doing a literature review in nursing health and social care

Doing a Literature Review in Nursing, Health and Social Care (Second edition) Coughlan Michael and Cronin Patricia Doing a Literature Review in Nursing, Health and Social Care (Second edition) 184pp £19.99 Sage Publishing 9781412962049 1412962048 [Formula: see text]

• PMID: 28326921
• DOI: 10.7748/nr.24.4.8.s3

This book provides a concise and informative guide to the process of literature review in nursing, health and social care, and is applicable to students and professionals.

• Medical Books

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Doing a Literature Review in Nursing, Health and Social Care Third Edition

Purchase options and add-ons.

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

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

The third edition includes:

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

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

• ISBN-10 1526497522
• ISBN-13 978-1526497529
• Edition Third
• Publisher SAGE Publications Ltd
• Publication date March 9, 2021
• Language English
• Dimensions 6.69 x 0.5 x 9.61 inches
• Print length 192 pages
• See all details

Editorial Reviews

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

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

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

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

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

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

About the Author

Patricia Cronin is an Assistant Professor in the School of Nursing and Midwifery, Trinity College Dublin. She is a registered General Nurse and her clinical background is in surgical and gastrointestinal nursing. She has a special interest in theory, and research and systematic review methodologies and considerable expertise in qualitative research methodologies. She is also a contributor and member of the editorial board for an online clinical skills training tool. Her research interests lie in the areas of chronic illness and gastrointestinal health in people with intellectual disability. She has published widely, co-authoring four books and book chapters and journal articles related to clinical skills, gastrointestinal nursing, research and theory. Qualifications: PhD, MSc, MA, BSc Nursing & Education, DipN (Lond), RN.

Product details

• Publisher ‏ : ‎ SAGE Publications Ltd; Third edition (March 9, 2021)
• Language ‏ : ‎ English
• Hardcover ‏ : ‎ 192 pages
• ISBN-10 ‏ : ‎ 1526497522
• ISBN-13 ‏ : ‎ 978-1526497529
• Item Weight ‏ : ‎ 1.08 pounds
• Dimensions ‏ : ‎ 6.69 x 0.5 x 9.61 inches
• #657 in Nursing Research & Theory (Books)
• #3,563 in Medical Research (Books)

About the author

Patricia cronin.

Discover more of the author’s books, see similar authors, read author blogs and more

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Doing a Literature Review in Nursing, Health and Social Care

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

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

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

The third edition includes:

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

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

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

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

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

Praise for the previous edition:

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

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

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

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

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

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

Excellent resource. Useful for any stage of studying

Excellent text for masters and doctoral level students

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

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

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

Accessible, informative, step to step guide

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

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

Preview this book

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Doing a Literature Review in Nursing, Health and Social Care Paperback – 23 Dec. 2020

Purchase options and add-ons.

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

Providing you with straightforward guidance on how to successfully carry out a literature review as part of your research project or dissertation, this book uses examples and activities to demonstrate how to complete each step correctly, from start to finish, and highlights how to avoid common mistakes. Perfect for any nursing or healthcare student new to literature reviews and for anyone who needs a refresher on this important topic.

The third edition includes:

• Expert advice on selecting and researching a topic
• A chapter outlining the different types of literature review you may come across
• Increased focus on Critical Appraisal Tools and how to use them effectively
• New real-world examples presenting best practice
• Instructions on writing up and presenting the final piece of work
• ISBN-10 1526497514
• ISBN-13 978-1526497512
• Edition Third
• Publisher SAGE Publications Ltd
• Publication date 23 Dec. 2020
• Language English
• Dimensions 17 x 1.12 x 24.2 cm
• Print length 192 pages
• See all details

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Product description

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

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

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

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

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

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

From the Back Cover

About the author.

Patricia Cronin is an Assistant Professor in the School of Nursing and Midwifery, Trinity College Dublin. She is a registered General Nurse and her clinical background is in surgical and gastrointestinal nursing. She has a special interest in theory, and research and systematic review methodologies and considerable expertise in qualitative research methodologies. She is also a contributor and member of the editorial board for an online clinical skills training tool. Her research interests lie in the areas of chronic illness and gastrointestinal health in people with intellectual disability. She has published widely, co-authoring four books and book chapters and journal articles related to clinical skills, gastrointestinal nursing, research and theory. Qualifications: PhD, MSc, MA, BSc Nursing & Education, DipN (Lond), RN.

Product details

• Publisher ‏ : ‎ SAGE Publications Ltd; Third edition (23 Dec. 2020)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 192 pages
• ISBN-10 ‏ : ‎ 1526497514
• ISBN-13 ‏ : ‎ 978-1526497512
• Dimensions ‏ : ‎ 17 x 1.12 x 24.2 cm
• 392 in Medical Research & Equipment
• 438 in Nursing (Books)

About the author

Patricia cronin.

Discover more of the author’s books, see similar authors, read author blogs and more

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Health and Social Care

• Getting Started
• Journals & Databases
• NHS Scotland Knowledge Network
• Literature Reviewing

Literature reviewing - the overview

• What is a literature review?
• How are literature reviews relevant to health and social care?
• Types of Literature Review
• Reporting and Conducting Guidance
• What's in a good literature review?
• Common mistakes?

A literature review:

• Finds existing literature/sources published on a specific topic/to answer a review question.
• Brings together the literature sources into a single body of literature.
• Makes comparisons between the different included sources to identify both patterns/similarities and conflicts/differences.

Within healthcare literature reviews are often known as 'evidence synthesis reviews' and usually have specific methods and processes which are detailed in more depth in the section below titled 'Literature reviewing - the process'. This can differ from other field areas so if you have not done a healthcare evidence synthesis review before you may find it very different to previous expectations or experiences.

There are also a number of different types of evidence synthesis reviews within healthcare and the type of review impacts the purpose and methods. The next tab gives more information about different types of review. If you are doing a review as part of an academic assignment then please ensure you follow the requirements and any methods set out in your assignment brief.

Taking a Systematic Approach

Within healthcare evidence synthesis reviews there is an expectation that the approach taken, no matter what type of review is being done, is systematic. Whilst a systematic review is a specific review type, any review type can still take a systematic approach which strengths the quality of the methods, and therefore also strengthens the quality of the findings, write up, and usefulness/applicability of the review.

• Wakefield, A.(2014). Searching and critiquing the research literature. Nursing Standard, 28(39), 49-57
• Kable, A. K., Pich, J., & Maslin-Prothero, S. E. (2012). A structured approach to documenting a search strategy for publication: a 12 step guideline for authors. Nurse Education Today, 32(8), 878-886
• Smith, J., Noble, H. (2016) Reviewing the literature. Evidence Based Nursing, 19 (1), 2-3.

In health and social care there are a number of different types of review. The resources below give an outline of the different types and outline the differences between them:

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

Sutton, A., Clowes, M., Preston, L., & Booth, A. (2019). Meeting the review family: exploring review types and associated information retrieval requirements.  Health Information and Libraries Journal ,  36 (3), 202–222. https://doi.org/10.1111/hir.12276   

If you are doing a literature review as part of an academic assignment then please ensure you follow the requirements and any methods set out in your assignment brief. You may be advised to do a specific type of review, but when reading the guidance of how to conduct one find that it differs from your assignment brief. If so, discuss this with your supervisor or module leader.

Choosing a Review Type

You need to understand the purpose of different review types and match this up with what you are intending to achieve from carrying out your review in order to select the most appropriate type. You can include this explanation and justification within your write up. As well as the guidance above please see some further resources below to support your decision making.

