Review of literature

Review of literature
A research literature review is a written summary of the state of existing knowledge on a research problem. It helps the researches to seek knowledge on a topic of interest and synthesize evidence based information to gain knowledge and improve nursing practice. 

The purposes of review of literature among researchers are:
It helps to;
-assemble knowledge on a topic
-identification of relevant research problem
-refine research questions
-gain insight to what is known and not known about an area of inquiry
-determine gaps in a body of research
-determine he need of replication of many nursing studies
- identify the suitable methodology to carry out a study
-interpret study findings and in developing implications and recommendations
The research reviews also included in research proposals, documents that describe what a researcher is planning to study, how the study will be conducted and how much will cost to complete the study. 

The purposes of review of literature among non researchers
The nurses involved in policy making organizations are depended on review of literature to review and synthesize evidence based information.
It helps to;
-gain knowledge on a topic
-gather evidence to critique of existing nursing practice or recommend or implement the new nursing interventions
-develop proposals
-develop a theory or conceptual framework
-revise curriculum of nursing
-develop policy statements and practice guidelines

Sources of literature reviews 

• Electronic literature reviews

Most of the universities offer electronic data base with bibliographic files that can be accessed either through an online research. Nurses can access the data through online search, CD-ROM (Compact disks that store the bibliographic information) or commercial vendors (Ovid, Silver platter and so on). These services provide trial run for a few months for testing accessibility before subscribing. For example, CINAHL (Cumulative index to nursing and allied health literature), MEDLINE (Medical literature online), AIDSLINE (AIDS information online), CANCERLIT (Cancer literature) and CHID (Combined health information data base). In the electronic research data base, the studies can be searched by the key words, variables and researcher’s name.

• Print resources

These sources are overshadowed by electronic resources. The main disadvantages are time consuming due to manual search and unable to access to all researchers widely. The main advantage is one can access to reports before 1982, as it is not published in electronic sources.
Print indexes are books used to locate research reports in journals and published periodically with an annual cumulative index. For example, International nursing index, Index Medicus and so on. When using a print index, you need to first identify the appropriate subject heading. It can be located in Index’s thesaurus, which lists commonly used terms or key words. Abstract journals are useful for researchers, as they provide a summary if a study rather than lengthy report.

Writing a literature review
Researcher can collect reviews from two sources such as primary and secondary sources. The primary sources are written by the researchers who conducted them. The secondary sources are description of research articles prepared by some one. The review articles help the researcher to gin insight on what is known and what is unknown or related topic. 

The steps of preparing a written research review are:
Step 1: Identify the key words/concepts to be searched
Step 2: Identify the potential references through electronic/manual search
Step 3: Retrieve promising references
Step 4: Screen references for relevance and appropriateness
Step 5: Read relevant articles and concise the reports
Step 6: Organize the reports based on subject/year/nature of the results
Step 7: Write a review

Types of literature references
There are varieties of literature such as empirical literature, conceptual literature and others include opinion articles, anecdotes, incident reports or clinical impressions.
Empirical literature is objective and addresses the research questions with evidence based information. It increases the strength of the study.
Conceptual literature is based on a theory or conceptual model. In the conceptual literature, a primary source is a description of theory, written by the developer of the theory and a secondary source is a discussion or critique of the theory. Opinion article, anecdotes, incident reports and clinical impressions are mostly subjective; an expression of point of view by the researcher and it does not address any research questions. However, it plays an important role in formulating research ideas. 

Organizing the review
After collecting the relevant articles, the researcher should read carefully till she understands the research. The researcher prepares a summary of article by highlighting the main points such as author, year of the study, place of the study, type of approach and design, sample, data collection, data analysis, results, interpretation, implications, inconsistencies in the results, faults in the research and weakness of the research.

Types of literature reviews
There are several types of review that can be used to support evidence based practice such as:
1. Traditional narrative reviews
This type of review synthesizes and summarizes, in narrative terms, a body of research literature. These reviews are frequently published in nursing journals. It provides the state of the art research based information and foundation for the development of innovations for clinical practice.
2. Meta analysis
It is a method of integrating quantitative research findings statistically. Here, the writer will consider the individual studies are the unit of analysis in a meta-analysis. The writer will review the findings from multiple studies on the same topic are then combined to create a data set that can be analyzed. While reading meta-analysis, the reader gets an idea of strength and weakness of association of dependent and independent variable on related topic. 

