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History of Education

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In This Article Expand or collapse the "in this article" section History of Education in the United States

Introduction, professional societies, revisionists, traditionalists, general histories, african americans, asian americans, higher education, native americans, women, gender, and lesbian, gay, bisexual, and transgender (lbgt).

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History of Education in the United States by Christopher M. Span LAST REVIEWED: 29 July 2020 LAST MODIFIED: 29 October 2013 DOI: 10.1093/obo/9780199756810-0013

This annotated bibliography concentrates on the history of education in the United States. This history can be divided into two distinct areas: teacher training, and scholarship and research. Well before 1860, history of education, as a course of study, was associated with the professional education training of American teachers. To date, nearly all teacher education programs in the United States still incorporate the history of American education—even if only as part of a social foundations course—as a course requirement in its preservice teacher education programs. The assumption is that providing teachers with a general overview or survey of the most important developments in the history of education in the United States allows them to be self-reflective about the past and better understand the society in which they will teach. As a field of research, history of education has its earliest beginnings in the late 19th century, but by the mid-20th century it was a well-established field of study.

A number of journals specifically publish research on the history of education. The three most prominent journals in the field are the History of Education Quarterly (HEQ), History of Education , and Paedagogica Historica . Other important journals in the field are the American Educational History Journal , Historical Studies in Education/Revue d’histoire de l’éducation , and History of Education Review .

American Educational History Journal .

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The official annual publication of the Organization of Educational Historians (OEH), formerly the Midwest History of Education Society (MHES). The main criteria for publication in this journal is that authors present a cogent and coherent historical analysis at its annual conference.

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Historical Studies in Education/Revue d’histoire de l’éducation . 1989–.

Published twice a year, in both English and French, this peer-reviewed journal is the official journal of the Canadian History of Education Association (CHEA). The journal publishes all aspect of the history of education from informal to formal schooling, and from preschool to the university, as it relates primarily to Canada.

History of Education . 1972–.

This peer-reviewed journal is the official journal of the History of Education Society in the United Kingdom. It publishes six issues a year, and its aim and scope is to provide an outlet for the publication of theoretical, methodological, and historiographical articles on the history of education in Europe, Canada, and the United States.

History of Education Review .

This is the official journal of the Australian and New Zealand History of Education Society (ANZHES). Published biannually, the international journal publishes peer-reviewed research on the history of education, focusing primarily on Australia and New Zealand.

History of Education Quarterly . 1949–.

This outstanding peer-reviewed journal is the official journal of the History of Education Society (HES). First published under this title in 1961, the journal has been the primary publication outlet for scholars who seek to publish original research on the history of education in the United States. Between 1949 and 1961, the journal was published under the title History of Education Journal .

Paedagogica Historica: International Journal of the History of Education . 1961–.

This peer-reviewed journal is one of the leading journals in the field. It is the official journal of the International Standing Conference for the History of Education (ISCHE). Published six times a year and in three languages—English, French, and German—the scope of the research in the journal discusses education issues from a historical, theoretical, and methodological perspective.

There are a number of professional societies for historians of education. These professional societies allow historians of education the opportunity to present their research findings. The most prominent are the American Educational Research Association (AERA), Division F: History and Historiography , the American Educational Studies Association (AESA) , the Association for the Study of Higher Education (ASHE) , History of Education Society (HES) , History of Education Society, UK (HES) , the International Standing Conference for the History of Education (ISCHE) , and the Organization of Educational Historians (OEH) .

American Educational Research Association, Division F: History and Historiography .

Division F (History and Historiography) is dedicated to the study and practice of history and historiography. It is a division in the 25,000-member organization of the American Educational Research Association (AERA). It meets annually at different locations in the United States.

American Educational Studies Association .

The American Educational Studies Association (AESA) is a society primarily composed of college and university professors who teach and do research in the field of education, utilizing one or more of the liberal arts disciplines of philosophy, history, politics, sociology, anthropology, or economics, as well as comparative/international and cultural studies. It meets annually at different locations in the United States.

Association for the Study of Higher Education .

The Association for the Study of Higher Education (ASHE) is a scholarly society with about two thousand members dedicated to higher education as a field of study. It meets annually at different locations in the United States.

History of Education Society .

The History of Education Society (HES) is an international scholarly society whose purpose is to promote and improve the teaching of the history of education and encourage scholarly research in the history of education. It meets annually at different locations in the United States.

The UK History of Education Society (HES) promotes the study and teaching of history of education and is the annual conference for scholars and historians interested in presenting their research. It meets annually in the United Kingdom.

International Standing Conference for the History of Education .

The International Standing Conference for the History of Education (ISCHE) was founded in 1978 for the presentation of scholarship related to the history of education outside the United States. It meets annually at different locations in the world.

Organization of Educational Historians .

The Organization of Educational Historians (OEH) is an academic society for scholars interested in the history of education. It was formerly known as the Midwest History of Education Society. It meets annually in Chicago, Illinois.

A number of textbooks are available for the teaching of the history of education in the United States. These textbooks provide a comprehensive overview of the social, philosophical, historical, and economic foundations of education in the United States. The most noteworthy and widely used textbooks in the field are Mondale 2002 , Urban and Wagoner 2008 , Spring 2011 , and Tozer, et al. 2012 . These textbooks provide the most comprehensive information related to the social foundations of American education. An excellent documentary history of the United States is Fraser 2009 , a collection of primary sources of some of the most important personalities and milestones in the history of schools in the United States. Other textbooks that offer added value and alternative perspectives on the history of education in the United States include Gutek 2010 , Spring 2012 , and Rury 2012 .

Fraser, James W. 2009. The school in the United States: A documentary history . New York: Routledge.

This text uses primary sources to detail the educational history of the United States. Particular attention is paid to the role religion, race, language, gender, and the law played in determining who would have access to public schooling.

Gutek, Gerald L. 2010. Historical and philosophical foundations of education: A biographical introduction . 5th ed. Upper Saddle River, NJ: Pearson.

Through the biographies of some of the leading educational theorists in the history of humanity, this textbook illustrates how education and schools evolved because of their ideas.

Mondale, Sarah. 2002. School: The story of American public education . Boston: Beacon.

This short history is a compilation of essays from esteemed scholars in the field of history of education. It chronicles the evolution of schooling in the United States from the colonial era to the near present. It is the companion book to the PBS video documentary School .

Rury, John. 2012. Education and social change: Contours in the history of American schooling . 4th ed. New York: Routledge.

This short history of American schooling concentrates on the forever changing contours and evolution of schools. Considerable analysis is spent on the educational experiences of women, African Americans, and Native Americans.

Spring, Joel. 2011. American education . 15th ed. New York: McGraw-Hill.

This textbook offers a comprehensive overview of the history of American education. It is revised every two years to provide up-to-date analysis on the historical, social, and legal foundation of American education. It is formatted thematically around relevant issues of the day, such as educational equity and opportunity, diversity, and the politicization of American education.

Spring, Joel. 2012. Deculturalization and the struggle for equality: A brief history of the education of dominated cultures in the United States . 7th ed. New York: McGraw-Hill.

