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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 sample pdf nursing

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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Health (Nursing, Medicine, Allied Health)

  • Find Articles/Databases
  • Reference Resources
  • Evidence Summaries & Clinical Guidelines
  • Drug Information
  • Health Data & Statistics
  • Patient/Consumer Facing Materials
  • Images and Streaming Video
  • Grey Literature
  • Mobile Apps & "Point of Care" Tools
  • Tests & Measures This link opens in a new window
  • Citing Sources
  • Selecting Databases
  • Framing Research Questions
  • Crafting a Search
  • Narrowing / Filtering a Search
  • Expanding a Search
  • Cited Reference Searching
  • Saving Searches
  • Term Glossary
  • Critical Appraisal Resources
  • What are Literature Reviews?
  • Conducting & Reporting Systematic Reviews
  • Finding Systematic Reviews
  • Tutorials & Tools for Literature Reviews
  • Finding Full Text

What are Systematic Reviews? (3 minutes, 24 second YouTube Video)

Systematic Literature Reviews: Steps & Resources

literature review sample pdf nursing

These steps for conducting a systematic literature review are listed below . 

Also see subpages for more information about:

  • The different types of literature reviews, including systematic reviews and other evidence synthesis methods
  • Tools & Tutorials

Literature Review & Systematic Review Steps

  • Develop a Focused Question
  • Scope the Literature  (Initial Search)
  • Refine & Expand the Search
  • Limit the Results
  • Download Citations
  • Abstract & Analyze
  • Create Flow Diagram
  • Synthesize & Report Results

1. Develop a Focused   Question 

Consider the PICO Format: Population/Problem, Intervention, Comparison, Outcome

Focus on defining the Population or Problem and Intervention (don't narrow by Comparison or Outcome just yet!)

"What are the effects of the Pilates method for patients with low back pain?"

Tools & Additional Resources:

  • PICO Question Help
  • Stillwell, Susan B., DNP, RN, CNE; Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN; Melnyk, Bernadette Mazurek, PhD, RN, CPNP/PMHNP, FNAP, FAAN; Williamson, Kathleen M., PhD, RN Evidence-Based Practice, Step by Step: Asking the Clinical Question, AJN The American Journal of Nursing : March 2010 - Volume 110 - Issue 3 - p 58-61 doi: 10.1097/01.NAJ.0000368959.11129.79

2. Scope the Literature

A "scoping search" investigates the breadth and/or depth of the initial question or may identify a gap in the literature. 

Eligible studies may be located by searching in:

  • Background sources (books, point-of-care tools)
  • Article databases
  • Trial registries
  • Grey literature
  • Cited references
  • Reference lists

When searching, if possible, translate terms to controlled vocabulary of the database. Use text word searching when necessary.

Use Boolean operators to connect search terms:

  • Combine separate concepts with AND  (resulting in a narrower search)
  • Connecting synonyms with OR  (resulting in an expanded search)

Search:  pilates AND ("low back pain"  OR  backache )

Video Tutorials - Translating PICO Questions into Search Queries

  • Translate Your PICO Into a Search in PubMed (YouTube, Carrie Price, 5:11) 
  • Translate Your PICO Into a Search in CINAHL (YouTube, Carrie Price, 4:56)

3. Refine & Expand Your Search

Expand your search strategy with synonymous search terms harvested from:

  • database thesauri
  • reference lists
  • relevant studies

Example: 

(pilates OR exercise movement techniques) AND ("low back pain" OR backache* OR sciatica OR lumbago OR spondylosis)

As you develop a final, reproducible strategy for each database, save your strategies in a:

  • a personal database account (e.g., MyNCBI for PubMed)
  • Log in with your NYU credentials
  • Open and "Make a Copy" to create your own tracker for your literature search strategies

4. Limit Your Results

Use database filters to limit your results based on your defined inclusion/exclusion criteria.  In addition to relying on the databases' categorical filters, you may also need to manually screen results.  

  • Limit to Article type, e.g.,:  "randomized controlled trial" OR multicenter study
  • Limit by publication years, age groups, language, etc.

NOTE: Many databases allow you to filter to "Full Text Only".  This filter is  not recommended . It excludes articles if their full text is not available in that particular database (CINAHL, PubMed, etc), but if the article is relevant, it is important that you are able to read its title and abstract, regardless of 'full text' status. The full text is likely to be accessible through another source (a different database, or Interlibrary Loan).  

  • Filters in PubMed
  • CINAHL Advanced Searching Tutorial

5. Download Citations

Selected citations and/or entire sets of search results can be downloaded from the database into a citation management tool. If you are conducting a systematic review that will require reporting according to PRISMA standards, a citation manager can help you keep track of the number of articles that came from each database, as well as the number of duplicate records.

In Zotero, you can create a Collection for the combined results set, and sub-collections for the results from each database you search.  You can then use Zotero's 'Duplicate Items" function to find and merge duplicate records.

File structure of a Zotero library, showing a combined pooled set, and sub folders representing results from individual databases.

  • Citation Managers - General Guide

6. Abstract and Analyze

  • Migrate citations to data collection/extraction tool
  • Screen Title/Abstracts for inclusion/exclusion
  • Screen and appraise full text for relevance, methods, 
  • Resolve disagreements by consensus

Covidence is a web-based tool that enables you to work with a team to screen titles/abstracts and full text for inclusion in your review, as well as extract data from the included studies.

Screenshot of the Covidence interface, showing Title and abstract screening phase.

  • Covidence Support
  • Critical Appraisal Tools
  • Data Extraction Tools

7. Create Flow Diagram

The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow diagram is a visual representation of the flow of records through different phases of a systematic review.  It depicts the number of records identified, included and excluded.  It is best used in conjunction with the PRISMA checklist .

Example PRISMA diagram showing number of records identified, duplicates removed, and records excluded.

Example from: Stotz, S. A., McNealy, K., Begay, R. L., DeSanto, K., Manson, S. M., & Moore, K. R. (2021). Multi-level diabetes prevention and treatment interventions for Native people in the USA and Canada: A scoping review. Current Diabetes Reports, 2 (11), 46. https://doi.org/10.1007/s11892-021-01414-3

  • PRISMA Flow Diagram Generator (ShinyApp.io, Haddaway et al. )
  • PRISMA Diagram Templates  (Word and PDF)
  • Make a copy of the file to fill out the template
  • Image can be downloaded as PDF, PNG, JPG, or SVG
  • Covidence generates a PRISMA diagram that is automatically updated as records move through the review phases

8. Synthesize & Report Results

There are a number of reporting guideline available to guide the synthesis and reporting of results in systematic literature reviews.

It is common to organize findings in a matrix, also known as a Table of Evidence (ToE).

Example of a review matrix, using Microsoft Excel, showing the results of a systematic literature review.

  • Reporting Guidelines for Systematic Reviews
  • Download a sample template of a health sciences review matrix  (GoogleSheets)

Steps modified from: 

Cook, D. A., & West, C. P. (2012). Conducting systematic reviews in medical education: a stepwise approach.   Medical Education , 46 (10), 943–952.

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Library Home

Literature Reviews for Education and Nursing Graduate Students

(15 reviews)

literature review sample pdf nursing

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.

Attribution

Learn more about reviews.

Reviewed by Rebecca Appleton, Professor of Nursing, Marshall University on 5/7/24

It is very through in covering the steps of a well written literature review read more

Comprehensiveness rating: 5 see less

It is very through in covering the steps of a well written literature review

Content Accuracy rating: 5

I have not read the entire book, but what I did read was very good.

