literature review ethics in nursing

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• Iran J Nurs Midwifery Res
• v.18(1); Jan-Feb 2013

Nursing ethical values and definitions: A literature review

Mohsen shahriari.

Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Eesa Mohammadi

1 Department of Nursing, Medical Sciences Faculty, Tarbiat Modares University, Bridge Nasr (Gisha), Tehran, Iran

Abbas Abbaszadeh

2 Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Masoud Bahrami

3 Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Background:

Ethical values offer a framework for behavior assessment, and nursing values influence nurses’ goals, strategies, and actions. A literature review was adopted in order to determine and define ethical values for nurses.

Materials and Methods:

This literature review was conducted based on the Centre for Reviews and Dissemination guidelines. The key words used to search relevant sources were nursing, ethics, ethical values, and nursing values. The search of articles in English was carried out in Medline, CINAHL, PubMed, Scopus, Ovid, and Proquest databases. The search of articles in Persian was conducted in databases of Magiran, SID, and Irandoc publications. After assessing and analyzing the obtained data, 17 articles which had a distinct definition of ethical values were chosen and subjected to a thorough study.

The search yielded 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency.

Conclusions:

This study showed that common ethical values are generally shared within the global community. However, in several areas, influences of social, cultural, and economical status and religious beliefs on values result in a different definition of these values. This study revealed that based on humanistic nature of nursing, common values in nursing protect human dignity and respect to the patients. Recognizing and definition of ethical values can help to improve nursing practice and develop codes of ethics.

I NTRODUCTION

Nurses as one of the health service providers and members in health system who are responsible for giving care to the clients and patients based on ethical issues.[ 1 ] They need ethical knowledge to conduct their appropriate function to manage situations and to give safe and proper legal and ethical care in today's changing world.[ 2 ] With regard to practical care, they always try to answer the question of “What can I do?,” whereas they should try to answer what is essential to be done for the patients in the context of ethical principles.[ 3 ] Ethics seek the best way of taking care of the patients as well as the best nursing function.[ 4 ]

Nurses are responsible for their clinical function, and their main responsibility is to take care of the clients and patients who deserve appropriate and safe care.[ 5 ] They act based on the values they have selected. These values form a framework to evaluate their activities influencing their goals, strategies, and function.[ 6 ] These values can also be counted as a resource for nurses’ conduct toward clinical ethical competency and their confrontation with contemporary ethical concerns. Values conduct human life priorities and form the world we live in. They act as one of the most basic parts of human life. Ethical values are inseparable components of the society and, as a result, nursing profession.[ 7 , 8 ]

Discovery of basic values and reaching an agreement on clinical ethical values are essential with regard to constant changes in nurses’ social class and role.[ 9 ] Nurses’ awareness of their values and the effect of these values on their behavior is a core part of humanistic nursing care.[ 10 ] They need to tailor their function to the value system and cultural beliefs of their service recipients.[ 11 ] Values originate from cultural environment, social groups, religion, lived experiences, and the past. Social, cultural, religious, political, and economic considerations influence individuals and their value system,[ 6 ] and ultimately, health, education, social strategies, and patients’ care. Numerous documents have been prepared in nursing texts and literature concerning these values and clarification of their traits.[ 7 , 9 , 12 , 13 , 14 , 15 , 16 ]

Recognition and definition of nursing ethical values in various communities can help nurses have mutual understanding in international level. It can also bring nurses closer to reach a common meaning of care in patients with different cultures. However, there is a paucity of research particularly in the Iranian context to deeply explore nursing ethical values. Therefore, in the first step, the main aim of the study was to identify and explore nursing ethical values reflected in nursing texts. This search was then used to prepare code of ethics and clinical guidelines for Iranian nurses, along with other documents and evidences. Results of other aspects of the study have been reported in other articles from the researchers.

M ATERIALS AND M ETHODS

This study is a part of a bigger study conducted in the Isfahan University of Medical Sciences. A literature review was carried out in 2010 to determine ethical values and related definitions in nursing systems of various countries.

In this literature review, the York University four-step approach was applied. These steps are as follows: Forming questions and determining search strategies, extracting synthesis, providing quality assessments and applying study evaluation tools, and suggesting methods to analyze and data synthesis.[ 17 ]

Search strategy

The study tried to answer the following questions:

• What nursing ethical values are determined and offered in this study?
• What is the definition of each value?

In this literature review, all published articles in English language from 1995 to 2010, as well as articles in Persian from 1996 to 2010 were searched by separated keywords and then keywords in combination, respectively. AND/OR was used combination and collection of various key words together. A manual search was also adopted and the references of the articles were studied as well. The search yielded about 82 articles whose titles and abstracts were studied. The articles not meeting the inclusion criteria were left out. Inclusion criteria were: Articles published in English or Persian and those articles on nursing ethical values in patients’ care. At this stage, 37 articles were excluded and 45 were selected and comprehensively reviewed. In the next stage, the articles were completely studied with regard to inclusion criteria and their answers to the questions of the present study.

Finally, 17 related articles were selected and considered for the study. Data were extracted through firstly writing down the detected values and their definitions in the related articles. Then, the research team compared the findings and recorded them in a table, and selected the best definition of each value among the suggested definitions. Finally, after comparison of the names and words, a unique definition for each value was achieved based on the trait of definition.

Research team checked all selected articles concerning assessment of quality based on criteria of study quality evaluation tool. This tool was designed by the research team with regard to the study goal. Two questions were considered with respect to the various research methods employed in the selected articles. The questions were as follows:

• Does the article express nursing ethical values?
• Does the article contain a clear and specific definition for the expressed ethical values?

In order to increase study credibility, the abstracts were studied by researchers individually and the obscure points were discussed by the research team. In case of a disagreement to include an article in the study, a third member of the research team conducted further investigations, the obscure points were discussed in the group, and a final decision was made.

In the stage of data combination, all textual obtained data from the selected articles were classified and completely described. After textual data had been extracted and studied critically, the traits were separated and finalized based on the obtained definition for each value or ethical concept and finally a unique definition was obtained. Each obtained defined value has been explained in the section “Discussion.” These defined values suggested appropriate answers to literature review questions.

Articles methodological traits

The articles were from 12 countries: Four from US, two from Canada, five from European countries (Belgium, England, Finland), and six from Asian countries (Iran, Japan, China, Thailand, and Taiwan).

Reviewed articles included two quantitative studies, eight qualitative studies, three literature reviews, two philosophical inquiries, and two action research philosophical methods. Various sampling methods had been precisely employed in these studies. 1360 subjects comprised the recruited subjects in these 17 articles. In two quantitative descriptive studies, 922 clinical nurses and nursing students had been randomly selected through census sampling. In qualitative researches, the participants comprised 438, randomly selected through purposive sampling. The number of participants ranged between 20 and 300 individuals. In most of these qualitative studies, the participants included clinical nurses accompanied by nurse educators.[ 9 , 18 , 19 , 20 ] In one study, the participants were just clinical nurses, and in another,[ 21 ] they were just nursing students.[ 22 ]

The data were mostly collected through individual interviews which were, in some cases, the only source of data and in some other cases accompanied by other methods. The data had been collected by different methods: One by individual interviews and group discussion,[ 20 ] one by individual interview and observation,[ 18 ] one by narration and individual interview,[ 19 ] one by group discussion and narration,[ 22 ] and finally, in only one by group discussion.[ 9 ] In two studies, data had been collected through literature content analysis;[ 10 , 13 ] in two, by applying intervention;[ 16 , 23 ] in two other, through literature review;[ 7 , 24 ] and finally, in two studies, the data had been collected through philosophical inquiries.[ 6 , 25 ]

In two quantitative studies adopted to collect data, standard tools had been employed. In the study of Weis (2000), Nurses’ Professional Values Scale (NPVS) with confirmed reliability and validity had been utilized.[ 26 ] Rassin (2008) used nursing code of ethics related to International Nursing Association to evaluate nurses’ professional values as well as the Rokeach Values Survey with confirmed reliability and content validity to assess nurses’ personal values.[ 15 ]

Quality appraisal

The selected articles were reviewed concerning their quality. Application of a systematic literature scientific method in the present literature review study let the research review the articles based on research questions, research project, data collection method, data analysis method, data credibility, ethical considerations, and the results.