This textbook offers a short educational history of groups—African Americans, Native Americans, Latinos, women, etc.—historically marginalized in the United States. It has a specific focus on the impact of race and racism, segregation, and the deculturalization of Native Americans.

Tozer, Steven, Guy Senese, and Paul Violas. 2012. School and society: Historical and contemporary perspectives . 7th ed. New York: McGraw-Hill.

This textbook illustrates the how schools arose in the United States and how certain issues—such as race, gender, region, socioeconomic status, and language—determined the overall schooling experiences of children in the United States. The text relies on a triangulated analytic framework of how schools, ideology, and political economy shaped schools from the colonial era to the present.

Urban, Wayne J., and Jennings L. Wagoner Jr. 2008. American education: A history . 4th ed. New York: Routledge.

One of the most widely used textbooks on the history of education in the United States from the colonial era to the present. Well-written, and very inclusive of the diversity and ever-changing demographics of the nation, it offers an excellent chronology of the history of education (K-12 and higher education) in the United States.

Very little meaningful scholarship was published that surmised the history of education prior to 1950. Much of the pre-1950 scholarship pertained to statewide reports of schools or were cursory chapters embedded in dense tomes devoted to broader topics in the discipline of history. The earliest publications, such as Boone 1907 , Thwing 1910 , Dexter 1916 , or Cubberly 1919 , served as “house histories” or textbooks for professional teacher education courses. They were flowery narratives that chronicled the early history of schools in the United States. Minimal attention was paid to the role gender, race, religion, socioeconomic status, region, language, or special needs played in the educational experiences and lives of teachers, parents, administrators, or school children. The only publications to articulate aspects of these specifics were typically written by historians, who wrote counter-narratives to these traditional turn-of-the-century histories on American education; these works include Blandin 1909 , Woodson 1919 , Bond 1934 , and Du Bois 1935 .

Blandin, Isabella Margaret Elizabeth. 1909. History of higher education of women in the South prior to 1860 . New York: Neale.

Offers a very early history of the higher educational opportunities of women in the United States prior to the Civil War. Particular attention is paid to women’s access to college in the South and the type of curriculum they were offered. Very little can be discerned as to what impact these collegiate experiences had on these women’s lives.

Bond, Horace Mann. 1934. The education of the Negro in the American social order . New York: Prentice-Hall.

First full-length history of the African American educational experience in the United States from the end of the Civil War to the contemporary present. Considerable attention is paid to the perceived role African Americans were to play in society, because this determined the type of schooling opportunities they would be afforded.

Boone, Richard Gause. 1907. Education in the United States . New York: Appleton.

Offers a flowery and cursory overview of the earliest examples of schooling in the United States. Illustrates the differentiation in education—theological education, legal education, medical education, teacher training, etc.—at the time. Book is available through Google e-books.

Cubberly, Ellwood P. 1919. Public education in the United States: A study and interpretation of American educational history . New York: Houghton Mifflin.

This work is an early textbook that illustrates the history of schooling in the United States from the colonial era to the early 20th century. Particular attention is paid to colonial Massachusetts, educational developments in the early republic, and the reorganization of the nation’s system of schools following the Civil War. Book is available through Google e-books.

Dexter, Edwin Grant. 1916. A history of education in the United States . London: Macmillan.

An early textbook that offers a chronological history of schools in the United States from colonial Virginia to the beginning of the 20th century. Teacher training programs, higher education institutions, and regional analyses is the primary focus of the book. Book is available through Google e-books.

Du Bois, William Edward Burghardt. 1935. Founding the public school. Chapter 15 in Black Reconstruction in America: An essay toward a history on the part which black folk played in the attempt to reconstruct democracy in America, 1860–1880 . By William Edward Burghardt Du Bois. London: Oxford Univ. Press.

Magnificent social history on the role African Americans played in the social, political, economic, and educational reconstruction of the American South following the Civil War. The book provides the first comprehensive assessment on the founding of public education in the American South and the role former slaves played in this development.

Thwing, Charles Franklin. 1910. A history of education in the United States since the Civil War . New York: Houghton Mifflin.

Offers a romantic overview of the major philosophical thoughts and organizational practices that defined schooling in the United States following the Civil War. Very little attention is paid to the diverse demographics of the nation and their schooling experiences, or how time, region, or context impacted the development of schools during this era. Book is available through Google e-books.

Woodson, Carter G. 1919. The education of the Negro prior to 1861: A history of the education of the colored people of the United States from the beginning of slavery to the Civil War . Washington, DC: Associated Publishers.

Arguably the first history devoted to the education of African Americans in the United States. Great attention is paid to the role education played in the lives of enslaved and freeborn African Americans in the North and South, and how religion served as the primary catalyst for the earliest schooling opportunities of African Americans. Book is available through Google e-books.

It was only in the 1950s, as history of education came under assault by schools and colleges of education across the nation, that scholars in the field began to write a completely different kind of history of both the purpose of schooling and the pedagogical value of history of education in the teacher-training curriculum. Historians such as Arthur Bestor spurred this shift (see Bestor 1953 ). He argued that schools or colleges of education were failing to train teachers to understand the past to educate the present and future. Historians of education responded in a series of publications defending the functionality and relevance of both their pedagogy and field of expertise. The most prominent of these publications came in a series of articles published in the first three issues of Volume 7 of the History of Education Journal in 1955–1956. The general themes of the issue focused on the past, present, and future role of history of education in the teacher-training curriculum, preparation of doctoral students as future academicians, and the advancement of scholarship based on original sources and research. Key texts in this effort were Butts and Cremin 1953 , Cremin 1955 , Cremin 1956 , and Anderson 1956 , written by three of the most prominent historians in the field. Some historians, such as Louis Harlan, wrote histories to explain contemporary issues, such as legal segregation in public schools ( Harlan 1958 ). It was another way of demonstrating the functional role the history of education played in addressing some of the most pressing problems in American education.

Anderson, Archibald W. 1956. Bases of proposals concerning the history of education. History of Education Journal 7.2: 37–98.

Establishes the premise that the history of education as a course of study in the professional development of teachers is very functional and needed to enhance the everyday knowledge of teachers in their professional careers.

Bestor, Arthur. 1953. Educational wastelands: The retreat from learning in our public schools . Urbana: Univ. of Illinois Press.

Scathing critique of the educational philosophy, curriculum, and practices of schools during the Progressive Era. Bestor calls on the nation to abandon Progressive educational reform because he felt the nation’s schoolchildren had regressed under its guise. He calls for a return to the traditional curriculum that heavily emphasized literacy, rhetoric, and numeracy.

Butts, R. Freeman, and Lawrence Cremin. 1953. A history of education in American culture . New York: Holt.

Offers a detailed overview of the history of education in the United States and synthesizes the aesthetics of American iconography and culture into this analysis. The central argument is that the way schools developed and evolved in the United States, writ large, is unique compared to any other nation-state.

Cremin, Lawrence A. 1955. The recent development of the history of education as a field of study in the United States. History of Education Journal 7.1: 1–35.

Offers a short overview of the role the history of education has played in the professional development of teachers in the United States, and why it is necessary for the field to remain in colleges or schools of education rather than shift to departments of history.

Cremin, Lawrence A. 1956. The role of the history of education in the professional preparation of teachers: Recommendations of the committee. History of Education Journal 7.3: 99–132.