Relevance/Longevity rating: 5

It is up to date, but doing a Literature Review is covered in a step-wise manner, includes writing the LR>

Clarity rating: 5

Very clear step-by-step approach

Consistency rating: 5

It is very consistent!

Modularity rating: 5

Chapters are orderly and succinct

Organization/Structure/Flow rating: 5

Strait forward order.

Interface rating: 5

I did not notice Interface issues.

Grammatical Errors rating: 5

No grammatical errors were noticed.

Cultural Relevance rating: 5

I did not notice any problems with cultural Insensitivity

I plan to use this in a Nursing Research class for Graduate Students, and I am trying a new approach to finding the best Research Evidence on a Nursing Topic. Can't wait to see if this help my graduate students understand research literature better.

Reviewed by Barbara Schneider, Professor, University of Texas at Arlington on 4/29/24

This textbook covers the range of topics important for a literature review, including formulating a research question, finding scholarly articles, evaluating sources, and synthesizing source content. The videos are great supplements to the text. read more

This textbook covers the range of topics important for a literature review, including formulating a research question, finding scholarly articles, evaluating sources, and synthesizing source content. The videos are great supplements to the text.

Overall, the content is accurate. Consider labeling Nursing as a health profession/discipline.

Relevance/Longevity rating: 4

Much of the content remains relevant. Updated examples would be helpful to today's graduate students.

The textbook is clearly written.

Consistency rating: 4

In general, the text is consistent. There could be more consistency in the formatting of the references.

The modularity is an asset.

There is a logical flow to the topics.

The links to outside materials are helpful.

No grammatical errors were evident.

The examples seemed inclusive.

Those who are new to writing a literature review would find this book useful.

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

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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: 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.

  • Brainfuse Tutoring and Writing Assistance for Regis Online Students by Tricia Reinhart Last Updated Oct 26, 2023 335 views this year
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Book Title: Literature Reviews for Education and Nursing Graduate Students

Authors: Linda Frederiksen, Sue F. Phelps

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Book Description: This open textbook is designed for students in graduate-level nursing and education programs. From developing a research question to locating and evaluating sources to writing a sample literature review using appropriate publication guidelines, readers will be guided through the process. This book has been peer-reviewed by 7 subject experts and is now available for adoption and use in courses or as a library resource. If you’d like to adopt the book, please let us know . You can view the book's Review Statement for more information about reviewers and the review process. The Accessibility Assessment for this is book is also available. If you'd like to adopt or adapt this book, please let us know .

Book Information

Book description.

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.

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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Nursing - Graduate Studies Research Guide

Literature review, literature review steps.

  • Scholarly Writing
  • Library Presentations

Templates for Starting Your Literature Review

  • Literature search strategy planner
  • Literature search log template
  • Review Literature
  • Literature Matrix

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literature review sample pdf nursing

A literature review is an essay or part of an essay that summarizes and analyzes research in a particular discipline. It assess the literature by reviewing a large body of studies on a given subject matter. It summarizes by pointing out the main findings, linking together the numerous studies and explaining how they fit into the overall academic discussion on that subject. It critically analyzes the literature by pointing out the areas of weakness, expansion, and contention. 

Literature Review Sections:

  • Introduction: indicates the general state of the literature on a given subject.
  • Methodology: states  where (databases), how (what subject terms used on searches), and what (parameters of studies that were included); so others may recreate the searches and explain the reasoning behind the selection of those studies.
  • Findings: summary of the major findings in that subject.
  • Discussion: a general progression from broader studies to more focused studies.
  • Conclusion: for each major section that again notes the overall state of the research, albeit with a focus on the major synthesized conclusions, problems in the research, and even possible avenues for further research.
  • References: a list of all the studies using proper citation style. 

Literature Review Tips:

  • Beware of stating your own opinions or personal recommendations (unless you have evidence to support such claims).
  • Provide proper references to research studies.
  • Focus on research studies to provide evidence and the primary purpose of the literature review.
  • Connect research studies with the overall conversation on the subject.
  • Have a search strategy planner and log to keep you focused.

Literature reviews are not a book reports or commentaries; make sure to stay focused, organized, and free of personal biases or unsubstantiated recommendations.

Literature Review Examples:

  • Lemetti, T., Stolt, M., Rickard, N., & Suhonen, R. (2015). Collaboration between hospital and primary care nurses: a literature review. International Nursing Review , 62 (2), 248-266. doi:10.1111/inr.12147  

1. Choose a topic and define your research question.

Your literature review should be guided by a focus research question.   Consider PICO and FINER criteria for developing a research question.

  • Make sure your research question is not too broad or too narrow. Do a couple of pre-searches to see what information is out there and determine if it is a manageable topic.
  • Identify the main concepts of your research question and write down terms that are related to them. Keep a list of  terms that you can use when searching.
  • If possible, discuss your topic with your professor. 

2. Decide on the scope of your review.

Check with your assignment requirements and your professor for parameters of the Literature Review.

  • How many studies are you considering?
  • How comprehensive will your literature review be?
  • How many years should it cover? 

3. Select appropriate databases to search.

Make a list of the databases you will search. 

  • Don't forget to look at books, dissertations or other specialized databases .
  • Contact your librarian to make sure you are not missing any vital databases for that topic.

4. Conduct searches and find relevant literature.

As you are searching in databases is important to keep track and notes as you uncover information.

  • Read the abstracts of research studies carefully instead of just downloading articles that have good titles.
  • Write down the searches you conduct in each database so that you may duplicate or avoid unsuccessful searches again.
  • Look at the bibliographies and references of research studies you find to locate others .
  • Look for subject terms or MeSH terms that are associated with the  research studies you find and use those terms in more searches.
  • Use a citation manager such as Zotero or Endnote Basic to keep track of your research citations.

5. Review the literature. 

As you are reading the full articles ask the following questions when assessing studies:

  • What is the research question of the study?
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  • Are there any conflicting studies; if so why?

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The impact of evidence-based nursing leadership in healthcare settings: a mixed methods systematic review

  • Maritta Välimäki 1 , 2 ,
  • Shuang Hu 3 ,
  • Tella Lantta 1 ,
  • Kirsi Hipp 1 , 4 ,
  • Jaakko Varpula 1 ,
  • Jiarui Chen 3 ,
  • Gaoming Liu 5 ,
  • Yao Tang 3 ,
  • Wenjun Chen 3 &
  • Xianhong Li 3  

BMC Nursing volume  23 , Article number:  452 ( 2024 ) Cite this article

Metrics details

The central component in impactful healthcare decisions is evidence. Understanding how nurse leaders use evidence in their own managerial decision making is still limited. This mixed methods systematic review aimed to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurse leaders and their performance, organizational, and clinical outcomes.

We included articles using any type of research design. We referred nurses, nurse managers or other nursing staff working in a healthcare context when they attempt to influence the behavior of individuals or a group in an organization using an evidence-based approach. Seven databases were searched until 11 November 2021. JBI Critical Appraisal Checklist for Quasi-experimental studies, JBI Critical Appraisal Checklist for Case Series, Mixed Methods Appraisal Tool were used to evaluate the Risk of bias in quasi-experimental studies, case series, mixed methods studies, respectively. The JBI approach to mixed methods systematic reviews was followed, and a parallel-results convergent approach to synthesis and integration was adopted.

Thirty-one publications were eligible for the analysis: case series ( n  = 27), mixed methods studies ( n  = 3) and quasi-experimental studies ( n  = 1). All studies were included regardless of methodological quality. Leadership problems were related to the implementation of knowledge into practice, the quality of nursing care and the resource availability. Organizational data was used in 27 studies to understand leadership problems, scientific evidence from literature was sought in 26 studies, and stakeholders’ views were explored in 24 studies. Perceived and measured effects of evidence-based leadership focused on nurses’ performance, organizational outcomes, and clinical outcomes. Economic data were not available.