3.Qualitative meta-synthesis
It is an integration of narrative information and summary of qualitative findings. It has been defined as the ‘theories, grand narratives, generalizations or interpretive translations produced from integration or comparison of findings from qualitative studies. 

To conclude, the nurses have to read literature reviews to gain insight on the various problem statements and its findings that is existed in the society, which helps to equip them to explore from known to unknown world.

Research Problem

Research Problem
A research problem is a state or source of troubling and perplexing situation or condition. The purpose of the disciplined research is to solve the problem in the reality by exploring and identifying the contributing factors. A problem statement reveals the nature of the problem. A research question is the statement about what the researchers want to answer. Hypothesis is the statement, in which the researcher predicts the answer before data collection and is tested empirically. A statement of purpose is summary of specific objectives and the researcher hopes to achieve by conducting the study. 

An example of the research problem is ‘level of stress among adolescent girls’.
An example of the problem statement is ‘a quantitative study to assess the level of stress among adolescent girls in urban area, India’.
An example of the research question is ‘what is the level of stress among adolescent girls?’
An example of the hypothesis is ‘there is an association between the level of stress and socio demographic variables’.
An example of the statement of purpose is ‘the purpose of the study is to assess the level of stress among adolescent girls and test association between level of stress and socio demographic variables’.
Examples of the objectives are ‘to assess the demographic variables of adolescent girls, to assess the level of stress among adolescent girls and to associate the level of stress and socio demographic variables of adolescent girls’.

The developments of an interesting and innovative research process, researchers begin with a topic of interest, explore its relevance in the current scenario, having discussion with experts and then develop the topic into a more specific problem.

Sources of research problem
The researchers can identify and develop research problem from own clinical experience, thorough review of literature, current political and societal issues, testing and validating theory and emerges ideals from external sources such as conference, interviews, brain storming session with other faculties and so on. The researcher can select an appropriate approach such as qualitative and quantitative, based on the nature of the problem to be explored in detail. For example; (1)if the researcher wants to assess the level of stress among adolescent girls, he/she has to select quantitative approach, which gives the results in numeric terms, in which, the researcher can assess the level of stress in terms of low, moderate and high level of stress. (2) If the researcher wants to explore the stress and its contributing factors among adolescent girls, he/she has to proceed with qualitative approach, which gives the narrative details of information regarding stress and its contributing factors. Thus, the researcher can develop a theory or conceptual model from related qualitative study.

Problem statement
A problem statement is an expression of troubling situation that needs investigation. It identifies the nature of the problem being studied, the population, setting, its content and its significance. In general, in qualitative study, problem statement shows the nature of the problem in terms of concepts, population being studied and setting being carried out in the study, for example; a study to assess the knowledge on child abuse among the mothers of under five children in rural area in India.
In qualitative study, the problem statement expresses the phenomena to be explored, population being studied and setting being carried out in the study. For example; a qualitative study to explore social burden among wives of alcoholics in tribal area, India.

Statement of purpose
It is vital to articulate the researcher’s goals as a broad statement of purpose in declarative form. In a quantitative study, a well worded statement or purpose identifies the key study variables and their possible interrelationship as well as the nature of the population of interest. For example; the purpose of the study was to assess the knowledge on child abuse among the mother’s of under-five children. The statement identifies the population of interest (mothers of under-five children), independent variables (socio demographic variables) and dependent variables (knowledge on child abuse).
In qualitative study, the statement of purpose indicates the nature of the inquiry (exploration), the phenomenon under investigation (social burden), the group (wives of alcoholics) and the setting (tribal area) under study. For example; the purpose of the study was to explore the social burden among wives of alcoholics in tribal area. In quantitative study, the researcher uses verbs of ‘assess, test or compare’ to show the degree of purpose of research. In qualitative research, they use ‘explore, describe, understand and develop’ verbs to show the nature of the purpose of the study. 

Research questions
Research questions are rewording of statement of purpose which phrased interrogatively. This questions help to focus on the data needed to give the answer. In qualitative study, research questions identify key variables (most often dependent and independent variables), the relationships among them and the population under study.
Is there any relationship between knowledge (dependent variable) and education level of participants (independent variable)?
In qualitative study, the researcher starts the study and evolves questions during the study period. 