This article lists five recommendations as to how history of education can continue to play a prominent role in the professional preparation of teachers, colleges of education, and the discipline of history.

Harlan, Louis R. 1958. Separate and unequal: Public school campaigns and racism in the southern seaboard states, 1900–1915 . Chapel Hill: Univ. of North Carolina Press.

First book to illustrate in great detail the impact racism had on the educational advancement of African Americans in the first decades of the 20th century. Written during the mass movements for human freedom in the United States, it utilizes the struggles of the times as the primary impetus for retracing this educational history.

History of education evolved tremendously during these two decades as a distinct field of study. In addition to more detailed histories being written on the development of systems of education in the United States and abroad, historians of this time period began to write about the challenges facing contemporary society and how schools have been historically called upon to answer or provide remedy to these challenges. Bailyn 1960 , Cremin 1961 , Karier 1967 , Katz 1968 , and Tyack 1974 all established the argument that schools shaped the progress of the United States. How schools developed and evolved in essence determined the progress of society. As such, many publications during this time period both promoted and challenged the premise that schooling was the panacea to societal problems. No longer was there a uniformed opinion on why schools were created, that they were positive developments, or what their overall purpose was in the nation. The historians who wrote in this era can be divided into two distinct groups: revisionists and traditionalists (discussed in detail in the next two subsections). The histories written by both groups pushed the boundaries of how the history of American education was previously written. They synthesized the history of education into broader considerations in American history; they illustrated both the success and failures of schooling in the United States; and they disaggregated populations such as students, teachers, communities, administrators, theorists, and school communities to provide a more nuanced history of how systems of education evolved in the United States.

Bailyn, Bernard. 1960. Education in the forming of American society: Needs and opportunities for study . Chapel Hill: Univ. of North Carolina Press.

Provides a broader definition of education to illustrate the fundamental shifts in American education. Education was not just the formal pedagogy or practice of teaching in schools; it was the entirety of the American culture transmitted from one generation to the next. Ideology, political economy, and schools all shaped and reshaped each other, and this, in turn, formed American society.

Cremin, Lawrence A. 1961. The transformation of the school: Progressivism in American education, 1876–1957 . New York: Alfred A. Knopf.

Details the rise and decline of Progressive education in the United States. Similar to Bailyn, the book expands the definition of education to include the myriad of cultures in American society.

Karier, Clarence J. 1967. Man, society, and education: A history of American educational ideas . Glenview, IL: Scott, Foresman.

This book presents a history of the history of educational ideas and how they shaped American society and schools. It directly challenges earlier and contemporary histories that argued that schooling is by nature good for society. Karier argues that no real differences existed between liberalism and conservativism, since proponents of both ideologies deemed schools to be beneficial to societal advancement.

Katz, Michael. 1968. The irony of early school reform: Education innovation in mid-nineteenth century Massachusetts . Boston: Beacon.

Offers an analysis of the development of schooling in Massachusetts during the 19th century. It particularly details the philosophies and practices of Massachusetts educational reformers. Whereas early histories offered sweeping overviews of the development of schools in Massachusetts, Katz situates his history in what he called a “small, concrete situation,” (p. 15) to illustrate how schools evolved in Massachusetts.

Tyack, David B. 1974. The one best system: A history of American urban education . Cambridge, MA: Harvard Univ. Press.

This history details the origins and challenges of education in urban America. It discusses the rise of massive levels of educational bureaucracy, decentralization, standardized testing, segregation, and ability tracking, and how education theorists and bureaucrats sought to develop one system of education to best meet the needs of all, regardless of their differences in access, ability, and outcome.

Some historians, including those mentioned in the previous section, insisted that schooling was rarely if ever beneficial to everyone in the United States. They sought to offer a revision or corrective history to earlier or contemporary histories that offered interpretations that schooling was universally beneficial to the advancement of the nation and its citizenry. Revisionist historians argued in their respective publications that schools in the 18th, 19th, and first half of the 20th century were not beneficial to most Americans. These works include Karier 1972 ; Karier, et al. 1973 ; Clifford 1975 ; Bowles and Gintis 1976 ; Katz 1976 ; Webber 1978 ; Franklin 1979 ; and Butchart 1980 . They argued that schools were established to replicate the status quo, to control discontent, to control the educational access and outcomes of marginalized populations, to be an engine for coercive assimilation, to determine access of opportunity to limited resources, to simply prepare individuals for employment, and a host of other factors. Using an array of primary source evidence, these historians set out to write the educational histories of how schools and society advanced democracy for some literally at the expense of others. Their emphasis pertained to writing histories of people who had been historically marginalized or simply denied schooling altogether. Their histories illustrated that schools were particularly harmful or unbeneficial, in general, to women, African Americans, Native Americans, Latinos, the poor, and immigrants.

Bowles, Samuel, and Herbert Gintis. 1976. Schooling in capitalist America: Education reform and the contradictions of economic life . New York: Basic Books.

Offers a quantitative and economic regression analysis of how schools have served to advance capitalism in the United States at the expense of advancing the overall livelihood of the average citizen. Discusses the uneven distribution of school resources, the origins of standardized testing, and the impact of intergenerational wealth and poverty on school performance and outcome.

Butchart, Ronald E. 1980. Northern schools, southern blacks, and Reconstruction . Westport, CT: Greenwood.

A corrective history to earlier publications written on the role of northern teachers who taught freedpeople during and after the Civil War. Previous scholarship was deeply sympathetic to the South’s defeat following the Civil War. This book challenged this historiography and illustrates a more accurate portrayal of the northern teachers who taught African Americans—free and freed.

Clifford, Geraldine Joncich. 1975. Saints, sinners, and people: A position paper on the historiography of American education. History of Education Quarterly 15.3: 257–272.

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This Division F Vice-Presidential Address details the more recent publications in the history of education and suggests future directions of where the field should continue to grow and conduct research. A comprehensive bibliography of all the known publications on the history of education in the Midwest.

Franklin, Vincent P. 1979. The education of black Philadelphia: The social and education history of a minority community, 1900–1950 . Philadelphia: Univ. of Pennsylvania Press.

A detailed history on the education of African Americans in Philadelphia. The book illustrates how African Americans were purposefully denied a quality education because they were thought to be inferior to whites. It also shows that the type of schooling afforded to African Americans served more as an impediment to the group’s social advancement rather than as a resource.

Karier, Clarence J. 1972. Liberalism and the quest for orderly change. History of Education Quarterly 12.1: 57–80.

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Offered a sharp critique of liberalism as an ideology for social change and good with regard to schools, particularly when there is a crisis or difficult situation. The essay is the first of its kind to offer a critical assessment of John Dewey, the Progressive Era, and the limited impact schools have had in addressing systemic and structural problems in society.

Karier, Clarence J., Paul C. Violas, and Joel Spring. 1973. Roots of crisis: American education in the twentieth century . Chicago: Rand McNally.

This book offers a revisionist history of education in the first half of the 20th century. It challenges established interpretations that important personalities and milestones in education in the United States were not producers of social good, but instead were producers and maintainers of social control. This book quickly became the standard for revisionist educational history.

