EDITORIAL

The Purpose, Process,

and Methods of Writing
a Literature Review
JOY DON BAKER, PhD, RN-BC, CNOR, CNE, NEA-BC, FAAN,
EDITOR-IN-CHIEF

P erioperative nurses are bombarded with an over-

whelming volume of nursing and health care publi-
cations; however, in-depth literature reviews provide a
foundation for consolidating information from myriad publi-
cations with the potential to lead to improving clinical practice.
and avoid pitfalls in previous research.”1(p102) Literature
reviews afford a means for “validating assumptions” and
opinions and “providing insight into the dynamics underlying
the findings of other studies,” and they “may offer more
conclusive results than a single primary research study.”1(p102)
Authors write literature reviews to examine previous studies, Specific purposes of literature reviews are to
provide background regarding what is known on a topic, and
establish the foundation for a change in practice.1-3 Marshall
provide a theoretical framework for the specific topic under
defines a literature review as “a systematic method for identi- study;
fying, evaluating, and interpreting work produced by re-
define relevant or key terms and important variables used for
searchers, scholars, and practitioners.”2(p20) Using a culminating a study or manuscript development;
clinical literature review on a specific topic aids perioperative
provide a synthesized overview of current evidence for
nurses and other health care practitioners by providing a way practice to gain new perspectives and support assumptions
to identify best practices for clinical strategies and therefore and opinions presented in a manuscript using research
maximize their time with patients.1 Articulating what studies, quality improvement projects, models, case studies,
interventions are successful and unsuccessful is a targeted and so forth;
outcome of systematic literature reviews.4 This article focuses
identify the main methodology and research techniques
on four key elements of literature reviews: the purpose, previously used; and
preparation process, types, and methods.
demonstrate the gap (distinguishing what has been done from
what needs to be done) in the literature, pointing to the sig-
nificance of the problem and need for the study or building a
PURPOSE case for the quality improvement project to be conducted.1-3,5-7
Literature reviews should “objectively report the current
Building a case or defining a research gap assists an author in
knowledge on a topic”1(p102) and provide a summary of the best
positioning his or her own work in the context of previous
available research from previously published studies related to a
research findings.1-3 The clinical implications developed from
specific topic.1,5 The synthesis of the literature reviewed
a research study must also relate to its preceding literature
provides an informed perspective or a comprehensive overview
review.2 The purpose of a review focused on clinical
of the knowledge available on the topic. This detailed
intervention is generally stated as follows:
overview should be written in such a way as to provide clarity
and promote understanding by the reader.1 Clinicians and To assess the effect of [intervention or comparison] for [health
researchers use literature reviews in decision making as well as problem] in [types of people, disease, or problem], and health-
“to identify, justify, and refine hypotheses and to recognize care setting if appropriate. The parts of the review question
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ª AORN, Inc, 2016
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Baker March 2016, Vol. 103, No. 3