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach.  BMC Medical Research Methodology ,  18 (1), 143–143. https://doi.org/10.1186/s12874-018-0611-x

Jonkoping University. (n.d.). Which review is right for you?   https://guides.library.ju.se/c.php?g=690269&p=4943634

Right Review. (2024). Right Review Tool.  https://rightreview.knowledgetranslation.net/

There are a number of published reporting and conducting guidelines and handbooks to support you in both carrying out and writing up your review. These help to ensure the quality and transparency of your review by ensuring you have included and conducted your review in a way that meets established methodological expectations.

Reporting guidelines give information on what you need to include in the write up of the review. Conducting guidelines provide more methodological guidance on how to carry out and undertake each stage of a review, not just stating what you need to include/report. When using these they need to be cited and referenced and the wording you would use needs to distinguish if it is a reporting or conducting resource, and therefore how it has been used. Examples:

'this review/protocol was reported using . . . '

'the conducting of this review was guided by . . . '

A lot of these were designed for quantitative systematic reviews of interventions, however a number of resources now exist for different types of evidence synthesis reviews. Below are resources of some of the most commonly used guidelines.

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement consists of a 27-item checklist that covers the elements needed in the write up of a systematic review, and a flow diagram.

There is an article giving further explanation of every element of the checklist and a glossary of terms .

PRISMA also have guidance for reporting protocols, known as the  PRISMA-P extension.

There is also a checklist extension for Scoping Reviews called PRISMA- ScR , which is very similar to the Systematic Review checklist but with some key differences.

Also a more in-depth explanatory paper for this checklist as well.  

The Cochrane Handbook for Systematic Reviews of Interventions needs to be followed if you were to publish a review or review protocol in the Cochrane Library of Systematic Reviews.

There are a set a reporting guidelines for both review protocols and full reviews .

Key aspects of the Cochrane handbook are collated as the Methodological Expectations for Cochrane Intervention Reviews – takes you through steps needed to conduct.

The Cochrane Handbook Chapter V also details methodology for conducting Overviews of Reviews.

The Cochrane Qualitative and Implementation Methods Group have published a series of 6 papers covering qualitative evidence synthesis methods .

Other Guides

The JBI Manual for Evidence Synthesis separates SRs out by types of evidence included, as well as having chapters on Mixed Methods Reviews, Scoping Reviews and Umbrella Reviews.

RAMSES reporting can be used for realist reviews and meta-narrative reviews.

The ENTREQ checklist can be used to report reviews of qualitative literature, alongside a fuller article explaining the development of the checklist .

Further reporting and conducting guidelines can be found on this useful page from the University of Illinois .

Booth, A. (2016). EVIDENT Guidance for reviewing the evidence: a compendium of methodological literature and websites.  https://www.researchgate.net/publication/292991575_EVIDENT_Guidance_for_Reviewing_the_Evidence_a_compendium_of_methodological_literature_and_websites

A good literature review should:

• Address a focused, explicit research question.
• Take a systematic approach to the searching of the literature.
• Document the search process so that it is replicable  by others  (often a requirement for publication within many academic journals)
• Demonstrate that a wide range of sources have been searched.
• Undertake a critical analysis of the retrieved literature, not merely describe what has been read.
• Justify why particular items of literature are being referred to. They should summarise the current state of research,  perhaps debates that have taken place over a period of time within that topic or arguments for and against a particular aspect of the topic.
• Relate the question to the larger body of knowledge within which your topic sits, and to put your work into context.
• Summarise the current state of the research evidence.
• Identify the gap in the literature that your research question is going to answer.

Common Mistakes

• Review is too descriptive. No critiquing or critical evaluation of the evidence. No identification of strengths and weaknesses. It becomes an essay, not a review. It does not set the foundation for your own research process.
• It becomes a dumping ground to write down everything you know about the topic  or is presented as a series of quotes from the papers you have read.
• Not enough time has been allocated to searching and reviewing the literature. Do your literature reviewing early. It helps inform your final research question, future methodologies and identifies whether there is indeed a "gap" in the current research literature that your queston is going to answer.
• Literature used is not from scholarly peer reviewed sources.
• There is no documentation or explanation of how the search was undertaken and the key terms used. No explanation of inclusion/exclusion criteria.
• Referencing does not follow the School guidelines. It is not consistent in style or presentation.
• There has been no revision or proof reading. Thinking develops as you write. Go back over what you have written a few days after you have done it. Check grammar and language – give it to someone else to proof read.

Here are 5 top tips towards a stress free  literature review

• Top tips for literature reviewing

Literature reviewing - the process

• Question Development
• Eligibility Criteria
• Planning the Search Strategy
• Searching the Literature
• Selecting the Literature
• Keeping track of your literature
• Critical Appraisal
• Analysing and Discussing the Literature

Formulating a review question is a key stage of the review process as this impacts the development of the outcomes of the review, the eligibility criteria for selection, and the development of the search strategy. If you make changes to your review question after already moving on to other stages of the review you may need to go back and make changes to these other steps.

Ideally a review should add new knowledge to that topic or field, so you want to develop a question that has a new focus or outcomes that has not previously been explored. Sometimes it is appropriate to update a previous review using the same question and outcomes to see if the findings of the review have changed with the inclusion of new literature since the previous one was published.

If you are a Masters student it is particularly important that you choose a topic that is both viable and manageable within the word count and timescales for completion. Viable means a topic where there is published literature, you cannot do a literature review on a question where there is no available literature. Manageable means selecting a focused topic where there will not be too vast an amount of literature to include as you have a word count limit and a timescale in which to submit the assignment.

To help you develop a question try and identify an area from practice that you are interested in – ideally something the practice area can benefit from which will give value to your review findings.

The question you develop from this topic should be focused, manageable and answerable within the timescales you have.

Scoping the Literature

This is where we run initial literature searches around our topic of interest to get an initial idea of what literature is out there. This will help us to:

• Check what reviews have already been done on this topic.
• Check our topic is viable - there is enough literature out there.
• Check our topic is not too broad - too much literature out there.

From these initial searches of the literature you can start to refine your review question, broadening or focusing as necessary. Please see the following video on Scoping Searches to Refine Your Topic for an example of how this works in practice.

• Question Formulation Frameworks

Question formulation frameworks are used particularly within healthcare to help you identify the key concepts of your topic, to then structure into a research or review question. The following document shows you examples of the most commonly used ones in healthcare, breaking down each framework into what the concepts mean, giving examples in practice of questions structured using that framework, and suggestions of review outcomes and types best suited to each framework.

The eligibility criteria can also be referred to as the inclusion and exclusion criteria. This is a set of criteria you will develop which you will use during the selection process of the review to decide which sources of literature to include and exclude. This criteria helps to reduce selection bias, because every decision you make should be based on this pre-determined set of criteria. 

When take a systematic approach to searching and selecting the literature your eligibility criteria needs to be very detailed, both for you to be able to make decisions for each of the pieces of literature you have found, but also for someone else to be able to use the criteria with the same set of literature and make the same decisions as you. If you are doing a review as part of a review team for publication then there should be a minimum of two people involved in the selection of the literature, both using the same criteria to make selection decisions. This aligns to the systematic criteria of transparency . 

When developing your eligibility criteria think about the following elements:

• Each of your question concepts from your question formulation framework and detail exactly what criteria would mean a source would be included or excluded in relation to each question concept.

E.g. your population group is people with dementia, so as inclusion criteria you would state that each literature source needs this population group and any source without this population group would be excluded. But what about literature where participants and both people with dementia and people with Parkinsons. Would this be included or excluded? Your criteria needs to be detailed enough to capture all of the potential decisions you would need to make.

