Literature Review and Protocol

1. Literature Review and Protocol Mahi Gill and Dev Joshi w/ Management Society

2. Disclaimer

3. Literature Review

4. What is it? • A literature review is a body of text that aims to review the critical points of current knowledge including substantive findings as well as theoretical and methodological contributions to a particular topic (Wikipedia) • Review = 2° research, therefore no new findings • Critical points = analysis to find these • Current = time frame e.g. 2005 to present • Substantive findings/topic applicable = focussed and comprehensive

5. Picking a Topic • What are the factors affecting physician perception of Electronic Health Records in primary care? • The organisational factors that affect burnout in nurses • What impact does Caesarean deliver on maternal request (CDMR) have on hospital managers? • The use of smart phones and handheld devices by student doctors and their impact on medical education

6. A good Topic • Focussed but not too narrow • ~? feasible papers within last 5 years • Interest to you • Topical/controversial – go on NHS website • Possibility of publication

7. Databases • OVID • PubMed • MEDLINE • EBSCO • Business databases – Factiva, Econ Lit, Passport GMID, HMIC

8. Forming a search string

9. Study Selection

10. Diagram

11. Analysis – PRISMA 2009 CHECKLIST

13. Getting to Know your papers • Read another literature review • Read abstracts • Brainstorm 3-5 overarching themes • Read your papers thoroughly: • Method • Conclusions • Limitations • Adjust your themes so findings can be appropriately grouped

14. THEMES • What impact does caesarean delivery on maternal request (CDMR) have on hospital managers? • Cost of procedure • Complication rates • Training • Length of hospital stay

15. How to gather themes • Read through papers and find similarities amongst them as to how they answer your review question • Group these similarities into ‘themes’ • Aim for 3 or 4 themes

16. Discussing each theme • Start with a short summary of theme’s relevance to answering the review question • For example, for cost of procedure... Maternal choice has been reported to contribute to a rise in c-section rates due to a shift from vaginal to caesarean delivery (P.O.S.T, 2002). With efficient resource allocation becoming an increasingly important consideration for hospital managers, the effect of a potential increased total cost of c-sections could put a major strain on management (Hurst & Williams, 2012).

17. Discussing each theme • Detail of study (brief if methods table) • What study showed with respect to the theme. Always link back to review question • Critical appraisal of paper • Never give your own opinion! • Short summary at end of theme discussing papers and what they show; consider relative strength of papers

18. Finding Things to Critique • Methodology- Sample Size, Sampling demographics (Male/ female only, age, country?) Sampling Technique (random, simple, voluntary), Data collection instruments (Validated surveys? Modifyed surveys?), Longitudinal or Cross section? • Analysis- Regression? Correlation? ANOVAs? etc. • Results- response rate • Limitations section!

19. Abstracts Job stress, achievement motivation and occupational burnout among male nurses. ABSTRACT: This paper is a report of an exploration of job stress, achievement motivation and occupational burnout in male nurses and to identify predictors of occupational burnout. BACKGROUND: Since the Nightingale era, the nursing profession has been recognized as 'women's work'. The data indicate that there are more female nurses than male nurses in Taiwan. However, the turnover rate for male nurses is twice that of female nurses. Understanding the factors that affect occupational burnout of male nurses may help researchers find ways to reduce the likelihood that they will quit. METHOD: A survey was conducted in Taiwan in 2008 using a cross-sectional design. A total of 121 male nurses participated in the study. Mailed questionnaires were used to collect data, which were analysed using descriptive statistics and stepwise multiple regression. RESULTS: The job stress of male nurses was strongly correlated with occupational burnout (r = 0.64, P < 0.001). Stepwise multiple regression analyses indicated that job stress was the only factor to have a statistically significant direct influence on occupational burnout, accounting for 45.8% of the variance in this. Job stress was comprised of three dimensions, of which role conflict accounted for 40.8% of the variance in occupational burnout. CONCLUSION: The contribution of job stress to occupational burnout of male nurses was confirmed. As occupational burnout may influence the quality of care by these nurses, nurse managers should strive to decrease male nurses' job stress as this should lead to a reduction of negative outcomes of occupational burnout.

20. NARRATIVE VS. CRITICAL ANALYSIS

21. Narrative • Laschingeret al. (2003) found that creating environments increasing nurses psychological empowerment was shown to predict a lower level of emotional exhaustion after a three year period of exposure to the environment. These findings conflicted with a study with a similar design conducted by Hochwalder (2008) which found high levels of empowermentto be related to low levels of burnout cross sectionally, but with higher levels of burnout longitudinally.

