Literature Review - Paper Answers

Ford_ABfinale xRubric_LiteratureReviewPaper_Summer2020-1 xStudent_Sample_Literature_Review_7th_Edition_APA2-1 DraftingtheLitReview-HelpfulTips x

Annotated Bibliography

Jalisa K. Ford

Department of Nursing, Eastern Michigan University

NURS 300W: Reading and Writing in Nursing Studies

Amy McBain

July 21, 2020

Annotated Bibliography

Research Question: How does nurse’s mental health affect burnout and patient safety and what can be done to change this?

Argaud, L., Azoulay, E., Beuret, P., Blot, F., Garrouste-Orgeas, M., Klouche, K., Maxime, V., Perrin, M., Soufir. L., Timsit J. F., Troche´, G. & Vesin, A., (2015). The iatroref study: Medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture. Intensive Care Med, 41, 273–284. https://doi.org10.1007/s00134-014-3601-4

The purpose of this study was to determine if burnout, depression and the strength of patient safety has an effect on medication errors. The methods used by the authors in this study consist of an observational, prospective, questionnaire. This questionnaire was answered by intensive care practitioners at 38 hospitals and consisted of categories related to burnout symptoms, depression symptoms, and safety culture. This study found that most practitioners did not have increased medical errors related to burnout or related to safety culture but did have increased errors related to depression. One interesting fact of this article is that the authors of this study found that staff coming to work after a day off had increased medical errors. Some of the limitations of this study included having a young of age population pool, the fact that most of the safety scores showed little change and that they previous performed a study with this same group, which could have biases. One of the similarities I noticed between this study and Baggs et al. (2018) they both agree that a higher workload increases the chances of having medication errors. This study appears useful because it unlike the other articles believe that burnout is not a factor of patient safety but believes depression is. The theme being noticed between articles is that they all have different reasons of how patient safety is affected by nurses mental health but in different ways.

Baggs, J. G., Liu, J., Liu, K., Liu, X., Wu, Y., You, L., & Zheng, J. (2018). Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis. International Journal of Nursing Studies, 86(2018), 82–89. https://doi.org/10.1016/j.ijnurstu.2018.05.005

The purpose of this article is to evaluate how excessive amounts of non-nursing duties, tasks left incomplete, work atmosphere, and work assignment affect the mental exhaustion of nurses and decrease patient safety. The methods used by these authors include a cross-sectional study conducted across south China. This study sampled over 1,500 nurses who answered an anonymous questionnaire. The findings of this study concluded that nurses who had improved work atmospheres and fewer non-nursing tasks, were able to complete more essential nursing tasks, feel less exhausted and have increased patient safety ratings. The authors of this article believe dissatisfaction with work atmospheres and the increase in non-nurses’ tasks cause nurses to feel overwhelmed by incomplete tasks causing burnout which increases incidents in patient safety. The limitations of this study include effects of patient safety not being reported, self-reporting, which could lead to biases and time variances of data collection. The difference seen in this article is this it looks at the nurse’s environment which causes burnout then decreased patient safety whereas De Witte et al. (2016) seeks to look at the patient incident as the cause for dissatisfaction and exhaustion. This source is helpful because it answers the question of why there is exhaustion and dissatisfaction in the nurse before the patient incident occurs. The theme noticed in relation to the research question is what can be done to decrease burnout in nurses so patient safety can be improved.

Cooper L. B., Halbesleben, J. R. B., Wakefield B. J. & Wakefield D. S., (2008). Nurse burnout and patient safety outcomes: Nurse safety perception versus reporting behavior. Western Journal of

Nursing Research, 30(5), 560-577. https://doiorg.ezproxy.emich.edu/10.1177/0193945907311322

The purpose of this study is to analyze practitioner burnout and their discernment of patient safety. It seeks to understand if practitioner burnout decreases their desire and motivation to go the extra mile to provide exceptional patient care resulting in sub-par care and leading to decreased patient safety. This study also seeks to understand if burnout will decrease the amount of errors reported by staff. The methods used in this study includes a cross-sectional survey mailed to and filled out by 148 practitioners on their own time. It asks question related to exhaustion, personal accomplishments, depersonalization, patient safety perception and reporting. This study found a decreased in the amount of reporting of medication errors related to burnout and that practitioners with increased burnout discerned they had a less safe environment. Some limitations include practitioners not knowing what possible should be a reportable offense, practitioners self-reporting could be biased and that this study only included one hospital. One of the main differences I see between this article and Argaud et al. (2015) they have an opposite view as to what causes burnout, one believes burnout solely comes from depression and isn’t associated with burnout at all, were this one solely believes it is because of burnout. This source could be useful because it helps to give a comparison in oppositional views. The theme noticed is burnout does show a decrease in patient safety.

