entering the operating room. Participant 7 illustrated it like this:

«When I was new in the emergency department, I thought it was frightening to call a physician if the patient deteriorated. Now, I’m not afraid to call the anesthesiologist if I’m unsecure».

Integration of non-technical and technical skills

The participants also referred to having achieved technical skills and competence in various practical tasks also included in NAs’ work, due to their previous experience as a nurse. This enabled them to focus on anesthesia-specific issues, to further develop these skills, and last but not least to combine these skills with a patient-centred approach.

Possessing procedural competence

All of the participants agreed that the NA education program was based on an assumption that students were able to for example insert peripheral vein catheters (PVC), to prepare and administer medications and to handle critically ill patients. Several of the participants stated that without previous nursing experience, much effort would have been put into learning basic nursing skills and procedures. This would impact the focus on learning anesthesia-specific skills and procedures. Participant 12 said: «You have to train a lot on the basic skills before being able to advance to a higher level». Additionally, several of the participants had experience from specialized hospital wards, and hereby experience with non-invasive ventilation, ventilators and handling of multiple infusion pumps. This was also seen and advantage in the specialized setting the operating room is.

Additionally, this was related to having experience from an high-technological environment, which reduced the need to use time to learn to master the equipment.

Taking responsibility in medication administration

The participants described that their previous experience had contributed to an understanding of medications and medication administration, that increased their respect for this aspect of nursing. One of the participants [ 3 ] also underlined the importance of having administered medications without supervision. Participant 8 said: «No stress for me in the operating room when we needed to add a pressor, when the patient got unstable, or in airway difficulties. I’m used to such issues.» Participant 9 also described having an increased respect for the medications’ potency throughout his career, for example when in retrospect acknowledging having administered potent drugs too fast. He stated: «Many things I’ve learnt is scary when reflecting on it in retrospect. Having sedated patients on propofol, without knowing….I would have been more afraid now than then…So, overdosing, handling respiratory challenges, I have more respect and knowledge now than before».

Including a patient-centred approach

Most of the participants agreed that having experience with high-technological equipment gave an ability to see beyond the equipment itself, and focus on the patient. They emphasized that due to their previous knowledge and skills, the equipment was almost ‘invisible’. Participant 1 described it like this:

«I am so used to these technical gadgets.The equipment surrounding us, so this doesn’t distract me much. I don’t need to use much energy on it, and can provide safety and focus on the patient».

The balance of vigilance on the patient and on the equipment was described by several of the participants. For example, participant 7 stated:

«I noticed in practice that there are so many screens you’re supposed to overview, so it’s easy to forget the person lying there. But, I think that my previous experience with monitors…the screens…made it easier to week out the screen and rather monitor the patient».

However, one of the participants [ 12 ] reported that she did not get enough time to learn the monitoring equipment during the NA education, and that this had led to the patient being ignored.

This is, to our knowledge, the only study focusing on students’ experiences with clinical experience as a prerequisite to NA education. Our results indicate that previous clinical experience as a nurse prior to entry to a NA education program provides a basis of non-technical and technical competencies, that supports further learning and development of advanced level competencies that are needed for NAs.

In the current study, all participants stated that their previous nursing experience had developed their non-technical skills relating to task management, recognizing and interpreting various situations, and taking part in a new role, as a NA, in teamwork. These competencies are in-line with the non-technical skill areas described by e.g. Flynn et al. [ 16 ], namely situation awareness (recognizing and understanding), decision making (assessing risks and selecting options, re-evaluating), task management (prioritizing, planning and preparing), and teamworking (displaying authority and assertiveness, assessing roles and capabilities) [ 17 ]. Clinical decision-making is essential in anesthesia, and has been described as a central nursing practice task that links a nurse’s perceptions with behavior [ 18 ]. Of course, it may be argued that including participants with limited previous experience could have provided different results. To ensure a correct understanding of a patient’s problem and selection of the optimal intervention, cognitive decision-making processes have been underlined as essential to achieve quality nursing [ 19 ]. Hwang [ 20 ] stated that nurses’ decision-making processes should be founded on evidence-based knowledge, as well as personal knowledge and experience gained in clinical settings. Specifically, nurses with higher levels of knowledge and clinical competency have been found to make clinical decisions more intuitively [ 21 , 22 ]. Hence, shorter or no previous nursing experience prior to entry to the NA education program may impact on the students’ level of non-technical skills generally and in clinical decision-making specifically, throughout and at the end of the program. This again may lead to a need for revision of the curruculum, to ensure a certain level of non-technical skills before building this competence further due to removing the prerequisite. Until date, NA students in Norway have had the prerequisite of a minimum of two years clinical nursing practice prior to entry to the NA education program. Hence, this study should be repeated in students without clinical experience as a nurse both during and after completion of the NA, or other APN, education programs.

