Literature Review
You will write your Literature Review Section of your EBP Project Proposal. Here is a Review of Literature Example (Word) to use as a model or guide. To conduct your literature review, you begin with the search strategy, gather your resources, then start writing your literature review and gap analysis.
Search Strategy
In the literature review section, you are to identify your search strategy, which can include the following:
- the databases and internet sites or search engines used to explore the literature (CINAHL, Medline, Google, Yahoo, etc.)
- the search terms you used
- the beginning and ending dates of the period covered in this study
- the time period when the search was conducted (e.g., Fall 2008)
- any special journals hand-searched and any relevant sources used in performing the literature search
Description of Literature or Gaps in the Literature
The literature review section is a review of studies that are related to your phenomenon. It should take up about eight to ten pages, or approximately 3,000 to 4,000 words. The purpose is to tell the reader what is known about your phenomenon and lead the reader to what is not known about your phenomenon (your research problem). You should have sub-headings throughout this section of the paper.
The literature section discusses the relevant research related to your study. Do not discuss each study individually; instead, synthesize the literature based on your literature matrix. You can discuss individual findings of studies (include all eight studies that you described in your literature matrix in Weeks 4 and 9) as appropriate including the statistical findings and study samples. This section needs to tell the reader what is known about your clinical area of interest. You will also summarize your review of the literature and discuss the gaps you have identified.
Assignment Instructions
Your assignment should be:
- Eight to ten pages, or approximately 3,000 to 4,000 words, no cover page required, and the page count doesn’t include the references list
- Your search strategy
- Description of articles (who, population, sample, what was done, statistical findings, limitations, and so on)
- Gaps section: the gaps you have identified from your literature search
Please refer to the Grading Rubric for details on how this activity will be graded.
Example of A Literature Review : Follow the below example
Week 9 Review of Literature Example
Written by Jennifer Oddy, Entitled: Distress And Coping of Mothers of Children With Muscular Dystrophy
Introduction
The purpose of this literature review is to discuss the current knowledge regarding experiences of mothers who care for their child with muscular dystrophy, their coping mechanisms, and to understand their lived experiences in order to provide better nursing care to these mothers. Not only will the current knowledge be addressed, this literature review will also speak to what is unknown about this phenomenon. The concepts of maternal stress/well-being, adjustment, anxiety, and coping will all be addressed as common themes emerging from the data.
The research question for this study is:
What are the lived experiences of mothers who care for their child with muscular dystrophy?
The search for literature took place in the spring of 2015, which was completed using EBSCOhost to search 17 online databases through the Regis College Library. Google Scholar was also used, which brought up articles from PubMed that have been utilized. Eight peer- reviewed research journal articles were obtained and scrutinized for the purpose of this review of literature and the literature matrix (Appendix B). Search terms included: children, chronic disease, mother, distress, coping, muscular dystrophy, maternal experience, stress, and adjustment. To ensure the most relevant literature was cited, the majority of the articles were from 2007-2013. One article was from 2003, two from 2005, and the remaining five articles were between 2007 and 2013. The older articles were included for the purpose of their significance to the subject matter. However, this gap in literature provides evidence that there is need for further research regarding the lived experiences of mothers who care for their child with muscular dystrophy.
This review of literature will include empirical and theoretical sections, as well as a brief description of how the researcher arrived at this topic of interest. In the empirical literature section, the literature from eight peer-reviewed journals will be synthesized. Individual findings from certain articles will be cited in order to provide details about the experiences of mothers caring for their child with muscular dystrophy. These experiences will then be related to the discipline of psychology, demonstrating the importance of a multi-disciplinary approach. The empirical literature will be concluded with the gap in literature and why there is a need to further investigate this topic. These topics are all used to form the following sub-headings: overview, lifestyle as a contributor to maternal stress and well-being, difficulty adjusting, anxiety directly relates to quality of life, the struggles of coping, maternal stress related to other disciplines, a summary, and the gaps in literature. The purpose of these sub-headings is to organize the empirical literature section.
Empirical Literature
Overview. There have been a number of research articles that delve into the experiences of mothers who care for their child with muscular dystrophy. The Literature Matrix (Appendix B) is an overview of eight research articles that studied the experiences and lifestyle of these women. Two research articles were literature reviews and six were experimental studies. One study used a conceptual model to guide the research, which will be presented in the theoretical section of this literature review.
