Literature Reviews in MHLP
This section of the workshop considers the purposes, organization, and features of successful literature reviews (LRs) in MHLP, using as a sample the LR in a recently published paper in nursing policy. Having reviewed the purposes and factors involved in organizing LRs (Swales & Lindemann, 2002), we turn now to a high-quality example of the LR genre in Nursing Policy, which we shall refer to as Fetta et al (2023). This workshop includes the sampled writing from this paper as they become necessary in the tasks below.
Full Reference
Fetta JM, Starkweather AR, Van Hoof T, Huggins R, Casa D, & Gill J., (2023). Policy analysis of return to learn after sport and recreational related concussion for secondary schools in New England: relevance to school nurses and nursing practice. Policy, Politics, & Nursing Practice, 4(4):278-287. doi:10.1177/15271544231186359
In the following tasks, we will explore the writing in the LR of this model paper, first for its purposes and organization and then on to more specific language features. It will be evident from this exploration that this paper’s LR is cohesive and exemplary in these respects.
Task 10: Determining the Primary Purpose of the Literature Review in Fetta et al’s 2023 Study
We have learned that LRs vary in their purpose and type, falling somewhere between a more general survey of previous studies, concluding with a summary perspective on ‘the lay of the land’ in the field or, at the other extreme, the LR is used to narrow down the literature for the purpose of motivating and introducing a specific study. In the latter case, the LR has been characterized as an argument for the focal research.
The range of purposes of LRs:
- To gain a broad understanding of the relevant research in a specific subfield.
- To analyze the research in a specific subfield for research topics and contributions.
- To highlight a specific gap, problem, or opportunity as a rationale and background for a new study.
At the conclusion of the LR and Introduction in Fetta et al (2023), we find the following purpose statement for the paper. Which of the three above purposes does this statement assume for its LR?
“This policy analysis was conducted to identify the key components to a successful RTL [Return to Learn] process for students [after their concussion diagnosis] in New England secondary school public school systems and identify where RTL policies were posted or disseminated. This policy analysis has a secondary aim of critiquing the accessibility of the guidelines and a tertiary aim of attempting to identify why RTL protocols have not been implemented in all 50 states” (Fetta et al, 2023, p. 2).
Task 11: Sequencing Topic Sentences from General to Specific in a Literature Review
As with much academic writing, LRs are organized into paragraphs, each paragraph having a particular topic focus. Paragraphs within LRs typically proceed from more general to more specific topics, culminating in the specific concerns (such as research question) of the paper. The paragraphs themselves, internally, also tend to follow a general to specific pattern, typically leading with a topic sentence that, at once, previews the specific content and stance of the paragraph and is supported by those details.
Below are only the topic sentences for each of the seven paragraphs in the LR; however, they are not shown in the order in which they appear. Read and try to put them in order from the most general to the most specific, with the initial paragraph potentially breaking this mold by highlighting the significance of the issue.
Put the topic sentences of the seven paragraphs into a sensible order, reflecting the purposes of initially highlighting the importance of the research focus and then moving from general to specific topic foci.
Task 12: Analyzing the Organization of Research in Fetta et al’s Literature Review by Type, Scope, and Positioning
Let’s consider more closely the organization of the LR in Fetta et al (2023) in terms of the nature of research reviewed. Recall from Part 1 in the workshop how we tracked the organization of LRs based on three features of the material reviewed: Type, Scope and Positioning.
In this version, we’ve illustrated what is meant by scope in this field; for example, this LR does not consider individual patient cases so feature “2C” in the classification below, the micro view within the scope of material, is not instantiated in this LR.
Organization of LR by Type, Scope and Positioning of Materials Reviewed
- The type of research-based materials reviewed
A. applied, empirical studies
B. methodological studies
C. professional training materials
D. policy documents
E. theoretical studies - Scope of perspective on the topic adopted
A. macro view: e.g., population-wide
B. midlevel view: e.g., institutional practices
C. micro view: e.g., individual cases - Positioning of research studies relative to (writer’s) preference
A. aligned
B. non-aligned
C. neutral
D. complexly aligned
Review the arrangement of topic sentences and paragraphs in the LR, and their functional descriptions offered in Task 11.
Task 12: In the right-hand column, add a letter indicating the kind, scope and positioning of the research (such as 1A, 2C, 3B) that, to you from each leading sentence for the seven paragraphs, seems to motivate that particular stage in the organization of the LR. This task has been completed for the first paragraph.
For example, the sentence leading the first paragraph provides a general statistic (2A) of a population’s health, which is an applied (1A) focus. The claims are complexly aligned (3D) with the author’s interests in that these matters positively compelled to help address a problematic health issue.