Conclusions

This is the first systematic review to examine how evidence is used to solve leadership problems and to describe its measured and perceived effects from different sites. Although a variety of perceptions and effects were identified on nurses’ performance as well as on organizational and clinical outcomes, available knowledge concerning evidence-based leadership is currently insufficient. Therefore, more high-quality research and clinical trial designs are still needed.

Trail registration

The study was registered (PROSPERO CRD42021259624).

Peer Review reports

Global health demands have set new roles for nurse leaders [ 1 ].Nurse leaders are referred to as nurses, nurse managers, or other nursing staff working in a healthcare context who attempt to influence the behavior of individuals or a group based on goals that are congruent with organizational goals [ 2 ]. They are seen as professionals “armed with data and evidence, and a commitment to mentorship and education”, and as a group in which “leaders innovate, transform, and achieve quality outcomes for patients, health care professionals, organizations, and communities” [ 3 ]. Effective leadership occurs when team members critically follow leaders and are motivated by a leader’s decisions based on the organization’s requests and targets [ 4 ]. On the other hand, problems caused by poor leadership may also occur, regarding staff relations, stress, sickness, or retention [ 5 ]. Therefore, leadership requires an understanding of different problems to be solved using synthesizing evidence from research, clinical expertise, and stakeholders’ preferences [ 6 , 7 ]. If based on evidence, leadership decisions, also referred as leadership decision making [ 8 ], could ensure adequate staffing [ 7 , 9 ] and to produce sufficient and cost-effective care [ 10 ]. However, nurse leaders still rely on their decision making on their personal [ 11 ] and professional experience [ 10 ] over research evidence, which can lead to deficiencies in the quality and safety of care delivery [ 12 , 13 , 14 ]. As all nurses should demonstrate leadership in their profession, their leadership competencies should be strengthened [ 15 ].

Evidence-informed decision-making, referred to as evidence appraisal and application, and evaluation of decisions [ 16 ], has been recognized as one of the core competencies for leaders [ 17 , 18 ]. The role of evidence in nurse leaders’ managerial decision making has been promoted by public authorities [ 19 , 20 , 21 ]. Evidence-based management, another concept related to evidence-based leadership, has been used as the potential to improve healthcare services [ 22 ]. It can guide nursing leaders, in developing working conditions, staff retention, implementation practices, strategic planning, patient care, and success of leadership [ 13 ]. Collins and Holton [ 23 ] in their systematic review and meta-analysis examined 83 studies regarding leadership development interventions. They found that leadership training can result in significant improvement in participants’ skills, especially in knowledge level, although the training effects varied across studies. Cummings et al. [ 24 ] reviewed 100 papers (93 studies) and concluded that participation in leadership interventions had a positive impact on the development of a variety of leadership styles. Clavijo-Chamorro et al. [ 25 ] in their review of 11 studies focused on leadership-related factors that facilitate evidence implementation: teamwork, organizational structures, and transformational leadership. The role of nurse managers was to facilitate evidence-based practices by transforming contexts to motivate the staff and move toward a shared vision of change.

As far as we are aware, however, only a few systematic reviews have focused on evidence-based leadership or related concepts in the healthcare context aiming to analyse how nurse leaders themselves uses evidence in the decision-making process. Young [ 26 ] targeted definitions and acceptance of evidence-based management (EBMgt) in healthcare while Hasanpoor et al. [ 22 ] identified facilitators and barriers, sources of evidence used, and the role of evidence in the process of decision making. Both these reviews concluded that EBMgt was of great importance but used limitedly in healthcare settings due to a lack of time, a lack of research management activities, and policy constraints. A review by Williams [ 27 ] showed that the usage of evidence to support management in decision making is marginal due to a shortage of relevant evidence. Fraser [ 28 ] in their review further indicated that the potential evidence-based knowledge is not used in decision making by leaders as effectively as it could be. Non-use of evidence occurs and leaders base their decisions mainly on single studies, real-world evidence, and experts’ opinions [ 29 ]. Systematic reviews and meta-analyses rarely provide evidence of management-related interventions [ 30 ]. Tate et al. [ 31 ] concluded based on their systematic review and meta-analysis that the ability of nurse leaders to use and critically appraise research evidence may influence the way policy is enacted and how resources and staff are used to meet certain objectives set by policy. This can further influence staff and workforce outcomes. It is therefore important that nurse leaders have the capacity and motivation to use the strongest evidence available to effect change and guide their decision making [ 27 ].

Despite of a growing body of evidence, we found only one review focusing on the impact of evidence-based knowledge. Geert et al. [ 32 ] reviewed literature from 2007 to 2016 to understand the elements of design, delivery, and evaluation of leadership development interventions that are the most reliably linked to outcomes at the level of the individual and the organization, and that are of most benefit to patients. The authors concluded that it is possible to improve individual-level outcomes among leaders, such as knowledge, motivation, skills, and behavior change using evidence-based approaches. Some of the most effective interventions included, for example, interactive workshops, coaching, action learning, and mentoring. However, these authors found limited research evidence describing how nurse leaders themselves use evidence to support their managerial decisions in nursing and what the outcomes are.

To fill the knowledge gap and compliment to existing knowledgebase, in this mixed methods review we aimed to (1) examine what leadership problems nurse leaders solve using an evidence-based approach and (2) how they use evidence to solve these problems. We also explored (3) the measured and (4) perceived effects of the evidence-based leadership approach in healthcare settings. Both qualitative and quantitative components of the effects of evidence-based leadership were examined to provide greater insights into the available literature [ 33 ]. Together with the evidence-based leadership approach, and its impact on nursing [ 34 , 35 ], this knowledge gained in this review can be used to inform clinical policy or organizational decisions [ 33 ]. The study is registered (PROSPERO CRD42021259624). The methods used in this review were specified in advance and documented in a priori in a published protocol [ 36 ]. Key terms of the review and the search terms are defined in Table  1 (population, intervention, comparison, outcomes, context, other).

In this review, we used a mixed methods approach [ 37 ]. A mixed methods systematic review was selected as this approach has the potential to produce direct relevance to policy makers and practitioners [ 38 ]. Johnson and Onwuegbuzie [ 39 ] have defined mixed methods research as “the class of research in which the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, concepts or language into a single study.” Therefore, we combined quantitative and narrative analysis to appraise and synthesize empirical evidence, and we held them as equally important in informing clinical policy or organizational decisions [ 34 ]. In this review, a comprehensive synthesis of quantitative and qualitative data was performed first and then discussed in discussion part (parallel-results convergent design) [ 40 ]. We hoped that different type of analysis approaches could complement each other and deeper picture of the topic in line with our research questions could be gained [ 34 ].

Inclusion and exclusion criteria

Inclusion and exclusion criteria of the study are described in Table  1 .

Search strategy

A three-step search strategy was utilized. First, an initial limited search with #MEDLINE was undertaken, followed by analysis of the words used in the title, abstract, and the article’s key index terms. Second, the search strategy, including identified keywords and index terms, was adapted for each included data base and a second search was undertaken on 11 November 2021. The full search strategy for each database is described in Additional file 1 . Third, the reference list of all studies included in the review were screened for additional studies. No year limits or language restrictions were used.

Information sources

The database search included the following: CINAHL (EBSCO), Cochrane Library (academic database for medicine and health science and nursing), Embase (Elsevier), PsycINFO (EBSCO), PubMed (MEDLINE), Scopus (Elsevier) and Web of Science (academic database across all scientific and technical disciplines, ranging from medicine and social sciences to arts and humanities). These databases were selected as they represent typical databases in health care context. Subject headings from each of the databases were included in the search strategies. Boolean operators ‘AND’ and ‘OR’ were used to combine the search terms. An information specialist from the University of Turku Library was consulted in the formation of the search strategies.

