PROFESSIONAL DEVELOPMENT
Written communication: from staff nurse to nurse consultant
Part 5: literature reviews John Fowler
‘With reference to the literature, critically explore the nursing needs of a patient following stroke.’ The key words are ‘with reference to the literature’. This has correctly encouraged the nurse to base and inform their practice on
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evidence and knowledge drawn from sources greater than a single ward sister. However, even 30 years on from the introduction of literature reviews in the nursing profession, I am still reading essays by students on degree courses, qualified nurses on Masters-level courses and specialists undertaking PhDs who conceptually see and use the authority of ‘literature’ in the same way that nurses used the authority of the ward sister many years ago. I will read sentences such as: Smith (2013) states that patients are anxious when undergoing invasive surgery. Anxiety can be reduced by informing the patient of the procedure (Brown, 2013), reassuring the patient (Jones, 2012) and taking a full history (Watson, 2010). Take a few moments to think about this and ask yourself if you would change your practice based on that review of the literature. The problem with those sentences—and many examples of poor literature reviews—is that they give no indication of the type of literature they are coming from. They may be the common-sense opinions of four people who think that anxiety is worse in patients undergoing invasive surgery and is reduced by information, reassurance and listening. All good common sense, but they have no evidence to prove it. Alternatively, Smith, Brown, Jones and Watson may be the leading researchers and experts in this field and may have undertaken extensive controlled trials and these are the results of their findings. The person reviewing the literature here has not communicated to the reader the strength or reliability of that literature. If we do not understand the varying authority of different types of published literature, or if we do not communicate our evaluation of it in our writing, then we are in danger of simply replacing the concept of ‘sister says’ with ‘the literature says’.When writing a literature review, then, you need to: ■■ State how you selected the literature. Was
this a computerised search of particular databases and, if so, which ones and what key words and dates did you use? ■■ State why you chose the pieces of literature you ended up using. There may have been 2000 articles identified by the search and you chose the 20 randomised controlled studies. Or maybe there were only 5 papers, which were largely descriptive accounts. ■■ When referring to a piece of literature, give the reader an indication as to its reliability and validity. Smith (2014), in a randomised controlled study of 500 patients, states that anxiety is a key factor. Brown (2013), in a qualitative study of 10 patients, states that patients who were given reassurance by a qualified nurse… A literature review is not just an academic exercise for a university lecturer. Care pathways and clinical procedures should be developed following a review of the evidence. When writing a literature review, you need to communicate the strength of that evidence, any weaknesses, whether the results from a single study in an inner city can be applied to a county setting, and whether there is enough evidence to inform and possibly change clinical practice. BJN Fowler J (2014a) Written communication: from staff nurse to nurse consultant. Part 1 Core principles. Br J Nurs 23(15): 866 Fowler J (2014b) Written communication: from staff nurse to nurse consultant. Part 2: patient records. Br J Nurs 23(16): 910 Fowler J (2014c) Written communication: from staff nurse to nurse consultant. Part 3: email communication. Br J Nurs 23(17): 958 Fowler J (2014d) Written communication: from staff nurse to nurse consultant. Part 4: case studies. Br J Nurs 23(18): 1004
Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to primary care trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2014 MA Healthcare Ltd
T
his is the fifth article in the ‘staff nurse to nurse consultant’ series discussing the use of written communication by clinically based nurses. Previous articles have explored the need for clarity, precision and brevity when communicating via the written word and how these principles can be applied to patients’ records, email communications and case studies (Fowler, 2014a, 2014b, 2014c, 2014d). This article examines the principles involved when writing a literature review. When I started my general nurse training in the 1970s, there were two main sources of knowledge on which I was taught to base my practice.The first was textbooks, one on medical nursing and another on surgical nursing. The second, far more powerful influence on my nursing practice was what the ward sister said. ‘Sister says’ was a very common phrase uttered by nurses as a way of giving credibility to practical procedures and actions. Obedience was a cornerstone of nursing in those days and, like the majority of the nurses and patients, I would never dream of questioning the wisdom and knowledge of the ward sister. I did, however, have my faith in such authority weakened when on one ward with the luxury of two ward sisters, procedures and practices differed depending on which ward sister was on duty for that particular shift! In the late 1970s and early 1980s, the concept of evidence-based practice began to infiltrate mainstream clinical nursing. The authority of the phrase ‘sister says’ was replaced by ‘the literature says’. Since the 1980s, nurse training has emphasised the need for evidence-based practice. A common assignment question throughout pre- and post-registration education became something like:
British Journal of Nursing, 2014, Vol 23, No 19
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 24, 2015. For personal use only. No other uses without permission. . All rights reserved.