De Witte, H., Dierickx, S., Euwema, M., Godderis, L., Sermeus, W., Vandenbroeck, S., Vander Elst, T., Van Gerven, E., & Vanhaecht, K. (2016). Increased risk of burnout for physicians and nurses involved in a patient safety incident. Medical Care, 54(10), 937-943. https://doi.org/10.1097/mlr.0000000000000582

The purpose of this study is to evaluate how the measures of harm to patients can lead to feeling overwhelmed, less-confident, withdrawn and exhausted practitioners. The methods the authors’ used were a multicentered cross-sectional study design were data was collected by several organizations; Nurses and physicians currently working in the hospital were surveyed filling out an online questionnaire. The participants were asked to answer questions about causing patient injury, thoughts of leaving their current profession, symptoms of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and problematic medication use. The authors found that as the degree of patient harm increased so did the practitioners feeling of burnout and alcohol use. This put the practitioner at a greater risk for future incidents in patient safety and even more burnout and decreased feelings of skill satisfaction. However, once the harm of a patient lead to death the overall health of the practitioner was less stressful than permanent harm. A few limitations of this study include not having a fully represented sample of the practitioners, a short six-month period time-frame and skewed results related to being self-reported by practitioners. The connection seen between this study and Baggs et al. (2018) is trying to understand what causes decreased patient safety. This source will be useful in helping to better understand how the mental health of nurses is affected by their job and what can be done to decrease burnout which increases patient safety. The theme noticed in relation to presented research question is patient incidents increase burnout and can continue to increase it if not resolved.

Criteria for Literature Review (Total 10 0 points) The 6-7-page paper, should include the following:	Points Possible
1. Introduction clearly states the research question and the topic of the literature review. Provides background of the issue and establishes the importance for the field (see 3.4 – APA Manual). The purpose of the paper is noted ( 5 points). Methods are discussed in detail, noting the databases searched in, keywords used, dates your sources were limited to. Table is referred to. (5 points)			10
2. Table is created following APA Format. Use Table 7.1 (p. 20 0) as a guide to creating your table. Pay attention to the title (bold) and the title of the table (in italics and in title case). Use the same font as the rest of your paper. Table should have your two (2) themes at the top and your authors alphabetized along the left side. Use et al. for authors’ names that are three or more.		5
2. Organizes the body of the paper purposefully and logically using 2 themes. Headings are used and correctly formatted (Methods, Review of the Literature, Discussion, Recommendations, Conclusion). Uses Level 2 subheadings within the lit review to organize the research under the themes selected
3. Ideas, evidence and examples taken from the sources are organized in a concise manner that follows the themes the writer has chosen for the lit review. Topic sentences are utilized within sections, especially when introducing a new theme. Transitional devices within and between sections are used to demonstrate the connections between ideas and texts. The writer shows connections (similarities/differences) between the different authors’ findings. Search Purdue Owl for a list of Transitional Devices. Paper is written in prose style (10 pts)
4. For each theme, the writer should review 3 sources’ findings. For each article discussed in the lit review section, the writer clearly and succinctly states the author(s) purpose (for context) and all specific findings (in detail!) in regard to the research question. Main points of the article are addressed in detail for articles that are not research based. The reader should be able to gain a good sense of all the findings noted from each article reviewed relating to the writer’s research question. 1 (10 points)
5. Integrates evidence from all sources reviewed by paraphrasing, quoting and/or summarizing from the texts to support the review of each article. Signal phrases are used to introduce all evidence. The paper does not overuse quotes. (10 points)
6. Includes a substantial discussion section which synthesizes, analyzes and critiques the information presented from the research. The discussion section should answer, but is not limited to, the following questions: – Why is this research important for the topic and the profession? – In what ways does the lit review contribute to the larger discussion within the field? – As a whole, what does this literature tell readers about this particular issue? – Overall did you find the sources to be accurate, current, reliable? – What gaps or limitations overall (not each article individually) did you note? – What could be done further regarding this issue? Recommendations for the future? Future Research? (20 points)	20
7. Uses APA style (7th ed.) correctly throughout the paper, both with formatting throughout the paper (including the title page) and in-text citations. Summarized and paraphrased material is quoted throughout with the author/date. Direct quotations included author/date/page number citation (10 points)
8. Includes a complete references page (last page of the paper) with all sources from the literature review in correct APA style. (10 points)
9. Surface Conventions : Sentence structure is clear and precise, and grammar and punctuation are correct. Paper has been spell checked and all blue and red lines in the document have been corrected. All past track changes comments and edits have been deleted and a clean copy is submitted. Personal pronouns (I, me, my, we, us, our) are not used in the paper. The writer made revisions from the rough draft. (10 points)

Lit Review Final Grade (100 points Possible):

Fall Risk Factors in Hospitalized Acute Stroke Patients: A Literature Review

Firstname I. Lastname

Department of Nursing, Eastern Michigan University

NURS 300W: Reading and Writing in Nursing Studies

Professor Amy McBain

January 10, 2020

Commented [BA1]: The full title appears in the upper 1/3
of the title page in title case and centered.