# | Topic Sentences | Key Function of Sentence & its Paragraph within LR | Key Factor(s) influencing LRs’ Organization |
1. | In the United States, the adolescent population accounts for 61% of total sport and recreation-related concussions (SRRC) sustained each year (Bryan et al., 2016). | The scope of the condition, SRRCs, in the target population. Relative to the definition in (G), this point is specific; however, the statistic highlights the vulnerability of the target population to SRRC. | Type: A |
Scope: A | |||
Positioning: D | |||
2. | An SRRC is defined as a biomechanical force resulting in a “direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head” (McCrory et al., 2017, p. 1). | The definition of the SRRCs |
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3. | Initially following the injury, physical and cognitive rest is recommended for 24 to 48 hours (McCrory et al., 2017). | Indications for immediate and longer-term treatment of SRRCs |
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4. | Since 2009, all 50 U.S. states have legislation pertaining to return to play following an SRRC (National Conference of State Legislatures, 2018). | National scope of policy on Return to Play following SRRC. |
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5. | Overall, return to play is widely accepted and viewed as necessary for student-athletes; however, return to learn (RTL) which includes care coordination to facilitate academic progress following SRRC, is disregarded in legislation | Identification of gap in policy, lack of Return to Learn (RTL) legislation. |
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6. | In the Essential Elements in Returning to Learn Following a Concussion (McAvoy et al., 2020)* RTL legislation is advocated. | Support for RTL legislation. |
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7. | Other benefits of RTL legislation include an increased awareness of the needs of this subpopulation of students as well as increased accountability of schools to provide academic support (McAvoy et al., 2020). | Further, more specific support for RTL legislation. |
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*McAvoy, K., Eagan-Johnson, B., Dymacek, R., Hooper, S., McCart, M., & Tyler, J. (2020). Establishing consensus for essential elements in returning to learn following a concussion. The Journal of School Health, 90(11), 849–858. https://doi.org/10.1111/josh.12949
Task 13: Linking the Writer’s Evaluation, the Organization of the LR, and the Motivation for Policy Research
To gain further insight into the intersection of the purpose and organization of the LR of the Policy Analysis in Nursing, this task examines these from the view of the writer’s evaluations and their role in motivating the study. We examine, in particular, what is evaluated, how it is evaluated, and how the patterns in these choices change across the LR. The analysis provides insight into two key areas of the writing: its organization and the role of the writer’s interpersonal positioning.
We’ve selected and numbered the key instances of evaluative language across the seven paragraphs of the LR. This classification includes implicit evaluations associated with health and medical conditions, for example, as well as direct evaluation of these and other matters. We’ve found that the following entities are evaluated across the LR:
- Health: Patients’ health and medically-relevant experiences Code: [H]
- Research: Research on SRRC, return to learn, & related policy Code: [R]
- Policy: Policy on interventions and practices following SRR concussions Code:[P]
- Practices: Nursing practices and training Code: [A]
Read the LR and for each incidence of evaluative language, identify which of these four entities is being evaluated. Classifications of the first three instances of evaluative language, in the first paragraph, have has been provided.
# | Literature Review: Evaluative Language by Paragraph (1-7) |
Positive/Negative Evaluation | What is Evaluated? |
1 | In the United States, the adolescent population accounts for 61% of total (1) sport and recreation-related concussions (SRRC) sustained each year (Bryan et al., 2016). The incidence of adolescent concussion is estimated to range between 980,800 to 2.3 million; however, the total number of people affected each year is (2) underestimated (Bryan et al., 2016). This is because the majority of SRRCs go (3) undiagnosed as approximately 23–53% of individuals younger than 18 years of age do not seek medical treatment (Bryan et al., 2016). Despite this, nearly 70% of all emergency room visits due to SRRC are individuals younger than 19 years of age (Coronado et al., 2015). | (1) Negative
(2) Negative (3) Negative |
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2 | An SRRC is defined as a biomechanical force resulting in a “ (4) direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head” (McCrory et al., 2017, p. 1). SRRC typically results in the rapid onset of short-lived (5) impairment of neurological function that often (6) resolves spontaneously. SRRC may result in neuropathological changes, but the acute clinical signs and symptoms reflect (7) a functional disturbance rather than (8) a structural injury (McCrory et al., 2017). Symptoms experienced by individuals who have sustained an SRRC typically include (9) headache, changes in vision, dizziness, sensitivity to light/sounds, difficulty focusing, impaired memory, and mood changes (most often depressive symptoms) and confusion (McCrory et al., 2017). The symptom experience from SRRC is highly individualized and symptoms typically resolve within two to four weeks but with 20–30% of adolescents having (10) prolonged symptoms (McAvoy et al., 2020). | (4) Negative