are often referred to as “PICO” (Participants, Interventions, clarify the resulting selection of articles.10 It is important for
Comparisons, and Outcomes). The included studies generally others to be able to follow or replicate the search processes
randomly assign participants to the intervention under inves- used and understand how the literature was selected.10
tigation or control or comparative intervention.8(p1-2) Conducting the search by using multiple electronic databases
is imperative. These databases may include but are not
limited to the following:
PREPARATION PROCESS
The literature review process begins with a research question
MEDLINE,
that clearly defines the topic and the intended audience.9
the Cumulative Index to Nursing and Allied Health
Authors can avoid searching and reading irrelevant papers by (CINAHL),
placing the specific research question(s) on which they are
Google Scholar,
building the literature review in a prominent visible location
ScienceDirect, and
as a reminder of the precise topic.2 Marshall suggests using a
the Cochrane Collaboration.2
three-stage process to develop an effective literature review:
searching, critiquing, and synthesizing.2 These three Critiquing
elements then lead to the culminating stage of writing the Critical evaluation is a process of applying rigorous and
literature review for dissemination. consistent literature review methods to provide an analysis or
deconstruction of the content.2 Reviewers should determine
the strengths and weaknesses of the evidence presented in
Searching
the literature, whether the results are small or provide a
A complete review of the literature incorporates an appropriate
power sufficient for generalization, and whether the evidence
breadth and depth of the topic.2 Searching and re-searching
provided can possibly change clinical practice.10
the literature to gather and collect data for analysis are
critical elements of the literature review development As a means to evaluate research studies and consider changes
process. To search the literature effectively, reviewers must to practice, AORN perioperative practice specialists developed
have clear inclusion and exclusion criteria to ensure a new evidence rating model and new research appraisal tools.
relevancy to the study or topic.2 They must define the years The AORN Research Evidence Appraisal TooldSummary is
of inclusion, such as literature from the past five years. It is designed for appraising systematic reviews of multiple quan-
important to be up-to-date, but older seminal studies may titative and qualitative studies, and the AORN Research
also have a role in the literature review article.9 The reviewer Evidence Appraisal TooldStudy is designed for appraising
must provide rationale for the inclusion of older studies. singular quantitative and qualitative studies.11 Using a tool to
analyze the articles under consideration for inclusion allows for
The search can yield three different results or a combination of consistency among team members when evaluating a large
the three. There could be: sample of articles divided among the team for initial
evaluation. Exploring the value of an article in relation to

A common consensus or near consensus about a topic. If this
the topic in question is critical to producing a solid,
is so, this will represent the conventional wisdom on a topic.
informative review.

Areas of disagreement or debate, which give rise to various
schools of thought.

Gaps in the literature, eg, questions that have not been Synthesizing and Writing
researched or perspectives that none has considered.2(p21) Synthesizing the available literature results from critical anal-
ysis of the varied sources and leads to a summary of knowledge
Extremely large search results can make a review difficult to on the topic.2 It is important that an author of a literature
handle, particularly if there is a limited time frame and budget review recognizes his or her own biases and seeks
with which to conduct the search. In that case, reviewers objectivity.1,2 This lends credibility to the work for
should consider narrowing the focus of the search to “that publication. One’s own viewpoint is acceptable when it can
produced by leading authorities, work that is the most recent be justified clearly for the reader. This includes using one’s
(five years or less), and work that most closely aligns with your own previously published works; however, objectivity
own.”2(p22) Reviewers should always take detailed notes becomes critical as the author writes the literature review.2,9
regarding search methods and while reading the articles,9 It is important to be critical for both positive and negative
noting specifically the databases and key words used, and results and apply consistent methods. Remaining focused on

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March 2016, Vol. 103, No. 3 Editorial