Study selection

All identified citations were collated and uploaded into Covidence software (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia www.covidence.org ), and duplicates were removed by the software. Titles and abstracts were screened and assessed against the inclusion criteria independently by two reviewers out of four, and any discrepancies were resolved by the third reviewer (MV, KH, TL, WC). Studies meeting the inclusion criteria were retrieved in full and archived in Covidence. Access to one full-text article was lacking: the authors for one study were contacted about the missing full text, but no full text was received. All remaining hits of the included studies were retrieved and assessed independently against the inclusion criteria by two independent reviewers of four (MV, KH, TL, WC). Studies that did not meet the inclusion criteria were excluded, and the reasons for exclusion were recorded in Covidence. Any disagreements that arose between the reviewers were resolved through discussions with XL.

Assessment of methodological quality

Eligible studies were critically appraised by two independent reviewers (YT, SH). Standardized critical appraisal instruments based on the study design were used. First, quasi-experimental studies were assessed using the JBI Critical Appraisal Checklist for Quasi-experimental studies [ 44 ]. Second, case series were assessed using the JBI Critical Appraisal Checklist for Case Series [ 45 ]. Third, mixed methods studies were appraised using the Mixed Methods Appraisal Tool [ 46 ].

To increase inter-reviewer reliability, the review agreement was calculated (SH) [ 47 ]. A kappa greater than 0.8 was considered to represent a high level of agreement (0–0.1). In our data, the agreement was 0.75. Discrepancies raised between two reviewers were resolved through discussion and modifications and confirmed by XL. As an outcome, studies that met the inclusion criteria were proceeded to critical appraisal and assessed as suitable for inclusion in the review. The scores for each item and overall critical appraisal scores were presented.

Data extraction

For data extraction, specific tables were created. First, study characteristics (author(s), year, country, design, number of participants, setting) were extracted by two authors independently (JC, MV) and reviewed by TL. Second, descriptions of the interventions were extracted by two reviewers (JV, JC) using the structure of the TIDIeR (Template for Intervention Description and Replication) checklist (brief name, the goal of the intervention, material and procedure, models of delivery and location, dose, modification, adherence and fidelity) [ 48 ]. The extractions were confirmed (MV).

Third, due to a lack of effectiveness data and a wide heterogeneity between study designs and presentation of outcomes, no attempt was made to pool the quantitative data statistically; the findings of the quantitative data were presented in narrative form only [ 44 ]. The separate data extraction tables for each research question were designed specifically for this study. For both qualitative (and a qualitative component of mixed-method studies) and quantitative studies, the data were extracted and tabulated into text format according to preplanned research questions [ 36 ]. To test the quality of the tables and the data extraction process, three authors independently extracted the data from the first five studies (in alphabetical order). After that, the authors came together to share and determine whether their approaches of the data extraction were consistent with each other’s output and whether the content of each table was in line with research question. No reason was found to modify the data extraction tables or planned process. After a consensus of the data extraction process was reached, the data were extracted in pairs by independent reviewers (WC, TY, SH, GL). Any disagreements that arose between the reviewers were resolved through discussion and with a third reviewer (MV).

Data analysis

We were not able to conduct a meta-analysis due to a lack of effectiveness data based on clinical trials. Instead, we used inductive thematic analysis with constant comparison to answer the research question [ 46 , 49 ] using tabulated primary data from qualitative and quantitative studies as reported by the original authors in narrative form only [ 47 ]. In addition, the qualitizing process was used to transform quantitative data to qualitative data; this helped us to convert the whole data into themes and categories. After that we used the thematic analysis for the narrative data as follows. First, the text was carefully read, line by line, to reveal topics answering each specific review question (MV). Second, the data coding was conducted, and the themes in the data were formed by data categorization. The process of deriving the themes was inductive based on constant comparison [ 49 ]. The results of thematic analysis and data categorization was first described in narrative format and then the total number of studies was calculated where the specific category was identified (%).

Stakeholder involvement

The method of reporting stakeholders’ involvement follows the key components by [ 50 ]: (1) people involved, (2) geographical location, (3) how people were recruited, (4) format of involvement, (5) amount of involvement, (6) ethical approval, (7) financial compensation, and (8) methods for reporting involvement.

In our review, stakeholder involvement targeted nurses and nurse leader in China. Nurse Directors of two hospitals recommended potential participants who received a personal invitation letter from researchers to participate in a discussion meeting. Stakeholders’ participation was based on their own free will. Due to COVID-19, one online meeting (1 h) was organized (25 May 2022). Eleven participants joined the meeting. Ethical approval was not applied and no financial compensation was offered. At the end of the meeting, experiences of stakeholders’ involvement were explored.

The meeting started with an introductory presentation with power points. The rationale, methods, and preliminary review results were shared with the participants [ 51 ].The meeting continued with general questions for the participants: (1) Are you aware of the concepts of evidence-based practice or evidence-based leadership?; (2) How important is it to use evidence to support decisions among nurse leaders?; (3) How is the evidence-based approach used in hospital settings?; and (4) What type of evidence is currently used to support nurse leaders’ decision making (e.g. scientific literature, organizational data, stakeholder views)?

Two people took notes on the course and content of the conversation. The notes were later transcripted in verbatim, and the key points of the discussions were summarised. Although answers offered by the stakeholders were very short, the information was useful to validate the preliminary content of the results, add the rigorousness of the review, and obtain additional perspectives. A recommendation of the stakeholders was combined in the Discussion part of this review increasing the applicability of the review in the real world [ 50 ]. At the end of the discussion, the value of stakeholders’ involvement was asked. Participants shared that the experience of participating was unique and the topic of discussion was challenging. Two authors of the review group further represented stakeholders by working together with the research team throughout the review study.

Search results

From seven different electronic databases, 6053 citations were identified as being potentially relevant to the review. Then, 3133 duplicates were removed by an automation tool (Covidence: www.covidence.org ), and one was removed manually. The titles and abstracts of 3040 of citations were reviewed, and a total of 110 full texts were included (one extra citation was found on the reference list but later excluded). Based on the eligibility criteria, 31 studies (32 hits) were critically appraised and deemed suitable for inclusion in the review. The search results and selection process are presented in the PRISMA [ 52 ] flow diagram Fig.  1 . The full list of references for included studies can be find in Additional file 2 . To avoid confusion between articles of the reference list and studies included in the analysis, the studies included in the review are referred inside the article using the reference number of each study (e.g. ref 1, ref 2).

figure 1

Search results and study selection and inclusion process [ 52 ]

Characteristics of included studies

The studies had multiple purposes, aiming to develop practice, implement a new approach, improve quality, or to develop a model. The 31 studies (across 32 hits) were case series studies ( n  = 27), mixed methods studies ( n  = 3) and a quasi-experimental study ( n  = 1). All studies were published between the years 2004 and 2021. The highest number of papers was published in year 2020.

Table  2 describes the characteristics of included studies and Additional file 3 offers a narrative description of the studies.

Methodological quality assessment

Quasi-experimental studies.

We had one quasi-experimental study (ref 31). All questions in the critical appraisal tool were applicable. The total score of the study was 8 (out of a possible 9). Only one response of the tool was ‘no’ because no control group was used in the study (see Additional file 4 for the critical appraisal of included studies).