Katz, Michael. 1976. The origins of public education: A reassessment. History of Education Quarterly 16.4: 381–407.

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This article offers a revisionist critique and response to scholars opposed to Katz’s interpretation and findings in The Irony of Early School Reform ( Katz 1968 , cited under 1960–1980 ). It offers additional interpretation as to why and how public schools in the United States were established and what outcomes can be ascertained from their development and maintenance.

Webber, Thomas L. 1978. Deep Like the Rivers: Education in the Slave Quarter Community, 1831–1865 . New York: W. W. Norton.

First comprehensive study of the formal and informal education of enslaved African Americans during the antebellum era.

Contemporaries of revisionist historians were quick to respond and defend their historical interpretations that proffered schooling as essentially the quintessential hallmark of American democracy. Historians such as Jill Conway, Lawrence Cremin, Edward Krug, and Diane Ravitch argued that schooling contributed to a more productive economy, gave the average citizen greater access to resources and opportunities, and alleviated societal ills (see Conway 1974 , Cremin 1970 , Cremin 1980 , Krug 1972 , Ravitch 1974 , and Ravitch 1978 ). Despite the limited progress some groups in the United States had achieved, schools were not the primary culprit of their underdevelopment, according to these historians; instead, it was the very reason many individuals within these marginalized groups achieved economic and social mobility. Schools were a story of democracy at its best, of places where opportunities abounded if one applied one’s talents, and of places that defined the very meaning of societal progress. Without schools there would be no societal advancement, so schools, according to traditionalists, were not as detrimental as the revisionists wrote. Notwithstanding this belief, the challenge for traditionalist historians was that as primary source evidence became increasingly available, and as people from historically marginalized or denied populations demanded their histories be written and told, it became nearly impossible to adhere to the interpretation that schools did more good than harm in remedying the needs and wants of these, and many other, groups in American society. As such, fewer and fewer histories were written from this perspective in the decades that followed.

Conway, Jill K. 1974. Perspectives on the history of women’s education in the United States. History of Education Quarterly 14.1: 1–12.

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Offers a brief overview of the early educational opportunities of women in the United States. The article is part of a themed issue in the Quarterly on “Reinterpreting Women’s Education.”

Cremin, Lawrence A. 1970. American education: The colonial experience, 1607–1783 . New York: Harper & Row.

The first of a three-volume synthesis of the history of American education. The books adheres to the argument that American culture—an American Paideia —defined how schools and democracy, writ large, would be developed in colonial America and beyond.

Cremin, Lawrence A. 1980. American education: The national experience, 1783–1876 . New York: Harper & Row.

The second of Cremin’s three-volume synthesis on the history of American education. Despite the greater emphasis on specificity of example and analysis in other contemporary histories of education, the book still adheres to a broad definition and interpretation of education. This interpretive framework made it difficult to assess the strengths and limitations of schooling in the United States during this time period.

Krug, Edward A. 1972. The shaping of the American high school, 1920–1941 . Madison, WI: Univ. of Wisconsin Press.

Offers one of the earliest and most complete histories of the rise of the high school during the Progressive Era.

Ravitch, Diane. 1974. The great school wars: New York City, 1805–1973; A history of the public schools as battlefield of social change . New York: Basic Books.

Details the early educational history of the denouncement of the common school model in New York City. The book highlights the influential work of Catholic Bishop John Hughes, who singlehandedly defended the culture and religion of Irish Catholics in the city, the rise of parochial education as an alternative to public schooling, and how New York City public schools evolved in the 20th century.

Ravitch, Diane. 1978. The revisionists revised: A critique of the radical attack on the schools . New York: Basic Books.

A series of essays that challenge contemporary histories written by historians critical of historical scholarship, and emphasizing the progress schooling historically had on society.

1981–Present

Since 1980, scholarship in history of education has become more nuanced, complicated, and abundant. Every possible topic related to the field of education has been effectively research by historians of education. Some areas—such as the African American educational experience, the history of higher education, women’s educational experiences, and the history teachers in the United States—have been more thoroughly research than other areas—such as the history of special education, or the Asian American, Native American, and Latino educational experience. These subsections contain the foremost publications in each of these respective areas.

There are a number of general histories in the field of history of education that provide excellent insights regarding the development and advancements of schools in the United States. Histories such as Kaestle 1983 , Ravitch 1983 , Mirel 1993 , Beatty 1995 , Tyack and Cuban 1995 , Angus and Mirel 1999 , Donato and Lazerson 2000 , and Graham 2005 are still the standard interpretations in their respective field of specialty in history of education. These publications vary in style and emphasis. Some are longitudinal regional studies, and others are more concise state or case studies. Nonetheless, all are well researched and/or ask questions relevant to future directions of the field of history of education. They illustrate to current and future historians how to effectively use evidence and historical methodology to write histories of education relevant to questions and concerns in the present, and to American history in general.

Angus, David F., and Jeffrey E. Mirel. 1999. The failed promise of the American high school, 1890–1995 . New York: Teachers College.

This book is a reinterpretation of the history of the high school in the United States. It illustrates the rise of the differentiated curriculum, struggles over educational equity, and the perceived role of the high school in preparing youth for citizenship and employment. Latter chapters offer insight as to how the federal educational reform of the 1980s shaped educational outcomes and curriculum.

Beatty, Barbara. 1995. Preschool education: The culture of young children from the colonial era to the present . New Haven, CT: Yale Univ. Press.

This book offers a comprehensive history that details the policies and programs that shaped preschool education in the United States from the colonial era to the present. This well-researched book illustrates that preschools, despite their effectiveness in preparing children for formal schooling at the elementary level, have not been universally accepted as part of the public school system.

Donato, Ruben, and Marvin Lazerson. 2000. New directions in American educational history: Problems and prospects. Educational Researcher 29.4: 4–15.

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Important article that discusses the state of the field and the role historians of education will need to play in 21st-century educational reform. Forty historians of education gathered to reflect upon the past and speculate about the future of the field.

Graham, Patricia A. 2005. Schooling America: How the public schools meet the nation’s changing needs . New York: Oxford Univ. Press.

This book is a comprehensive history of schooling in the 20th century. Assimilation, desegregation, access to special education programs for the gifted and disabled, and the role everyday people play in the education of children are all illustrated in this magnificent publication.

Kaestle, Carl F. 1983. Pillars of the republic: Common schools and American society, 1780–1860 . New York: Hill and Wang.

This book still serves as the standard in the field on the history of common schools in the United States. Kaestle details the development of public schools being funded through local taxation, the establishment of teacher education training institutes, the debates over the uniformity of a standard curriculum, and the overall purpose that schools served in 19th-century America.

Mirel, Jeffrey. 1993. The rise and fall of an urban school system: Detroit, 1907–81 . Ann Arbor: Univ. of Michigan Press.

This book is an excellent, well-research history on the Detroit public school system in the 20th century. Arguably the most detailed case study of a major metropolis ever published in the field.

Ravitch, Diane. 1983. The troubled crusade: American education, 1945–1980 . New York: Basic Books.

This book traces the educational developments of the mid-20th century. It argues that educational reforms during the mid-20th century were mediocre at best, and offers an interpretation of why schools failed during this era.