Children and families who are faced with the stress of having a child with muscular dystrophy must adapt to physical, emotional, social, and financial challenges. The increase in every-day caregiving requirements, lifestyle, the disease complexities, and family dynamics can influence long-term health outcomes (Barlow & Ellard, 2005). In addition, the financial status and interactions of the child and/or family with their environment can be severely impacted (Brown et al., 2007). Through this review of literature from the eight articles, four emerging themes became evident: the lifestyle associated with having a child with muscular dystrophy affects maternal stress and well-being; mothers experience difficulty adjusting; maternal anxiety is directly related to quality of life; and the struggles with the experience of coping. This empirical research section will use the themes to organize the literature, followed by a brief section about maternal distress relating to other disciplines, as well as the gap in the current literature.
Lifestyle as a contributor to maternal stress and well-being. While both mothers and fathers may have worries about maintaining family function when caring for a child with muscular dystrophy, typically the mother herself is identified as the primary caregiver (Brown et al., 2008). This is described as “carrying the burden,” since the mothers are the individuals following through with doctor appointments, monitoring the child’s status, administering medications/treatments, all in addition to feeding the rest of the family and cleaning the home (Brown, et al. 2008). This places a large stressor on the mother, who may be so concerned about everyone else’s well-being, that she may not have time for her own. The literature has shown that the lifestyle of having a child with muscular dystrophy can severely impact maternal well-being (Barlow & Ellard, 2005).
Carroll, Gallagher, and Phillips (2010) conducted a descriptive comparative study regarding the psychosocial predictors of sleep quality in parents caring for a child with a chronic disease. The researchers used convenience sampling to obtain 67 parents of children with developmental disabilities to compare to 42 parents of typically-developing children. The results of the study identified sleep quality as an important aspect of well-being and strongly related it to overall quality of life. There is reasonable consensus across the literature that problematic and challenging behaviors are a main source of stress for parents of children with a chronic disease (Carroll et al., 2010). Having a child with muscular dystrophy may invoke a state of stress in mothers. Unfortunately, stress has been found to be the strongest predictor of poor sleep quality (β =.45, t = 4.17, p <.001) and accounted for 30% of the variation in sleep quality among mothers who care for a child with a chronic disease. Knowing this, it is no surprise that parents of children with chronic disease report poorer sleep quality than parents who do not face this burden. In addition, the majority of these parents met the “poor sleepers” criterion. While sleep is something that most people take for granted, it is an important part of well-being that can be altered in impeding circumstances such as having a child with muscular dystrophy (Carroll et al., 2010).
Another descriptive comparative research study conducted by Nereo, Fee, and Hinton (2003), was aimed at examining parental stress in mothers of boys with muscular dystrophy (MD). The sample was done by consecutive and convenience sampling, and consisted of 112 mothers of boys with MD, 800 mothers of healthy children, 28 mothers of children with cerebral palsy, and 46 siblings of boys with MD. The results demonstrated that stress related to child behavior was higher in the MD group (23.98) than the normative group (18.7). The mean MD parent-child dysfunctional interaction score was also much great in the MD group (M=23.98) than the normative sample (M=18.7). Lastly, the mean MD difficult child score (M=30.64) was greater than the normative sample (M=26). These results demonstrate the presence of problem child behaviors consistently predicting maternal stress, which relates to child behavior and the difficulty of caring for a child with muscular dystrophy. In addition, Nereo and colleagues (2003) characterize muscular dystrophy as a complex chronic condition since it involves specialized and time-consuming care. The disease poses stressors in terms of daily care requirements. Negotiating wheelchair transportation, meeting recommended physical therapy requirements, and increasing physical demands are just a few of the accommodations that mothers must make time for in their daily schedules. These physical burdens can place a strain on the caregiving mother and increase preexisting stress (Nereo et al., 2003).
In addition to the physical aid that mothers provide, muscular dystrophy can also affect mental health. The disease is both chronic and terminal, therefore carrying the necessity for many psychological adjustments to occur within the family at any given time (Nereo et al., 2003). Furthermore, parental stress can have a direct impact on the health of the child. Lynn et al. describe the concept of uncertainty in relation to family and dynamics. As parental uncertainty increased, child uncertainty also increased (Lynn et al., 2010). As uncertainty in the child increases, so do anxiety, depression, and psychological distress. This is not healthy for the child, nor the mother and/or the rest of the family that is involved.