Written communication: from staff nurse to nurse consultant
Part 5: literature reviews John Fowler
‘With reference to the literature, critically explore the nursing needs of a patient following stroke.’ The key words are ‘with reference to the literature’. This has correctly encouraged the nurse to base and inform their practice on
1046
evidence and knowledge drawn from sources greater than a single ward sister. However, even 30 years on from the introduction of literature reviews in the nursing profession, I am still reading essays by students on degree courses, qualified nurses on Masters-level courses and specialists undertaking PhDs who conceptually see and use the authority of ‘literature’ in the same way that nurses used the authority of the ward sister many years ago. I will read sentences such as: Smith (2013) states that patients are anxious when undergoing invasive surgery. Anxiety can be reduced by informing the patient of the procedure (Brown, 2013), reassuring the patient (Jones, 2012) and taking a full history (Watson, 2010). Take a few moments to think about this and ask yourself if you would change your practice based on that review of the literature. The problem with those sentences—and many examples of poor literature reviews—is that they give no indication of the type of literature they are coming from. They may be the common-sense opinions of four people who think that anxiety is worse in patients undergoing invasive surgery and is reduced by information, reassurance and listening. All good common sense, but they have no evidence to prove it. Alternatively, Smith, Brown, Jones and Watson may be the leading researchers and experts in this field and may have undertaken extensive controlled trials and these are the results of their findings. The person reviewing the literature here has not communicated to the reader the strength or reliability of that literature. If we do not understand the varying authority of different types of published literature, or if we do not communicate our evaluation of it in our writing, then we are in danger of simply replacing the concept of ‘sister says’ with ‘the literature says’.When writing a literature review, then, you need to: ■■ State how you selected the literature. Was
this a computerised search of particular databases and, if so, which ones and what key words and dates did you use? ■■ State why you chose the pieces of literature you ended up using. There may have been 2000 articles identified by the search and you chose the 20 randomised controlled studies. Or maybe there were only 5 papers, which were largely descriptive accounts. ■■ When referring to a piece of literature, give the reader an indication as to its reliability and validity. Smith (2014), in a randomised controlled study of 500 patients, states that anxiety is a key factor. Brown (2013), in a qualitative study of 10 patients, states that patients who were given reassurance by a qualified nurse… A literature review is not just an academic exercise for a university lecturer. Care pathways and clinical procedures should be developed following a review of the evidence. When writing a literature review, you need to communicate the strength of that evidence, any weaknesses, whether the results from a single study in an inner city can be applied to a county setting, and whether there is enough evidence to inform and possibly change clinical practice. BJN Fowler J (2014a) Written communication: from staff nurse to nurse consultant. Part 1 Core principles. Br J Nurs 23(15): 866 Fowler J (2014b) Written communication: from staff nurse to nurse consultant. Part 2: patient records. Br J Nurs 23(16): 910 Fowler J (2014c) Written communication: from staff nurse to nurse consultant. Part 3: email communication. Br J Nurs 23(17): 958 Fowler J (2014d) Written communication: from staff nurse to nurse consultant. Part 4: case studies. Br J Nurs 23(18): 1004
Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to primary care trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2014 MA Healthcare Ltd
T
his is the fifth article in the ‘staff nurse to nurse consultant’ series discussing the use of written communication by clinically based nurses. Previous articles have explored the need for clarity, precision and brevity when communicating via the written word and how these principles can be applied to patients’ records, email communications and case studies (Fowler, 2014a, 2014b, 2014c, 2014d). This article examines the principles involved when writing a literature review. When I started my general nurse training in the 1970s, there were two main sources of knowledge on which I was taught to base my practice.The first was textbooks, one on medical nursing and another on surgical nursing. The second, far more powerful influence on my nursing practice was what the ward sister said. ‘Sister says’ was a very common phrase uttered by nurses as a way of giving credibility to practical procedures and actions. Obedience was a cornerstone of nursing in those days and, like the majority of the nurses and patients, I would never dream of questioning the wisdom and knowledge of the ward sister. I did, however, have my faith in such authority weakened when on one ward with the luxury of two ward sisters, procedures and practices differed depending on which ward sister was on duty for that particular shift! In the late 1970s and early 1980s, the concept of evidence-based practice began to infiltrate mainstream clinical nursing. The authority of the phrase ‘sister says’ was replaced by ‘the literature says’. Since the 1980s, nurse training has emphasised the need for evidence-based practice. A common assignment question throughout pre- and post-registration education became something like:
British Journal of Nursing, 2014, Vol 23, No 19
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 24, 2015. For personal use only. No other uses without permission. . All rights reserved.