• The study criteria for research literature, so the methodology, design and any further details. Depending on your review question there will sometimes be specific types of data most suited to answer the question, so sometimes either quantitative or qualitative data only would be appropriate, and sometimes only specific study designs like randomised controlled trials

E.g. you're question is exploring the experiences and views of a particular group of participants, therefore the data most appropriate to 'answer' this question would be qualitative.

• Types of publications, so are you only including primary research or wider sources of literature? Even with primary research there are a number of different source types this could be presented in such as journal articles, theses, conference proceedings.
• Publication dates, so is there a specific date range you will only be including literature from? Try to think about the context of your specific topic/question and what would make something too old. 

E.g. there has been a new guideline in your topic area published in a specific year with major changes to how a specific procedure is done in practice, meaning that older literature is not relevant to the current guideline. Topics related to technology could be outdated more easily due to specific technological developments in a specific field or equipment. 

A search strategy includes where and how you are searching. Can someone else use your process to find what you found? This aligns with the systematic criteria of being  transparent.

You need to plan and include the following detail in your write up to allow someone else to replicate your search:

• Search Strategy Planning Template

When searching in databases most of the time you want to use the advanced search feature to build a search that will find a more relevant set of search results. To do this you need to be able to plan effective search strategies, using appropriate keyword search terms, and inputting these into the database in the most effective combination.

The videos below demonstrate how to input a planned systematic search strategy into a database. Different database platforms will look slightly different, but the principles for doing an advanced search are the same across them all, but differences are demonstrated.

Searching in EBSCO databases (CINAHL, Medline, APA PsycInfo etc.)

Searching in PubMed

Searching in Ovid

Searching in Web of Science

Searching in Proquest

The selection process is where you will use your eligibility criteria to select the literature for inclusion in your review. Considerations needed are:

Keeping track of literature

Writing a literature review will mean that you will collect a large number of pieces of information from many sources.  Before you begin searching, give some thought as to how you are going to manage this information. 

Reference management software will enable you to automatically  export references you collect from database searches and store them in the reference manager.   Once you have read each paper you can then make personal research notes and store these within each reference inside the reference manager.

Use the software  to format the citations within the text of your review. It will also produce the reference list at the end of your document formatted in a style of your choosing e.g.   APA 7th.

See  our Reference Management LibGuide  on how to get started with Endnote or Mendeley, Edinburgh Napier’s referencing management software.

NHS Scotland users can also use the Refworks ref management software supplied on the NHS Knowledge network site instead of Endnote,  if they would prefer.

What is critical appraisal? 

Critical appraisal/quality assessment is a specific aspect of critical analysis where you examine and assess research in order to judge its:

You are evaluating the quality of the research and how it has been conducted, as well as the findings themselves and how it has been reported. Please see the following video by Cochrane on an Introduction to Critical Appraisal for a more in depth description.

Why do we do it?

Critical appraisal is often carried out using checklists that help signpost areas to look for while reading a paper. There are different types of checklist depending on the type of research you are reviewing.

The following document lists some of the main appraisal tools used in published reviews and would be a good place to start when deciding on which tool to use. 

• Critical Appraisal/Quality Assessment Tools

Further Critical Appraisal Resources

Two excellent videos from Andrew Booth at SCHARR at the University of Sheffield. These take you through the actual process of appraising papers using the CASP tool.

Appraising a Quantitative Study              [13 mins]

Critical Appraisal of a Qualitative Study   [12 mins]

Data Extraction and Charting

Your literature findings need to be presented and discussed both descriptively and analytically. It is usually to present a summary of the included sources in the form of a data extraction or study characteristics table, a process also referred to as data extraction and charting your results.  The video below covers how to present your findings in this way.

• Presenting Your Results in a Study Characteristics Table

Analysing and Synthesising the Findings of the Literature

Depending on the type of review you are doing and also whether the review is being done as an assignment, there may be differing expectations of how you analyse the included literature sources.

At Masters dissertation level you would be expected as a minimum to provide a narrative thematic analysis, where you compare and contrast the literature to identify patterns and themes and interpret these in relation to your review question. You can use a deductive approach where you start with a pre-existing framework of themes, or an inductive approach where themes are generated from reading the literature.

At PhD or researcher for publication level there would be an expectation of a more complex analysis of the literature, appropriate to the literature sources. A scoping review including a wide range of source types would likely best be suited to a narrative analysis, but if the review literature is all research then an appropriate quantitative, qualitative, or mixed methods form of analysis of the data would be expected.

Most Systematic Review conduction and reporting guidelines are designed around an analysis of quantitative data, so if this does not fit the data of your literature you may need to use different analysis and synthesis guidance. There are a number of different analysis methods, some examples and resources are listed below as a starting point but you may also want to look at examples of similar reviews fur further methods.

• Chapters 10 and 11 of the Cochrane Handbook covers quantitative meta-analysis.
• Chapter 12 covers over methods, however these are all still mainly quantitative methods.
• The eMergE reporting guidance covers meta-ethnography qualitative synthesis, and the ENTREQ statement can also be used for qualitative synthesis.

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Doing a Literature Review in Nursing, Health and Social Care

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Doing a literature review in nursing, health and social care (second edition), claire lee paediatric research nurse, department of paediatric gastroenterology, addenbrooke’s hospital, cambridge.

This book provides a concise and informative guide to the process of literature reviewing in nursing, health and social care, and is applicable to students and professionals.

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The role of nurses for patients with Parkinson’s disease at home: a scoping review

• Takako Fujita 1 ,
• Miho Iwaki 1 &
• Yoko Hatono 1  

BMC Nursing volume  23 , Article number:  318 ( 2024 ) Cite this article

169 Accesses

Metrics details

Parkinson’s disease is a neurodegenerative disease, and many patients are cared for at home by nurses. Parkinson’s disease nurse specialists have been certified in several countries. This study aimed to provide an overview of what is known about the role of nurses in the care of patients with Parkinson’s disease at home and to determine the differences between nurses and Parkinson’s disease nurse specialists.

A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were searched (keywords: Parkinson’s disease AND nurse AND [community OR home]) for studies published in English up to September 2023 describing the nurse’s role in caring for patients with Parkinson’s disease at home. Studies without abstracts were removed, along with protocols, systematic reviews, and studies concerned with other diseases or including data that were difficult to distinguish from those of other diseases. Roles were described and organized by category.

A total of 26 studies were included. The nurses’ roles were categorized as overall assessment and support, treatment management, safety assessment regarding falls, care for non-motor symptoms, palliative care, support for caregivers, education for care home staff, multidisciplinary collaboration, and provision of information on social resources. Medication management and education of care home staff were identified as roles of nurse specialists.

Conclusions

This study revealed the role of nurses caring for patients with Parkinson’s disease at home. Because of the complexity of the patients’ medication regimens, nurse specialists provide assistance, especially with medication management and the provision of education to care staff. This study will facilitate the preparation of nurses to acquire the knowledge and skills necessary to help patients with Parkinson’s disease, even in countries where Parkinson’s disease nurse specialists are not officially certified, and will help patients feel comfortable with the care they receive.

Peer Review reports

Parkinson’s disease (PD) is a neurodegenerative disease affecting 8.5 million patients worldwide as of 2019 [ 1 ]. PD is more common in older people, and the risk increases over time [ 2 , 3 , 4 ]. There are prevalence differences by country even within the same ethnic group [ 4 ].

Patients with PD experience both motor and non-motor symptoms. Oral medication, levodopa–carbidopa intestinal gel (LCIG), apomorphine management, deep brain stimulation (DBS), and non-pharmacologic therapy, such as rehabilitation, can relieve motor symptoms. Oral medication is used as the first-line treatment based on previous evidence [ 5 , 6 ].