See this link for more information.
https://apastyle.apa.org/style-grammar-guidelines/paper-
format/title-page

Commented [BA2]: Note that there is a specific context
for the research: a narrowed focus within the larger topic.

Commented [BA3]: The entire APA paper should be
consistently double-spaced (except for the text in tables,
which can be single, 1.5, or double spaced; try and keep
each table on a single page and make them easily readable
for your audience).

Also, be sure to check your Paragraph formatting to make
sure the spacing “Before” and “After” are both set at “0pt.”

https://apastyle.apa.org/style-grammar-guidelines/paper-format/title-page

Fall Risk Factors in Hospitalized Acute Stroke Patients: A Literature Review

Stroke has been classified as the most disabling chronic disease with deleterious

consequences for individuals, families, and society (Schmid et al., 2010a). Stroke patients,

sometimes already devastatingly compromised, are susceptible to several complications. Despite

increased supervision, falls are the most common hospital-acquired condition in patients with

neurological disease (Cox et al., 2017). While the length of stay in the hospital setting is

decreasing, patients who have suffered a cerebral infarction still spend 4-5 days on an acute

stroke unit undergoing testing, medical stabilization, and rehabilitation evaluations (Cox et al.,

2017); understanding fall risk factors are essential to providing appropriate nursing care to these

patients.

The percentage rate of patient falls in the stroke unit has been found to be as high as

12.9% with 15.4% of those falls causing visible physical damage (Persson et al., 2017).

Consequences of falls include broken bones, soft tissue injuries, head injuries, as well as an

inability to perform activities of daily living (ADLs), including eating, dressing, bathing, and

toileting (Cho et al., 2015). Patient falls can even result in death. Patients who fell also had an

increased length of stay, tripling their hospital days (Schmid et al., 2010a), which can leave them

potentially immobile, make them vulnerable to further complications, and potentially exhaust

their limited insurance and financial resources. Much of the responsibility for the patients’ safety

resides with their nurse. This literature review will examine patient risk factors for falling in an

acute stoke unit.

Methods

The methods used to find literature consisted of a search using several variations of the

same keywords in the CINAHL, Google Scholar, and PubMed databases. Keywords included in

the searches were: fall risk in stroke unit, patient fall risks and stroke or cerebrovascular

accident (CVA), and characteristics of stroke patients who fall. Also used were the search terms

functional status and postural control; the latter two search terms provided definitions to clarify

Commented [BA4]: The full title appears bold and
centered as the first line on p. 2 and should be the same
exact wording as appears on the title page.

“introduction” is not used as a heading in APA papers.

Commented [BA5]: When sources have 3 or more
authors, use et al. for in text citations. See this link for the
in-text citation rules and examples.
https://apastyle.apa.org/style-grammar-
guidelines/citations/basic-principles/author-date

Remember “et al.” is a Latin abbreviation for et alli, which
means “and others.” Since alli is abbreviated to al. there is
always a period.

Also, parenthetical in-text citations have a comma between
the authors’ names and the year of publication.

Commented [AM6]: Notice that the introduction
provides information and background about the topic
providing some context for the review that will follow. The
purpose of the paper is clearly noted within the
introduction.

Commented [BA7]: This is the correct formatting for an
APA level one heading.

See this link for more information.
https://apastyle.apa.org/style-grammar-guidelines/paper-
format/headings

Commented [BA8]: The writer in this section notes the
databases that were used to find all of the sources, notes
the keywords and lets readers know what years were
limited within the search.

https://apastyle.apa.org/style-grammar-guidelines/citations/basic-principles/author-date

https://apastyle.apa.org/style-grammar-guidelines/paper-format/headings

information found in the review of the literature. The search was restricted to peer-reviewed

journal articles written between 2010 and 2018. Table 1 summarizes the common themes that

developed as a result of this research.

Table 1

Risk Factors for Falls in Hospitalized Acute Stroke Patients

Source

Decreased functional

status

Stroke severity

Cho et al. (2015)

Cox et al. (2017)

Ingeman et al. (2011)

Persson et al. (2018)

Schmid et al. (2010a)

Schmid et al. (2010b)

Review of the Literature

Careful review of the literature revealed two prevalent themes of risk factors associated

with hospitalized acute stroke patients: decreased functional status and stroke severity. These

two risk factors are demonstrated in the research to be important to consider when developing

fall risk prevention plans.