In quantitative studies reviewed, standard questionnaires had been adopted for data collection, data analysis method had been clearly defined, and the necessary permissions had been obtained from university and other needed institutes to respect ethical considerations. The results were also in the direction of research questions.

In qualitative studies, research methodology and data analysis had been clearly stated, and participants’ consents had been obtained to respect ethical considerations. Various methods had been employed for credibility: Data collection from various methods,[ 19 , 20 , 22 ] precise transcription, and data recheck and conformability with participants and colleagues.[ 18 , 19 , 20 ]

Data analysis methods of the studies, conducted based on philosophical research methodology and action research, had not been clearly mentioned, but their results were related.

General traits of reviewed studies

General traits of reviewed studies in the context of nursing ethical values have been presented in Table 1 . The reviewed articles had investigated nurses’ ethical values from different aspects.

Outline of studies included in the review

In various studies, the values had been differently introduced and defined. Most of the reviewed articles had focused on common nursing ethical values.[ 22 ] In some, several values and in some other, only one value had been introduced and defined. Konishi (2009) had only studied the value of harmony in nursing and had suggested that as one of the most fundamental values in Japan.[ 13 ] Verpeet (2003) had defined values as nurses’ responsibility against their patients, profession, other health team members, and society.[ 10 ] Naden (2004) in his study to define components of human dignity indicated braveness, responsibility, respect, commitment, and ethical desires.[ 18 ] Wros (2004) reported a significant difference in ethical value of decision making among the nurses in two countries.[ 19 ] Trailer (2004) claims that respect to the patients has the highest priority among codes of ethics and acts as a basic value to design the nursing ethical codes which include three main elements of respect, reliability, and mutuality.[ 25 ]

Shih (2009) reported that 75% of the participants had indicated taking care of the patients and their related individuals and altruism as the most common nursing values. Other values in his study were provision of holistic professional and appropriate care, promotion of personal and professional competency, disease prevention, health promotion, promotion of interpersonal communication skills, and receiving fair reward.[ 9 ]

Weis (2000), through factor analysis, introduced eight factors for professional values of which the most important one was nurses’ role in care and dimension of commitment.[ 26 ] Pang (2009) stated nursing professional values in seven themes of altruism, care, respecting the dignity, trust, accountability, independency, and justice.[ 20 ] Mahmoodi (2008) indicated responsibility, having mental and emotional communication, value, and ethics criteria such as honesty in work, mutual respect, religious margins and confidentiality, justice and fairness.[ 21 ] Shaw (2008) and Fahrenwald (2005) in our studies, in a different way, investigated application of five nursing professional values in nursing education, including altruism, independency, respect to dignity, nursing interventions’ integrity, and social justice.[ 16 , 23 ] Horton (2007) stated that personal and organizational values have effects on nursing and introduced values such as responsibility, honesty, patients’ participation, integrity and humanity protection, patients’ independency, deep humanistic relationship, dignity, hope, passion, teamwork, differentiation, versatility, altruism, nurturing, integrity and support, reciprocal trust, sound knowledge, clinical competence, communications, unity, homogeneity, coordination, self-sacrifice and devotion, self-protection, privacy preservation, creativity, aesthetics, management, economizing, braveness, commitment, ethical attitude, personal orientation, judgment, freedom, individualism, acknowledgment, and personal success.[ 7 ] Two studies had stated detection of ethical values as the basis for collection of codes of ethics.[ 24 , 27 ]

D ISCUSSION

In all of the articles studied in the present literature review, patients’ dignity and respect had been stated as the most frequent value indicated in 12 articles, equality and justice in 8 articles, and altruism and precise care and making appropriate relationships were indicated in 6 articles, respectively.

Comparison and finalization of the obtained data concerning nursing ethical values in patients’ care yielded 10 values mostly indicated in the articles: Human dignity, altruism, social justice, autonomy in decision making, precision and accuracy in caring, responsibility, human relationship, individual and professional competency, sympathy, and trust. The 10 obtained values in this literature review and their definitional traits are presented subsequently.

Human dignity

Respecting human dignity was the most common value indicated in the reviewed articles. Respect to individuals including the persons, their families, and the society has been mentioned as an important nursing ethical value. Dignity respect has been defined with definitional traits as consideration of human innate values, respecting patient's beliefs and preservation of their dignity and privacy during clinical procedures, and communication with the patients, and contains understanding the patients and devoting to fulfill clients’ needs.[ 15 , 16 , 18 , 20 , 22 , 23 , 24 , 27 ] Pang (2009) argues that nurses should accept that people deserve respect and dignity in action. They should practically cover patients’ body parts if exposed and keep patients’ secrets confidential.[ 20 ]

This value has been suggested in most of the articles possibly as a result of humanistic nature of nursing profession in helping others. This value had been emphasized in all articles of Asian countries, reflecting cultural similarities in these countries. This value has also been indicated in most of the codes of ethics in various countries all over the world.

Social justice

Justice is an ethical value suggested in nursing literatures. Social justice has been defined by the traits which, in addition to consideration of individuals’ dignity and respect, focus on equal access to health services and the right of being fairly treated and cared free of economic, social, and cultural status.[ 9 , 10 , 15 , 16 , 20 , 21 , 23 ] Social justice had been the indication in most of the countries and had been defined as fair distribution of resources and provision of individuals’ equal treatment and care.

Verpeet (2003) stated that equality means access of all individuals to health services. She claims every individual in Belgium is supposed to have equal right of receiving equal nursing care.[ 10 ]

Altruism is a common nursing value in various countries. It has been defined with traits of consideration of human as the axis of attention and focus in nursing, helping others and provision of the utmost health and welfare for the clients, their families, and the society, selflessness, and self-devotion.[ 6 , 9 , 13 , 15 , 16 , 18 , 22 , 23 , 27 ] Therefore, altruism is defined as focusing on clients as a human and struggling to preserve their health and well-being. Pang (2009) debated that based on the principle of altruism, nurses should have spirit of selflessness and helpfulness toward others.[ 20 ]

Autonomy in decision making

Independency in decision making is a value suggested in some studies as a nursing ethical value. Nurses have defined its traits as having right of independency in decision making, right to accept or reject suggested treatments, interventions, or care. In addition, autonomy in decision making necessitates giving appropriate and adequate information to the clients and, if necessary, to their families.[ 13 , 15 , 23 ] So, autonomy in decision making occurs when nurses let patients be informed, free, and independent to decide on the diagnosis, treatment, and prevention through giving them appropriate information.

Konishi (2009) debates that conscious adult patients should themselves decide. With regard to nursing profession, nurses should provide the patients with information, explain suggested interventions, and let them free to either accept or reject oncoming procedures so that they and their families can make a decision about their condition.[ 13 ]

Precision and accuracy in caring

Precise and accurate care has been indicated as a nursing ethical value. Based on this definition, this sort of care is a precise, safe, appropriate, multidimensional, and kind care given to the patients by nurses. This is also thoughtful, based on adequate clinical skills and nursing knowledge to fulfill clients’ needs, promote their health, and relieve their pain and suffering. It is also based on standards and results in patients’ safety and satisfaction.[ 6 , 9 , 15 , 23 , 24 , 27 ] In this regard, Shih (2009) states that holistic and appropriate professional care is to prevent diseases, promote health, and make the feeling of comfort and safety for the patients.[ 9 ]

Responsibility

Responsibility has been defined as a nursing ethical value. It is defined with traits of commitment, feeling responsible for the duties toward patients, and respecting the patients’ rights for decision making.[ 15 , 18 , 19 , 21 , 24 , 26 , 28 ] Based on this definition, nurses are responsible for giving evidence-based care, best clinical function, and applicable and valid research, and are accountable for their actions and duties. Verpeet (2005) argues that nurses are responsible for promotion of patients’ well-being, having a holistic approach toward them and completing their duties.[ 28 ]

Human relationship

Human relationship has been indicated as a nursing ethical value with traits of mutual respect, trust, and reliance which are accompanied by patients’ confidentiality and privacy. It can be verbal or non-verbal and defined through having honesty in words and practice, sympathy and mutual understanding, courtesy, and friendliness.[ 9 , 15 , 19 , 21 , 25 ]

In this regard, giving care is possible only through making humanistic, efficient, and effective relationship, a relationship based on mutual respect and understanding.