the research question for the review will help produce older reference, and it is best if it is limited to no more than
constructive outcomes.2,9 one to three such resources to support opinions in a
manuscript. The current state of the science information
The reviewer must determine the type of review to conduct, that is relevant to any given topic is what is sought for
find a logical structure for writing the literature review, and literature reviews.
clarify the rationale for the final selection of literature used and
information suggesting reliability and validity of specific Traditional methods (eg, the narrative method of review) can
studies.9,10 Conciseness and a clear focus is imperative when result in evidence that is mixed or conflicting, with little infor-
writing a literature review to help make it of interest to the mation about why an intervention did or did not work, spe-
targeted audience.2,9,12 Authors of literature reviews also seek cifically when applied in contexts different from the original
and make use of quality feedback from peers and experts studies and purposes.13 Weaknesses that must be considered
before submitting the article.9 This process improves the when preparing or critiquing studies for a literature review
results with each iterative draft during the preparation of the are: “(a) A large number of studies may make it difficult to
article for publication. draw conclusions, and (b) the process is subject to bias
[subjectivity] that supports the researcher’s own work,”14 and
TYPES AND METHODS an unsystematic approach “lacks explicit criteria for inclusion
According to Goodall et al,13 the nursing and medical and leads to a biased review.”1(p104) Faulty synthesis can be
professions approach data collection for research from perpetuated when subsequent authors base their work(s) on
different perspectives, with nursing favoring mixed methods faulty reviews, thus leading to a “potential danger in health
or qualitative research and medicine favoring the quantitative care if readers make patient health care decisions based
approach. Two types of reviews (narrative and systematic) upon faulty reviews.”1(p104) Narrative reviews are generally
and two methods for conducting reviews (meta-analysis and descriptive and may use limited search strategies, resulting in a
mixed methods) are explored in this section. subset of studies based on availability or author selection that
can reflect bias in the paper.4 However, narrative literature
reviews provide updates for the perioperative nurse and
Narrative or Traditional Review promote discourse among professionals.1
There are two ways narrative or focused overviews of the
literature are used in a scholarly journal, such as the AORN
Journal. The first is to provide the foundational overview and Systematic Review
significance of a problem addressed in a full-length manu- A systematic review uses a detailed, rigorous method to
script. This foundation illustrates the state of the nursing summarize results of health care studies (eg, controlled trials).
science from current literature (within the past five years) and The detailed search of the literature is structured around a
illustrates the gap in research or lays groundwork for content focused question, allowing the researcher to develop criteria for
to be presented in the manuscript (ie, clinical, management, inclusion or exclusion, effectiveness of the intervention, and
research, quality improvement, education, literature review, judgment regarding evidence that informs recommendations
concept analysis articles). The second type is a stand-alone for practice.1,4,5,16 This plan subsequently assists the
research article, including a “comprehensive narrative synthe- researcher in reducing bias and limiting subjectivity.4
sis of previously published information.”1(p103) Using a
narrative approach to a literature review, an author “(a) This complex and often time-consuming process is developed
critiques and summarizes a body of literature, (b) draws through a step-by-step sequence of iterative evaluation of the
conclusions about the topic, (c) identifies gaps or content under review.16 Maintaining a detailed list of the
inconsistences in a body of knowledge, and finally [leads the databases searched, key words and phrases used, and time
reader to] (d) a sufficiently focused research question.”14 frame for search inclusion (eg, the previous five years) are
critical for referencing and tracking progress and potential
Timeliness of the content and extent of the review are future replication purposes.4,5,14,16 The next step is
important. However, there are times when a seminal work, screening the articles and reviewing titles and abstracts,
such as Benner’s Novice to Expert model,15 which is well excluding those that do not meet the predetermined criteria,
known to the perioperative nurse, may be used to provide to aid in narrowing the full-text review.16
the framework or theory basis for the study and therefore
should be included in the literature review portion of the Subsequently, each paper is reviewed generally with a
manuscript. The author must build a case for including an scoring system by the author.1,5 The author then creates an

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Baker March 2016, Vol. 103, No. 3