Tyack, David, and Larry Cuban. 1995. Tinkering toward Utopia: A century of public school reform . Cambridge, MA: Harvard Univ. Press.

This book asks great questions about the role of educational reform, why society thinks schools have regressed, and why it is so difficult to change or shift school culture and practices. It is an excellent resource for anyone interested in assessing current school reform with past considerations.

One subfield of history of education that has been well researched is the educational history of African Americans. The standard interpretation in this subfield is provided by Anderson 1988 . Most histories written after this important publication either reference or borrow the important theses proffered by Anderson. The best historiographic essay published in this subfield is Butchart 1988 . The other publications listed in this subsection— Walker 1996 , Williams 2005 , Fairclough 2007 , Moss 2009 , Span 2009 , and Butchart 2010 —are quickly becoming standard interpretations in the field, as they extend one’s understanding of the educational history of African Americans from their arrival in 1619 to the present.

Anderson, James D. 1988. The education of blacks in the South, 1860–1935 . Chapel Hill: Univ. of North Carolina Press.

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Pioneering study, arguably the best book ever written on the subject. This book is still the standard interpretation in the field regarding the education of African Americans in the South. Virtually all publications related to the history of the African American educational experience have either complemented or challenged the central and subsidiary theses in this book since its initial publication.

Butchart, Ronald E. 1988. “Outthinking and outflanking the owners of the world”: A historiography of the African American struggle for education. History of Education Quarterly 28.3: 333–366.

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To date, the only historiographical essay on the African American educational experience. Provides tremendous insight with regards to the ways historians and social scientists wrote the earliest educational histories of African Americans.

Butchart, Ronald E. 2010. Schooling the freed people: Teaching, learning, and the struggle for black freedom, 1861–1876 . Chapel Hill: Univ. of North Carolina Press.

Rich in primary source evidence, and extremely well written, this book offers an excellent reinterpretation of the teachers who taught southern blacks following the Civil War. Answers to questions such as who the teachers were, where they came from, and what they taught are all provided in great detail in this magnificent history.

Fairclough, Adam. 2007. A class of their own: Black teachers in the segregated South . Cambridge, MA: Harvard Univ. Press.

Pioneering study on the lives of African American teachers in the segregated South. The book adds a much-needed layer of complexity to the lives of these teachers and is a far departure from the general assessment that African American teachers were powerless in the face of segregation by law.

Moss, Hillary J. 2009. Schooling citizens: The struggle for African American education in antebellum America . Chicago: Univ. of Chicago Press.

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A magnificent study that traces the early schooling opportunities of African Americans in three antebellum cities. The book highlights the tension between the rise of universal schooling for all and the rise of systemic racism that precluded African Americans from being able to gain full access to public schools and other accommodations of public life.

Span, Christopher M. 2009. From cotton field to schoolhouse: African American education in Mississippi, 1862–1875 . Chapel Hill: Univ. of North Carolina Press.

Excellent case study of African American education following the Civil War. The book illustrates the educational motivation of formerly enslaved African Americans in Mississippi and how they sought to develop a system of schools for themselves and their children. It is the first comprehensive history of African American education in Mississippi.

Walker, Vanessa Siddle. Their highest potential: An African American school community in the segregated South . Chapel Hill: Univ. of North Carolina Press, 1996.

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Groundbreaking case study on a segregated school community in North Carolina. Through primary source evidence and interviews, Walker illustrates how one African American school community succeeded in providing a nurturing educational environment to its students. This book is required reading for anyone doing research on the African American educational experience in the 20th century.

Williams, Heather Andrea. 2005. Self-taught: African American education in slavery and freedom . Chapel Hill: Univ. of North Carolina Press.

This book is the standard interpretation in the field as it relates to the role African Americans played in advancing their own education during and after the Civil War. It is arguably the best book in the field on the subject.

This subfield in the history of education in the United States is an emerging field of inquiry. The standard interpretations— Ng, et al. 2007 ; Pak 2001 ; Tamara 1994 ; and Tamara 2001 —illustrate the educational histories of Asian Americans and their important contributions to the United States. Asian Americans have been advocating for equal schooling in the United States since the mid-19th century. These publications are important because they offer corrective histories to past publications that ignored or underresearched the educational experiences of Asian Americans in the history of schooling in the United States.

Ng, Jennifer C., Sharon S. Lee, and Yoon K. Pak. 2007. Contesting the model minority and perpetual foreigner stereotypes: A critical review of literature on Asian Americans in education. Review of Research in Education 31.1:95–130.

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Excellent historiography of the Asian American educational experience and the challenges this group has historically faced in the United States. It is a must read for any interested in this field of inquiry.

Pak, Yoon K. 2001. Wherever I go I will always be a loyal American: Seattle’s Japanese American schoolchildren during World War II . New York: Routledge.

This book is the standard interpretation in the field and illustrates the educational history of Japanese American schoolchildren during World War II. Pak interviews some of these children as adults to further detail this painful history. The combined use of oral and archival history makes for a narrative that is both methodologically sound and engaging.

Tamara, Eileen H. 1994. Americanization, acculturation, and ethnic identity: The Nisei generation in Hawaii . Urbana: Univ. of Illinois Press.

Exceptional history that examines the widespread discrimination against the Nisei—children of Japanese immigrants—experienced in Hawaii during World War II. Well written and well researched, this book is one of the earliest histories on the Asian American experience in the United States.

Tamara, Eileen H. 2001. Asian Americans in the History of Education: An Historiographical Essay. History of Education Quarterly 41.1: 58–71.

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A historiographical essay that details the limited research and publications related to the educational history of Asian Americans.

Higher education, as a subfield of the history of education, has a long history. Midcentury publications such as Rudolf 1962 and Veysey 1965 still serve as important interpretations in the field. More contemporary histories offer a more detailed overview of higher education in general. The most notable of these publications are Lucas 1994 and Thelin 2004 . Thelin 2004 is the standard interpretation in this subfield. More recent scholarship, notably Gasman 2007 and Loss 2011 , has positioned the impact higher education has had on the overall development of the everyday citizen, or on those institutions of higher education that have been historically marginalized, such as the historically black colleges and universities (HBCUs). There is also a growing body of scholarship on the history and impact of the community college, the most notable being Brint and Karabel 1989 .

Brint, Steven, and Jerome Karabel. 1989. The diverted dream: Community colleges and the promise of educational opportunity in America, 1900–1985 . New York: Oxford Univ. Press.

This book details the rise and evolution of the community college in the United States. It illustrates the important role it played in offering higher educational opportunities to adults unable or uninterested in attending a traditional four-year baccalaureate university. This book is one of the earliest comprehensive histories on the community college.

Gasman, Marybeth. 2007. Envisioning black colleges: A history of the United Negro College Fund . Baltimore: John Hopkins Univ. Press.

This book addresses an important gap in the historiography of higher education as it relates to philanthropy and African American education. It demonstrates the struggles historically black colleges and universities (HBCUs) have faced since their creation in the late 19th century to sustain themselves in the wake of ever-increasing costs and dwindling revenue.

Loss, Christopher P. 2011. Between citizens and the state: The politics of American higher education in the 20th century . Princeton, NJ: Princeton Univ. Press.