Difficulty adjusting. Chronic diseases in children have an impact not only on the child, but also on other members of the family. Barlow and Ellard (2005) provided an overview of the current literature regarding the psychosocial well-being of children with chronic disease, their parents, and siblings. A total of 391 articles were identified that were selected according to strict inclusion criteria. Two researchers reviewed the articles for reliability. The findings were consistent that emotional distress (anxiety and depression) was greater among parents of children diagnosed with chronic diseases. Mothers may not have the financial ability to hire a caregiver, leaving the stress solely on her. It then becomes an issue that the mother does not have time to run errands, get the household chores done, or even be able to work. Not only does this hinder the mother, it also impedes on the already delicate health of the child (Barlow & Ellard, 2005). Consistent with this research, the article “Correlates of maternal and paternal adjustment to chronic childhood disease” states that mothers reported significantly more difficulties than fathers while attempting to adjust to things like new lifestyle, caregiving requirements, and changing prognosis (Crawford & Dewey, 2007). Specifically, mothers were prone to higher levels of psychological distress if they had poor family cohesion and less social support. This is consistent with the rest of the literature, Barlow & Ellard (2005) stating that mothers are less likely to be affected by the stress of their child’s chronic disease if they have a social output, and Brown et al. (2008) referring to demographic variables such as resources and social groups and how they play a role in the support of these parents.
Crawford and Dewey (2007) conducted a descriptive study in order to determine if different factors were associated with maternal and paternal adjustment to having children with life-limiting chronic diseases. Convenience sampling was used in order to obtain a sample of 11 mothers and 9 fathers of children with muscular dystrophy. A control group of 19 mothers and 11 fathers of healthy children was also obtained for comparison. The results demonstrated that mothers reported significantly more adjustment difficulties than fathers (F[1,124]= 6.57, p< .05), had a harder time adapting (F[1,124]= 4.80, p< .05), and families with children with chronic diseases had lower scores in family cohesion (F[2,124]= 4.84, p< .01). Through data collection, Crawford and Dewey attribute adaptation struggles to things like previous psychological functioning of family members, socioeconomic status, concurrent psychosocial stressors, and quality of relationships. These are all things that have the potential to significantly alter a mother’s ability to adjust. Another large factor that plays a role in maternal adjustment is the prognosis of muscular dystrophy. It is a progressive and fatal disease where the child can take a turn for the worse at any given moment (Nereo et al., 2003). Because of this, it is difficult for mothers to adjust to an ever-changing state of health of their child (Lucio et al., 2013). Lucio et al. also states the significance of this in the health care setting. “The adaptation process of mothers is not instantaneous and it can change from one period of control to a situation of lack of control. Taking care of a sick child requires skills, knowledge about the disease and the devices to be used. The mothers need clear information from the health professionals and their doubts need to be clarified, so that the care to these children is performed safely and autonomously,” (Lucio et al., 2013, p. 87)
Anxiety directly relates to quality of life. In a qualitative, descriptive research study, Lucio and colleagues (2013) aim to understand the mother’s perspective on caring for their child with muscular dystrophy. Convenience sampling was used to select children with muscular dystrophy from a public hospital, and the nurses then made contact with their mothers. The open- ended interviews revealed important information about the quality of life while caring for a child with muscular dystrophy. Mothers considered caring for their child to be a difficult task, since they deal with unknown devices that their child has become dependent on. This leads to a chronic fear of losing their child and fear of what happens when the electricity goes out. All this fear causes anxiety, which the researchers found to directly affect the quality of life of the mother as well as child. Quality of life can be greatly negated while caring for a child with muscular dystrophy. Mothers often leave their chores, change their daily routine, and postpone their commitments in order to stay with their child who is dependent on their care. Not only are these children care-dependent, a lot of them also rely on mechanical equipment to live. Much of the anxiety experienced in these mothers roots from “being afraid with the possibility of them not surviving, due to the malfunction of the equipment,” (Lucio et al., 2013, p. 86). Besides the fear of death, anxiety is highlighted as a factor that directly afflicts with quality of life of both the children and mothers (Lucio et al., 2013).
The struggles with coping. Webb (2005) completed a qualitative grounded theory study that was completed with the purpose of addressing the lack of available information for parents about coping with muscular dystrophy (Webb, 2005). Twenty-three parents (15 families) of children with MD were selected from postings on the internet and from an annual Parent Project Muscular Dystrophy Conference. Six major coping themes emerged from the in-depth interviews: (1) MD is caused from a mutation in the X chromosome, therefore mothers tend to blame themselves; (2) Diagnosis is the first tough issue that parents face; (3) Mothers feel fear, denial, anger, guilt, and confusion about the diagnosis; (4) Mothers sought “treatment” to help slow the progression; (5) The anxiety related to their child chronically relying on equipment; (6) Worries about the child finishing school. These are all issues that cause stress and anxiety in mothers caring for their child with muscular dystrophy. In one instance, the researcher found that families “coped” by overprotection, lack of child discipline, and magical thinking (Webb, 2005). On the contrary, there were some positive findings. Four types of coping strategies emerged: (1) Families focused on the present, living one day at a time; (2) Families attempt to live as normal a life as possible; (3) Families had a proactive attitude regarding care for the child in order to reduce the risk of crises; (4) Families developed coping resources based on personal strength (Webb, 2005). Although there are not a lot of studies regarding coping skills in parents of children with disabilities, what is available demonstrates the need for progression. This demonstrates the necessity to empower other families to learn coping strategies like these. Parents want to proactively participate in their sons’ lives, and they, as well as practitioners, need to encourage other parents to do the same (Webb, 2005).