Case series studies . A case series study is typically defined as a collection of subjects with common characteristics. The studies do not include a comparison group and are often based on prevalent cases and on a sample of convenience [ 53 ]. Munn et al. [ 45 ] further claim that case series are best described as observational studies, lacking experimental and randomized characteristics, being descriptive studies, without a control or comparator group. Out of 27 case series studies included in our review, the critical appraisal scores varied from 1 to 9. Five references were conference abstracts with empirical study results, which were scored from 1 to 3. Full reports of these studies were searched in electronic databases but not found. Critical appraisal scores for the remaining 22 studies ranged from 1 to 9 out of a possible score of 10. One question (Q3) was not applicable to 13 studies: “Were valid methods used for identification of the condition for all participants included in the case series?” Only two studies had clearly reported the demographic of the participants in the study (Q6). Twenty studies met Criteria 8 (“Were the outcomes or follow-up results of cases clearly reported?”) and 18 studies met Criteria 7 (“Q7: Was there clear reporting of clinical information of the participants?”) (see Additional file 4 for the critical appraisal of included studies).

Mixed-methods studies

Mixed-methods studies involve a combination of qualitative and quantitative methods. This is a common design and includes convergent design, sequential explanatory design, and sequential exploratory design [ 46 ]. There were three mixed-methods studies. The critical appraisal scores for the three studies ranged from 60 to 100% out of a possible 100%. Two studies met all the criteria, while one study fulfilled 60% of the scored criteria due to a lack of information to understand the relevance of the sampling strategy well enough to address the research question (Q4.1) or to determine whether the risk of nonresponse bias was low (Q4.4) (see Additional file 4 for the critical appraisal of included studies).

Intervention or program components

The intervention of program components were categorized and described using the TiDier checklist: name and goal, theory or background, material, procedure, provider, models of delivery, location, dose, modification, and adherence and fidelity [ 48 ]. A description of intervention in each study is described in Additional file 5 and a narrative description in Additional file 6 .

Leadership problems

In line with the inclusion criteria, data for the leadership problems were categorized in all 31 included studies (see Additional file 7 for leadership problems). Three types of leadership problems were identified: implementation of knowledge into practice, the quality of clinical care, and resources in nursing care. A narrative summary of the results is reported below.

Implementing knowledge into practice

Eleven studies (35%) aimed to solve leadership problems related to implementation of knowledge into practice. Studies showed how to support nurses in evidence-based implementation (EBP) (ref 3, ref 5), how to engage nurses in using evidence in practice (ref 4), how to convey the importance of EBP (ref 22) or how to change practice (ref 4). Other problems were how to facilitate nurses to use guideline recommendations (ref 7) and how nurses can make evidence-informed decisions (ref 8). General concerns also included the linkage between theory and practice (ref 1) as well as how to implement the EBP model in practice (ref 6). In addition, studies were motivated by the need for revisions or updates of protocols to improve clinical practice (ref 10) as well as the need to standardize nursing activities (ref 11, ref 14).

The quality of the care

Thirteen (42%) focused on solving problems related to the quality of clinical care. In these studies, a high number of catheter infections led a lack of achievement of organizational goals (ref 2, ref 9). A need to reduce patient symptoms in stem cell transplant patients undergoing high-dose chemotherapy (ref 24) was also one of the problems to be solved. In addition, the projects focused on how to prevent pressure ulcers (ref 26, ref 29), how to enhance the quality of cancer treatment (ref 25) and how to reduce the need for invasive constipation treatment (ref 30). Concerns about patient safety (ref 15), high fall rates (ref 16, ref 19), dissatisfaction of patients (ref 16, ref 18) and nurses (ref 16, ref 30) were also problems that had initiated the projects. Studies addressed concerns about how to promote good contingency care in residential aged care homes (ref 20) and about how to increase recognition of human trafficking problems in healthcare (ref 21).

Resources in nursing care

Nurse leaders identified problems in their resources, especially in staffing problems. These problems were identified in seven studies (23%), which involved concerns about how to prevent nurses from leaving the job (ref 31), how to ensure appropriate recruitment, staffing and retaining of nurses (ref 13) and how to decrease nurses’ burden and time spent on nursing activities (ref 12). Leadership turnover was also reported as a source of dissatisfaction (ref 17); studies addressed a lack of structured transition and training programs, which led to turnover (ref 23), as well as how to improve intershift handoff among nurses (ref 28). Optimal design for new hospitals was also examined (ref 27).

Main features of evidence-based leadership

Out of 31 studies, 17 (55%) included all four domains of an evidence-based leadership approach, and four studies (13%) included evidence of critical appraisal of the results (see Additional file 8 for the main features of evidence-based Leadership) (ref 11, ref 14, ref 23, ref 27).

Organizational evidence

Twenty-seven studies (87%) reported how organizational evidence was collected and used to solve leadership problems (ref 2). Retrospective chart reviews (ref 5), a review of the extent of specific incidents (ref 19), and chart auditing (ref 7, ref 25) were conducted. A gap between guideline recommendations and actual care was identified using organizational data (ref 7) while the percentage of nurses’ working time spent on patient care was analyzed using an electronic charting system (ref 12). Internal data (ref 22), institutional data, and programming metrics were also analyzed to understand the development of the nurse workforce (ref 13).

Surveys (ref 3, ref 25), interviews (ref 3, ref 25) and group reviews (ref 18) were used to better understand the leadership problem to be solved. Employee opinion surveys on leadership (ref 17), a nurse satisfaction survey (ref 30) and a variety of reporting templates were used for the data collection (ref 28) reported. Sometimes, leadership problems were identified by evidence facilitators or a PI’s team who worked with staff members (ref 15, ref 17). Problems in clinical practice were also identified by the Nursing Professional Council (ref 14), managers (ref 26) or nurses themselves (ref 24). Current practices were reviewed (ref 29) and a gap analysis was conducted (ref 4, ref 16, ref 23) together with SWOT analysis (ref 16). In addition, hospital mission and vision statements, research culture established and the proportion of nursing alumni with formal EBP training were analyzed (ref 5). On the other hand, it was stated that no systematic hospital-specific sources of data regarding job satisfaction or organizational commitment were used (ref 31). In addition, statements of organizational analysis were used on a general level only (ref 1).

Scientific evidence identified

Twenty-six studies (84%) reported the use of scientific evidence in their evidence-based leadership processes. A literature search was conducted (ref 21) and questions, PICO, and keywords were identified (ref 4) in collaboration with a librarian. Electronic databases, including PubMed (ref 14, ref 31), Cochrane, and EMBASE (ref 31) were searched. Galiano (ref 6) used Wiley Online Library, Elsevier, CINAHL, Health Source: Nursing/Academic Edition, PubMed, and the Cochrane Library while Hoke (ref 11) conducted an electronic search using CINAHL and PubMed to retrieve articles.

Identified journals were reviewed manually (ref 31). The findings were summarized using ‘elevator speech’ (ref 4). In a study by Gifford et al. (ref 9) evidence facilitators worked with participants to access, appraise, and adapt the research evidence to the organizational context. Ostaszkiewicz (ref 20) conducted a scoping review of literature and identified and reviewed frameworks and policy documents about the topic and the quality standards. Further, a team of nursing administrators, directors, staff nurses, and a patient representative reviewed the literature and made recommendations for practice changes.