Decreased Functional Status

Functional status is an individual’s ability to perform normal daily activities required to

meet basic needs, fulfill usual roles, and maintain health and well-being (American Thoracic

Society, 2007). Persson et al. (2018) found that patients who required the use of a walking aid

such as a cane or walker more than doubled the risk of fall. Similarly, a study by Cox et al.

(2017) found that patients who needed assistance with ambulation at the time of discharge were

Commented [CS9]: The format is in APA format, with the
label Table 1 above in bold; a title in title case and italicized.

Commented [BA10]: The table has two themes, with at
least three sources per theme; the stub head (see p. 200 in
your APA Manual) is left aligned with the authors listed as
the first citation in text; the column headings are centered
and in sentence case. The authors’ names are alphabetized.

See this resource for more info:
https://apastyle.apa.org/style-grammar-guidelines/tables-
figures/sample-tables

Commented [BA11]: Use the same font for your tables as
in the rest of your paper; remember consistency in your
document design.

Commented [BA12]: Typically, students include a brief
overview after the Review of Literature heading before the
first theme. The overview would just be 1-3 sentences
indicating why the themes were selected and what the
themes are.

Commented [BA13]: Notice how the author discussed
these themes below in the same order as presented here to
offer readers parallelism.

Commented [BA14]: This level two heading titles the
section on the first theme. Level two headings are sub-
categories of the level one heading under which they
appear.

Again, see this resource for more on APA headings:
https://apastyle.apa.org/style-grammar-guidelines/paper-
format/headings

Commented [BA15]: Notice how the topic sentences are
about ideas instead of individual sources. The topic
sentence should provide your readers with an introduction
to this topic and an overview of the main points of this
paragraph.

https://apastyle.apa.org/style-grammar-guidelines/tables-figures/sample-tables

https://apastyle.apa.org/style-grammar-guidelines/paper-format/headings

statistically more likely to have experienced falling in the inpatient setting. Schmid et al. (2010b)

associated a loss of functional status as identified by ataxia, aphasia, gait abnormality, brainstem

stroke, previous CVA, history of anxiety, history of urinary tract infection, and history of

syncope to a fall in the hospital. Additionally, loss of functional status leads to a self-care deficit.

Functional status is closely tied with dependence in ADLs in that dependency in ADLs is

a measurement indicative of a loss of functional status. Dependence in ADLs is defined as the

amount of assistance one needs to perform basic self-care tasks such as dressing, eating, going to

the bathroom, grooming and transferring; postural control, in turn, affects a patient’s functional

status, because the ability to maintain, achieve or restore a state of balance impacts one’s ability

to perform ADLs (Persson et al., 2018). Cho et al. (2015) found that ADL performance was the

most statistically relevant variable of several tested in measuring patient fall risk. They measured

bowel control, bladder control, grooming, toilet use, feeding, transferring, walking, dressing,

bathing, and climbing stairs using the Modified Barthel Index to get these results. Similar to the

study by Cox et al. (2017), Schmid et al. (2010b) found that formerly independent stroke patients

who were discharged with a loss in the above-mentioned status were statistically more likely to

have fallen during their hospitalization. Similarly, Schmid et al. (2010a) measured ADL

independence using the Functional Independence Measure, a universally recognized tool in

measuring functional ability in disabled persons, statistically correlating requiring help with

ADLs to an increased risk of falls. It is not surprising that the highest incidence of falls occurred

during transfers to and from the toilet and toileting devices (Cox et al., 2017). To emphasize the

importance of independence in ADLs, Cox et al. (2017) also found that most falls took place

during the day shift when many patients were engaging in their daily routines.

Stroke Severity

The National Institutes of Health Stroke Scale (NIHSS) was originally developed in 1989

and tests stroke severity by measuring 15 different cognitive and physical abilities (Schmid et al.,

2010b). A higher NIHSS scale indicates a more severe stroke, with the highest possible score

Commented [BA16]: Connections and transitions lead
the reader from one idea to the next.

See the tables on these websites as useful tools listing
transitions and the relationships they establish:

https://owl.purdue.edu/engagement/ged_preparation/part
_1_lessons_1_4/transitions.html

Transitions

Commented [BA17]: A key finding is presented clearly
here.

Commented [BA18]: The methods are smoothly
integrated into the paragraph and do not overtake the
discussion. One sentence should be enough to describe the
methods for the lit review paper.

Commented [BA19]: Unlike the annotated bibliography
where each source is addressed one paragraph at a time, in
the literature review, each paragraph contains references to
many sources that are related and synthesized according to
thematic connections.