(5) Negative (6) Positive (7) Positive (8) Negative (9) Negative (10) Negative |
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3 | Initially following the injury, physical and cognitive rest is recommended for 24 to 48 hours (McCrory et al., 2017). Cognitive rest is the practice of limiting external stimuli to minimize (11) brain energy demand. This is followed by a graded reentry to the academic workload. The reentry speed is unique to each student and requires observation and frequent evaluation of symptom presentation (McAvoy et al., 2020). The clinical presentation of the resulting symptom clusters from an SRRC can be (12) detrimental to students’ academic performance. In a study conducted by Wasserman et al. (2016) students who had sustained a concussion from school athletics took twice as long to return to school than students who had sustained an injury to an extremity. Overall a lengthier return to academics translates to (13) an increased workload to avoid falling behind in class. Additionally, students who had sustained an SRRC reported (14) higher academic dysfunction compared to those who had extremity injuries (Wasserman et al., 2016). Students who have sustained an SRRC also reported (15) higher cognitive impairment and lower self-reported grade point average (GPA; Lowry et al., 2019). Students with two or more SRRCs had even higher levels of (16) academic dysfunction, cognitive impairment, and self-reported GPA (Lowry et al., 2019). The complications surrounding return to academics following SRRC can compound and lead to (17) an increased level of stress and cognitive load which in turn increases the likelihood of symptom exacerbation (Russell et al., 2016). | (11) Negative
(12) Negative (13) Negative (14) Negative (15) Negative (16) Negative (17) Negative |
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4 | Since 2009, all 50 U.S. states have legislation pertaining to return to play following an SRRC (National Conference of State Legislatures, 2018). Typically, the legislation involves three key components including (18) education for coaches on the signs and symptoms of concussion, removal from play, and evaluation by a medical professional (Bell et al., 2017). While the three components are universal for return to play following SRRC the coordination of care continues to vary among states and can impose (19) difficulties for healthcare providers who aim to (20) clearly identify a standard of care following SRRC (Bell et al., 2017). | (18) Positive
(19) Negative (20) Positive |
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5 | Overall, return to play (21) is widely accepted and viewed as necessary for student-athletes; however, return to learn (RTL) which includes (22) care coordination to facilitate academic progress following SRRC, (23) is disregarded in legislation. Only nine states have legislation that mentions RTL following SRRC (National Conference of State Legislatures, 2018). Seven states specifically require an RTL protocol to be in place (LawAtlas, 2017; National Conference of State Legislatures, 2018). The legislation for these states is broad and allows for individual states to interpret the (24) best practice for RTL protocols and do not specify enforcement of these protocols. | (21) Positive
(22) Positive (23) Negative (24) Positive |
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6 | In the Essential Elements in Returning to Learn Following a Concussion (McAvoy et al., 2020) RTL legislation is advocated. The argument for uniform RTL legislation is based on the following: (25) Existing educational safeguards exist for students. They are (26) prompt, flexible, and systematic for all concussed student athletes and non-athletes with academic needs. Return to learn can be (27) robust, widespread, systematized, and sustainable if embedded into existing educational frameworks (McAvoy et al., 2020, p853). |
(25) Positive
(26) Positive (27) Positive |
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7 | Other (28) benefits of RTL legislation include (29) an increased awareness of the needs of this subpopulation of students as well as increased accountability of schools to provide academic support (McAvoy et al., 2020). Increased legislation and policy generation are (30) facilitators of successful RTL implementation. Federal legislation is currently (31) working toward two proposed bills regarding student concussions and the return to academics and sports. H.R. 5611— Protecting Student Athletes from Concussion Act of 2020 and the SAFE PLAY Act (S.4056 and H.R. 7478). These bills highlight (32) the need for regulated RTL and adequate accommodation for each student. These bills also state that concussion management teams (CMTs) (34) must be developed (35) to improve the RTL process for students. However, the key components of policy for (36) guiding a successful RTL process in secondary school public school systems (37) have not been previously analyzed. | (28) Positive
(29) Positive (30) Positive (31) Positive (32) Negative (33) Positive (34) Negative (35) Positive (36) Positive (37) Negative |
Task 14: Focus on Language: Information Ordering in Paragraphs
Tasks 10-13 suggest the benefits of preparing an outline for your LR including the nature of topics covered and materials reviewed, the scope between macro and micro perspectives, and how the topics and materials are evaluated.