Research hypothesis
A hypothesis is a statement of prediction about the relationship between two or more variables.

• Hypothesis and qualitative research

In a qualitative study, the researchers don’t begin with hypothesis because the study is guided by the participant’s view points rather than researcher’s view points. Some qualitative studies may lead to the formulation of hypothesis.

• Hypothesis and quantitative research

In quantitative research, a hypothesis is the translation of research question into a prediction of possibilities of outcomes.
Research question: Is there any relationship between weight bearing exercises and loss of weight among women?
Hypothesis: There is a relationship between weight bearing exercises and loss of weight among women.

The theory is too abstract and not able to be tested. However, predictions based on the theory can be tested. For example, theory of reinforcement tells that behavior is positively reinforced (rewarded) tends to be learned. The researcher can develop hypothesis based on the reinforcement theory to test the validity of the predictions such as nursing students who are praised by nursing authority are more hardworking than who are not praised. This proposition can be tested in the real world. The theory gains support if the hypothesis is confirmed.

Testable research hypothesis states the expected relationship between the independent variable (presumed cause) and the dependent variable (the presumed effect with in a population). It is otherwise called as simple hypothesis. A complex hypothesis is the prediction of relationship between two or more independent variables or two or more dependent variables. A directional hypothesis is one that specifies the expected direction of the relationship between the variables. For example, lower level of exercise in post partum is associated with greater weight retention. A non directional hypothesis does not stipulate the direction of relationship, for example, there is a relationship between post partum exercise and weight retention. Research hypotheses are statements of expected relationship between variables. For example, there is a relationship between antenatal exercises and stress reduction among women.

Null hypothesis states that there is no relationship between the independent and dependent variable. For example, there is no relationship between antenatal exercises and stress reduction among women. 

To conclude, hypotheses are never proved through hypothesis testing rather they are accepted or supported. The study results are always vary if the same findings are replicated in many study projects, greater confidence can be placed in the conclusions. The strength of the supported hypothesis depends on the replication of the same results in numerous researches.

Nursing Research Ethics

Nursing Research Ethics 

Most of the professions have established their own code of ethics. The American Nurses Association has formulated ‘human rights guidelines for nurses in clinical and other research’.
In the United States, the National Commission for the Protection of Human Subjects of Bio medical and Behavioral Research issued a report, referred it as Belmont report and served as a model for many of the guidelines adopted by discipline. The Belmont report tells about three primary ethical principles on which standards of ethical conduct in research are based.

I. Beneficence
II. Respect for human dignity
III. Justice

 
I. Principle of Beneficence

 
The principle of beneficence aims at ‘do not harm’. It includes freedom from harm, freedom from exploitation and risk/benefit ratio.
1. Freedom from harm
It is not permitted to harm the study participants during the research. Before proceeds with humans, a new medical procedure or drug is being tested with animals or tissue culture. The psychological harm of the study participants during the study requires close attention and sensitivity, for example, interviewing a rape victim. The psychological harm can be minimized by carefully phrasing questions, obtain informed consent, assure of confidentiality and anonymity, significance of conducting research on the related topic, provide privacy, gain mutual trust, frequent counseling sessions and so on.
2. Freedom from exploitation
The researcher should not place participants at a disadvantage or expose them to situations for which they have not been explicitly prepared. The researcher maintains a relationship and it is crucial that this relationship not to be exploited, for example, sexual exploitation. It is not advisable to utilize the study participants under poor economic circumstances, for example, conducting experimental studies in developing countries by offering free treatment. In qualitative research, the risk of exploitation may be less because that gap between the investigator and participants decrease as the study progresses.
3. Risk/Benefit ratio
The researcher should weigh the potential risks to participants to benefit to society and nursing profession. The degree of risk to be taken by those participating in the research should never exceed the potential humanitarian benefits of the knowledge to be gained. Major potential benefits are accessibility of the treatment when they are in need monetary gains through incentives and so on. The potential risks are physical harm, loss of time, fatigue, boredom, loss of privacy and fear of disclosure. 