Individual and professional competency

Individual and professional competency as a nursing ethical value has been defined with traits of struggling to make nursing as a profession, feeling the need to acquire personal and professional competency so that nurses can grow and develop in the direction of advances and new technology. Personal competency and development of the nurses result in acquiring up-to-date knowledge and promotion of clinical skills and practical abilities, and the ability to give more holistic and comprehensive care. Promotion of personal and professional competency comes true when nurses make a background for the best patients’ care by trying to give evidence-based care, and their empowerment for participation in activities in relation with other health team members and interpersonal and inter-professional skills development.[ 7 , 9 , 15 , 20 , 24 ] Pang (2009) debates that participation in continuing professional development suggests that individuals should preserve their competency in their activities and participate in professional continuing education programs throughout their occupational life.[ 20 ]

Sympathy has been indicated as a nursing ethical value with traits of understanding patients’ and their families’ needs and giving care based on making a fair communication.[ 6 , 19 ] In some cultures, such as Japanese, nurses share patients’ physical and mental pains and sufferings.[ 19 ]

Trust has been indicated as a nursing ethical value and is defined by traits of honesty in words and practice. Nurses should gain patients’, their families,’ and society's trust through understanding patients’ situation and status and appropriate conformation with them.[ 15 , 20 , 23 , 24 ] Based on this definition, gaining clients’ trust and reliance comes true when nurses are honest in their words and practice, and gain individuals’ trust and reliance by doing their duties appropriately.

C ONCLUSION

This study showed that nursing ethical values in patients’ and clients’ care are similar in many cases due to a common core in humanistic and spiritual approach of nursing profession, which is taking care of a human. Values such as human dignity, kindness and sympathy, altruism, responsibility and commitment, justice and honesty, and personal and professional competency were similar in most of the cultures.

Despite the similarities in ethical and professional values among various countries, it is essential to detect and highlight these values in each country, for example, in Iran, with regard to the prevalent social, cultural, economic, and religious conditions. Detection and declaration of nursing ethical values in each country can be a valuable, scientific, valid, and essential document to design nursing codes of ethics. This search was used to prepare proposed code of ethics and clinical guidelines for Iranian nurses. Findings of this study search must be considered within its limitation. An attempt was made to conduct a search as vast as possible. However, it might be possible that we could not access to all articles available in the period of the search.

A CKNOWLEDGMENT

The authors would also like to acknowledge the Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, for supporting this work.

Source of Support: Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences

Conflict of Interest: None

R EFERENCES

Handbook of Research Ethics and Scientific Integrity pp 1051–1069 Cite as

Ethics and Integrity in Nursing Research

• Edie West 2  
• Reference work entry
• First Online: 02 April 2020

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Most ethical issues that arise in the field of nursing tend to focus on human rights or direct client care issues, while the existing ethical frameworks and “nursing codes of ethics” put forth by leading nursing organizations tend to focus on increasing the ethical sensitivity or competence of nurses. Professional nursing, in its position as “art” and “science,” conducts cutting-edge research spanning a cornucopia of topics in the natural, social, formal, and applied sciences. However, the nature of nursing, which focuses on caring, preventing harm, protecting dignity, and advocacy roles in defense of patient rights, is sometimes at odds with the ethics of what can be considered more purely scientific research. This is primarily due to ambiguity or outright conflict with nursing standards (i.e., existing guidance frameworks or nursing ethics codes) and current research standards. This chapter will briefly explore the history of ethics development within the discipline of nursing. It will then explore the dichotomy between nursing and current research ethics via a comprehensive review and analysis of current relevant nursing literature. Identification of key ethical issues faced by nurse-researchers and how these issues were addressed can help to provide clarity and shed some light on the key issues identified in this chapter. In addition, it can help to formulate a framework that other nurse-researchers can use to maintain ethics and scientific integrity while investigating issues and proposing viable solutions to problems yet to be addressed in the field of nursing research.

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Banner D, Zimmer L (2012) Informed consent in research: an overview for nurses. Can J Cardiovasc Nurs 22(1):26–30

Google Scholar  

Barrett R (2010) Strategies for promoting the scientific integrity of nursing research in clinical settings. J Nurses Staff Dev 26(5):200–205

Article   Google Scholar  

Behi R, Nolan M (1995) Ethical issues in research. Br J Nurs 4(12):712–716

Berg B (1995) Qualitative research methods for the social sciences, 2nd edn. Allyn and Bacon, Boston

Cabral IE, Egry EY, Barbosa DA (2015) Integrity and ethics in research and scientific communication: issues for nursing considerations. Rev Escola Enfermagem USP 49(5):710–715. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342015000500710&lng=en&tlng=en

Casey D (2006) Choosing an appropriate method of data collection. Nurse Res 13:75–93

Cate O, Brewster D, Cruess R, Calman K, Rogers W, Supe A, Gruppen L (2013) Research fraud and its combat: what can a journal do? Med Educ 47:638–640

Cole C (2012) Implied consent and nursing practice: ethical or convenient? Nurs Ethics 19(4):550–557

Colling J (2004) Procedures, ethics and funding sources. Urol Nurs 24(2):130–133

Czimbal B (2006) Excerpt from ‘skills for success: personal skills for professional excellence’. http://www.abundancecompany.com/index.htm

Davies S, Ellis L, Laker S (2000) Promoting autonomy and independence for older people within nursing practice: an observational study. J Clin Nurs 9(1):127–136

Devine C, Chin E (2018) Integrity in nursing students: a concept analysis. Nurs Educ Today 60:133–138

Doody O, Noonan M (2016) Br J Nurs 25(14):803–807

DuBois J, Chibnall J, Tait R, Vander J (2018) The professionalism and integrity in research program: description and preliminary outcomes. Acad Med 23(4):586–592

Ellenberg S (2012) Protecting clinical trial participants and protecting data integrity: are we meeting the challenges? Acad Med 9(6):1–4

Elliott R, Wright L (1999) Verbal communication: what do critical care nurses say to their unconscious or sedated patients? J Adv Nurs 29(6, 1):412–1420

Ensign J (2003) Ethical issues in qualitative health research with homeless youths. J Adv Nurs 43(1):43–50

Epstein B, Turner M (2015) The nursing code of ethics: its value, its history. ANA’s OJIN 20(2):4. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/The-Nursing-Code-of-Ethics-Its-Value-Its-History.html#History

Fang FC, Steen RG, Casadevall A (2012) Misconduct account for the majority of retracted scientific publications. Proc Natl Acad Sci USA 109(42):17028–17033. [Internet] 2012 [cited 2015 June 16]. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479492/

Fierz K, Gennaro S, Dierickx K, Van Achterberg T, Morin KH, De Geest S (2014) Scientific misconduct: also an issue in nursing science? J Nurs Scholarsh 46(4):271–280

Fouka G, Mantzorou M (2011) What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Sci J 5(1):3–14

Grout G (2004) Using negotiated consent in research and practice. Nurs Older People 16(4):18–20

Gunsalus CK, Marcus AR, Oransky I (2018) Institutional research misconduct reports need more credibility. J Am Med Assoc 319(13):1315–1316

Habermann B, Broome M, Pryor ER, Ziner KW (2010) Research coordinators’ experiences with scientific misconduct and research integrity. Nurs Res 59(1):51–57

Holloway I, Wheeler S (2002) Qualitative researching, 2nd edn. Blackwell Publishing, Oxford

Hurst K (1985) A real debate by two imaginary people. Nurs Mirror 160(24):34–35

Ingham-Broomfield J (2017) A nurses’ guide to ethical considerations and the process for ethical approval of nursing research. Aust J Adv Nurs 35(1):40–46

Jokinen P, Lappalainen M, Meriläinen M, Pelkonen M (2002) Ethical issues in ethnographic nursing research with children and elderly people. Scand J Caring Sci 16:165–170

Jones C, Jack B (1999) Dilemmas in the ethics of health-care research. Prof Nurse 14(7):452–455

Judkins-Cohn T, Kielwasser-Withrow K, Owen M, Ward J (2014) J Contin Educ Nurs 45(1):35–42

Karlberg J, Speers M (2010) Reviewing clinical trials: a guide for the ethics committee. https://www.pfizer.com/files/research/research_clinical_trials/ethics_committee_guide.pdf