Informative social history that deepens our understanding of American higher education. The book illustrates the meaningful role higher education has had in shaping progress in the American social order.

Lucas, Christopher J. 1994. American Higher Education: A History . New York: St. Martin’s.

This book offers a general overview of the history of higher education in the United States. It illustrates that the origins of higher education in the United States come from Europe, and it chronicles important events and developments that shaped the history of higher education in the United States.

Rudolf, Frederick. 1962. The American college and university: A history . New York: Knopf.

This book was the first to offer a detailed history of higher education in the United States. Despite the outgrowth of higher education opportunities in the United States in its publication, the book is still deemed a standard in the field.

Thelin, John R. 2004. A history of American higher education . Baltimore: John Hopkins Univ. Press.

Magnificent publication and the standard interpretation in the field on the history of higher education. This book details the long history of higher education in the United States from the colonial era to the present. It is a must read by any in the field of the history of higher education.

Veysey, Laurence R. 1965. The emergence of the American university . Chicago: Univ. of Chicago Press.

This book is a complementary publication to Rudolf’s history of higher education in the United States ( Rudolf 1962 ). Veysey concentrates on the development of the American university at the close of the 19th century and beginning of the 20th century. He offers a more nuanced assessment of the everyday experiences of students, faculty, and administrators in the university setting.

Since the 1980s, historians of education have chronicled the educational experiences of Native Americans. The standard interpretation in this specific subfield of the history of education is Adams 1995 . Virtually all other important contributions in this subfield— Lomawaima 1995 , Deyhle and Swisher 1997 , Szasz 1999 , Reyhner and Eder 2004 , and Lawrence 2011 —reference or complement the theses offered by Adams. The challenges Native Americans faced in the United States are unique to any other population, and historians of this era have chronicled this history well. From their earliest informal educational experiences among English colonists in the early 17th century to the present, no group in the United States has had their overall livelihood obstructed and altered as have Native Americans.

Adams, David Wallace. 1995. Education for extinction: American Indians and the boarding school experience, 1875–1928 . Lawrence: Univ. Press of Kansas.

Offers the first comprehensive history of boarding schools for Native Americans in the United States. Arguably the best book written thus far on the history of Native American education.

Deyhle, Donna, and Karen Swisher. 1997. Research in American Indian and Alaska Native education: From assimilation to self-determination. Review of Research in Education 22:113–194.

Extensive review of literature on the educational experiences and history of Native Americans. Arguably the most comprehensive review of literature on the subject.

Lawrence, Adrea. 2011. Lessons from an Indian day school: Negotiating colonization in northern New Mexico, 1902–1907 . Lawrence: Univ. Press of Kansas.

This book offers a biographical sketch of two educators in an Indian day school in Santa Clara Pueblo in northern New Mexico. It addresses important gaps in the historiography of Native American education.

Lomawaima, K. Tsianina. 1995. They called it prairie light: The Story of Chilocco Indian School . Lincoln: Univ. of Nebraska Press.

History of an off-reservation boarding school designed to assimilate Native American children into white Anglo-Saxon Protestant culture. It utilizes the first-person testimonies of former students to both recall the hardships of attending the school and the love and support they developed with their fellow students while attending Chilocco.

Reyhner, Jon, and Jeanne Eder. 2004. American Indian education: A history . Norman: Univ. of Oklahoma Press.

A comprehensive history of Native American education from the precolonial era to the present. Thematically written, the book offers an excellent synopsis of the events, developments, and personalities that shaped schooling for Native Americans in the United States.

Szasz, Margaret Connell. 1999. Education and the American Indian: The road to self-determination since 1928 . 3d ed. Albuquerque: Univ. of New Mexico Press.

This book traces the evolution of the federal reforms related to Native American education from the 1928 Meriam Report to the passage of the Indian Education Act in 1972. It is the first comprehensive history to detail the education of Native Americans and their struggles both in and outside of schools in the 20th century.

Another emerging subfield in the history of education in recent decades is the history of Latinos in the United States. The majority of publications in this subfield have offered case studies of the educational experiences of people of Mexican, Central American, Puerto Rican, and South American origin. More recent contributions such as McDonald 2001 and McDonald 2004 extend our understanding of the long educational history of Latinos in the United States. McDonald’s scholarship also points to how this group has been misrepresented and under-studied in the field of history of education. Much of the scholarship on Latinos has concentrated on their schooling experiences in the 20th century. San Miguel 1987 , San Miguel 2001 , Gonzalez 1990 , and Donato 1997 have all established important interpretations of the agency and expectations of Latinos in the California, Colorado, and Texas, and during important milestones in American history such as the rise of compulsory schooling and the high school during the Progressive Era (1910–1940) and the civil rights movement (1954–1968).

Donato, Ruben. 1997. The other struggle for equal schools: Mexican Americans during the civil rights era . Albany: State Univ. of New York Press.

An excellent book on the educational history of Mexican Americans during the Civil War. Emphasis is placed on the role Mexican Americans played in advancing the legal and educational rights of all in American society. The book addresses an important gap in the civil rights historiography.

Gonzalez, Gilbert G. 1990. Chicano education in the era of segregation . Philadelphia: Balch Institute.

This book examines the history of Chicano education in the American Southwest between 1910 and 1950. It illustrates the immense inequality Chicanos faced with regard to schools, economic opportunities, and political empowerment. It also proffers that the type of segregated schooling Chicanos received made them a permanent and subordinate underclass in American society during this era.

McDonald, Victoria-María. 2001. Hispanic, Latino, Chicano, or “Other”?: Deconstructing the relationship between historians and Hispanic-American educational history. History of Education Quarterly 41.3: 365–413.

DOI: 10.1111/j.1748-5959.2001.tb00093.x Save Citation » Export Citation » Share Citation »

Historiographical essay on the educational history of Spanish-speaking people in the United States. The article is both a survey and critical examination of the historical works written on this group. It is a must read for anyone in this specific field of inquiry.

McDonald, Victoria-María, ed. 2004. Latino education in the United States: A narrated history from 1513–2000 . New York: Palgrave Macmillan.

A documentary history of Latino education from 1513 to 2000. First documentary history to detail the different educational experiences of Spanish-speaking people in the United States. An important contribution to an ever-growing field of study.

San Miguel, Guadalupe, Jr. 1987. “Let all of them take heed”: Mexican Americans and the campaign for educational equality in Texas, 1910–1981 . Austin: Univ. of Texas Press.

This history illustrates the efforts of Mexican Americans to achieve educational equality in Texas in the 20th century. It is a well-researched and well-written book that documents the challenges segregation and inferior schooling posed for Mexican American children.

San Miguel, Guadalupe, Jr.. 2001. Brown not white: School integration and the Chicano movement in Houston . College Station: Texas A & M Univ. Press.

This book offers a comprehensive history of the efforts of Chicanos in Houston to achieve public school integration. The book illustrates the complexities of concepts like race and ethnicity and highlights how local white officials sought to legally define Chicanos as “white” in order to achieve their desegregation efforts and avoid sending white children to school with African Americans and Latinos.