Clinical practice guidelines were also used to offer scientific evidence (ref 7, ref 19). Evidence was further retrieved from a combination of nursing policies, guidelines, journal articles, and textbooks (ref 12) as well as from published guidelines and literature (ref 13). Internal evidence, professional practice knowledge, relevant theories and models were synthesized (ref 24) while other study (ref 25) reviewed individual studies, synthesized with systematic reviews or clinical practice guidelines. The team reviewed the research evidence (ref 3, ref 15) or conducted a literature review (ref 22, ref 28, ref 29), a literature search (ref 27), a systematic review (ref 23), a review of the literature (ref 30) or ‘the scholarly literature was reviewed’ (ref 18). In addition, ‘an extensive literature review of evidence-based best practices was carried out’ (ref 10). However, detailed description how the review was conducted was lacking.

Views of stakeholders

A total of 24 studies (77%) reported methods for how the views of stakeholders, i.e., professionals or experts, were considered. Support to run this study was received from nursing leadership and multidisciplinary teams (ref 29). Experts and stakeholders joined the study team in some cases (ref 25, ref 30), and in other studies, their opinions were sought to facilitate project success (ref 3). Sometimes a steering committee was formed by a Chief Nursing Officer and Clinical Practice Specialists (ref 2). More specifically, stakeholders’ views were considered using interviews, workshops and follow-up teleconferences (ref 7). The literature review was discussed with colleagues (ref 11), and feedback and support from physicians as well as the consensus of staff were sought (ref 16).

A summary of the project findings and suggestions for the studies were discussed at 90-minute weekly meetings by 11 charge nurses. Nurse executive directors were consulted over a 10-week period (ref 31). An implementation team (nurse, dietician, physiotherapist, occupational therapist) was formed to support the implementation of evidence-based prevention measures (ref 26). Stakeholders volunteered to join in the pilot implementation (ref 28) or a stakeholder team met to determine the best strategy for change management, shortcomings in evidence-based criteria were discussed, and strategies to address those areas were planned (ref 5). Nursing leaders, staff members (ref 22), ‘process owners (ref 18) and program team members (ref 18, ref 19, ref 24) met regularly to discuss the problems. Critical input was sought from clinical educators, physicians, nutritionists, pharmacists, and nurse managers (ref 24). The unit director and senior nursing staff reviewed the contents of the product, and the final version of clinical pathways were reviewed and approved by the Quality Control Commission of the Nursing Department (ref 12). In addition, two co-design workshops with 18 residential aged care stakeholders were organized to explore their perspectives about factors to include in a model prototype (ref 20). Further, an agreement of stakeholders in implementing continuous quality services within an open relationship was conducted (ref 1).

Critical appraisal

In five studies (16%), a critical appraisal targeting the literature search was carried out. The appraisals were conducted by interns and teams who critiqued the evidence (ref 4). In Hoke’s study, four areas that had emerged in the literature were critically reviewed (ref 11). Other methods were to ‘critically appraise the search results’ (ref 14). Journal club team meetings (ref 23) were organized to grade the level and quality of evidence and the team ‘critically appraised relevant evidence’ (ref 27). On the other hand, the studies lacked details of how the appraisals were done in each study.

The perceived effects of evidence-based leadership

Perceived effects of evidence-based leadership on nurses’ performance.

Eleven studies (35%) described perceived effects of evidence-based leadership on nurses’ performance (see Additional file 9 for perceived effects of evidence-based leadership), which were categorized in four groups: awareness and knowledge, competence, ability to understand patients’ needs, and engagement. First, regarding ‘awareness and knowledge’, different projects provided nurses with new learning opportunities (ref 3). Staff’s knowledge (ref 20, ref 28), skills, and education levels improved (ref 20), as did nurses’ knowledge comprehension (ref 21). Second, interventions and approaches focusing on management and leadership positively influenced participants’ competence level to improve the quality of services. Their confidence level (ref 1) and motivation to change practice increased, self-esteem improved, and they were more positive and enthusiastic in their work (ref 22). Third, some nurses were relieved that they had learned to better handle patients’ needs (ref 25). For example, a systematic work approach increased nurses’ awareness of the patients who were at risk of developing health problems (ref 26). And last, nurse leaders were more engaged with staff, encouraging them to adopt the new practices and recognizing their efforts to change (ref 8).

Perceived effects on organizational outcomes

Nine studies (29%) described the perceived effects of evidence-based leadership on organizational outcomes (see Additional file 9 for perceived effects of evidence-based leadership). These were categorized into three groups: use of resources, staff commitment, and team effort. First, more appropriate use of resources was reported (ref 15, ref 20), and working time was more efficiently used (ref 16). In generally, a structured approach made implementing change more manageable (ref 1). On the other hand, in the beginning of the change process, the feedback from nurses was unfavorable, and they experienced discomfort in the new work style (ref 29). New approaches were also perceived as time consuming (ref 3). Second, nurse leaders believed that fewer nursing staff than expected left the organization over the course of the study (ref 31). Third, the project helped staff in their efforts to make changes, and it validated the importance of working as a team (ref 7). Collaboration and support between the nurses increased (ref 26). On the other hand, new work style caused challenges in teamwork (ref 3).

Perceived effects on clinical outcomes

Five studies (16%) reported the perceived effects of evidence-based leadership on clinical outcomes (see Additional file 9 for perceived effects of evidence-based leadership), which were categorized in two groups: general patient outcomes and specific clinical outcomes. First, in general, the project assisted in connecting the guideline recommendations and patient outcomes (ref 7). The project was good for the patients in general, and especially to improve patient safety (ref 16). On the other hand, some nurses thought that the new working style did not work at all for patients (ref 28). Second, the new approach used assisted in optimizing patients’ clinical problems and person-centered care (ref 20). Bowel management, for example, received very good feedback (ref 30).

The measured effects of evidence-based leadership

The measured effects on nurses’ performance.

Data were obtained from 20 studies (65%) (see Additional file 10 for measured effects of evidence-based leadership) and categorized nurse performance outcomes for three groups: awareness and knowledge, engagement, and satisfaction. First, six studies (19%) measured the awareness and knowledge levels of participants. Internship for staff nurses was beneficial to help participants to understand the process for using evidence-based practice and to grow professionally, to stimulate for innovative thinking, to give knowledge needed to use evidence-based practice to answer clinical questions, and to make possible to complete an evidence-based practice project (ref 3). Regarding implementation program of evidence-based practice, those with formal EBP training showed an improvement in knowledge, attitude, confidence, awareness and application after intervention (ref 3, ref 11, ref 20, ref 23, ref 25). On the contrary, in other study, attitude towards EBP remained stable ( p  = 0.543). and those who applied EBP decreased although no significant differences over the years ( p  = 0.879) (ref 6).

Second, 10 studies (35%) described nurses’ engagement to new practices (ref 5, ref 6, ref 7, ref 10, ref 16, ref 17, ref 18, ref 21, ref 25, ref 27). 9 studies (29%) studies reported that there was an improvement of compliance level of participants (ref 6, ref 7, ref 10, ref 16, ref 17, ref 18, ref 21, ref 25, ref 27). On the contrary, in DeLeskey’s (ref 5) study, although improvement was found in post-operative nausea and vomiting’s (PONV) risk factors documented’ (2.5–63%), and ’risk factors communicated among anaesthesia and surgical staff’ (0–62%), the improvement did not achieve the goal. The reason was a limited improvement was analysed. It was noted that only those patients who had been seen by the pre-admission testing nurse had risk assessments completed. Appropriate treatment/prophylaxis increased from 69 to 77%, and from 30 to 49%; routine assessment for PONV/rescue treatment 97% and 100% was both at 100% following the project. The results were discussed with staff but further reasons for a lack of engagement in nursing care was not reported.