evidence table for recording the data from the screening to regarding the processes of mixed methods. For example, the
track the information gleaned.1 This method is qualitative realist or meta-synthesis “approach seeks to establish what
because the integrative summary includes a critique of works, for whom, in what circumstances, in what respects,
the findings, but the results of all studies are not to what extent and why, and provides the option of a realist
statistically combined.1 literature review, also known as a realist synthesis.”13(p33),19
In Sandelowski’s method, “syntheses are conducted
Meta-analysis separately and then recommendations from the qualitative
A meta-analysis is a quantitative statistical analysis of multiple syntheses are used to contextualize quantitative data and
studies with similar experiments to test the pooled data for generate reasons behind the success and/or failure of a
statistical significance.1,2,14,17 This process affords conclusions program.”18(p7),20 In another approach, “two or more
to be drawn and patterns and relationships to be identified by [separate] syntheses are conducted and then combined in a
the author.14 The summary effect size measures the “strength secondary synthesis.”18(p7)
of the relationship between two variables [in this case from Multiple frameworks can be used to develop the mixed
multiple studies], thereby providing information about the methods review. However, regardless of the framework
magnitude of the intervention effect (i.e., small, medium, or selected by the author(s) when preparing the review, they
large).”4(p57) Therefore, meta-analysis is especially useful to should convert the “summary into one or more statements
authors and practitioners when reports of clinical trials exist explicitly describing what a clinician needs in order to adhere
in the literature but possess low sample sizes that prevent to evidence-based best practice.”18(p17) This summary
the authors from making conclusions that can be generalized statement of a mixed-methods review should take on an
to the population at large. “This can be particularly indicative approach, meaning “The clinician should consider
powerful if the studies under review are very similar in their administering X rather than Y as this has been shown to be
construction because several studies can be combined as one both more effective and results in shorter length of hospital
larger base of data leading to more powerful [effect size] stay.”18(p17) The Joanna Briggs Institute uses “the segregated
conclusions.”1(p105) Uman suggests eight stages of systematic approach to the mixed methods synthesis” consisting of
review and meta-analysis: “separate syntheses of each component method of the
1. Formulate the review question. review.”18(p19) Those separate syntheses are then used “to
2. Define inclusion and exclusion criteria (PICO or translate the findings of the initial quantitative synthesis into
PICOC: population, intervention, comparison, out- qualitative theme and pooling these with the findings of the
comes, and context). initial qualitative synthesis” (Figure 1).18(p19)
3. Develop the search strategy and locate studies. The meta-synthesis review is appropriate when studies such as
4. Select studies. intervention comparative trials, either controlled or non-
5. Extract data. randomized, “produced inconsistent estimates of efficacy
6. Assess study quality. and there is no consensus on when, how and with whom to
7. Analyze and interpret the results. use these interventions.”13(p33) A meta-synthesis incorporates
8. Disseminate the findings.4(p57-59)

The limited similarity of the studies can make it difficult to

determine valid comparisons.1 However, this high level of
evidence lends itself to broader, more generalizable
conclusions than the single-purpose study as a result of the
rigorous critique of pooled data.1

Mixed Methods (Meta-synthesis)

The mixed method or meta-synthesis is a “focus on pooling
the findings of both quantitative and qualitative inquiry.”18(p5)
This method of focusing on evidence-based practice narrows
the gap between research and practice with the potential for Figure 1. Joanna Briggs Institute model of mixed
relevance to policymakers, leaders, and practitioners,18 such method synthesis.18(p20) Reproduced with permission
as perioperative nurses. There are varied schools of thought from The Joanna Briggs Institute.

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March 2016, Vol. 103, No. 3 Editorial