II. Principle of respect for human dignity
This principle includes right of self determination, right of full disclosure and informed consent.
4. Right to self determination
The researcher has to respect the study participants for their self determination. The participants have the right to decide voluntarily whether to participate in a study without the risk of increasing any penalty or prejudicial treatment. The participants have the right to ask questions, clarify the doubts, if they do not want to proceed, can terminate their participation. The researcher should be very carful to not to be coercive in the study. Coercion involves implying threats of penalty for failing to participate in a study or excessive rewards from agreeing to participate, for example; rewarding excess internal marks to students, who agreed to participate.
5. Right to full disclosure
The researcher has to describe the study participants regarding the nature of the study, the participant’s right to refuse participation, the researcher’s responsibilities and the potential risks and benefits that would be incurred.
6. Right to obtain informed consent
Informed consent means that the researcher provides adequate information regarding the research to the participants includes study purposes, time period, voluntary nature of the participants, potential risks and benefits and so on. The researcher asks the study participants to sign a consent form prior to the study. In qualitative research, the researcher asks the study participants to sign a process consent, which means consent is viewed as ongoing and transactional process and the researcher continuously negotiates the consent, allowing participants to play a collaborative role in the decision making process regarding their ongoing participation.
Problems related to the principle of respect
There are two biases can be expected in relation to full disclosure to the study participants during the research such as the bias resulting from distorted information and the bias resulting from failure to recruit a good sample. Sometimes, the principle of respect will be questioned while the researcher use two methods in data collection approach such as covert data collection (concealment) and deception technique. If the researcher wanted to observe people’s behavior in real world setting and the informed consent would result in changes in the behavior of interest. Deception is a technique in which, the researcher deliberately withholding information about the study or providing participants with false information. For example, the researcher conduct a study on adolescent drug abuse, might describe the research as a study of student’s health practices. Deception and concealment are problematic from an ethical stand point, if there are anticipated benefits to the society and minimal risk to the participants may be justified to enhance the validity of the findings. 

III. Principle of justice
The principle of justice includes the participant’s right to fair treatment, right to privacy and right to protect vulnerable groups.
7. Right to fair treatment
Participants have the right to fair and equitable treatment before, during and after their participation in the study.
It includes;
-selection of participants non discriminatory
-clarify the doubts of participants
-provide assistance to participants for accessing treatment
-respect their beliefs, habits and life styles
-courteous and tactful treatment at all time
8.  Right to privacy
The researcher should maintain anonymity and confidentiality through out the study. Anonymity occurs when ever the researcher can not link a participant with his or her data. Confidentiality occurs when the researcher promises the participant that any information will not be publicly reported or made accessible to other parties not involved in the research. In qualitative study, the researcher has to take extra precaution to safe guard participant’s identity as the number of participants is small by withholding information about the characteristics of the informant such as age and occupation.
9. Right to protect vulnerable groups
Vulnerable groups such as children, mentally disabled people, physically disabled, institutionalized people, pregnant women, old age groups and patients in unconscious stage are at high risk of unintended side effects because of their circumstances. The researcher should pay extra attention to the ethical dimensions of the study when vulnerable people are involved.

 It includes;
-obtain informed consent from the study participant or guardian of study participant
-explain the procedure to the study participants including benefits and risks
-allow withholding from the study when they wanted
-protect their privacy
-respect their beliefs and practices
Obtain approval of permission from the Institution Review Board or Human Subjects Committee to carry out the study among the vulnerable groups.

Research reports/ Writing a research abstract or research manuscript

Research reports
A research report is a document that summarizes the study including research questions, need of the study, methodology, relevant findings, interpretation and implication of the findings.
Types of research reports
A research report describes what was studied, how it was conducted and what was found. Researchers can communicate their research findings through various ways such as theses and dissertation, books, presentation at conferences and journal articles.

• Theses and dissertation

Most masters and doctoral degrees are granted on the completion of a study that is described in a theses or dissertation.

• Books

A research can be published in books under related topic.

• Presentation at conferences

There are two methods to present a study in the conferences: oral and poster presentation. Oral report of the study is to be presented with in allotted time (10-20 minutes) with visual displays summarizing their studies and proceed to discuss between researcher and conference attendees. During poster presentation, the researcher displays the summary of the study on the poster and can ask questions to help them better understand how they were conducted or what the findings mean.