Nurses play an important role in supporting patients with PD, and nurses specializing in PD or related diseases (PD nurses) have been certified in several countries. The United Kingdom was the first nation to implement this system, and a competency framework that outlines the competencies for each level of nurse has also been developed [ 7 ]. In the United Kingdom, PD nurse specialists (PDNSs) run clinics in hospitals or the community, and they visit patients’ homes if the patients cannot attend clinics [ 7 ]. However, some countries have not officially approved such certification, even though the number of patients and treatment complexity has been increasing. Therefore, those countries may need to introduce certification in the future.

Many patients are cared for at home by nurses, and the basic treatment is oral medication. As stated previously, some countries have not introduced qualifications for PD nurses. Additionally, nurses in hospitals and clinics only provide care within their departments, and home-visiting nurses only provide care to patients in their own homes or in care homes. Some countries have guidelines for nurses specializing in PD, but these are not focused only on home-based care

This review aimed to provide an overview of what is known about the role of nurses in caring for patients with PD at home, and to determine the differences between nurses and PD nurses caring for these patients.

A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines [ 8 ]. Because the focus of this study was on the role of nurses in caring for patients with PD at home, a scoping review was conducted. We employed the PCC framework to identify the review question [ 9 ], as follows:

P (Population): patients with Parkinson’s disease

C (Concept): the role of nurses

C (Context): the home environment

All types of studies about the role of nurses caring for patients with PD at home were considered. The review protocol was not registered, in accordance with the guidelines.

Search methods

The PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases were searched with the keywords Parkinson’s disease AND nurse AND (community OR home). All types of studies published up to September 2023 were included, as the qualifications of PD nurses vary among countries and the role of nurses needs to be understood in broad terms.

Inclusion and/or exclusion criteria

All references of interest were imported into EndNote 21 (Clarivate Analytics, Philadelphia, PA, USA). Of the 1,190 references extracted during the search, 900 remained after removing duplicates (Fig.  1 ). Those without abstracts and those written in languages other than English were then removed, along with protocols, systematic reviews, studies concerned with other diseases or including data that were difficult to distinguish from those of other diseases, and studies that did not discuss the role of the nursing profession or home support. Two researchers determined whether studies should be excluded, and another researcher was added to the team to adjudicate for studies that caused a difference in opinion.

Flow diagram of the study

Search outcome

Only English-language literature describing the nurse’s role in caring for patients with PD at home was considered. Roles were described and organized by category.

Quality appraisal

Quality appraisal is optional according to the guidelines for a scoping review; therefore, quality assessment of each study was not performed [ 8 ].

Data abstraction

For each of the selected studies, we listed the author, year of publication, country in which the study was conducted, objective, study design, participants and sample size, type of nurse, and roles of the nurses. The roles of nurses were organized and described based on the thematic content.

All themes relating to the nurses’ roles were extracted from each study by three researchers. The researchers discussed and organized the roles based on similarities. The thematic content of the extracted roles was integrated into the narrative.

The included studies were published between 1999 and 2023 and performed in the United Kingdom ( n  = 12), United States ( n  = 7), Australia ( n  = 2), Sweden ( n  = 1), Germany ( n  = 1), Italy ( n  = 1), China ( n  = 1), and Japan ( n  = 1). PD nurses are referred to as PDNSs in the United Kingdom, Italy, and Germany; as community Parkinson’s nurse specialists (CPNSs) or community-based nurses specializing in PD in the United Kingdom; as registered PD nurses in China; as Parkinson’s nurse experts or movement disorder nurses in Australia; as neuroscience nurses in the United States; and as Duodopa nurse specialists in Sweden. A summary of the selected studies is presented in Table  1 .

In the following section, we describe the identified roles of nurses caring for patients with PD at home.

Comprehensive assessment and care

Comprehensive assessment is required of nurses not only for patients with PD but also for general patient support. Nurses need to plan appropriate care for patients with PD covering communication, personal hygiene, mobility, constipation, swallowing and diet, and psychological problems [ 10 ]. In addition, nurses provide education to the patients, including on therapeutic medications and fall prevention [ 11 ].

PDNSs are responsible for supporting patients by conducting regular in-person assessments, considering possible complications, and identifying changes in motor and non-motor symptoms to prevent worsening of the disease [ 12 , 13 ].

Because worsening idiopathic PD is likely to affect some aspects of a patient’s health and cause serious problems that can lead to hospitalization, such as dysphagia resulting in a chest infection or fractures following falls, an accurate assessment of symptoms by the nurse and an understanding of the concerns of patients with PD and their families and caregivers can help ensure timely responses to emerging problems [ 12 ]. In addition, since patients with PD are knowledgeable about their symptoms and the impact of idiopathic PD, PDNSs can consider patients’ concerns and involve them in decision-making at every stage [ 12 ].

Therapeutic management of motor symptoms

Support for medication adherence.

Medication management is one of the most common forms of support provided by nurses to patients with PD [ 11 ]. The support given by both PD nurses and other nurses includes discussing medication management, providing information and education about PD medications and side effects, and reviewing medication schedules [ 11 , 14 , 15 , 16 , 17 ]. In a study conducted in the United States, nurses performed a detailed medication reconciliation, reviewing multiple medication management methods (e.g., pillboxes, timers) and prescriptions, over-the-counter medications, and supplements, and comparing the actual regimen to that listed at the most recent outpatient visit [ 16 , 18 ]. Patients can also be supported by PD nurses in these respects through telenursing. Neuroscience nurses in the United States provided videophone and telephone guidance, which is helpful in confirming medications, side effects, and schedules [ 14 ]. The nurse–patient relationship was reportedly strengthened by this strong individualized support, and patients appreciated the guidance, especially the visual aspect provided by videophone [ 14 ].

Because oral medications for patients with PD are complex, it is necessary to be aware of a possible decline in medication adherence. A US medication error study involving registered nurses who made home visits to patients with PD reported that the most common medication errors were taking medications that were not known to their care providers, taking medications that patients were instructed to discontinue, taking an incorrect number of doses, and omitting or forgetting to take a dose [ 19 ]. Medication delays can have serious consequences, including impaired physical function and dysphagia, and neuroleptic malignant syndrome can be life-threatening. PDNSs need to be constantly vigilant to ensure that PD medications are not unexpectedly discontinued for any reason [ 12 ]. CPNSs may also consult with pharmacies about medication management and introduce dispensing aids, such as reminders and blister packaging [ 20 ]. One reason for poor medication adherence may be dysphagia. Crushing tablets or opening capsules to make swallowing easier for patients with PD should not be implemented without seeking advice from the dispenser [ 17 ]. Therefore, community nurses should consult with the pharmacist to discuss whether other forms of medications can be used when swallowing difficulties are affecting adherence [ 17 ].

Medication adjustment

Only studies regarding the adjustment of oral medication by PD nurses were extracted. In these studies, medications were adjusted based on knowledge of the association between diet and medications, including the time between meals and medications, and the timing of oral medications was adjusted to reduce drowsiness as a side effect [ 14 , 21 ]. PDNSs may also adjust medications. Studies in the United Kingdom and Italy have shown that PDNSs provide information about medical conditions and the purposes of medications, change medications via formal consultations or by telephone, aim to detect problems early, including side effects, when treatment is changed, and advise on medication adjustments [ 20 , 21 , 22 , 23 ].