Commented [BA20]: The expected finding is
contextualized here.

Commented [BA21]: In the first reference to an
organization, the name is fully spelled out with the acronym
following in parentheses.

Commented [BA22]: This author clearly defines
important information before digging into the results to
provide context for the reader and the significance of the
research.

Commented [BA23]: In the second and each subsequent
reference to an organization, just the acronym is used.

https://owl.purdue.edu/engagement/ged_preparation/part_1_lessons_1_4/transitions.html

Transitions

being 42; a stroke scale score of greater than 8, which indicates a moderate to severe stroke, was

associated with a risk of falling while in the acute hospital phase of recovery (Schmid et al.,

2010a). Similarly, a study conducted on outpatients using data from both their inpatient medical

records and current outpatient assessments found that those with a higher stroke scale were at

greater risk for falls. To give an example, of that high-risk group those with a stroke scale score

of greater than 4 had the highest risk for falls (Schmid et al., 2010b). Cox et al. (2017) found that

patients who presented with new onset weakness as a symptom of stroke, an NIHSS

measurement, were also more likely to experience a fall. These findings are in contrast to those

of Persson et al. (2017) who found no statistical association between falling and stroke scale

score. However, several of the motor-control-based attributes which would lead to a higher

rating on the stroke scale could also contribute to dependency in ADLs. Persson et al. (2017)

failed to address this possible confounding factor in their data, which may explain why in this

regard Persson et al.’s findings are both counterintuitive and in conflict with the findings of other

studies.

Discussion

Stroke victims remain vulnerable to falls throughout their hospital admission. It is worth

noting that at least one of the hospitals in the above-mentioned studies was using an evidence-

based fall prevention program with 100% participation, yet still sustained patient falls (Cox et

al., 2017). Schmid et al. (2010b) suggests the possibility of allotting special resources for those

with NIHSS scores of 8 and over which may lead to a decrease in falls in the latter stages of

recovery. Schmid et al. (2010b) argue for the use of a neuroscience specific fall risk assessment

tool. The risk factors discussed in this review—functional status and dependency in ADLs—are

very closely related to each other and to the items in the NIHSS score suggesting that the NIHSS

score may be used as a quick snapshot of fall risk.

Commented [BA24]: Sources do not have to agree or
have the same findings to be connected thematically in the
literature review. Pointing out the differences in results is
important to educating the reader on the issue, too.

Commented [BA25]: This shows a nuanced look at the
limitations of the research.

Commented [BA26]: Notice how robust of a section this
author’s Discussion section is.

Commented [BA27]: This point responds to the question:
“Why is this research important for the issue presented and
to the nursing profession?”

Commented [BA28]: Calling attention to important
elements in the research allows the writer to highlight ideas
that are central to the research question explored. It also
responds to the question: “In what ways does the literature
review contribute to the larger discussion within the field?”

Commented [BA29]: This point responds to the question:
“As a whole, what does this literature tell readers about this
particular issue?”

There is little research addressing the issue of patient falls in an acute stroke unit setting.

Most studies focus on patients in a rehabilitation setting or patients living in the community after

returning home. Two studies used in this review, in fact, used data from both an acute hospital

setting and that of either rehabilitation or home. At least one of the studies excluded patients who

had received tissue plasminogen activator (TPA) and endovascular procedures such as

mechanical thrombectomy and intra-arterial TPA. These patients represent a growing number of

stroke patients and will only increase. A number of existing studies focusing on the acute

hospitalization period are nearly 20 years old or older. Therefore, they do not take into

consideration changes in the average length of stay or current interventions in the treatment of

acute stroke such as endovascular procedures and the administration of tissue plasminogen

activator (TPA). More research is needed to identify patient fall risk factors in the acute setting

where patients spend on average 4 to 5 days (Cox et al., 2017). For this review, only two current

studies measuring fall risk in stroke patients during the acute hospitalization period were found.

A third study used was conducted on a unit that cared for both acute stroke patients and those in

rehabilitation.

Two recent studies, Persson et al. (2017) and Cox et al. (2017), have findings that future

research could address and corroborate. Despite the fact that more women have strokes than

men, both studies found that male stroke patients were at higher risk for falls (Cox et al., 2017).

Persson et al. (2017) found that male study participants had an 88% higher risk of falling than

females. This finding is corroborated anecdotally by many nurses, particularly by stroke floor

nurses, and warrants further investigation.

Lastly, the subject of comorbidities leading to a risk for falls also warrants further

research. Stroke patients often have more than one chronic condition. Studies have identified

several diseases that increase fall risk among stroke patients. However, each study found

different conditions to cause a risk for falls. Schmid et al. (2010a) found that patients with a

history of anxiety and urinary tract infection were more likely to fall. Cox et al. (2017) found that

Commented [BA30]: This point responds to the question:
“Are there any limitations or gaps in the research that you
noticed and that need to be addressed?”