The pattern of organization we’ve observed for the LR in Nursing Policy aligns with a well-known model for understanding and writing research article introductions, the Create A Research Space (CARS) model. In this model, introducing a study involves three stages, the first two stages focused on the LR and the third stage introducing the purposes and nature of the study typically motived by the ‘gap’ in research that is identified in the previous stage 2:
The CARS Model for Research Article Introductions (Swales, 1990) | |
Stage 1: Establishing a research territory (Paragraph 1-7) | |
Claiming the centrality and significance of the field | |
Making topic generalizations | |
Reviewing previous research & related references | |
Stage 2: Establishing a research niche (Paragraph 7, closing sentence) | |
Indicating a gap in research | |
Counter-claiming | |
Question raising | |
Stage 3: Occupying a research niche by | |
Outlining purposes of new research | |
Announcing present research | |
Announcing principle methods and findings |
The CARS model for writing research paper introductions illustrates a general pattern in academic communications, which tends to favor a general-to-specific order and a move from established knowledge to new knowledge.
Task 14 now examines similar patterns in information ordering at smaller scales, in paragraphs and sentences.
Below are two paragraphs from another literature review from a policy analysis paper (Thomas, Martsolf, & Puskar, 2020*). The two paragraphs contain about the same information but the paragraphs differ in other aspects. Read them both to identify which of the two is easier to read in the sense of the flow of ideas.
*Thomas T, Martsolf G, & Puskar K (2020). How to engage Nursing students in Health Policy: results of a survey assessing students’ competencies, Experiences, interests, and values. Policy, Politics, & Nursing Practice 21(1):12-20. doi:10.1177/1527154419891129
Task 14 Feedback (Please complete the task first before proceeding)
Experienced readers will almost certainly prefer the first version of this paragraph over the second even though they contain the same ideas and claims. In Paragraph 1, each new sentences flows from the previous sentence, facilitating the reader’s cohesive understanding and interpretation of the paragraph. Why is this? How does the flow of ideas actually work in writing?
To answer these questions, we need to decompose the version of the paragraph that flows well into sentences, and examining how each sentence begins, which we shall call its DEPARTURE, and ends, which we shall call its DESTINATION. The basic function of language in representing the world and experience is expressed in the structure of the sentence. In sentences, meaning flows from the point of departure to its destination. Accordingly, how we order information matters to the achievement of flow between the departure and destination. The question becomes “what kind of information is best suited to sentence departures and what kind for sentence destinations, respectively?”
Given we use language and writing to exchange new ideas, it’s easy to point out that destinations – ends of sentences – are expected to include information that we expect will be new to the reader. As for the point of departure of the sentence, that should be information that is already known or expected to be known by the target reader. In this way, the ideal order of information in sentences involves starting with information that is known or expected to be known by the reader or background circumstantial information, establishing this information as a shared point of departure between writer and reader, with the remainder of the sentence involving new information. In this way, all new information is based on a foundation of shared information.
In the table below, we have divided the five sentences in the extract into sentence departures – which include the first content elements of the sentence – and destinations, which begin with the first main verb phrase of the sentence. If our above theoretical proposal about information order is true, then the departures should contain information that is known or recognized by the target reader while the remainder should contain information that has not been previously mentioned. The analysis shown below bears this out. Note especially that well-written departures will contain information that readers reasonably recognize from their background knowledge or information that was recently presented in the destinations, that is, recently new information that is now known. In the latter case, reference words like “This” or “such” often remind the reader that the information links to a previous sentence, as shown in the table. This common pattern of information transfer is called the zigzag pattern.
Table 1: Building Flow in Writing using the ZigZag Pattern
In Version 2 of the same paragraph above, we disrupted the flow of information by repeatedly
- including new or unexpected information in the departure position while
- ending sentences with information that the reader already knows.
These are the two practices in writing effective sentences that must be avoided.
To summarize the strategies for organizing literature reviews that have emerged across the workshop so far, we note the need to lead into a literature review with an introduction involving a general perspective on the topic and sub-field, which are evaluated as significant and worthy of attention. The overall structure of the LR reflects careful planning of the type and scope of the studies and other references reviewed, generally moving towards increasingly specific topic foci. The LR often closes with by identifying a gaps in the research or an opportunity, which typically leads immediately into the aims of a new study or research proposal. In the body of the literature review, we’ve observed the importance of lead or topic sentences of the paragraphs in previewing the topic and the direction at each stage of the literature review. Focusing in on the flow of information in paragraphs, we’ve noted that sentences should build on each other by beginning with information known or recognized by the target readers and ending with information that for them will be new. It’s worth noting, too, that strategies such as general-to-specific information order across a text, and the known-new information order of sentences are generalizable to most kinds of academic writing.