Khaki I, Abbasi M, Khalajinia Z, Momenyan S (2018) Barriers to observance of the codes of professional ethics in clinical care: perspectives of nurses and midwifery of hospitals affiliated with Qom University of Medical Sciences in 2016. Health Spiritual Med Ethics 5(1):33–39

Lachman V, Swanson E, Winland-Brown J (2015) The new ‘code of ethics for nurses with interpretative statements’ (2015): practical clinical application, part II. Medsurg Nurs 24(5):363–368

Mahon P (2014) Internet research and ethics: transformative issues in nursing education research. J Prof Nurs 30(2):124–129

Mcguire Dunn C, Chadwick G (1999) Protecting study volunteers in research: a manual for investigative sites. CenterWatch: University of Rochester Medical, Rochester, pp 2–4

Melnyk BM, Fineout-Overholt E (2014) Evidence based practice in nursing and health care: a guide to best practice, 2nd edn. Lippincott, Williams and Wilkins, Philadelphia

Mitchell J (2018) Ethics in clinical research: the ongoing effort for higher standards. Res Pract 19(4):63–69

Moody HR (1992) Ethics in an aging society. The John Hopkins Press Ltd., London

Moore L, Savage J (2002) Participant observation, informed consent and ethical approval. Nurse Res 9(4):58–69

Munhall PL (1988) Ethical considerations in qualitative research. West J Nurs Res 10(2):150–162

National Institutes of Health (NIH) Office of Intramural (2016) ‘Responsible conduct of research training’. https://oir.nih.gov/sourcebook/ethical-conduct/responsible-conduct-research-training

Nieswiadomy R (2007) Foundations of nursing research, 5th edn. Prentice Hall, Upper Saddle River

Nobel-Adams R (1999) Ethics and nursing research 1: development, theories and principles. Br J Nurs 8(13):1–5

Putnam J (2015) Giving research an online presence. Kans Nurse 90(1):12

Rachmawaty R (2017) Ethical issues in action-oriented research in Indonesia. Nurs Ethics 24(6):686–693

Raudonis BM (1992) Ethical considerations in qualitative research with hospice patients. Qual Health Res 2(2):238–249

Sackett DL, Straus SE, Richardson WS (2000) Evidence-based medicine: how to practice and teach EBM, 2nd edn. Churchill Livingstone, Edinburgh

Sellman D (2016) The practice of nursing research: getting ready for ‘ethics’ and the matter of character. Nurs Inq 23(1):24–31

Teitcher J, Bockting W, Bauermeister J, Hoefer, Miner M, Klitzman R (2015) Detecting, preventing, and responding to “fraudsters” in internet research: ethics and tradeoffs. J Law Med Ethics 43(1):116–133

Thorne S, Sawatzky R (2014) Particularizing the general sustaining theoretical integrity in the context of an evidence-based practice agenda. Adv Nurs Sci 37(1):5–18

U.S. Department of Health and Human Services (1998) Informed consent. https://www.hhs.gov/ohrp/regulations-and-policy/guidance/informed-consent/index.html

Ulrich M, Wallen G, Cui N, Chittams J, Sweet M, Plemmons D (2015) Establishing good collaborative research practices in the responsible conduct of research in nursing science. Nurs Outlook 63:171–180

Wager E, Tooley PJH (1995) Get patients’ consent to enter clinical trials. Br Med J 311:734–737

Ward-Smith P (2016) Evidence-based nursing: when the evidence is fraudulent. Urol Nurs 36(2):98–99

Woodfield K (2017) The Ethics of online research, Volume 2 in the series: advances in research ethics and integrity. Emerald Publishing, Bingley

Book   Google Scholar  

Worthington E, Miller A, Talley J (2011) Action-oriented research: a primer and examples. J Psychol Theol 39(3):211–221

Wynia M, Kishore S, Belar C (2014) A unified code of ethics for health professionals Insights from an IOM Workshop. J Am Med Assoc 311(8):799–800

Zeng W, Resnik D (2010) Research integrity in China: problems and prospects. Dev World Bioeth 10(3):164–171

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West, E. (2020). Ethics and Integrity in Nursing Research. In: Iphofen, R. (eds) Handbook of Research Ethics and Scientific Integrity. Springer, Cham. https://doi.org/10.1007/978-3-030-16759-2_46

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Nursing ethical values and definitions: A literature review

Affiliation.

• 1 Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
• PMID: 23983720
• PMCID: PMC3748548

Background: Ethical values offer a framework for behavior assessment, and nursing values influence nurses' goals, strategies, and actions. A literature review was adopted in order to determine and define ethical values for nurses.

Materials and methods: This literature review was conducted based on the Centre for Reviews and Dissemination guidelines. The key words used to search relevant sources were nursing, ethics, ethical values, and nursing values. The search of articles in English was carried out in Medline, CINAHL, PubMed, Scopus, Ovid, and Proquest databases. The search of articles in Persian was conducted in databases of Magiran, SID, and Irandoc publications. After assessing and analyzing the obtained data, 17 articles which had a distinct definition of ethical values were chosen and subjected to a thorough study.

Results: The search yielded 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency.

Conclusions: This study showed that common ethical values are generally shared within the global community. However, in several areas, influences of social, cultural, and economical status and religious beliefs on values result in a different definition of these values. This study revealed that based on humanistic nature of nursing, common values in nursing protect human dignity and respect to the patients. Recognizing and definition of ethical values can help to improve nursing practice and develop codes of ethics.

Keywords: Ethics; literature review; nursing; professional values; values.

• Research article
• Open access
• Published: 16 May 2019

An analysis of current practices in undertaking literature reviews in nursing: findings from a focused mapping review and synthesis

• Helen Aveyard   ORCID: orcid.org/0000-0001-5133-3356 1 &
• Caroline Bradbury-Jones 2  

BMC Medical Research Methodology volume  19 , Article number:  105 ( 2019 ) Cite this article

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In this paper we discuss the emergence of many different methods for doing a literature review. Referring back to the early days, when there were essentially two types of review; a Cochrane systematic review and a narrative review, we identify how the term systematic review is now widely used to describe a variety of review types and how the number of available methods for doing a literature review has increased dramatically. This led us to undertake a review of current practice of those doing a literature review and the terms used to describe them.

We undertook a focused mapping review and synthesis. Literature reviews; defined as papers with the terms review or synthesis in the title, published in five nursing journals between January 2017–June 2018 were identified. We recorded the type of review and how these were undertaken.

We identified more than 35 terms used to describe a literature review. Some terms reflected established methods for doing a review whilst others could not be traced to established methods and/or the description of method in the paper was limited. We also found inconsistency in how the terms were used.

We have identified a proliferation of terms used to describe doing a literature review; although it is not clear how many distinct methods are being used. Our review indicates a move from an era when the term narrative review was used to describe all ‘non Cochrane’ reviews; to a time of expansion when alternative systematic approaches were developed to enhance rigour of such narrative reviews; to the current situation in which these approaches have proliferated to the extent so that the academic discipline of doing a literature review has become muddled and confusing. We argue that an ‘era of consolidation’ is needed in which those undertaking reviews are explicit about the method used and ensure that their processes can be traced back to a well described, original primary source.

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Over the past twenty years in nursing, literature reviews have become an increasingly popular form of synthesising evidence and information relevant to the profession. Along with this there has been a proliferation of publications regarding the processes and practicalities of reviewing [ 1 , 2 , 3 , 4 ], This increase in activity and enthusiasm for undertaking literature reviews is paralleled by the foundation of the Cochrane Collaboration in 1993. Developed in response to the need for up-to-date reviews of evidence of the effectiveness of health care interventions, the Cochrane Collaboration introduced a rigorous method of searching, appraisal and analysis in the form of a ‘handbook’ for doing a systematic review [ 5 ] .Subsequently, similar procedural guidance has been produced, for example by the Centre for Reviews and Dissemination (CRD) [ 6 ] and The Joanna Briggs Institute [ 7 ]. Further guidance has been published to assist researchers with clarity in the reporting of published reviews [ 8 ].

In the early days of the literature review era, the methodological toolkit for those undertaking a literature was polarised, in a way that mirrored the paradigm wars of the time within mixed-methods research [ 9 ]. We refer to this as the ‘dichotomy era’ (i.e. the 1990s), The prominent methods of literature reviewing fell into one of two camps: The highly rigorous and systematic, mostly quantitative ‘Cochrane style’ review on one hand and a ‘narrative style’ review on the other hand, whereby a body of literature was summarised qualitatively, but the methods were often not articulated. Narrative reviews were particularly popular in dissertations and other student work (and they continue to be so in many cases) but have been criticised for a lack of systematic approach and consequently significant potential for bias in the findings [ 10 , 11 ].