Commented [BA31]: This point responds to the question:
“What could be done further regarding this issue?”

Commented [BA32]: This point responds to the question:
“What studies/research do you feel still need to be done in
this area? Be specific here.”

males with a history of heart disease or renal insufficiency to be at a very high risk for falls. The

above conditions were also found to contribute to fall risk in a large Dutch study that took place

in 1992. More studies need to be done to see if the specific results can be repeated under current

conditions.

Conclusion

This literature review reinforces the need for falls assessment, patient and caregiver

education, and planning early in the admission by a team made up of physical therapists,

occupational therapist, nurses, and physicians who can maximize patient safety throughout their

admission to the acute stroke unit. Early identification of patients’ functional status can prevent

falls with immediate implementation of safety interventions. Planning for assistance in ADLs by

nurses will also contribute to preventing falls. The NIHSS score provides nurses with a tool to

quickly measure their patient’s deficits and has been found to be statistically significant in

predicting a patient’s risk of falling in addition to standard unit protocols. Nurses should check

their patients’ previous NIHSS score and assess them throughout the shift for changes in this

score. There is also room for further research to identify potential fall risk by comorbidity and

gender.

Commented [BA33]: The succinct conclusion highlights
the important findings of the literature review while
indicating what research remains to be done.

Commented [BA34]: Connecting the research to practice
is essential.

References

American Thoracic Society. (2007). Functional status. http://qol.thoracic.org/sections/key-

concepts/functional-status.html

Cho, C., Yu, J., & Rhee, H. (2015). Risk factors related to falling in stroke patients: A cross-

sectional study. Journal of Physical Therapy Science, 27(6), 1751-1753.

https://doi.org/10.1589/jpts.27.1751

Cox, R., Buckholtz, B., Bradas, C., Bowden, V., Kerber, K., & McNett, M. M. (2017). Risk

factors for falls among hospitalized acute post-ischemic stroke patients. Journal of

Neuroscience Nursing, 49(6), 355-360. https://doi.org/10.1097/JNN.000000000000322

Ingeman, A., Andersen, G., Hundborg, H. H., Svendsen, M. L., & Johnsen, S. P. (2011). In-

hospital medical complications, length of stay, and mortality among stroke unit patients.

Stroke, 42, 3214-3218. https://doi.org/10.1161/STROKE.AHA.110.610881

Persson, C. U., Kjellberg, S., Lernfelt, B., Westerlind, E., Cruce, M., & Hanson, P. O. (2018).

Risk of falling in a stroke unit after acute stroke: The fall study of Gothenburg. Clinical

Rehabilitation, 32(3), 398-409. https://doi.org/10.1177/0269215517728325

Schmid, A. A., Kapoor, J. R., Dallas, M., & Bravata, D. M. (2010a). Association between stroke

severity and fall risk among stroke patients. Neuroepidemiology, 34, 158-162.

https://doi.org/10.1159/000279332

Schmid, A. A., Wells, C. K., Concato, J., Dallas, M. I., Lo, A. C., Nadeau, S. E., Williams, L. S.,

Peixoto, A. J., Gorman, M., Boice, J. L., Struve, F., McClain, V., & Bravata,

D. M. (2010b). Prevalence, predictors, and outcomes of poststroke falls in acute hospital

setting. Journal of Rehabilitation Research & Development, 47(6), 553-562.

https://doi.org/10.1682/JRRD.2009.08.0133

Commented [BA35]: The heading “References” is
centered and bolded.

Commented [BA36]: When the organization that
published the source is also listed as the author, this is the
correct formatting. See this resource for more info:
http://blog.apastyle.org/apastyle/2010/01/the-generic-
reference-who.html

Commented [BA37]: Hanging indents are used for each
source. See this video for instructions:

Commented [BA38]: In APA 7th edition, all DOIs should
be formatted the same way; see this resource for more info
and examples: https://apastyle.apa.org/style-grammar-
guidelines/references/dois-urls

Commented [BA39]: When presenting the title of an
article in a bibliographic entry, you should follow these
conventions: capitalize only the first letter of the first word
of a title and subtitle, the first word after a colon or a dash
in the title, and proper nouns.

Commented [BA40]: The volume number is italicized,
and the issue number is in plain font in parentheses, and
there is no space or label in-between the two.

Commented [BA41]: Sources should be alphabetized, so
this source (which starts with a “P”) would come after
Ingeman, A., Andersen, G., Hundborg, H. H., Svendsen, M.
L., & Johnsen, S. P. (2011) and so on.