A study that conducted semi-structured interviews reported that patients were satisfied with the information provided by PDNSs [ 21 ]. A study in which patients were questioned by community-based nurses specializing in PD, which included patients with and without regular interventions who had their clinical health status and response to treatment monitored (reporting back to their general practitioner or consultant as needed), reported that the intervention group had significantly better scores for overall health [ 24 ]. In a case study, a CPNS in the United Kingdom observed a patient’s hallucinations and discovered that they were a side effect of L-dopa, which led to an adjustment in dosage [ 20 ]. In Italy, a PDNS identified unpleasant hallucinations during telenursing, determined that they were possible side effects of cholinesterase, and provided this information to the physician, which led to modification of the prescription medication [ 23 ]. Similarly, in Australia, a movement disorder nurse conducted advocacy regarding medications, and medication was changed after physician–patient interactions [ 25 ].

LCIG care was reported in one study conducted in Sweden that implemented care at home using telehealth. In that study, Duodopa nurses provided training in the use of the equipment before and during the introduction of telemedicine, support through home visits, and instruction to patients using a video communication system; patients, neurologists, and nurses were all satisfied [ 26 ].

Apomorphine management

One study in the United Kingdom reported on apomorphine management. A community nursing team was responsible for the daily management of apomorphine, supported by guidance from PDNSs. The role of community nurses in apomorphine management was to supervise and support patients, caregivers, and family members, including by selecting appropriate sites for the infusion, setting up the pump, and siting and removing the needle. Apomorphine users, nurses, and caregivers should follow best practices to minimize severe reactions to apomorphine infusion, and better documentation of the rotation of the infusion site and nodule severity assures a high standard of care [ 27 ].

Postoperative management of DBS

In a US intervention study, home health nurses supported the postoperative management of patients who had undergone DBS. Postoperatively, trained nurses visited the patients at home to measure vital signs, implement an app-based program, and administer medications and clinical rating scales. The study reported no significant differences in motor symptoms, PD symptom severity, or quality of life compared with outpatients [ 28 ].

Safety assessment related to falls

As patients with PD are at increased risk of falling because of motor and non-motor symptoms, treatment, and other factors, they need to be assessed in terms of safety. Therefore, it is important to identify motor fluctuations [ 12 ]. Specifically, nurses use the Unified Parkinson’s Disease Rating scale (I and II) and fall assessments, paying particular attention to tremors; falls; frozen gait; dysphagia; independence level in dressing, toileting, and walking; and environmental safety assessments at home, such as in the bathroom and kitchen, including assessments of clutter and uneven floors [ 16 , 18 ]. In addition, nurses check orthostatic vital signs given the prevalence of orthostatic hypotension [ 16 ]. Because conditions change over time, PDNSs have a role in providing strategies for adapting to changes and advice for maintaining safety, such as by avoiding falls [ 12 ]. The appropriateness of mobility aids such as canes and walkers should also be assessed, and it is essential to educate family members about these aids [ 15 ].

In a study from the United Kingdom, it was reported that there were no significant differences in motor symptoms or quality of life between patients treated by community-based nurses specializing in PD and those treated by general physicians, and the nurse group had significantly better overall health scores [ 24 ]. An Italian telenursing service operated by PDNSs reported 13 telephone contacts during a 3-month intervention period and, at enrollment, 99 falls in the previous 3 months; this decreased to 3 falls in the 3 months after the intervention [ 23 ].

Support for non-motor symptoms

Support for sleep disorders.

Sleep disorders are also associated with quality of life and the risk of falls in patients with PD. One study from the United Kingdom found that after PDNSs received education on helping patients with PD and sleep disorders, patients reported a reduction in anxiety over sleep problems, feeling able to manage their sleep, having a sense of control over their sleep, and experiencing improved sleep efficiency (time to fall asleep) and quality of life [ 29 ]. This education included recognition of sleep problems in patients with PD, health education on sleep and insomnia, sleep assessment, sleep hygiene practices, use of stimulus control and sleep restriction procedures, implementation of relaxation methods, and cognitive approaches to manage insomnia symptoms [ 29 ].

Support for Dysphagia

Dysphagia is also associated with the previously mentioned oral medications. One role of community nurses for patients with PD in the United Kingdom is to be aware of the risks of dysphagia, to actively ask patients if they have experienced swallowing difficulties, and to consult with pharmacists about the shape and other aspects of the medication, given that difficulty swallowing can affect medication adherence [ 17 ]. In Italy, a case study reported that after 13 telenursing sessions over 3 months, in which a PDNS provided symptom assessment and individualized advice by telephone, the initial moderate dysphagia completely disappeared at the follow-up interview 3 months later [ 23 ].

Support for excretory problems

Urinary problems and constipation need to be incorporated into the nursing plan because of their impact on patient distress [ 10 , 15 ]. For urinary problems, a comprehensive assessment should be conducted before an appropriate treatment plan is implemented, including a continence assessment conducted with a trained professional and supporting families with tailored bladder training, such as a regular toileting routine, pelvic floor muscle training, and the supply of products for incontinence [ 30 ]. Regular clinical monitoring, medication management, and good communication with patients can help empower them to make decisions and choices related to their care [ 30 ]. It was reported that urinary problems were common in patients with Hoehn and Yahr stage V, and urinary and indwelling bladder catheters were commonly required [ 31 ].

Support for mental health

Mental health support and counseling are provided by nurses and PD nurses [ 11 , 22 ], and were among the most frequently performed nursing activities for patients with PD in a study of nurse care managers in the United States [ 11 ].

In terms of specific individualized support, in the United Kingdom, CPNSs found that patients continued to fall, lost weight because of anorexia, and felt increasingly depressed; the nurses discussed the best way forward with multidisciplinary staff and family members [ 20 ]. In Australia, a movement disorder nurse provided emotional support to her patient, with a reduction in illness uncertainty achieved through the sharing of information about future expectations [ 25 ]. In a case report about a telenursing service provided by a PDNS in Italy, 13 telephone support calls in 3 months led to a reduction in depression and anxiety [ 23 ].

Palliative care

Palliative care is designed to provide specialized disease management and physical, psychological, spiritual, and social support, to reduce suffering and improve quality of life for patients and their caregivers [ 32 ]. PDNSs play a role in symptom reduction and pain relief for both patients and caregivers, for example, by addressing dysuria, constipation, and sedation in patients and providing counseling, education, and advice for both patients and caregivers, including by facilitating referrals and collaborations with other agencies [ 22 ].

In China, a study of factors promoting and inhibiting palliative care provision by registered PD nurses was conducted, and the facilitatory factors included the desire for palliative care knowledge among healthcare professionals, the presence of social support, nurses acting as a bridge between the patient and physician, convenient community services, and the availability of hospital–community–family based services [ 32 ]. Factors inhibiting palliative care included misconceptions about this form of care among healthcare professionals, patients, and caregivers (e.g., believing that palliative care does not include surgical or conservative treatments and is similar to hospice care); lack of time for communication between patients and healthcare professionals; lack of specialized palliative care nurses; lack of palliative care referral criteria; lack of information on palliative care resources; and lack of maintenance of continuity of care [ 32 ].

Support for caregivers

Counseling and education about PD are provided to both patients and caregivers by PD nurses and other nurses, both in the home and over the phone, when patients are living at home [ 18 , 24 , 31 ]. In a US study, a program of home visits by several professionals, including nurses, to assess the psychosocial needs of patients and caregivers, along with follow-up by telephone to address any remaining needs, indicated that 98.1% of caregivers were satisfied with the program [ 18 ]. Another study reported that nurses mediated between physicians and patients or their families, such as by providing information to caregivers when the patient’s medication was changed [ 25 ]. When palliative care is provided, as noted above, PDNSs are responsible for providing counseling, education, and advice to both the patients and caregivers, as well as for facilitating referrals and coordination with other agencies [ 22 ].