In recent years, no subgroup has been more thoroughly researched in the field of history of education than women. Since the beginning of the 20th century, historians have written about or included the educational experiences of women, but these histories were generally flowery descriptions of their inclusion in education settings. Since the 1980s, however, countless scholars have historicized the role women have played as active agents of change in schools. Solomon 1985 and Eisenmann 2007 contextualize their role as students in both K-12 and higher education very well. Few works have articulated their roles or identities as teachers better than Rousmaniere 1997 , Weiler 1998 , Blount 2006 , and Graves 2009 . In addition, Gordon 1990 and Nash 2005 , general overview histories on the education of women in the United States, provide excellent context and depth on the role women have played as administrators, parents, and advocates.

Blount, Jackie M. 2006. Fit to teach: Same-sex desire, gender, and school work in the twentieth century . Albany: State Univ. of New York Press.

This book is the standard interpretation in the field. It is impressively researched and is arguably the most important book published on the subject. It is the first comprehensive history on same-sex issues in public schools in the United States.

Gordon, Lynn D. 1990. Gender and higher education in the Progressive Era . New Haven, CT: Yale Univ. Press.

Early history on the women in higher education during the Progressive Era. It highlights the second generation of women to attend college and how this group of women differed from their predecessors.

Graves, Karen L. 2009. And they were wonderful teachers: Florida’s purge of gay and lesbian teachers . Urbana: Univ. of Illinois Press.

This book is the first state study to historicize the challenges gay and lesbian teachers faced in their profession. It is an important contribution to a growing body of historical research on gay and lesbian experiences in schools in the United States.

Eisenmann, Linda. 2007. Higher education for women in postwar America, 1945–1965 . Baltimore: John Hopkins Univ.

Groundbreaking book about the impact higher education opportunities had on women following World War II. It is the standard interpretation in the field and is a must read for historians of higher education and women.

Nash, Margaret A. 2005. Women’s education in the United States, 1780–1840 . New York: Palgrave Macmillan.

Comprehensive national study on women in higher education. This book is another standard interpretation in the field that highlights the social, economic, and cultural forces that shaped and reshaped the educational experiences of women in the 18th and 19th centuries. It is an extremely important book in the field.

Rousmaniere, Kate. 1997. City teachers: Teaching and school reform in historical perspective . New York: Teachers College.

Arguably the best book written on the history of teaching. Rousmaniere interviews teachers from the 1920s and combines their testimonies with an astonishing cache of archival source materials. It is the first history to utilize the firsthand perspective of former teachers.

Solomon, Barbara. 1985. In the company of educated women: A history of women and higher education in America . New Haven, CT: Yale Univ. Press.

Early comprehensive history of women in higher education. It reads as a contributionist history that acknowledges a major gap in the historiography of higher education at the time, when women were excluded from such analyses.

Weiler, Kathleen. 1998. Country schoolwomen: Teaching in rural California, 1850–1950 . Stanford, CA: Stanford Univ. Press.

This book focuses on the lives of female teachers in rural California. It offers an excellent social history and biographical sketch of the successes and challenges of teachers on the frontier.

Scholarship on alternative schooling is growing in the United States. Ravitch 1974 was one of the first to offer a history of Catholic or parochial schools in the United States; this was the first alternative school system in the United States. This book was followed up by a short history, Buetow 1986 . In recent decades, many more publications have concentrated on alternative school models to public schooling. Home schooling, the rise of charter schools, and the new push to offer virtual public schooling all serve as examples of the evolution of alternative schools in the United States. Holt 1964 was the first to articulate the need for another alternative to public, private, and parochial schools, and Holt questioned the way federal educational reforms like the National Defense Education Act (1958) changed what children would learn in school. His efforts led to the push for home schooling in the United States. During the 1980s and 1990s, the federal report A Nation at Risk similarly forced many Americans to rethink the advantages of public schools. It was during these decades that many parents chose to send their children to a parochial or charter school rather than a traditional public school. Arguably the best educational history on these contemporary issues regarding alternative schooling is Labaree 2007 .

Buetow, Harold A. 1986. A history of United States Catholic schooling . New York: National Catholic Education.

Short history of Catholic schooling in the United States. Illustrates the earliest establishment of the Catholic school system in New York City, the three plenaries of the 19th century, and how Catholic schools evolved in the 20th century.

Holt, John. 1964. How children fail . New York: Pitman.

Nonfiction polemic on the impact federal educational reform and poor public school options had on children reaching their highest potential. Holt argues that one remedy to the poor preparation schoolchildren received from their educational environments was for parents to educate their children at home. This book ushered in the rise of home schooling in the United States.

Labaree, David F. 2007. Education, markets, and the public good: Selected works of David F. Labaree . London: Routledge.

This books details the market indicators that impact public schools. The collection of essays in the book challenges the notion that education is a necessary public good and that alternative models of schooling such as vouchers, charter schools, and parochial schools are necessary disruptors to ensure that all children receive a high-quality education in the United States.

Historians of education in the United States have also written on education reform and policy and their impact on schools. The most notable of these publications are Ravitch and Vinovskis 1995 , Vinovskis 2005 , and Vinovskis 2008 . Vinovskis has singlehandedly written the standard histories and interpretations in the field on this subject. Others, such as Charles Payne, Jane David, and Larry Cuban, have used their expertise as historians to weigh in on important debates and issues about education reform (see Payne 2008 , David and Cuban 2010 ).

David, Jane L., and Larry Cuban. 2010. Cutting through the hype: The essential guide to school reform . Cambridge, MA: Harvard Education.

A book about how educators can address the countless education reforms and policies they have to endure while teaching or administering their schools. The book particularly highlights the difficulties educators have with education reforms and expectations in impoverished school communities with a high minority population.

Payne, Charles M. 2008. So much reform, so little change: The persistence of failure in urban schools . Cambridge, MA: Harvard Education.

This books assesses thirty years of school reform in Chicago, Illinois, and how little has changed for the better. It shows the challenges of overcoming decades of neglect, poverty, racism, and low expectations. It is a must read for anyone interested in urban education reform and policy.

Ravitch, Diane, and Maris Vinovskis. 1995. Learning from the past: What history teaches us about school reform . Baltimore: Johns Hopkins Univ. Press.

Important contribution to understanding the impact federal education policy has had on the evolution of schooling in the United States.

Vinovskis, Maris. 2005. The birth of Head Start: Preschool education policies in the Kennedy and Johnson administrations . Chicago: Univ. of Chicago Press.

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Illustrates the rise of educational reforms and policy related to the establishment of preschool education in the United States.

Vinovskis, Maris. 2008. From A Nation at Risk to No Child Left Behind: National education goals and the creation of federal education policy . New York: Teachers College.

Offers a detailed history of the impact federal educational reforms and policy in the last two decades of the 20th century had on schools in the United States. Illustrates the long history of educational reform and policy in 20th-century schooling.

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Understanding, Educating, and Supporting Children with Specific Learning Disabilities: 50 Years of Science and Practice

Elena l. grigorenko.

1 University of Houston, Houston, USA

2 Baylor College of Medicine, Houston, USA

Donald Compton

3 Florida State University, Tallahassee, USA

4 Vanderbilt University, Nashville, USA

Richard Wagner

Erik willcutt.