And third, six studies (19%) reported nurses’ satisfaction with project outcomes. The study results showed that using evidence in managerial decisions improved nurses’ satisfaction and attitudes toward their organization ( P  < 0.05) (ref 31). Nurses’ overall job satisfaction improved as well (ref 17). Nurses’ satisfaction with usability of the electronic charting system significantly improved after introduction of the intervention (ref 12). In handoff project in seven hospitals, improvement was reported in all satisfaction indicators used in the study although improvement level varied in different units (ref 28). In addition, positive changes were reported in nurses’ ability to autonomously perform their job (“How satisfied are you with the tools and resources available for you treat and prevent patient constipation?” (54%, n  = 17 vs. 92%, n  = 35, p  < 0.001) (ref 30).

The measured effects on organizational outcomes

Thirteen studies (42%) described the effects of a project on organizational outcomes (see Additional file 10 for measured effects of evidence-based leadership), which were categorized in two groups: staff compliance, and changes in practices. First, studies reported improved organizational outcomes due to staff better compliance in care (ref 4, ref 13, ref 17, ref 23, ref 27, ref 31). Second, changes in organization practices were also described (ref 11) like changes in patient documentation (ref 12, ref 21). Van Orne (ref 30) found a statistically significant reduction in the average rate of invasive medication administration between pre-intervention and post-intervention ( p  = 0.01). Salvador (ref 24) also reported an improvement in a proactive approach to mucositis prevention with an evidence-based oral care guide. On the contrary, concerns were also raised such as not enough time for new bedside report (ref 16) or a lack of improvement of assessment of diabetic ulcer (ref 8).

The measured effects on clinical outcomes

A variety of improvements in clinical outcomes were reported (see Additional file 10 for measured effects of evidence-based leadership): improvement in patient clinical status and satisfaction level. First, a variety of improvement in patient clinical status was reported. improvement in Incidence of CAUTI decreased 27.8% between 2015 and 2019 (ref 2) while a patient-centered quality improvement project reduced CAUTI rates to 0 (ref 10). A significant decrease in transmission rate of MRSA transmission was also reported (ref 27) and in other study incidences of CLABSIs dropped following of CHG bathing (ref 14). Further, it was possible to decrease patient nausea from 18 to 5% and vomiting to 0% (ref 5) while the percentage of patients who left the hospital without being seen was below 2% after the project (ref 17). In addition, a significant reduction in the prevalence of pressure ulcers was found (ref 26, ref 29) and a significant reduction of mucositis severity/distress was achieved (ref 24). Patient falls rate decreased (ref 15, ref 16, ref 19, ref 27).

Second, patient satisfaction level after project implementation improved (ref 28). The scale assessing healthcare providers by consumers showed improvement, but the changes were not statistically significant. Improvement in an emergency department leadership model and in methods of communication with patients improved patient satisfaction scores by 600% (ref 17). In addition, new evidence-based unit improved patient experiences about the unit although not all items improved significantly (ref 18).

Stakeholder involvement in the mixed-method review

To ensure stakeholders’ involvement in the review, the real-world relevance of our research [ 53 ], achieve a higher level of meaning in our review results, and gain new perspectives on our preliminary findings [ 50 ], a meeting with 11 stakeholders was organized. First, we asked if participants were aware of the concepts of evidence-based practice or evidence-based leadership. Responses revealed that participants were familiar with the concept of evidence-based practice, but the topic of evidence-based leadership was totally new. Examples of nurses and nurse leaders’ responses are as follows: “I have heard a concept of evidence-based practice but never a concept of evidence-based leadership.” Another participant described: “I have heard it [evidence-based leadership] but I do not understand what it means.”

Second, as stakeholder involvement is beneficial to the relevance and impact of health research [ 54 ], we asked how important evidence is to them in supporting decisions in health care services. One participant described as follows: “Using evidence in decisions is crucial to the wards and also to the entire hospital.” Third, we asked how the evidence-based approach is used in hospital settings. Participants expressed that literature is commonly used to solve clinical problems in patient care but not to solve leadership problems. “In [patient] medication and care, clinical guidelines are regularly used. However, I am aware only a few cases where evidence has been sought to solve leadership problems.”

And last, we asked what type of evidence is currently used to support nurse leaders’ decision making (e.g. scientific literature, organizational data, stakeholder views)? The participants were aware that different types of information were collected in their organization on a daily basis (e.g. patient satisfaction surveys). However, the information was seldom used to support decision making because nurse leaders did not know how to access this information. Even so, the participants agreed that the use of evidence from different sources was important in approaching any leadership or managerial problems in the organization. Participants also suggested that all nurse leaders should receive systematic training related to the topic; this could support the daily use of the evidence-based approach.

To our knowledge, this article represents the first mixed-methods systematic review to examine leadership problems, how evidence is used to solve these problems and what the perceived and measured effects of evidence-based leadership are on nurse leaders and their performance, organizational, and clinical outcomes. This review has two key findings. First, the available research data suggests that evidence-based leadership has potential in the healthcare context, not only to improve knowledge and skills among nurses, but also to improve organizational outcomes and the quality of patient care. Second, remarkably little published research was found to explore the effects of evidence-based leadership with an efficient trial design. We validated the preliminary results with nurse stakeholders, and confirmed that nursing staff, especially nurse leaders, were not familiar with the concept of evidence-based leadership, nor were they used to implementing evidence into their leadership decisions. Our data was based on many databases, and we screened a large number of studies. We also checked existing registers and databases and found no registered or ongoing similar reviews being conducted. Therefore, our results may not change in the near future.

We found that after identifying the leadership problems, 26 (84%) studies out of 31 used organizational data, 25 (81%) studies used scientific evidence from the literature, and 21 (68%) studies considered the views of stakeholders in attempting to understand specific leadership problems more deeply. However, only four studies critically appraised any of these findings. Considering previous critical statements of nurse leaders’ use of evidence in their decision making [ 14 , 30 , 31 , 34 , 55 ], our results are still quite promising.

Our results support a previous systematic review by Geert et al. [ 32 ], which concluded that it is possible to improve leaders’ individual-level outcomes, such as knowledge, motivation, skills, and behavior change using evidence-based approaches. Collins and Holton [ 23 ] particularly found that leadership training resulted in significant knowledge and skill improvements, although the effects varied widely across studies. In our study, evidence-based leadership was seen to enable changes in clinical practice, especially in patient care. On the other hand, we understand that not all efforts to changes were successful [ 56 , 57 , 58 ]. An evidence-based approach causes negative attitudes and feelings. Negative emotions in participants have also been reported due to changes, such as discomfort with a new working style [ 59 ]. Another study reported inconvenience in using a new intervention and its potential risks for patient confidentiality. Sometimes making changes is more time consuming than continuing with current practice [ 60 ]. These findings may partially explain why new interventions or program do not always fully achieve their goals. On the other hand, Dubose et al. [ 61 ] state that, if prepared with knowledge of resistance, nurse leaders could minimize the potential negative consequences and capitalize on a powerful impact of change adaptation.

We found that only six studies used a specific model or theory to understand the mechanism of change that could guide leadership practices. Participants’ reactions to new approaches may be an important factor in predicting how a new intervention will be implemented into clinical practice. Therefore, stronger effort should be put to better understanding the use of evidence, how participants’ reactions and emotions or practice changes could be predicted or supported using appropriate models or theories, and how using these models are linked with leadership outcomes. In this task, nurse leaders have an important role. At the same time, more responsibilities in developing health services have been put on the shoulders of nurse leaders who may already be suffering under pressure and increased burden at work. Working in a leadership position may also lead to role conflict. A study by Lalleman et al. [ 62 ] found that nurses were used to helping other people, often in ad hoc situations. The helping attitude of nurses combined with structured managerial role may cause dilemmas, which may lead to stress. Many nurse leaders opt to leave their positions less than 5 years [ 63 ].To better fulfill the requirements of health services in the future, the role of nurse leaders in evidence-based leadership needs to be developed further to avoid ethical and practical dilemmas in their leadership practices.