Education for care home staff

Patients with PD may need to be admitted to a care home if they have difficulty living at home. Staff providing care to patients with PD find hallucinations, falls, and physical difficulties difficult to manage [ 33 ]. In the United Kingdom, 62% of PDNSs reported training care home staff, providing training to staff when a patient who had been in the care of a CPNS was admitted to a care home and providing training in the area of responsibility in collaboration with the Education and Training Officer of Parkinson’s UK [ 20 , 33 ]. Specifically, they provided materials and information related to the care of patients with PD, regular reviews of patients by PD nurses or general practitioners, and regular training for new employees [ 33 ]. An Australian study introducing an educational program (including video presentations, a 1-hour lecture, and a refresher program after 4–6 weeks) for staff in residential aged care facilities, developed primarily by Parkinson’s nurse experts and focusing specifically on therapeutic medication knowledge and management, reported that program implementation increased levels of knowledge [ 34 ].

Multidisciplinary approach

According to the included studies, PD nurses and nurses collaborated with neurologists, pharmacists, movement disorder specialists, social workers, psychologists, physiotherapists, occupational therapists, speech therapists, and other therapists specializing in neurology, as well as with nutritionists, care staff and, in the United Kingdom, other staff involved in caring for Parkinson’s patients, with contact maintained with hospital staff during admission and discharge [ 12 , 15 , 16 , 18 , 24 , 33 , 35 ]. Collaboration involved joint home visits, the exchange of information through conferences, and referrals to other professionals such as psychologists and therapists [ 12 , 20 , 33 ].

Nurses need to work as a care team to address both aspects of the clinical environment and the care provided in the home for patients with PD [ 13 ]. When working within a multidisciplinary team, nurses need to assess the patient’s abilities and plan appropriate care, including in relation to both written and verbal communication; personal hygiene; mobility (with consideration of problems related to moving in bed, transferring, and initiating and maintaining mobility); toileting, with special attention paid to the possibility of constipation; swallowing and eating; and psychological issues [ 10 ]. Nurses play a liaison role, working with the primary care team for ongoing assessment and treatment as needed [ 24 , 32 ]. The role also includes training nursing home staff and various other clinical and general staff, as well as educating the community [ 20 , 22 ].

The effects of multidisciplinary collaboration on patients have also been reported. A study conducted in Germany reported clear improvements in emotional well-being, stigma, communication, and physical discomfort through collaboration among PDNSs, community neurologists, and movement disorder specialists [ 35 ]. A study of palliative care in China stated that the registered PD nurse should serve as a coordinator between the physician and the patient, as the absence of this collaboration results in poor palliative care [ 32 ].

Provision of information on social resources

Nurses have a role in providing patients with PD, and their families and caregivers, with local and national resources and information, such as recommendations for respite and day hospitalization care, assessment of eligibility for social benefits, and special assistance at home [ 12 , 15 , 22 , 24 ]. For example, in an Australian study, movement disorder nurses provided extensive practical support through a variety of strategies, incorporating home modifications and housekeeping support to assist patients with daily living [ 25 ]. In a study of palliative care in China, a lack of information on social resources led to a lack of service utilization [ 32 ]. Finally, a case study conducted in the United Kingdom reported that a patient who had repeated falls, worsening depression, and difficulty living alone was referred to a nursing home [ 20 ].

This study was conducted to provide an overview of what is known about the role of nurses in caring for patients with PD at home, and to determine the differences between nurses and PDNSs caring for these patients. Nine main roles were identified: overall assessment and support, treatment management, safety assessment regarding falls, care for non-motor symptoms, palliative care, support for caregivers, education for care home staff, multidisciplinary collaboration, and provision of information on social resources. Most of the roles were similar to those associated with nursing care at home for patients in general [ 36 ] and were performed by both nurses and PD nurses. The results suggest that the main role of PD nurses at home is to manage medication and educate care staff. While these are also important roles for PD nurses in clinics, PD nurses in the home environment can provide superior support because they understand patients’ daily lives. The results of this study will help nurses prepare by providing them with the knowledge and skills needed to help patients with PD, leading to more reliable care for patients, especially in countries lacking a PD nurse system.

Because the basic treatment for PD is oral medication, medication management by nurses, subsuming medication adherence and dosage adjustment considering side effects and timing, is considered to be particularly important in supporting home care. Most patients with PD, particularly those with early stage disease, engage in medication non-adherence behaviors, often intentionally [ 21 , 37 ]. One common reason for hospitalization among patients with PD is falls or fractures caused by motor symptoms; in fact, this accounts for 65% of all falls [ 38 ]. For preventing hospitalization, nurses should be aware that patients are likely to show non-adherence behaviors, and they should aim to prevent missed or incorrectly taken medications by using medication boxes, building a relationship in which the patient feels free to ask for help regarding medication problems, and possibly providing guidance to family members and other support persons. The role of medication dosage adjustment was extracted only from the studies about PD nurses included in this review. It would be particularly meaningful for PD nurses to be involved in this aspect of care because they might spend more time with patients than other professionals; they can assess side effects and the need to add, subtract, or change medication doses at particular times, as well as explain the situation to the physician. In addition to oral medication, nurses are responsible for the daily management of apomorphine in homebound patients and are supported by guidance from PD nurses [ 27 ]. Novel non-oral medications may emerge in the future as alternatives to apomorphine, LCIG, and non-pharmacological treatments such as DBS. PD nurses may be required to advise nurses and to make suggestions to the patient’s physician regarding changes in administration methods and treatments, including implementing other non-pharmacologic therapies.

When patients with PD have difficulty living at home, they may be considered for admission to a care home, especially if they have advanced PD or comorbidities that significantly increase the possibility of admission, such as hip fracture or dementia [ 39 , 40 ]. Care needs for admitted patients with PD may not be met if staff knowledge of PD-related problems is insufficient [ 41 ]. In addition to the complexity of oral medications for PD, patients take medicines for the treatment of comorbidities as needed, which may make it difficult for care home staff without sufficient knowledge to assist patients in taking their medications. Therefore, education of care staff by PD nurses is necessary to ensure the safety of patients with PD.

Other roles of nurses related to motor and non-motor symptoms in patients with PD at home are generally applicable to patients with other diseases as well. Specific details of the nurse’s role regarding constipation, which is one of the non-motor symptoms of PD, were not extracted from the studies included in this review. However, the frequency of constipation varied among the studies, from 7 to 70%, and constipation is considered a common symptom in patients with PD because of the effects of the both the disease itself and oral medications [ 42 ]. In the management of constipation, dietary intervention with probiotics and prebiotics and the use of lubiprostone and macrogol have been suggested to be potentially effective, whereas the evidence for the efficacy of abdominal massage is considered insufficient [ 43 , 44 ]. A nurse intervention program for constipation in patients with PD has been created in China [ 45 ], and its results suggests that support for defecation is one of the forms of care that nurses should provide. Sleep medications are sometimes used to treat sleep problems, which are classified as non-motor symptoms. However, in patients with PD, only the dopamine agonist rotigotine has been shown to be effective; evidence for the efficacy of other drugs is insufficient [ 44 ]. Among older patients with PD, 18.6% were prescribed hypnotics, with benzodiazepines being reported to increase the risk of injury significantly, and melatonin receptor agonists reportedly significantly increasing the risk of femoral fractures [ 46 ]. Therefore, it is important to understand the treatments for non-motor symptoms and to provide nursing care while considering their side effects. This can be expected to improve the quality of life of patients with PD.