22. Critical • Laschinger et al. (2003) used a two wave longitudinal study on a sample of 412 nurses ( 73% participation rate) working in Ontario, Canada… • Hochwalder (2008) used a similar two wave longitudinal design, however the period between the first and second wave was one year… • Hochwalder’s large sample size improves the validity of the results, while the longitudinal design permits causal inferences between empowerment and burnout to be made. Despite this, a time lag of only 1 year between the two cross sectional studies is insufficient to prove this causal relationship as the effects of empowerment on burnout longitudinally may not be apparent after such a short period.

23. Discussing • Start narrative • The first time you mention the paper outline the methodology, response rate, sample size and method of analysis • Critical analysis

24. For example In contrast, Sequist et al. (2007) reported only 35% of primary care clinicians (PCCs) perceived EHR to improve quality of care, attributing this to the 1.5yr average duration of system usage, speculating this would increase with time, similar to speculations by Perera et al. (2011). This study was published in JAMIA, the top journal in health informatics, and surveyed all 223 PCCs (56% response rate) across all 26 health centres that had implemented EHRs within the (American) Indian Health Service (IHS). Amongst other things, the robust questionnaire design, 3 stage implementation, wide capture and large number of participants add to the reliability of the findings. Sequist et al. (2007) also correlated system usage with clinician characteristics through multivariate regression analysisallowing better prediction of the effects of other variables. Despite the low perception on quality of care improvements, 78% of PCCs regularly used the system, believing it to be important in some other way and 87% of PCCs did consider HIT would improve care in ‘rural and underserved areas’. One should be cautious when generalising the results as these were collected in the unique setting of the IHS and secondly, there may be an element of bias resulting from the IHS being an early adopter of HIT systems.

25. Added Slide Layout • Introduction • Methods • Discussion (layout described in themes) • Further Direction • Conclusion

26. Introduction • Define / clarify anything in the question e.g. CDMR, hospital manager’s priorities • If a topical issue, discuss how it has been raised in news and your question’s relative importance • What areas linked to your review have been covered, and how does your review fill a clear gap • List themes you are about to discuss

27. Methods • Databases and inclusion/exclusion rationale in main body (expand in appendix) • Search string in appendix • Table in main body (excluded in word count)

29. Added Slide Further Direction • Ways in which your review could be improved • e.g. Constraints meant you didn’t have access to those not on Imperial VPN and time constraints meant used only published material – publication bias • Studies which could help improve knowledge in topic area • e.g. If studies in a theme were poorly constructed, suggest how they should be done – such as adjusting for confounders. Additionally, suggest carrying studies out under NHS, if yours are abroad, to get a more domestically applicable view • For these suggest the kind of study and possible methodology

30. Added Slide Conclusion • Summarise what your themes show individually and as a group with respect to your research question • based on my feedback it is better to include more in conclusion and less at end of each theme • How does this help answer your review question? • e.g. Showed CDMR is likely to add pressure to hospital managers across all themes since... • Be thorough – where we lacked marks • Re-emphasise the data available isn’t complete in this area and further research can help fill that gap

31. Feedback • I enjoy reading this paper.I think you did a very good job, well done. It would have been better to had your table in the main body of your paper and use some text to summarize the key themes that emerged form your search. You have demonstrated with your work that you have sound knowledge of how to perform a literature search and how to bring the reader up to date with current literature on the topic. Well done. • Your review is very well written. You have collated and sythesised the data very nicely and critically appraised the studies. My only comment is that the conclusions are weaker compared to the whole review. We would expect to give us some direction for the future and some research suggestions. What kind of studies do we need which methodology for what questions. Beyond that your review is an exemplar of how the SLR method should be approached.

32. Group PROTOCOL

33. Don’t Forget THE FOLLOWING: • Clear aims and objectives – talk to Theti, great help! • Sound justification of the methodology you have chosen – markers know their stuff!!! • Ethics – access rights, how to store data, confidentiality • Timeline/milestones for proposed project • List of chapter headings that you will use in the final report • Conflicts of interest

34. Questions? • dj408@ic.ac.uk • Thursday, 22nd November 2012 at1800 • ACEX 544 • Thanks to Bhavesh Patel for contributing examples • Management Soc Committee 2011/12