At the same time, you should never ever change the order
of the authors’ names from the way they originally appear
on the article—even if they are not in alphabetic order.

Commented [BA42]: Notice the 2010a here versus the
next source’s 2010b—this is necessary because, while
these two sources are not written by the exact same
team of authors (although they do include some of the
same people, i.e. Schmid, when the in-text citations of
this source are used in the body of the paper they will
appear as Schmid et al. (2010a) and as Schmid et al.
(2010b) so your readers can tell these two sources
apart from one another.

More information:

Two or More Works by the Same Author in the
Same Year
If you are using more than one reference by the same
author (or the same group of authors listed in the same
order) published in the same year, organize them in the
reference list alphabetically by the title of the article or
chapter. Then assign letter suffixes to the year. Refer
to these sources in your essay as they appear in your …

Commented [BA43]: In APA 7th edition, up to 20 authors
are listed. See this link for more information.
https://apastyle.apa.org/style-grammar-
guidelines/references/elements-list-entry#author

https://doi.org/10.1589/jpts.27.1751

https://doi.org/10.1097/JNN.000000000000322

https://doi.org/10.1161/STROKE.AHA.110.610881

https://doi.org/10.1177/0269215517728325

https://doi.org/10.1159/000279332

https://doi.org/10.1682/JRRD.2009.08.0133

http://blog.apastyle.org/apastyle/2010/01/the-generic-reference-who.html

https://apastyle.apa.org/style-grammar-guidelines/references/dois-urls

https://apastyle.apa.org/style-grammar-guidelines/references/elements-list-entry#author

Drafting the Lit Review – Helpful Tips

Helpful tips regarding the Lit Review Paper:

Please read through the end carefully!

Just a reminder that the lit review section (Review of the Literature heading) of your paper should be organized by themes (threads) that you have chosen for your paper based on the main ideas found within all of the literature that you reviewed in regards to your research question. They are the main points that you have noticed your sources discussing in relation to your research question. Two themes should be used for this paper (please do not use more than two themes). You must use these as Level 2 headings within your paper, and you can see how this is set up within the Student Sample papers. You should have three sources (their findings) to review under each theme
to provide a thorough review of the literature and to show similarities/differences within the literature you found. Each review of the findings of the source must be in detail and list all of the findings within the article in relation to the research question, not just one or two sentences. Your readers should be able to get a good sense of what the particular sources you’ve found in your lit searches have written about in relation to your research question, along with making those important connections between the sources so show similarities and differences within the findings.

For example, if I was writing on the nursing shortage and my research question was “What are the factors that contribute to the nursing shortage?” I would then look at my Annotated Bibliography to see what all of my sources said about this particular question. Then I would choose the top two factors (themes) that all authors stated about this research question. Let’s say out of all of my sources that I reviewed, the top factors that contribute to the nursing shortage that all authors talked about in answer to my research question was: 1. Faculty Shortage 2. Nurse Burnout/Dissatisfaction. Those two themes would actually become the Level 2 headings underneath the Review of the Literature Section of my paper (see student sample). Then, within each heading, I would review the sources that mentioned something about each particular theme under that heading. I would review their studies (their purpose in only one or two sentences maximum!) and the findings in detail using paraphrases and summaries and some quotations regarding what each author had to say under that particular theme/heading. You should have a mixture of paraphrases, quotes and summary in your paper, with more weight leaning towards paraphrasing as that is preferred by APA. Avoid over-quoting in your paper. Your reader should get a good sense of what the literature out there says about this particular theme and the connections (similarities/differences) between the sources. Do not copy from your Annotated Bibliography, as that is considered self-plagiarism, but you can certainly refer to it to help you weave together the main points from the articles to show readers a glimpse into what the literature has to say about the particular theme. Remember, in the literature review section, you are reviewing what the literature/authors stated on the issue only in relation to your research question, and you should be paraphrasing often and quoting some, too, by bringing in examples from the texts.

You should also be showing connections between your sources as you are reviewing them, using Transitional Devices to link and transition into new paragraphs (words like: in addition, further, moreover, similarly, in contrast, etc.) You must cite everything that you take from the sources. Direct quotes should include a page number citation. Keep in mind that it is not enough to just have a citation at the beginning or the end of a paragraph in APA. You will be citing often in this section of the paper since you’re reviewing other sources so don’t worry about having too many citations here — it really is just a convention of APA Style.

In a formal paper in APA, you should not use the first-person “I” in the Review of the Literature or other personal pronouns such as “me, we, us, our, etc..” Many professors in the program do not allow the use of personal pronouns in the paper and most scholarly sources avoid this as well. Just remember that your reader knows it’s you talking as it’s your paper, so there really is no reason to use “I” in formal writing. I would encourage you to start practicing this now in this class as you will most likely run into this later in the program.