In addition to nursing care to address the symptoms of patients with PD at home, we found that nurses need to play roles in multidisciplinary collaborations and provide information on social resources. There are differences among countries and regions in terms of the granting of qualifications and the tasks performed in accordance therewith. This study found that there are PD nurses in the United Kingdom, Italy, Germany, Sweden, Australia, the United States, and China, and a competency framework for nurses working in PD management has been created in the United Kingdom [ 7 ]. In the Netherlands, which was not covered by this study, professional qualifications have been granted, and guidelines have been created [ 47 ]. Nurse-led community care is also provided in Singapore, particularly for patients with severe motor impairments and those without a caregiver; patients are visited by a PD nurse and, if necessary, referred to relevant community services [ 48 ]. In these countries, PD nurses take the lead in supporting patients, which is essential for patients to live at home. By contrast, in Japan, for example, nurses at hospitals and clinics only provide care within their departments, and home-visiting nurses only provide care to patients at home or in care homes. As such, some countries are not able to provide nursing care across all inpatient, outpatient, and home care settings. Instead, Japan has a national qualification for public health nurses, who are mainly affiliated with government agencies, playing a liaison role by providing information on available social services and communicating with various agencies. However, they do not provide patient support under the orders of a physician and cannot provide medical assistance. The introduction of PD nurses in countries such as Japan will require that they be given PD-specific roles in accordance with the national system. Clarifying the roles of each type of care provider in every country may increase the likelihood that patients with PD can continue to live at home.

This review has some limitations. First, we only included articles written in English; references written in other languages or included in databases from other countries were not extracted. On the basis of the distribution of the included studies by country, selection bias is plausible given that the countries with multiple references were all English-speaking countries. Second, no studies in this review described in detail the differences between the roles of PD nurses and other nurses in countries where PD nurses are qualified, and the relative impact on patients of interventions implemented by the different types of nurses was not evaluated. Interventions implemented by PD nurses may lead to greater improvements in patients’ symptom control and quality of life compared with those implemented by nurses. Therefore, further research focusing on the differences in nursing roles and outcomes is needed.

This study clarified the nine main roles of nurses caring for patients with PD at home, including overall assessment and support, treatment management, safety assessment regarding falls, care for non-motor symptoms, palliative care, support for caregivers, education for care home staff, multidisciplinary collaboration, and provision of information on social resources. Because PD medications are complex, medication management and education for care staff are particularly important roles for PD nurses. This study will help prepare nurses by providing them the knowledge and skills necessary to assist patients with PD, even in countries that do not have a PD nurse system, thereby leading to care that will improve patients’ sense of security.

Data availability

Not applicable.

Abbreviations

• Parkinson’s disease

levodopa–carbidopa intestinal gel

deep brain stimulation

Parkinson’s disease nurse specialist

community Parkinson’s nurse specialists

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We thank Michael Irvine, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

This work was supported by JSPS KAKENHI (grant numbers JP23H03231 and JP23K27921). The funding body did not participate in the design of the study; the collection, analysis, or interpretation of the data; or the writing of the manuscript.

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Fujita, T., Iwaki, M. & Hatono, Y. The role of nurses for patients with Parkinson’s disease at home: a scoping review. BMC Nurs 23 , 318 (2024). https://doi.org/10.1186/s12912-024-01931-y

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Canada's foreign student push 'mismatched' job market, data shows

Nearly 800,000 international students got permits to study business, far more than health care or trades.

How Canada's recruitment of foreign students failed to match labour market needs

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Canada's recruitment of international students has tilted strongly toward filling spots in business programs, while doing little to meet the demand for workers in health care and the skilled trades, according to a CBC News analysis of federal data.

CBC obtained figures from Immigration, Refugees and Citizenship Canada (IRCC) showing the fields of education chosen by foreign students who received study permits from Ottawa to attend college or university in each year since 2018. 

Experts say the figures demonstrate that neither federal nor provincial governments — nor Canadian colleges and universities themselves — focused international student recruitment squarely on filling the country's most pressing labour needs.

"What we're seeing with this data is that oversight was really lacking," said Rupa Banerjee, an associate professor at Toronto Metropolitan University who holds the Canada Research Chair in the economic inclusion of immigrants. 

The figures, which have not previously been made public, show that business-related programs accounted for 27 per cent of all study permits approved from 2018 to 2023, more than any other field. 

Over that same time period, just six per cent of all permits went to foreign students for health sciences, medicine or biological and biomedical sciences programs, while trades and vocational training programs accounted for 1.25 per cent. 

Banerjee says the data shows far too many foreign students were lured to Canada for post-secondary programs with little prospect of a good job in an in-demand field. 

"Instead of really trying to bring in the best and the brightest to fill the labour market gaps that need to be filled, what we're doing is bringing in low skill, low wage, expendable and exploitable temporary foreign workers in the form of students," Banerjee said in an interview.  

Recruitment not aligned with demand for skilled workers

She says the figures point to a failure by both federal and provincial governments to ensure that international student recruitment was in line with Canada's need for skilled workers. 

"Students are graduating from programs that are not particularly valuable in the labour market, that are not allowing them to get the jobs that will then allow them to transition and become productive Canadian permanent residents," Banerjee said. 

• CBC Explains What's behind the problems with Canada's international student program?

The industries with the highest job vacancy rates and the largest absolute numbers of job vacancies have been generally consistent since 2018, both before and after the COVID-19 pandemic began: construction, health care and accommodation and food services, according to Statistics Canada data .

Yet from 2018 to 2023, the growth in the number of international students coming to Canada for business programs far outpaced the growth in any other post-secondary field. 

The number of study permits granted for programs in business management, marketing and related support services increased fivefold between 2018 and 2023. No other field of study saw anywhere near that rapid of an increase. 

The number of permits granted to non-business fields increased on average 1.7 times over the same time period, according to the data. The fields of health sciences (2.6 times) and computing/IT (2.4 times) saw the next-largest increases.         

Minister to raise issue Friday 

Marc Miller, the federal Minister of Immigration, Refugees and Citizenship, told CBC News that he'll be raising the issue of better matching Canada's intake of newcomers to labour market needs when he meets provincial and territorial ministers responsible for immigration on Friday. 

"There is a responsibility of provinces in this ... to make sure that the programs that [colleges and universities] are offering to international students are the ones that fit the job market," Miller said Tuesday on Parliament Hill.  

• CBC Investigates Canada's international student spike was blamed on private colleges. Here's what really happened

Foreign students pay significantly higher tuition fees than Canadians and have poured billions of dollars into the country's post-secondary institutions. CBC News revealed earlier this year that the biggest drivers of Canada's sharp increase in international students were public colleges, largely in Ontario. 

At the time, officials from several colleges with large foreign student enrolment told CBC News that they ramped up their international recruitment — at the urging of both federal and provincial governments — to fill the country's need for skilled workers.

"International students are needed to fill employment gaps," said a statement from Conestoga College in Kitchener, Ont., which topped the national list for international study permits in four of the past five years. "Our growth over the last few years has been tied to our mission: to meet workforce demands in the communities we serve." 

International students made up 70 per cent of the enrolment in Conestoga's business programs in 2021-22, according to Statistics Canada . 

• Federal government announces 2-year cap on student permits

An official from Cambrian College in Sudbury, Ont., which had a nearly fivefold increase in its international student intake between 2018 and 2023, said its recruitment "mirrors and aligns with the federal government's own efforts to increase annual levels of immigration, including students, in order to meet the demand for skilled workers now and in the future." 

The new data showing how many foreign students came to Canada to study business raise questions about why it happened.  

Ottawa was warned about mismatch

The Trudeau government was warned about the misalignment more than a year before it finally clamped down on international student numbers. 

A September 2022 report from RBC questioned whether Canada was doing enough to match its recruitment of international students with demand in the labour force.