The latter 1990s and early 2000, saw the emergence of other forms of review, developed as a response to the Cochrane/Narrative dichotomy. These alternative approaches to the Cochrane review provided researchers with reference points for performing reviews that drew on different study types, not just randomised controlled trials. They promoted a systematic and robust approach for all reviews, not just those concerned with effectiveness of interventions and treatments. One of the first published description of methods was Noblet and Hare’s (1998) ‘Meta-ethnography’ [ 12 ]. This method, although its name suggests otherwise, could incorporate and synthesise all types of qualitative research, not just ethnographies. The potential confusion regarding the inclusion of studies that were not ethnographies within a meta-ethnography, promoted the description of other similar methods, for example, the meta-synthesis of Walsh and Downe (2005) [ 13 ] and the thematic synthesis of Thomas and Harden (2008) [ 14 ]. Also, to overcome the dichotomy of the quantitative/qualitative reviews, the integrative review was described according to Whitemore and Knafl (2005) [ 15 ]. These reviews can be considered to be literature reviews that have been done in a systematic way but not necessarily adhering to guidelines established by the Cochrane Collaboration. We conceptualise this as the ‘expansion era’. Some of the methods are summarised in Table  1 .

Over the past two decades there has been a proliferation of review types, with corresponding explosion of terms used to describe them. A review of evidence synthesis methodologies by Grant and Booth in 2009 [ 20 ] identified 14 different approaches to reviewing the literature and similarly, Booth and colleagues [ 21 ] detailed 19 different review types, highlighting the range of review types currently available. We might consider this the ‘proliferation era’. This is however, somewhat a double-edged sword, because although researchers now have far more review methods at their disposal, there is risk of confusion in the field. As Sabatino and colleagues (2014) [ 22 ] have argued, review methods are not always consistently applied by researchers.

Aware of such potential inconsistency and also our own confusion at times regarding the range of review methods available, we questioned what was happening within our own discipline of nursing. We undertook a snap-shot, contemporary analysis to explore the range of terms used to describe reviews, the methods currently described in nursing and the underlying trends and patterns in searching, appraisal and analysis adopted by those doing a literature review. The aim was to gain some clarity on what is happening within the field, in order to understand, explain and critique what is happening within the proliferation era.

In order to explore current practices in doing a literature review, we undertook a ‘Focused Mapping Review and Synthesis’ (FMRS) – an approach that has been described only recently. This form of review [ 19 ] is a method of investigating trends in academic publications and has been used in a range of issues relevant to nursing and healthcare, for example, theory in qualitative research [ 23 ] and vicarious trauma in child protection research [ 24 ].

A FMRS seeks to identify what is happening within a particular subject or field of inquiry; hence the search is restricted to a particular time period and to pre-identified journals. The review has four distinct features: It: 1) focuses on identifying trends in an area rather than a body of evidence; 2) creates a descriptive map or topography of key features of research within the field rather than a synthesis of findings; 3) comments on the overall approach to knowledge production rather than the state of the evidence; 4) examines this within a broader epistemological context. These are translated into three specific focused activities: 1) targeted journals; 2) a specific subject; 3) a defined time period. The FMRS therefore, is distinct from other forms of review because it responds to questions concerned with ‘what is happening in this field?’ It was thus an ideal method to investigate current practices in literature reviews in nursing.

Using the international Scopus (2016) SCImago Journal and Country Rank, we identified the five highest ranked journals in nursing at that time of undertaking the review. There was no defined method for determining the number of journals to include in a review; the aim was to identify a sample and we identified five journals in order to search from a range of high ranking journals. We discuss the limitations of this later. Journals had to have ‘nursing’ or ‘nurse’ in the title and we did not include journals with a specialist focus, such as nutrition, cancer etcetera. The included journals are shown in Table  2 and are in order according to their ranking. We recognise that our journal choice meant that only articles published in English made it into the review.

A key decision in a FMRS is the time-period within which to retrieve relevant articles. Like many other forms of review, we undertook an initial scoping to determine the feasibility and parameters of the project [ 19 ]. In our previous reviews, the timeframe has varied from three months [ 23 ] to 6 years [ 24 ]. The main criterion is the likelihood for the timespan to contain sufficient articles to answer the review questions. We set the time parameter from January 2017–June 2018. We each took responsibility for two and three journals each from which to retrieve articles. We reviewed the content page of each issue of each journal. For our purposes, in order to reflect the diverse range of terms for describing a literature review, as described earlier in this paper, any paper that contained the term ‘review’ or ‘synthesis’ in the title was included in the review. This was done by each author individually but to enhance rigour, we worked in pairs to check each other’s retrieval processes to confirm inter-rater consistency. This process allowed any areas of uncertainty to be discussed and agreed and we found this form of calibration crucial to the process. The inclusion and exclusion criteria are shown in Table  3 .

Articles meeting the inclusion criteria, papers were read in full and data was extracted and recorded as per the proforma developed for the study (Table 4 ). The proforma was piloted on two papers to check for usability prior to data extraction. Data extraction was done independently but we discussed a selection of papers to enhance rigour of the process. No computer software was used in the analysis of the data. We did not critically appraise the included studies for quality because our purpose was to profile what is happening in the field rather than to draw conclusions from the included studies’ findings.

Once the details from all the papers had been extracted onto the tables, we undertook an analysis to identify common themes in the included articles. Because our aim was to produce a snap-shot profile, our analysis was thematic and conceptual. Although we undertook some tabulation and numerical analysis, our primary focus was on capturing patterns and trends characterised by the proliferation era. In line with the FMRS method, in the findings section we have used illustrative examples from the included articles that reflect and demonstrate the point or claim being made. These serve as useful sources of information and reference for readers seeking concrete examples.

Between January 2017 and June 2018 in the five journals we surveyed, a total of 222 papers with either ‘review’ or ‘synthesis’ in the title were retrieved and included in our analysis. We identified three primary themes: 1) Proliferation in names for doing a review; 2) Allegiance to an established review method; 3) Clarity about review processes. The results section is organised around these themes.

Proliferation in names for doing a review

We identified more than 35 terms used by authors to describe a literature review. Because we amalgamated terms such as ‘qualitative literature review’ and ‘qualitative review’ the exact number is actually slightly higher. It was clear from reading the reviews that many different terms were used to describe the same processes. For example qualitative systematic review, qualitative review and meta-synthesis, qualitative meta-synthesis, meta-ethnography all refer to a systematic review of qualitative studies. We have therefore grouped together the review types that refer to a particular type of review as described by the authors of the publications used in this study (Table  5 ).

In many reviews, the specific type of review was indicated in the title as seen for example in Table  5 . A striking feature was that all but two of the systematic reviews that contained a meta-analysis were labelled as such in the title; providing clarity and ease of retrieval. Where a literature review did not contain a meta-analysis, the title of the paper was typically referred to a ‘systematic review’; the implication being that a systematic review is not necessarily synonymous with a meta-analysis. However as discussed in the following section, this introduced some muddying of water, with different interpretations of what systematic review means and how broadly this term is applied. Some authors used the methodological type of included papers to describe their review. For example, a Cochrane-style systematic review was undertaken [ 25 ] but the reviewers did not undertake a meta-analysis and thus referred to their review as a ‘quantitative systematic review’.

Allegiance to an established literature review method

Many literature reviews demonstrated allegiance to a defined method and this was clearly and consistently described by the authors. For example, one team of reviewers [ 26 ] articulately described the process of a ‘meta-ethnography’ and gave a detailed description of their study and reference to the origins of the method by Noblet and Hare (1988) [ 12 ]. Another popular method was the ‘integrative review’ where most authors referred to the work of one or two seminal papers where the method was originally described (for example, Whitemore & Knafl 2005 [ 15 ]).

For many authors the term systematic review was used to mean a review of quantitative research, but some authors [ 27 , 28 , 29 ],used the term systematic review to describe reviews containing both qualitative and quantitative data.