It is worth noting that the perceived and measured effects did not offer strong support to each other but rather opened a new venue to understand the evidence-based leadership. Specifically, the perceived effects did not support to measured effects (competence, ability to understand patients’ needs, use of resources, team effort, and specific clinical outcomes) while the measured effects could not support to perceived effects (nurse’s performance satisfaction, changes in practices, and clinical outcomes satisfaction). These findings may indicate that different outcomes appear if the effects of evidence-based leadership are looked at using different methodological approach. Future study is encouraged using well-designed study method including mixed-method study to examine the consistency between perceived and measured effects of evidence-based leadership in health care.

There is a potential in nursing to support change by demonstrating conceptual and operational commitment to research-based practices [ 64 ]. Nurse leaders are well positioned to influence and lead professional governance, quality improvement, service transformation, change and shared governance [ 65 ]. In this task, evidence-based leadership could be a key in solving deficiencies in the quality, safety of care [ 14 ] and inefficiencies in healthcare delivery [ 12 , 13 ]. As WHO has revealed, there are about 28 million nurses worldwide, and the demand of nurses will put nurse resources into the specific spotlight [ 1 ]. Indeed, evidence could be used to find solutions for how to solve economic deficits or other problems using leadership skills. This is important as, when nurses are able to show leadership and control in their own work, they are less likely to leave their jobs [ 66 ]. On the other hand, based on our discussions with stakeholders, nurse leaders are not used to using evidence in their own work. Further, evidence-based leadership is not possible if nurse leaders do not have access to a relevant, robust body of evidence, adequate funding, resources, and organizational support, and evidence-informed decision making may only offer short-term solutions [ 55 ]. We still believe that implementing evidence-based strategies into the work of nurse leaders may create opportunities to protect this critical workforce from burnout or leaving the field [ 67 ]. However, the role of the evidence-based approach for nurse leaders in solving these problems is still a key question.

Limitations

This study aimed to use a broad search strategy to ensure a comprehensive review but, nevertheless, limitations exist: we may have missed studies not included in the major international databases. To keep search results manageable, we did not use specific databases to systematically search grey literature although it is a rich source of evidence used in systematic reviews and meta-analysis [ 68 ]. We still included published conference abstract/proceedings, which appeared in our scientific databases. It has been stated that conference abstracts and proceedings with empirical study results make up a great part of studies cited in systematic reviews [ 69 ]. At the same time, a limited space reserved for published conference publications can lead to methodological issues reducing the validity of the review results [ 68 ]. We also found that the great number of studies were carried out in western countries, restricting the generalizability of the results outside of English language countries. The study interventions and outcomes were too different across studies to be meaningfully pooled using statistical methods. Thus, our narrative synthesis could hypothetically be biased. To increase transparency of the data and all decisions made, the data, its categorization and conclusions are based on original studies and presented in separate tables and can be found in Additional files. Regarding a methodological approach [ 34 ], we used a mixed methods systematic review, with the core intention of combining quantitative and qualitative data from primary studies. The aim was to create a breadth and depth of understanding that could confirm to or dispute evidence and ultimately answer the review question posed [ 34 , 70 ]. Although the method is gaining traction due to its usefulness and practicality, guidance in combining quantitative and qualitative data in mixed methods systematic reviews is still limited at the theoretical stage [ 40 ]. As an outcome, it could be argued that other methodologies, for example, an integrative review, could have been used in our review to combine diverse methodologies [ 71 ]. We still believe that the results of this mixed method review may have an added value when compared with previous systematic reviews concerning leadership and an evidence-based approach.

Our mixed methods review fills the gap regarding how nurse leaders themselves use evidence to guide their leadership role and what the measured and perceived impact of evidence-based leadership is in nursing. Although the scarcity of controlled studies on this topic is concerning, the available research data suggest that evidence-based leadership intervention can improve nurse performance, organizational outcomes, and patient outcomes. Leadership problems are also well recognized in healthcare settings. More knowledge and a deeper understanding of the role of nurse leaders, and how they can use evidence in their own managerial leadership decisions, is still needed. Despite the limited number of studies, we assume that this narrative synthesis can provide a good foundation for how to develop evidence-based leadership in the future.

Implications

Based on our review results, several implications can be recommended. First, the future of nursing success depends on knowledgeable, capable, and strong leaders. Therefore, nurse leaders worldwide need to be educated about the best ways to manage challenging situations in healthcare contexts using an evidence-based approach in their decisions. This recommendation was also proposed by nurses and nurse leaders during our discussion meeting with stakeholders.

Second, curriculums in educational organizations and on-the-job training for nurse leaders should be updated to support general understanding how to use evidence in leadership decisions. And third, patients and family members should be more involved in the evidence-based approach. It is therefore important that nurse leaders learn how patients’ and family members’ views as stakeholders are better considered as part of the evidence-based leadership approach.

Future studies should be prioritized as follows: establishment of clear parameters for what constitutes and measures evidence-based leadership; use of theories or models in research to inform mechanisms how to effectively change the practice; conducting robust effectiveness studies using trial designs to evaluate the impact of evidence-based leadership; studying the role of patient and family members in improving the quality of clinical care; and investigating the financial impact of the use of evidence-based leadership approach within respective healthcare systems.

Data availability

The authors obtained all data for this review from published manuscripts.

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Acknowledgements

We want to thank the funding bodies, the Finnish National Agency of Education, Asia Programme, the Department of Nursing Science at the University of Turku, and Xiangya School of Nursing at the Central South University. We also would like to thank the nurses and nurse leaders for their valuable opinions on the topic.

The work was supported by the Finnish National Agency of Education, Asia Programme (grant number 26/270/2020) and the University of Turku (internal fund 26003424). The funders had no role in the study design and will not have any role during its execution, analysis, interpretation of the data, decision to publish, or preparation of the manuscript.

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Department of Nursing Science, University of Turku, Turku, FI-20014, Finland

Maritta Välimäki, Tella Lantta, Kirsi Hipp & Jaakko Varpula

School of Public Health, University of Helsinki, Helsinki, FI-00014, Finland

Maritta Välimäki

Xiangya Nursing, School of Central South University, Changsha, 410013, China

Shuang Hu, Jiarui Chen, Yao Tang, Wenjun Chen & Xianhong Li

School of Health and Social Services, Häme University of Applied Sciences, Hämeenlinna, Finland

Hunan Cancer Hospital, Changsha, 410008, China

Gaoming Liu

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Contributions

Study design: MV, XL. Literature search and study selection: MV, KH, TL, WC, XL. Quality assessment: YT, SH, XL. Data extraction: JC, MV, JV, WC, YT, SH, GL. Analysis and interpretation: MV, SH. Manuscript writing: MV. Critical revisions for important intellectual content: MV, XL. All authors read and approved the final manuscript.

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Correspondence to Xianhong Li .

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The authors declare no competing interests.

Differences between the original protocol

We modified criteria for the included studies: we included published conference abstracts/proceedings, which form a relatively broad knowledge base in scientific knowledge. We originally planned to conduct a survey with open-ended questions followed by a face-to-face meeting to discuss the preliminary results of the review. However, to avoid extra burden in nurses due to COVID-19, we decided to limit the validation process to the online discussion only.

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Välimäki, M., Hu, S., Lantta, T. et al. The impact of evidence-based nursing leadership in healthcare settings: a mixed methods systematic review. BMC Nurs 23 , 452 (2024). https://doi.org/10.1186/s12912-024-02096-4

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