• Research journal article

Research journal article are reports in professional journals that summarize an investigation. The researcher has to condense a lot of information about the study purpose, methods, findings, interpretation and clinical significance into a short report. The research articles are reviewed by blind peer reviewers who make recommendation about whether the article should be accepted, rejected, revised or reviewed. These are usually blind reviews, the reviewers are not told the name of researchers and the researchers are not told the identity of the reviewers.
Method of writing a manuscript for publication

General instructions

1. Identify a journal (national/international) which is indexed, peer reviewed and has ISSN (International Standard Serial Number) number.
2. Send an email or letter to the publisher by enquiring any need of article and give a detailed summary of your research.
3. If they replied, you have to go through general instructions to authors given in the journal regarding abstract, content, bibliography style and way of submission (online or post). Prepare a manuscript and send it for publication.

Content of research journal article
Research reports begin with a title (less than 15 words) conveys the nature of the study. In qualitative study, the title includes phenomena and group under investigation and in a quantitative study, the title indicates independent and dependent variables and population under study.

Research report often consists of 8 sections: AK-IMRAD-B. Abstract and Key words-Introduction, Methodology, Results and Discussion-Bibliography.

• Abstract

Abstract is a brief description of the study placed at the beginning of the journal article. The abstract has to be written with in 100-200 words by summarizing the key features of the study such as research questions, methods, results, interpretation and implication for nursing practice.

• Introduction

The introduction part introduces the topic to the readers, points out the need of the study. The introduction usually describes the phenomenon, concepts, variables, statement of purpose, objectives and tested hypothesis. A brief description of the review of related literature can give under the introduction part so that readers can understand how the study fits in with previous findings and can assess the contribution of the new study.

• Method section

The method section communicates what methods the researchers used to achieve research objectives. In quantitative study, the method section describes the subjects, the research design and data collection methods. In qualitative study, this section provides information about research setting, context of the study, sampling methods and data collection procedures.

• Results section

This section presents research findings, often with tables and figures that highlight main results. In quantitative study, the researcher provides basic description information for the key variables, using simple statistics. It also describes the name of the statistical tests used, the value of the calculated statistic and its significance. The most important information is whether the results of the statistical tests were significant. If a researcher reports that the results have statistical significance, it means that, based on the statistical test, the findings are probably valid and replicable with a new sample. For example, if a report indicates that a finding was significant at the 0.05 level, this means that only 5 times out of 100 would the obtained result be spurious or 95 times out of 100, similar results would be obtained in new studies.
Both the researchers and readers can have a high degree of confidence but not total assurance that the findings are reliable. In qualitative reports, the researcher organizes the findings according to the major themes and sub themes with direct quotes from the study participants. It also presents researchers emerging theory about the phenomena under study.

• Discussion

In the discussion, the researcher draws conclusions about the meaning and implications of the findings. It also consists of interpretation of results and implications. It can be included with possible study limitations such as sample deficiencies, design problem, errors in data collection and weakness in statistical analysis.

• References

It can be concluded with a list of books, reports and journal articles that were referenced in the text of the report.
The style of research journal articles
The researcher concentrates on four factors while writing an article for publication. 

• Compactness – The space of journal is limited. Hence, authors compress ideas and concepts into a short space. In qualitative study, important supporting quotes can be included.

• Jargon – The authors use research terms that are part of the reader’s vocabulary.

• Objectivity- Quantitative researchers avoid subjective description of the results, express in numeric forms. But, qualitative reports are personal and subjective ideas are written in conversational style.

• Statistical information- The researcher maintains the accuracy of the statistical reports and explains it in simple way to the readers, who do not have strong mathematic interest or training.

Reading and summarizing research reports
Tips to read and sumarize reports are:
-read it frequently whether you understand or not
-highlight the important portions
-read it slowly
-if you do not understand, read it frequently till you get the idea of author
-refer in detail about unfamiliar terms and concepts
-do not be scared of statistical information
-when you attain a reasonable level of comprehension of research reports, next step is to write a brief synopsis of the study. A synopsis summarizes the purpose of the study, research questions, methods, findings, its interpretation and implication of practice.
Critiquing research reports
A research critique is a careful, critical appraisal of the strengths and limitation of a study.
The aspects of the critique are:
-Is the problem significant to nursing?
-Is it sound theoretically?
-Are the methods appropriate?
-Did the researcher interpret data with rationales?
-Were the rights of the subjects protected?
-Is the report clearly written, grammatical and well organized?
A critique on the clinical ability of a study focuses on whether findings are accurate, believable and clinically meaningful. If the findings can not be trusted, it makes a little sense to incorporate them into nursing practice.