However in many reviews, commitment to a method for doing a literature review appeared superficial, undeveloped and at times muddled. For example, three reviews [ 30 , 31 , 32 ] , indicate an integrative review in the title of their review, but this is the only reference to the method; there is no further reference to how the components of an integrative review are addressed within the paper. Other authors do not state allegiance to any particular method except to state a ‘literature review’ [ 33 ] but without an outline of a particular method for doing so. Anther review [ 34 ] reports a ‘narrative review’ but does not give further information about how this was done, possibly indicative of the lack of methods associated with the traditional narrative review. Three other reviewers documented how they searched, appraised and analysed their literature but do not reference an over-riding approach for their review [ 35 , 36 , 37 ]. In these examples, the review can be assumed to be a literature review, but the exact approach is not clear.

In other reviews, the methods for doing a literature review appear to be used interchangeably. For example in one review [ 38 ] the term narrative review was used in the title but in the main text an integrative review was described. In another review [ 39 ] two different and distinct methods were combined in a ‘meta-ethnographic meta-synthesis’.

Some authors [ 40 , 41 ] referred to a method used to undertake their review, for example a systematic review, but did not reference the primary source from where the method originated. Instead a secondary source, such as a textbook is used to reference the approach taken [ 20 , 42 ].

Clarity about review processes

Under this theme we discerned two principal issues: searching and appraisal. The majority of literature reviews contain three components- searching, appraisal and analysis, details of which are usually reported in the methods section of the papers. However, this is not always the case and for example, one review [ 43 ] provides only a search strategy with no information about the overall method or how critical appraisal or analysis were undertaken. Despite the importance of the process of analysis, we found little discussion of this in the papers reviewed.

The overwhelming trend for those doing a literature review was to describe a comprehensive search; although for many in our sample, a comprehensive search appeared to be limited to a database search; authors did not describe additional search strategies that would enable them to find studies that might be missed through electronic searching. Furthermore, authors did not define what a comprehensive search entailed, for example whether this included grey literature. We identified a very small number of studies where authors had undertaken a purposive sample [ 26 , 44 ]; in these reviews authors clearly stated that their search was for ‘seminal papers’ rather than all papers.

We reviewed the approaches to critical appraisal described in the papers and there were varying interpretations of what this means and which aspect of the included articles were to be subject to appraisal. Some authors [ 36 , 45 , 46 ] used the term ‘critical appraisal’ to refer to relevance of the paper to the review, rather than quality criteria. In that sense critical appraisal was used more as an inclusion criterion regarding relevance, rather than quality in the methods used. Mostly though, the term was used to describe the process of critical analysis of the methodological quality of included papers included in a review. When the term was used in this way to refer to quality criteria, appraisal tools were often used; for example, one review [ 47 ] provides a helpful example when they explain how a particular critical appraisal tool was used to asses the quality of papers in their review. Formal critical appraisal was undertaken by the vast majority reviewers, however the role of critical appraisal in the paper was often not explained [ 33 , 48 ]. It was common for a lot of detail to be provided about the approach to appraisal, including how papers were assessed and how disagreements between reviewers about the quality of individual papers were resolved, with no further mention of the subsequent role of the appraisal in the review. The reason for doing the critical appraisal in the review was often unclear and furthermore, in many cases, researchers included all papers within their review regardless of quality. For example, one team of reviewers [ 49 ] explained how the process, in their view, is not to exclude studies but to highlight the quality of evidence available. Another team of reviewers described how they did not exclude studies on the basis of quality because of the limited amount of research available on the topic [ 50 ].

Our review has identified a multiplicity of similar terms and approaches used by authors when doing a literature review, that we suggests marks the ‘proliferation era’. The expansion of terms used to describe a literature review has been observed previously [ 19 , 21 ]. We have identified an even wider range of terms, indicating that this trend may be increasing. This is likely to give the impression of an incoherent and potentially confusing approach to the scholarly undertaking of doing a literature review and is likely to be particularly problematic for novice researchers and students when attempting to grapple with the array of approaches available to them. The range of terms used in the title of papers to describe a literature review may cause both those new to research to wonder what the difference is between a qualitative evidence synthesis and a qualitative systematic review and which method is most suitable for their enquiry.

The clearest articles in our review were those that reported a systematic review with or without a meta-analysis. For example, one team of reviewers [ 25 ] undertook a Cochrane-style systematic review but did not undertake a meta-analysis and thus referred to their review as a ‘quantitative systematic review’. We found this form of labelling clear and helpful and is indeed in line with current recommendations [ 8 ]. While guidelines exist for the publication of systematic reviews [ 8 , 51 ], given the range of terms that are used by authors, some may be unclear when these guidelines should apply and this adds some confusion to the field. Of course, authors are at liberty to call their review processes whatever they deem appropriate, but our analysis has unearthed some inconsistencies that are confusing to the field of literature reviewing.

There is current debate about the status of literature reviews that are not ‘Cochrane’ style reviews [ 52 ]. Classification can be complex and whilst it might be tempting to refer to all non Cochrane-style reviews as ‘narrative reviews’ [ 52 ], literature reviews that conform to a recognised method would generally not be considered as such [ 53 ] and indeed the Cochrane Collaboration handbook refers to the principles of systematic review as applicable to different types of evidence, not just randomised controlled trials [ 5 ] .This raises the question as to whether the term systematic review should be an umbrella term referring to any review with an explicit method; which is implicit in the definition of a systematic review, but which raises the question as to how rigorous a method has to be to meet these standards, a thorny issue which we have identified in this study.

This review has identified a lack of detail in the reporting of the methods used by those doing a review. In 2017, Thorne raised the rhetorical question: ‘What kind of monster have we created?‘ [ 54 ]. Critiquing the growing investment in qualitative metasyntheses, she observed that many reviews were being undertaken that position themselves as qualitative metasyntheses, yet are theoretically and methodologically superficial. Thorne called for greater clarity and sense of purpose as the ‘trend in synthesis research marches forward’ [ 54 ]. Our review covered many review types, not just the qualitative meta-synthesis and its derivatives. However, we concur with Thorne’s conclusion that research methods are not extensively covered or debated in many of the published papers which might explain the confusion of terms and mixing of methods.

Despite the proliferation in terms for doing a literature review, and corresponding associated different methods and a lack of consistency in their application, our review has identified how the methods used (or indeed the reporting of the methods) appear to be remarkably similar in most publications. This may be due to limitations in the word count available to authors. However for example, the vast majority of papers describe a comprehensive search, critical appraisal and analysis. The approach to searching is of particular note; whilst comprehensive searching is the cornerstone of the Cochrane approach, other aproaches advocate that a sample of literature is sufficient [ 15 , 20 ]. Yet in our review we found only two examples where reviewers had used this approach, despite many other reviews claiming to be undertaking a meta-ethnography or meta-synthesis. This indicates that many of those doing a literature review have defaulted to the ‘comprehensive search’ irrespective of the approach to searching suggested in any particular method which is again indicative of confusion in the field.

Differences are reported in the approach to searching and critical appraisal and these appear not to be linked to different methods, but seem to be undertaken on the judgement and discretion of the reviewers without rationale or justification within the published paper. It is not for us to question researchers’ decisions as regards managing the flow of articles through their reviews, but when it comes to the issue of both searching and lack of clarity about the role of critical appraisal there is evidence of inconsistency by those doing a literature review. This reflects current observations in the literature where the lack of clarity about the role of critical appraisal within a literature review is debated . [ 55 , 56 ].

Our review indicates that many researchers follow a very similar process, regardless of their chosen method and the real differences that do exist between published methods are not apparent in many of the published reviews. This concurs with previously mentioned concerns [ 54 ] about the superficial manner in which methods are explored within literature reviews. The overriding tendency is to undertake a comprehensive review, critical appraisal and analysis, following the formula prescribed by Cochrane, even if this is not required by the literature review method stated in the paper. Other researchers [ 52 ] have questioned whether the dominance of the Cochrane review should be questioned. We argue that emergence of different methods for doing a literature review in a systematic way has indeed challenged the perceived dominance of the Cochrane approach that characterised the dichotomy era, where the only alternative was a less rigourous and often poorly described process of dealing with literature. It is positive that there is widespread acknowledgement of the validity of other approaches. But we argue that the expansion era, whereby robust processes were put forward as alternatives that filled the gap left by polarisation, has gone too far. The magnitude in the number of different approaches identified in this review has led to a confused field. Thorne [ 54 ] refers to a ‘meta-madness’; with the proliferation of methods leading to the oversimplification of complex literature and ideas. We would extend this to describe a ‘meta-muddle’ in which, not only are the methods and results oversimplified, but the existence of so many terms used to describe a literature review, many of them used interchangeably, has added a confusion to the field and prevented the in-depth exploration and development of specific methods. Table  6 shows the issues associated with the proliferation era and importantly, it also highlights the recommendations that might lead to a more coherent reviewing community in nursing.