Maternal distress related to other disciplines. The effects of having a child with a chronic disease definitely influence the mind and behavior of the mothers doing the caregiving (Barlow & Ellard, 2005). A number of studies have confirmed an increased risk for psychological dysfunction in mothers who have chronically ill children, one of which will be discussed in detail, “Single parents of children with chronic illness: an understudied phenomenon,” (Brown et al., 2008). Brown and colleagues performed a narrative systematic review whose purpose was to examine the literature revolving around chronic illness and to evaluate the impact on single parenting and children with chronic diseases. Twenty articles were used to study single parenting. The researchers found that the anxiety experienced by a mother during the treatment of her child was a predictor for later posttraumatic stress symptoms (PTSS). Parents of children with chronic diseases also demonstrated increased rates of treatment for anxiety and had increased maternal negative affect scores. These parents have few social resources, thus increasing parental stress and other psychological disorders. These results just barely skim the surface of the complicated psychosocial issues experienced when caring for a child with a chronic disease (Brown et al., 2008).
Summary. The literature provided supports this study and addresses the research question. The literature provides insight on what the experiences of mothers are who care for their children with muscular dystrophy. In conclusion of the empirical literature section, it is safe to say that mothers caring for their child with muscular dystrophy experience a great amount of stress and anxiety (Barlow & Ellard, 2005; Brown et al., 2008; Carroll et al., 2010; Lynn et al., 2010; Nereo et al., 2003). This can affect maternal well-being, and also take a toll on the child’s health (Carroll et al., 2010). Stress and anxiety play a large role in the quality of life of mothers, which reflects in the care they provide to their child (Lucio et al., 2013). These things can all lead to difficulty adjusting and poor coping skills in the mother. Stress, anxiety, maternal well- being, adjustment, and coping all relate to the discipline of psychology, which demonstrates the need to approach this problem in a multi-disciplinary fashion. If practitioners, psychologists, social workers, parents, etc. can spread their knowledge about healthy coping and adaptation, other parents could be empowered to live the same way, bettering their lives as well as that of their child (Webb, 2005).
The range of psychological functioning in mothers is a very wide spectrum. That being said, the emphasis should be placed on identifying triggers that influence mothers’ psychological responses to the stressors of a child’s chronic disease. Mothers in this situation should make time for themselves, even if that means having a family member take over the caregiving role for a few hours. In an article based upon stress reduction in mothers of children with autism, researchers from Vanderbilt University speak on the subject. Studies have shown clear benefits of mother-led stress-reduction classes for women in the same, unique situation. Researchers created two programs: one focusing on mindfulness and training, the other emphasizing dealing with guilt by developing character strengths and positive, healthy mental exercises. “Evaluations conducted during and after the study showed that the mothers benefited from either program. They had lower levels of stress, anxiety and depression, along with improved sleep and life satisfaction. They also had fewer ‘dysfunctional,’ or unhelpful and negative, interactions with their children,” (Autism Speaks, 2014). It is essential that mothers partake in such activities in order to maintain a healthy lifestyle and relationship with their family and children.
Gaps in Literature. Muscular Dystrophy is a very time-consuming disease for the child and the mother. The experiences, adjustment skills, and coping capabilities should be shared for other mothers to feel empowered. “Studies based on coping skills of parents whose children have disabilities, although scant, add valuable information to the research literature,” (Webb, 2005, p. 386). If there were more research on this topic, mothers who are currently struggling could perhaps be inspired to better their situation.
One recommendation for further research should include adaptations by the child and family to the diagnosis of a chronic disease across the lifespan. Most of the articles focused on the effects and adaptations of the family in the immediate stage of diagnosis and soon after. If we knew more about the adaptations made over a long period of time, it would enable caregivers to plan for developmentally appropriate support as the patient changes over time (Mussatto, 2006). In addition, there should be tools to identify families that are at risk for poor adaptation/resilience. If families do not have access to necessary resources, they could struggle and be at risk for being in an even worse situation (Brown et al., 2008).