6. Roush K. A Nurse’s Step-By-Step Guide to Writing Your Disser-

Writing a Literature Review for the AORN Journal tation or Capstone. Indianapolis, IN: Sigma Theta Tau International;
Review the AORN Journal author guidelines (http:// 2015.
www.aornjournal.org/content/authorinfo) and reference the 7. Purpose of literature review. RMIT University. https://www.dlsweb
.rmit.edu.au/lsu/content/2_assessmenttasks/assess_tuts/lit_review_
literature review manuscript category, which provides a
LL/purpose.html. Accessed January 12, 2016.
detailed outline in Appendix K under the Seven Main 8. What is a systematic review? Cochrane Consumer Network.
Article Categories heading. http://consumers.cochrane.org/what-systematic-review. Accessed
January 12, 2016.
non-statistical technique; integrates, evaluates, and interprets 9. Pautasso M. Ten simple rules for writing a literature review. PLoS
findings of multiple qualitative studies, identifies common core Comput Biol. 2013;9(7):e1003149.
elements and themes; may use findings from phenomenological, 10. Fowler J. Written communication: from staff nurse to nurse
grounded theory, or ethnographic studies; and involves consultant. Br J Nurs. 2015;24(1):62.
11. Spruce L, Van Wicklin SA, Wood A. AORN’s revised model for
analyzing and synthesizing key elements,14
evidence appraisal and rating. AORN J. 2016;103(1):60-72.
with a goal of transforming “individual findings into new 12. Appendix K: Comprehensive literature reviews. Elsevier. http://cdn
.elsevier.com/promis_misc/K_LiteratureReviewSampleOutline.pdf
conceptualizations and interpretations.”14
Accessed January 12, 2016.
13. Goodall DL, Marples G, Roberts K. Approaches to producing
CONCLUSION credible and useful literature reviews. Cancer Nursing Pract. 2013;
Literature reviews that enrich perioperative clinical practice by 12(3):31-35.
connecting research and practice are needed. Perioperative 14. Literature review: lit review types. The University of Toledo. http://
nurses may use the various types of literature reviews to assist libguides.utoledo.edu/c.php?g¼284354&p¼1893889. Updated
in determining best practices for improving patient safety, December 9, 2015. Accessed January 12, 2016.
reducing medication errors, selecting interventions for pre- 15. Benner P. From Novice to Expert: Excellence and Power in Clinical
Nursing Practice. Menlo Park, CA: Addison-Wesley Publishing Co;
vention of pressure ulcers, or other clinical interventions.
1984.
Literature reviews are used to fill the gap between research and
clinical practice.
16. O’Mara-Eves A, Thomas J, McNaught J, Miwa M, Anaiadou S. Using
text mining for study identification in systematic reviews: a systematic
review of current approaches. Syst Rev. 2015;4(5):1-22.
Editor’s notes: Medline is a registered trademark of the National
17. Meta-analysis. Merriam Webster Dictionary. http://www.merriam
Library of Medicine, Bethesda, MD. CINAHL (Cumulative -webster.com/dictionary/meta-analysis. Accessed January 12, 2016.
Index to Nursing and Allied Health Literature) is a registered 18. Pearson A, White H, Bath-Hextall F, Apostolo J, Salmond S,
trademark of EBSCO Industries, Birmingham, AL. Cochrane Kirpatrick P. The Joanna Briggs Institute Reviewers’ Manual 2014:
Collaboration is a registered trademark of Cochrane Collaboration, Methodology for JBI Mixed Methods Systematic Reviews.
Oxford, UK. Adelaide, South Australia: The Joanna Briggs Institute; 2014.
19. Realist synthesis: new protocols for systematic review. In:
Pawson R, ed. Evidence-based Policy. London, England: SAGE
References Publications Ltd; 2006:73-105.
1. Green BN, Johnson CD, Adams A. Writing narrative literature re- 20. Sandelowski M, Leeman J, Knafl K, Crandell JL. Text-in-context: a
views for peer-reviewed journals: secrets of the trade. J Chiropr method for extracting findings in mixed-methods mixed research
Med. 2006;5(3):101-117. synthesis studies. J Adv Nurs. 2013;69(6):1428-1437.
2. Marshall G. Writing.a literature review. Synergy: Imaging &
Therapy Practice [serial online]. March 2010; 20-23. Accessed
December 19, 2015.
3. Jaidka K, Khoo C, Na JC. Literature review writing: how infor- Joy Don Baker, PhD, RN-BC, CNOR, CNE, NEA-BC,
mation is selected and transformed. Aslib Proc. 2013;65(3): FAAN, is the editor-in-chief of the AORN Journal and a
303-325. professor of clinical nursing at the University of Texas
4. Uman LS. Systematic reviews and meta-analyses. J Can Acad at Arlington College of Nursing and Health Innovation.
Child Adolesc Psychiatry. 2011;20(1):57-59. Dr Baker has no declared affiliation that could be
5. What is a systematic review? The Campbell Collaboration. http:// perceived as posing a potential conflict of interest in
www.campbellcollaboration.org/what_is_a_systematic_review/index the publication of this article.
.php. Accessed January 12, 2016.

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