The terms used for doing a literature review are often used both interchangeably and inconsistently, with minimal description of the methods undertaken. It is not surprising therefore that some journal editors do not index these consistently within the journal. For example, in one edition of one journal included in the review, there are two published integrative reviews. One is indexed in the section entitled as a ‘systematic review’, while the other is indexed in a separate section entitled ‘literature review’. In another edition of a journal, two systematic reviews with meta-analysis are published. One is listed as a research article and the other as a review and discussion paper. It seems to us then, that editors and publishers might sometimes also be confused and bewildered themselves.

Whilst guidance does exist for the publication of some types of systematic reviews in academic journals; for example the PRISMA statement [ 8 ] and Entreq guidelines [ 51 ], which are specific to particular qualitative synthesis, guidelines do not exist for each approach. As a result, for those doing an alternative approach to their literature review, for example an integrative review [ 15 ], there is only general publication guidance to assist. In the current reviewing environment, there are so many terms, that more specific guidance would be impractical anyway. However, greater clarity about the methods used and halting the introduction of different terms to mean the same thing will be helpful.

Limitations

This study provides a snapshot of the way in which literature reviews have been described within a short publication timeframe. We were limited for practical reasons to a small section of high impact journals. Including a wider range of journals would have enhanced the transferability of the findings. Our discussion is, of course, limited to the review types that were published in the timeframe, in the identified journals and which had the term ‘review’ or ‘synthesis’ in the title. This would have excluded papers that were entitled ‘meta-analysis’. However as we were interested in the range of reviews that fall outside the scope of a meta-analysis, we did not consider that this limited the scope of the paper. Our review is further limited by the lack of detail of the methods undertaken provided in many of the papers reviewed which, although providing evidence for our arguments, also meant that we had to assume meaning that was unclear from the text provided.

The development of rigorous methods for doing a literature review is to be welcomed; not all review questions can be answered by Cochrane style reviews and robust methods are needed to answer review questions of all types. Therefore whilst we welcome the expansion in methods for doing a literature review, the proliferation in the number of named approaches should be, in our view, a cause for reflection. The increase in methods could be indicative of an emerging variation in possible approaches; alternatively, the increase could be due to a lack of conceptual clarity where, on closer inspection, the methods do not differ greatly and could indeed be merged. Further scrutiny of the methods described within many papers support the latter situation but we would welcome further discussion about this. Meanwhile, we urge researchers to make careful consideration of the method they adopt for doing a literature review, to justify this approach carefully and to adhere closely to its method. Having witnessed an era of dichotomy, expansion and proliferation of methods for doing a literature review, we now seek a new era of consolidation.

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

Google Scholar  

Coughlan M, Cronin P, Ryan F. Doing a literature review in nursing, Health and social care. London: Sage; 2013.

Aveyard H. Doing a literature review in health and social care. Maidenhead: Open University Press; 2018.

Davis D. A practical overview of how to conduct a systematic review. Nurs Stand. 2016;31(12):60–70.

Article   Google Scholar  

Higgins and Green. Cochrane handbook for systematic reviews of interventions version 5.1.0: Cochrane Collaboration; 2011.

Centre for Reviews and Dissemination. Systematic Reviews: CRD's guidance for undertaking reviews in health care. York: University of York; 2008.

Aromataris E, Munn Z, editors. Joanna Briggs Institute Reviewer's Manual: The Joanna Briggs Institute; 2017. Available from https://reviewersmanual.joannabriggs.org/

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart L. Preferred reporting items for systematic review and meta-analysis protocols. Br Med J. 2015;2:349 (Jan 02).

Creswell JW, Plano-Clark VL. Designing and conducting mixed methods research. 2nd ed. Thousand Oaks: Sage Publications; 2011.

Greenhalgh T. How to read a paper. 4th ed: Wiley; 2010.

Booth A, Papaioannou D, Sutton A. Systematic appproaches to a successful literature review Sage London; 2012.

Noblit GW, Hare RD. Meta-ethnography, synthesising qualitative studies, qualitative research methods, volume 11. London: SAGE Publications; 1988.

Walsh D, Downe S. Meta-synthesis method for qualitative research: a literature review. J Adv Nurs. 2005;50(2):204–11.

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.

Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52:546–53.

Scoping Peters MDJ, Godfrey CM, McInerney P, Soares CB, Khalil H, Parker D. Methodology for Joanna Briggs institute scoping review. Joanna Briggs institute reviewers manual: Australia; 2015.

Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES publication standards: realist synthesis BMC medicine, vol. 11; 2013. p. 21.

Plüddemann A, Aronson JK, Onakpoya I, Heneghan C, Mahtani KR. Redefining rapid reviews: a flexible framework for restricted systematic reviews. BMJ Evidence-Based Medicine Epub ahead of print: 27 June 2018. https://doi.org/10.1136/bmjemb-2018-110990 .

Bradbury-Jones C, Breckenridge J, Clark MT, Herber OR, Jones C, Taylor J. Advancing the science of literature reviewing: the focused mapping review and synthesis as a novel approach. Int J Soc Res Methodol. https://doi.org/10.1080/13645579.2019.1576328 .

Grant MJ, Booth A. A typology of review- an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26(2):91–108.

Booth, A., Noyes, J., Flemming, K., Gerhardus, A., Wahlster, P., van der Wilt G.J., Mozygemba K, Refolo P, Sacchini D, Tummers, M, Rehfuess, E. (2016) Guidance on choosing qualitative evidence synthesis methods for use in health technology assessments of complex interventions. Available: http://www.integrate-hta.eu/wp-content/uploads/2016/02/Guidance-on-choosing-qualitative-evidence-synthesis-methods-for-use-in-HTA-of-complex-interventions.pdf

Sabatino L, Stievano A, Rocco G, Kallio H, Pietila A, KAngasniemi M. The dignity of the nursing profession: a meta-synthesis of qualitative research. Nurs Ethics. 2014;2(6):659–72.

Bradbury-Jones C, Taylor J, Herber O. How theory is used and articulated in qualitative research: development of a new typology. Soc Sci Med. 2014;120:135–41.

Taylor J, Bradbury-Jones C, Breckenridge J, Jones C, Herber OR. Risk of vicarious trauma in nursing research: a focused mapping review and synthesis. J Clin Nurs. 2016. https://doi.org/10.1111/jocn.13235 .

Haggman Laitila A, Rompannen J. Outcomes of interventions for nurse leaders’ well being at work. A quantitative systematic review. J Adv Nurs. 2018;74:34–44.

Strandos M, Bondas T. The nurse patient relationship as a story of health enhancement in community care- a meta-ethnography. J Adv Nurs. 2018;74:11–8.

Gilissen J, Pivodic L, Smets T, Gastmans C, Stichels RV, Delieus L, Van den Black L. Preconditions for successful advanced care planning in nursing homes: a systematic review. Int J Nurs Stud. 2017;66:47–59.

Walczak A, Mcdonald F, Patterson P, Dobinson K, Kimberley A. How does parental cancer affect adolescent and young adult offspring. A systematic review. Int J Nurs Stud. 2018;77:54–80.

Leyva-Moral JM, Palmoero PA, Feijoo-Cid M, Edwards JE. Reproductive decision making in women living with HIV: systematic review. Int J Nurs Stud. 2018;77:207–21.

Pires S, Monteiro S, Pereira A, Chaló D, Melo E, Rodriguese A. Non technical skills assessment for pre-licensure nursing students: an integrative literature review nurse education today, vol. 58; 2017. p. 19–24.

Wilkinson A, Meilkle N, Law P, Yong A, Butler P, Kim J, Mulligan H, Hale L. How older adults and their informal carers prevent falls: an integrative review. Int J Nurs Stud. 2018;82:13–8.

Drewniak D, Krones T, Wild V. Do attitudes and behaviours of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review. Int J Nurs Stud. 2017;70:89–98.