In the Review of the Literature section, you should review only the articles related to that theme within that section of your paper. Please see the student sample and how it is set up with headings so that you can follow that structure. In other words, you may not use all five of your sources in your review section, especially if one source does not fit within a theme you selected, though you most likely could use the source in your introduction or some other area of your paper like the Discussion section. You may only end up with four sources on your final lit review, or you may need to find another source, and that is just fine.
You must use at least 4 sources for this lit review.
You should have three sources to review for each theme. Again, you might have one source that doesn’t fit within one of your themes, but it could be used in the introduction of your paper to show the history/background of the problem and to show the importance of the issue; these are all items that should be part of the introduction so don’t skimp on the intro! Keep quotes to a minimum in the introduction, but providing a surprising statistic or a really good short quote about your topic is often effective in the introduction of the paper to help provide some context for the rest of the paper and to demonstrate the importance of your topic. (Refer back to your APA manual for how to write effective introductions).

Very Important: Please be careful about paraphrasing your sources and remember
anytime you use even a string of even three or four words exactly from the text you must put the words in quotation marks and cite the author/date and the page number of where you found the source.
If you completely paraphrase or summarize in your own words, you should not include the page number. Also watch for patchwork phrasing as this is considered plagiarism (See the University of Wisconsin Handout on Acknowledging sources).

Please take a look at the student example Lit Review with my notes on it, please do so to help you with the formatting of your paper. Your paper should have these sections: An introductory paragraph (no heading is used for the introduction though in APA), a Methods section (how you went about searching in the databases for your articles, what years you limited your articles to, etc.) your Review of the Literature section (a Level 1 heading) and then your subheadings/themes (Level 2 headings) with all of your sources reviewed for your reader, a Discussion/Recommendations section (you can separate these two if you’d like) and finally a short Conclusion. If you take a look at the student sample, you will be able to see how these headings are set up. Below is a basic outline of the headings. Level 1 headings are centered and in bold and each word besides those three letters or less would be capitalized. Level 2 headings (your themes) are flush to the left Margin, in bold and capitalized. There is no heading for the introduction — you just note your title again and then indent for new paragraphs for the introduction. It would look something like the following (and again see the student sample for more details).

Title of Your Paper Centered on Line One of Page Two (not in bold)

Your introductory paragraphs (indent all paragraphs) would come next. See the section on writing introductions in the APA manual, but you should be providing the background of your topic, any important statistics that might show the importance of it, and then noting the research question that prompted your lit search in the first place or a sentence about the purpose of the paper for readers.

Methods

Review of the Literature

Theme 1

Theme 2

Discussion/Recommendations

Conclusion

References (this begins on a new page)

All papers should include recommendations either within the Discussion heading or in its own heading. You should include your table as part of the Lit Review under the Methods section and be sure to title it and refer your reader to it. Just remember everything in APA should be double spaced. The title of your paper should only be 12 words long in APA and the Running head can be no more than 50 characters, including spaces. Each introduction should provide the necessary background and context for the issue you’ve chosen and be thorough and the research question that prompted your search in the first place so that the reader can see the importance of the topic and your main focus for the review. See the Lit Review Rubric as well for help with this and in writing the Discussion section of your paper.
There are some questions on the rubric that you should answer that will help you write the Discussion section.

IMPORTANT: You should have a variety of summaries/paraphrases and quotes from all of the sources related to a particular theme for each section of the review part of your paper. You wouldn’t use many quotes in your discussion section or in your conclusion, because this is your place to synthesize and analyze (critique) the literature on your own. Be sure to use signal phrases before every quote to introduce it (you never want to start a sentence with quotation marks) and cite all of your sources correctly in APA format. Remember to include author/date/page number for a direct quote and only the author/date for a paraphrase and summary. ****
Please remember that even a string of even three or four words copied directly from a source must be placed in quotation marks and cited with the page number
. A paraphrase is more than just changing a few words around — it is a complete change of wording/structure. This is very important to avoid plagiarism. You might also want to review the Video/PowerPoint on Integrating Sources that is within Panopto Recordings and take a look at the section on patchwork phrasing as noted above in the handout “Acknowledging Sources” from the University of Wisconsin to avoid doing this in your paper. Don’t forget the UWC Online is there to review your papers as well and provide you help along the way if you need more help citing your sources!

Turn in your highest-quality paper
Get a qualified writer to help you with

“ Literature Review ”

Get high-quality paper

NEW! AI matching with writer

Order an Essay Now & Get These Features For Free:

Turnitin Report

Formatting

Title Page

Citation

Outline

Place an Order