Additionally, participants in the current study reported having procedural and technical competence, as well as competence in medication administration, gained through their previous experience as nurses. This allowed for focusing on anesthesia specific issues in the NA education program, and that they felt able to ‘see the patient’ despite the high-technological environment. It would be interesting to explore whether lack of such experience is viewed as a challenge for inexperienced nurses partaking NA education programs. A key aspect of anesthesia practice is the ability to efficiently and safely perform practical procedures. Gaba et al. [ 23 ] differentiated between technical performance, as the ‘adequacy of actions taken from a medical and technical perspective’, and non-technical performance. According to Pedowitz and Marsh [ 24 ] there are three stages in the acquisition of procedural skills: cognition, integration, and automation. Cognition includes developing an understanding of the task. Integration means incorporating the knowledge from the cognition phase into the learning of the motor skills for the specific task. Finally, the task becomes automatic and even subconscious. The acquisition of competence in a procedural skill requires experience through a variable number of attempts depending on the skill [ 25 , 26 ]. Without previous clinical nursing experience, students would need to progress through all these stages during the NA education program alongside learning anesthesia-specific tasks.

Some studies focusing on prerequisites to nursing education have been conducted. For example, Yousafzai & Jamil [ 27 ] reported a significant relationship between admission criteria and the academic performance of nursing students. Moreover, a 2020 scoping review found that academic program admission criteria, nonacademic program admission criteria, and admission criteria formulas or scoring systems were predictors of student program success [ 28 ]. However, the authors concluded that significant gaps in the literature exist regarding standards for determining program admission criteria that may be used to predict student success in undergraduate nursing programs. Another review suggested that it is challenging to isolate one single variable as the best predictor of student success, but that using a combination of variables can offer a reliable prediction method [ 29 ]. Yet, we have not been able to identify further studies than Burns [ 6 ] focusing on the specific prerequisite of clinical experience.

Benner [ 30 ] explained the acquisition of nursing expertise through five expertise levels: novice, advanced beginner, competent, proficient, and expert. Here, nurses at the novice level are still in nursing school. At the advanced beginner level, nurses use learned procedures and rules to determine what actions are required in a concrete situation. When competent, nurses are task-oriented and structure their work to achieve specific goals. At the proficient level, nurses perceive situations as a whole and have more ability to recognize and respond to changing circumstances, and finally expert nurses recognize unexpected situations and can alert others to potential problems before they occur [ 31 ]. Participants in our study may be compared to the proficient and competent level as nurses.

Nurse competence has been shown to increase with experience [ 32 , 33 , 34 ]. McHugh & Lake [ 35 ] stated that clinical nursing expertise is related to individual nurse level of education and year experience. Lima et al. [ 32 ] found a significant increase of the competence level in the first 6 months of transition from nursing students to Registered Nurses. Lejonqvist et al. [ 36 ] showed that therapeutic interventions require contextual awareness and co-ordination skills that develop during practice and use. When being exposed to the anesthesia setting, the participants in our study also acknowledged the lack of competence. However, being competent in some areas, transferable to the new setting, made the capacity to learn both new theory and new practical skills wider.

Strengths and limitations

Within the qualitative design also lies the lack of generalizability of findings. It may be discussed that the trustworthiness of the findings in this study is challenged due to the limited number of participants, from one university and in a Norwegian setting only. However, participants came from four different hospitals, of both gender and a variation in age and years of experience as a nurse. Also, our interpretation was that we had reached saturation in our data, indicated by the identification of no new themes in consecutive interviews. Additionally, member checking throughout the interview was used to increase the credibility of the findings, and the agreement between participants also strengthen this. However, we could of course have presented the results to the participants as well.

Also, it may be seen as a limitation that the study was conducted as part of a masters’ degree, and by NAs with limited experience themselves. However, reflexivity was sought throughout the analysis and presentation of results, also involving the last and more experienced author.

Conclusions

This study adds knowledge about the value of previous clinical nursing experience before entry to a NA education program- as experienced by NA students. Non-technical and technical nursing competence represented a solid base for achievement of anesthesia competence within the same areas, also ensuring patient-centred practice. The change in prerequisites to the NA education program must be followed by evaluations of consequences on students’ academic progress and competence at the end of the program, as well as a possible increased need for supervision throughout.

Implications for further research

There is a need for ongoing evaluations of potential implications for future NA education programs, also following changes in prerequisites.

Data availability

The datasets supporting the conclusions of this article are included within the article.

Abbreviations

advanced practice nurse/nursing

nurse anesthetist/nurse anesthesia

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Cecilie Aanderud-Larsen, Sara Østlien and Ann-Chatrin Linqvist Leonardsen shared first authorship.

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Sykehuset i Vestfold, Halfdan Wilhelmsens alle 17, 3116, Tønsberg, Norway

Cecilie Aanderud-Larsen

Oslo University Hospital, Ullevål, Kirkeveien 166, 0450, Oslo, Norway

Sara Østlien

University of South-eastern Norway, Raveien 215, 3184, Borre, Norway

Ann-Chatrin Linqvist Leonardsen

Østfold University College, Postal box code 300, 1757, Halden, Norway

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CAL and SØ made a significant contribution to the conception, study design, acquisition of data, analysis and interpretation, took part in critically reviewing the article, gave final approval of the version to be submitted, and agree to be accountable for all aspects of the work. ACLL wrote the initial draft of the article, and contributed to the conception and design of the study, analysis and interpretation, and gave final approval of the version to be submitted.

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Aanderud-Larsen, C., Østlien, S. & Leonardsen, AC.L. Prerequisites for entry to advanced nurse practitioner studies- a qualitative study of Norwegian nurse anesthetist students’ experiences. BMC Med Educ 24 , 158 (2024). https://doi.org/10.1186/s12909-024-05137-3

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