Garone A, Craen Van de P. The role of language skills abd internationalisation in nursing degree programmes: a literature review. Nurse Educ Today. 2017;49:140–4.

Casey M, O’Connor L, Cashin A (et al) An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice on quality of care, cost and access to services: A narrative review. Nurse Educ Today 2017;56:35-40.

Adib-Hajbaghery M, Sharifi N. Effect of simulation training on the development of nurses and nursing students critical thinking: a systematic review. Nurse Educ Today. 2017;50:17–24.

Irwin C, Bliss J, Poole J. Does preceptorship improve confidence and competence in newly qualified nurses: a systematic literature review. Nurse educ Today. 2018;60:35–46.

Jefferies D, McNallya S, Roberts K, Wallace A, Stunden A, D'Souzaa S, Glew P. The importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice: a systematic review. Nurse educ Today. 2018;60:84–91.

Lewis ML, Neville C, Ashkanasy NM. Emotional intelligence and affective events in nurse education- a narrative review. Nurse Educ Today. 2017;53:34–40.

Jensen D, Sorensen A. Nurses experiences of working in organisations undergoing restructuring: a meta-synthesis of qualitative research studies. Int J Nurs Stud. 2017;66:7–14.

Milligan F, Wareing M, Preston-Shoot M, Pappas Y, Randhawa G, Bhandol J. Supporting nursing, midwifery and allied health professional students to raise concerns with the quality of care: a review of the research literature. Nurse Educ Today. 2017;57:29–39.

Rozendo CA, Salas AS. A critical review of social and health inequalities in the nursing curriculum. Nurse Educ Today. 2017;50:62–71.

Kiteley R, Stogdon C. Literature reviews in social work. London: Sage; 2014.

Book   Google Scholar  

Rebeiro G, Evans A, Edward K, Chapman R. Registered nurse buddies. Educators by proxy? Nurse Educ Today. 2017;55:1–4.

Sinclair S, Raffin Bouchal S, Venturato L, Milsonic-Kondejewski J, Smith Macdonald L. Compassion fatigue: a meta-narrative review of the health care literature. Int J Nurs Stud. 2017;69:9–24.

Hovey S, Dyck MJ, Reese C, Myoung JK. Nursing students’ attitudes towards persons who are aged: an integrative review. J Adv Nurs. 2017;49:145–52.

Granheim B, Shaw J, Mansah M. Use of interprofessional learning and simulation in undergraduate nursing programmes to address interprofessional communication and collaboration- an integrative review. Nurse Educ Today. 2018;62:118–27.

Philips P, Lumley E, Duncan R, Aber A, Buckley Woods H, Jones GC. A systematic review of qualitative research into people’s experiences of living with venous leg ulcers. J Adv Nurs. 2018;74:550–63.

Slater CE, Cusick A. Factors relating to self directed learning readiness of students in health professional programmes a scoping review. Nurse Educ Today. 2017;52:22–33.

Vanderspank-Wright B, Efstathiou N, Vandjk A. Critical care nurses experience of withdrawing treatment: a systematic review of qualitative evidence. Int J Nurs Stud. 2018;77:15–26.

Kelly M, Wills J, Sykes S. Do nurses’ personal health behaviours impact their health promotion practice? A systematic review. Int J Nurs Stud. 2017;76:62–77.

Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in the reporting in the synthesis of qualitative research. BMC Med Res Methodol. 2012;12(1):181.

Greenhalgh T, Thorne S, Malterud K. Time to challenge the spurious hierarchy of systematic over narrative reviews? Eur J Clin Investig. 2018. https://doi.org/10.1111/eci12931 .

Aveyard H, Payne S, Preston N. A postgraduate’s guide to doing a literature review. Maidenhead: Open University Press; 2016.

Thorne S. Metasynthetic madness: what kind of monster have we created? Qual Health Res. 2017;27(1):3–12.

Sibeoni J, Orri M, Colin S, Valentin M, Pradere J, Revah-Levy A. The lived experience of anorexia nervosa in adolescence, comparison of parents’ view of adolescence, parents and professionals: a meta-synthesis. Int J Nurs Stud. 2017;65:25–34.

Nightingale S, Spiby H, Sheen K, Slade P. The impact of emotional intelligence in long term health care professionals on caring behaviours towards patients in clinical and long term settings. Integrative review. Int J Nurs Stud. 2018;80:106–17.

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Aveyard, H., Bradbury-Jones, C. An analysis of current practices in undertaking literature reviews in nursing: findings from a focused mapping review and synthesis. BMC Med Res Methodol 19 , 105 (2019). https://doi.org/10.1186/s12874-019-0751-7

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Received : 16 December 2018

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DOI : https://doi.org/10.1186/s12874-019-0751-7

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• Joanna Smith 1 ,
• Helen Noble 2
• 1 School of Healthcare, University of Leeds , Leeds , UK
• 2 School of Nursing and Midwifery, Queens's University Belfast , Belfast , UK
• Correspondence to Dr Joanna Smith , School of Healthcare, University of Leeds, Leeds LS2 9JT, UK; j.e.smith1{at}leeds.ac.uk

https://doi.org/10.1136/eb-2015-102252

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Implementing evidence into practice requires nurses to identify, critically appraise and synthesise research. This may require a comprehensive literature review: this article aims to outline the approaches and stages required and provides a working example of a published review.

Are there different approaches to undertaking a literature review?

What stages are required to undertake a literature review.

The rationale for the review should be established; consider why the review is important and relevant to patient care/safety or service delivery. For example, Noble et al 's 4 review sought to understand and make recommendations for practice and research in relation to dialysis refusal and withdrawal in patients with end-stage renal disease, an area of care previously poorly described. If appropriate, highlight relevant policies and theoretical perspectives that might guide the review. Once the key issues related to the topic, including the challenges encountered in clinical practice, have been identified formulate a clear question, and/or develop an aim and specific objectives. The type of review undertaken is influenced by the purpose of the review and resources available. However, the stages or methods used to undertake a review are similar across approaches and include:

Formulating clear inclusion and exclusion criteria, for example, patient groups, ages, conditions/treatments, sources of evidence/research designs;

Justifying data bases and years searched, and whether strategies including hand searching of journals, conference proceedings and research not indexed in data bases (grey literature) will be undertaken;

Developing search terms, the PICU (P: patient, problem or population; I: intervention; C: comparison; O: outcome) framework is a useful guide when developing search terms;

Developing search skills (eg, understanding Boolean Operators, in particular the use of AND/OR) and knowledge of how data bases index topics (eg, MeSH headings). Working with a librarian experienced in undertaking health searches is invaluable when developing a search.

Once studies are selected, the quality of the research/evidence requires evaluation. Using a quality appraisal tool, such as the Critical Appraisal Skills Programme (CASP) tools, 5 results in a structured approach to assessing the rigour of studies being reviewed. 3 Approaches to data synthesis for quantitative studies may include a meta-analysis (statistical analysis of data from multiple studies of similar designs that have addressed the same question), or findings can be reported descriptively. 6 Methods applicable for synthesising qualitative studies include meta-ethnography (themes and concepts from different studies are explored and brought together using approaches similar to qualitative data analysis methods), narrative summary, thematic analysis and content analysis. 7 Table 1 outlines the stages undertaken for a published review that summarised research about parents’ experiences of living with a child with a long-term condition. 8

• View inline

An example of rapid evidence assessment review

In summary, the type of literature review depends on the review purpose. For the novice reviewer undertaking a review can be a daunting and complex process; by following the stages outlined and being systematic a robust review is achievable. The importance of literature reviews should not be underestimated—they help summarise and make sense of an increasingly vast body of research promoting best evidence-based practice.

• ↵ Centre for Reviews and Dissemination . Guidance for undertaking reviews in health care . 3rd edn . York : CRD, York University , 2009 .
• ↵ Canadian Best Practices Portal. http://cbpp-pcpe.phac-aspc.gc.ca/interventions/selected-systematic-review-sites / ( accessed 7.8.2015 ).
• Bridges J , et al
• ↵ Critical Appraisal Skills Programme (CASP). http://www.casp-uk.net / ( accessed 7.8.2015 ).
• Dixon-Woods M ,
• Shaw R , et al
• Agarwal S ,
• Jones D , et al
• Cheater F ,

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Competing interests None declared.

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