The report described a "misalignment between the study programs pursued by international students and labour market needs" and called for numbers to rise in health care, some trades and services and education. 

"I don't think that there was any effort or plan to match the enrolments by field of study to the needs of the labour market," said Parisa Mahboubi, a senior policy analyst at the C.D. Howe Institute, in an interview.

IRCC approved more than 776,000 permits for students to enrol in programs classed as "business/commerce" or "business management, marketing and related support services" during the six-year timeframe covered by the data.  

By contrast, about 143,000 study permits were issued over the same time period for programs classed as health sciences, 36,000 for trades and vocational programs and 6,300 for medicine. 

• International students will be allowed to work 24 hours a week starting in September

Economist Armine Yalnizyan, the Atkinson Foundation's fellow on the future of workers, says there appears to have been "no rhyme or reason" to the pattern of international student recruitment. 

"It's selling a false bill of goods to the [students] that are coming here, because we don't need that many people that have expertise in business," Yalnizyan said in an interview.  

 "We need much closer scrutiny of what skills we are trying to build through our post-secondary institutions," Yalnizyan said. 

As a student from India, Akash Singh paid $34,000 for a two-year business program through St. Clair College, one of Ontario's 24 public colleges. Singh studied at the college's Toronto campus, in a program delivered by Ace Acumen Academy as part of a public college-private partnership  open only to international students. 

Since getting his diploma in 2021, the only jobs that Singh, 22, has managed to land were as a security guard and in a McDonald's restaurant. 

• Minister was warned about possible negative impacts of lifting international student work limit

"I thought I would do my course here, and if I get good marks, I'm going to find a good job related to that field," Singh said in an interview.  

"No opportunities are here for business students," he said. "I have been trying to find jobs in finance, and it's not possible."

Singh says recruiters for Canadian colleges based in India strongly encouraged students to apply for business programs, telling them that admission to the program and jobs after graduation would be easy to obtain. 

He says to his knowledge, none of the students in his cohort actually found work in business-related fields. 

Singh's challenges in finding relevant work do not reflect what most international business students have experienced, said Ron Seguin, senior vice president international relations at St. Clair College. 

"It's not a story we hear often, quite honestly," said Seguin in an interview. "Those employable skills that the student learns can be applied to many sectors, and that's more the case with business than anything else." 

'Fountain of money' for colleges

Alex Usher, president of Higher Education Strategy Associates, a consulting firm, says the explosive growth of international students in business programs was largely driven by colleges in Ontario seeking ways to make up for provincial underfunding. 

"I don't think it had much to do with labour market needs, I think what it had to do with was colleges' financial needs," Usher said in an interview. "It was a fountain of money." 

• Analysis Ontario public colleges depend on foreign students' money. Should they?

He says business programs are relatively cheap to run, especially in contrast with clinical and technical courses. 

With colleges charging each international student in the neighbourhood of $15,000 per academic year for such a program, a less-expensive-to-run course, such as business, leaves the school more revenue to spend elsewhere. 

Usher believes the provinces deserve more of the blame than the federal government for the makeup of the international student body. 

That's because the provinces have responsibility to oversee the type of programs their colleges and universities offer. Although IRCC has the role of approving study permits, the provinces have the power to limit the number of international students allowed to enrol in post-secondary programs. 

• Ontario colleges to face biggest hit from foreign student cap

Before this year's federal cap, the only province that exercised this power was Quebec, which required each international student to obtain an authorization letter from the provincial ministry of education. In other provinces, all a student needed before applying for a study permit was admission from a college or university program. 

"It was possible for provinces to regulate the numbers, it's just that nine out of 10 of them chose not to," said Usher.

Ontario's Minister of Colleges and Universities Jill Dunlop was not available for an interview, but her spokesperson provided a statement.

"Colleges and universities are autonomous and have the freedom to make their own decisions regarding international enrolment," said Liz Tuomi, Dunlop's press secretary in an email to CBC News. 

However, Ontario is barring international students from enrolling in one-year business/management programs while the ministry conducts a review, said Tuomi.

She said the priorities for Ontario's reduced allotment of international student permits will be programs that "help prepare graduates for in-demand jobs," including skilled trades, health human resources, hospitality, child care and the STEM fields (science, technology, engineering and math).

Marketa Evans, president and CEO of Colleges Ontario, the umbrella group representing the 24 publicly funded colleges in the province says a "significant number of international students" are enrolled in programs that fill key labour market needs, including logistics, computer programming, business analytics, hospitality management, travel and tourism and culinary arts. 

900 international nursing students in Ontario colleges 

"Students choose what programs they take, and Ontario's public colleges offer dozens of business programs that have clear labour market value," said Evans in a statement.

Some 18,000 international students are currently enrolled in programs related to advanced manufacturing and technology, while 900 international students are enrolled in nursing, according to figures provided by Colleges Ontario. 

• Conestoga College under fire by students, union leaders for aggressive international student recruitment

The data obtained from IRCC show large numbers of study permits issued in which the specific field of study was labelled other (367,000) or unspecified (339,000).

IRCC officials said this is a result of how students filled in their study permit applications: "other" represents when an applicant indicated their chosen field of study was not among the listed categories, and "unspecified" represents when the applicant left the field blank.

METHODOLOGY: HOW CBC ANALYZED STUDY PERMITS BY FIELD OF STUDY

The data presented in this story was compiled and provided by Immigration, Refugees and Citizenship Canada (IRCC) on March 18, 2024 and represents all new and extended study permits approved by Ottawa between calendar years 2018 to 2023. The tables provided had two fields of study categorized as "Other" (~12% of permits) and "Unspecified" (~12% of permits). Between 5-7 per cent of geography fields were identified as "Unknown/Unspecified". 

IRCC explained that "Other" is used "when a chosen field of study is not listed in a selection" and that "Unspecified" is used "when the system did not register a field of study. This is due [to] the field being left blank by applicants". In addition, "Unknown/Unspecified" is used "when the geographic location is not available or not entered into the system".

On April 23, IRCC provided a second "revised" data table, in which all values between 0 and 5 were suppressed "for privacy reasons to prevent individuals from being identified when IRCC data is compiled and compared to publicly available statistics". All others were rounded down by a multiple of 5 for the same reason. As a result of this rounding, some of the summed-up values in cells no longer matched the totals by geographies, years and programs.

In both tables, overall trends show the same significant growth of permits related to business programs and the same overrepresentation of those programs compared to other fields.

In an effort to present the most exhaustive and accurate numbers available – as figures have not previously been made public – CBC News has retained the March 2024 table where the values are not rounded for its analysis. One exception was made: to reflect significant revisions made by IRCC that were not rounding, cells showing a discrepancy of more than 5 between the old and new tables were updated with their revised number. Those updates largely affect study permits in Quebec (2018-2023), Unknown/Unspecified geographies (2018-2023) and a handful of 2023 programs in Ontario, BC and Alberta. All totals were recalculated to reflect the true sum of values in cells.

To protect the privacy of individuals, geographies and/or programs with 0-4 approved permits in a given year were replaced with "<5" in the publicly downloadable and searchable chart, however, the accurate values were used in all analyses and visualizations.

Data cleaning and analysis: Valerie Ouellet, Senior Data Journalist (March-April 2024)

ABOUT THE AUTHOR

Senior reporter

Mike Crawley covers provincial affairs in Ontario for CBC News. He began his career as a newspaper reporter in B.C., filed stories from 19 countries in Africa as a freelance journalist, then joined the CBC in 2005. Mike was born and raised in Saint John, N.B.

• Follow Mike Crawley on Twitter

with files from Aloysius Wong

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