Brown et al. (2008) included an entire table (Table II) dedicated to the gaps in research and questions to be addressed. The biggest gap in research seems to be during the adaptation phase. At what point in the child’s life does being a single parent matter post? How does adaptation for the single parent change over time? Are there protective factors enhancing single parenting? Negative factors? And culture. The articles seemed to have sampled a homogenous population. Would the results be different if other cultures were sampled? (Brown et al., 2008)
As one can tell, there are still many questions to be asked and research to be completed. Mothers who have children with muscular dystrophy are a very fragile population. Understanding the lived experiences of these women can help practitioners and other women in the same situation reach out to offer help and to empower mothers to do the same.
Grading Rubric
Writing the Literature Review Section Rubric
Writing the Literature Review Section Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsIntroductionIntroduction includes all of the following components and they are clearly stated: The purpose of the ROL (may want to repeat research questions).
How the ROL is organized (empirical literature, conceptual/theoretical literature, and the theory that will guide your study if appropriate).
Databases, internet sites, and search engines, and other sources that were used to explore the literature.
Search words used. Time period when the search was conducted.
10 pointsIntroduction includes most of the introduction components and they are clearly stated.
9 pointsIntroduction is somewhat clear, but only partially addresses the components of the ROL introduction.
8 pointsIntroduction is vague and unclear and does not include the purpose or any of the components of the ROL introduction.
7 points10Empirical ResearchThe first paragraph of the empirical literature clearly tells the reader what is included and how it is organized.
Critical thinking is present and there is evidence of synthesis of the literature that is based on the literature matrix.
Individual studies are presented as needed. All of the following elements are included and clearly stated: The review includes all of the major studies on the topic.
The review includes recent research. Studies from other related disciplines are included, if appropriate.
The eight articles from the literature matrix are in the review of literature (ROL).
The last paragraph summarizes what is known about the research area and identifies the gaps in the literature. The paragraph includes a statement about how the literature supports your study.
50 pointsThe first paragraph of the empirical literature clearly tells the reader what is included and how it is organized.
Critical thinking and synthesis of the literature is clearly evident.
Most of the ROL elements are included but some are missing.
The last paragraph summarizes what is known about the research area and identifies the gaps in the literature.
The paragraph includes a statement about how the literature supports your study.
45 pointsThe first paragraph of the empirical literature minimally tells the reader what is included and how it is organized.
Critical thinking and synthesis of the literature is not always evident.
Many of the ROL elements are missing.
The last paragraph does not clearly summarize what is known about the research area and identifies the gaps in the literature.
The paragraph does not include a statement about how the literature supports your study.
40 pointsThe first paragraph of the empirical literature does not tell the reader what is included and how it is organized.
Critical thinking and synthesis of the literature is seldom evident.
Most of the ROL elements are missing.
The last paragraph does not summarize what is known about the research area and omits the gaps in the literature.
The paragraph does not include a statement about how the literature supports your study.
35 points50Gaps from ROL
and SummaryGaps from the literature are identified and described.
Critical thinking is evident in summarizing the ROL.
The summary includes all the key elements of the ROL.
20 pointsGaps from the literature are identified.
Critical thinking is evident.
Some key elements of the ROL are missing.
18 pointsSome gaps from the ROL are identified.
Critical thinking is not evident consistently.
Many of the key elements of the ROL are missing.
16 pointsGaps from the literature are not identified and/or described.
Critical thinking is not evident.
Most of the key elements are missing.
14 points20Writing Mechanics
and APA FormatAPA is used throughout the paper with few to no errors.
Correct title page, headers, page numbers, grammar, and correct referencing format are used.
Few to no writing mechanic errors.
The writing was clear and easy to read.
Follows page recommendations:
Empirical Section: eight to ten pages
Theoretical/Conceptual: one to two pages.
Page length may vary depending on the literature found.
20 pointsAPA format was generally used correctly most of the time.
Few APA errors were included: title page, headers, page numbers, grammar, and referencing format.
Some writing mechanic errors.
The writing was not clear at times. It was difficult to read and understand at times.
Page recommendations are followed almost perfectly.
18 pointsAPA format was seldom used.
Many APA errors were included: title page, headers, page numbers, grammar, and referencing format.
Moderate to many writing mechanic errors.
The writing was unclear some of the time. It was very difficult to read and understand at times.
16 pointsAPA format was not used.
Many APA errors were included: title page, headers, page numbers, grammar, and referencing format.
Many writing mechanic errors.
The writing was unclear most of the time. It was not possible to read and understand at times.
14 points20Total Points100
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