5 University of Colorado Boulder, Boulder, USA

Jack M. Fletcher

Specific learning disabilities (SLD) are highly relevant to the science and practice of psychology, both historically and currently, exemplifying the integration of interdisciplinary approaches to human conditions. They can be manifested as primary conditions—as difficulties in acquiring specific academic skills—or as secondary conditions, comorbid to other developmental disorders such as Attention Deficit Hyperactivity Disorder. In this synthesis of historical and contemporary trends in research and practice, we mark the 50th anniversary of the recognition of SLD as a disability in the US. Specifically, we address the manifestations, occurrence, identification, comorbidity, etiology, and treatment of SLD, emphasizing the integration of information from the interdisciplinary fields of psychology, education, psychiatry, genetics, and cognitive neuroscience. SLD, exemplified here by Specific Word Reading, Reading Comprehension, Mathematics, and Written Expression Disabilities, represent spectrum disorders each occurring in approximately 5–15% of the school-aged population. In addition to risk for academic deficiencies and related functional social, emotional, and behavioral difficulties, those with SLD often have poorer long-term social and vocational outcomes. Given the high rate of occurrence of SLD and their lifelong negative impact on functioning if not treated, it is important to establish and maintain effective prevention, surveillance, and treatment systems involving professionals from various disciplines trained to minimize the risk and maximize the protective factors for SLD.

Fifty years ago, the US federal government, following an advisory committee recommendation ( United States Office of Education, 1968 ), first recognized specific learning disabilities (SLD) as a potentially disabling condition that interferes with adaptation at school and in society. Over these 50 years, a significant research base has emerged on the identification and treatment of SLD, with greater understanding of the cognitive, neurobiological, and environmental causes of these disorders. The original 1968 definition of SLD remains statutory through different reauthorizations of the 1975 special education legislation that provided free and appropriate public education for all children with disabilities, now referred to as the Individuals with Disabilities Education Act (IDEA, 2004). SLD are recognized worldwide as a heterogeneous set of academic skill disorders represented in all major diagnostic nomenclatures, including the Diagnostic and Statistical Manual-5 (DSM-5, American Psychiatric Association, 2013) and the International Statistical Classification of Diseases and Related Health Problems (ICD-11, World Health Organization, 2018).

In the US, the SLD category is the largest for individuals who receive federally legislated support through special education. Children are identified as SLD through IDEA when a child does not meet state-approved age- or grade-level standards in one or more of the following areas: oral expression, listening comprehension, written expression, basic reading skills, reading fluency, reading comprehension, mathematics calculation, and mathematics problem solving. Although children with SLD historically represented about 50% of the children aged 3–21 served under IDEA, percentages have fluctuated across reauthorizations of the special education law, with some decline over the past 10 years ( Figure 1 ).

The Individuals with Disabilities Education Act (IDEA), enacted in 1975 as Public Law 94–142, mandates that children and youth ages 3–21 with disabilities be provided a free and appropriate public school education in the least restricted environment. The percentage of children served by federally mandated special education programs, out of total public school enrollment, increased from 8.3 percent to 13.8 percent between 1976–77 and 2004–05. Much of this overall increase can be attributed to a rise in the percentage of students identified as having SLD from 1976–77 (1.8 percent) to 2004–05 (5.7 percent). The overall percentage of students being served in programs for those with disabilities decreased between 2004–05 (13.8 percent) and 2013–14 (12.9 percent). However, there were different patterns of change in the percentages served with some specific conditions between 2004–05 and 2013–14. The percentage of children identified with SLD declined from 5.7 percent to 4.5 percent of the total public school enrollment during this period. This number is highly variable by state: for example, in 2011 it ranged from 2.3% in Kentucky to 13.8% in Puerto Rico, as there is much variability in the procedures used to identify SLD, and disproportional demographic representation. Figure by Janet Croog.

This review is a consensus statement developed by researchers currently leading the National Institute of Child Health and Human Development (NICHD) supported Consortia of Learning Disabilities Research Centers and Innovation Hubs. This consensus is based on the primary studies we cite, as well as the meta-analytic reviews (*), systematic reviews (**), and first-authored books (***) that provide an overview of the science underlying research and practice in SLD (see references). The hope is that this succinct overview of the current state of knowledge on SLD will help guide an agenda of future research by identifying knowledge gaps, especially as the NICHD embarks on a new strategic plan. The research programs on SLD from which this review is derived represent the integration of diverse, interdisciplinary approaches to behavioral science and human conditions. We start with a brief description of the historical roots of the current view of SLD, then provide definitions as well as prevalence and incidence rates, discuss comorbidity between SLD themselves and SLD and other developmental disorders, comment on methods for SLD identification, present current knowledge on the etiology of SLD, and conclude with evidence-based principles for SLD intervention.

Three Historical Strands of Inquiry that Shaped the Current Field of SLD

Three strands of phenomenological inquiry culminated in the 1968 definition and have continued to shape current terminology and conventions in the field of SLD ( Figure 2 ). The first, a medical strand, originated in 1676, when Johannes Schmidt described an adult who had lost his ability to read (but with preserved ability to write and spell) because of a stroke. Interest in this strand reemerged in the 1870s with the publication of a string of adult cases who had lived through a stroke or traumatic brain injury. Subsequent cases involved children who were unable to learn to read despite success in mathematics and an absence of brain injury, which was termed “word blindness” ( W. P. Morgan, 1896 ). These case studies laid the foundation for targeted investigations into the presentation of specific unexpected difficulties related to reading printed words despite typical intelligence, motivation, and opportunity to learn.

A schematic timeline of the three stands of science and practice in the field of SLD. The colors represent the strands (blue—first, yellow—second, and green—third). Blue: provided phenomenological descriptions and generated hypotheses about the gene-brain bases of SLD (specifically, dyslexia or SRD); it also provided the first evidence that the most effective treatment approaches are skill-based and reflect cognitive models of the conditions. Yellow: differentiated SLD from other comorbid conditions. Green: stressed the importance of focusing on SLD in academic settings and developing both preventive and remediational evidence-based approaches to managing these conditions. Due to space constraints, the names of many highly influential scientists (e.g., Marilyn Adams, Joseph Torgesen, Isabelle Liberman, Keith Stanovich, among others) who shaped the field of SLD have been omitted. Figure by Janet Croog.

The second strand is directly related to the formalization of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). Rooted in the work of biologically oriented physicians, the 1952 first edition (DSM-I) referenced a category of chronic brain syndromes of unknown cause that focused largely on behavioral presentations we now recognize as hyperkinesis and Attention Deficit Hyperactivity Disorder (ADHD). The 1968 DSM-II defined “mild brain damage” in children as a chronic brain syndrome manifested by hyperactive and impulsive behavior with reference to a new category, “hyperkinetic reaction of childhood” if the origin is not considered “organic.” As these categories evolved, they expanded to encompass the academic difficulties experienced by many of these children.

After almost 30 years of research into this general category of “minimal brain dysfunction,” representing “... children of near average, average, or above average general intelligence with certain learning or behavioral disabilities ... associated with deviations of function of the central nervous system.” ( Clements, 1966 , pp. 9–10), the field acknowledged the heterogeneity of these children and the failure of general “one size fits all” interventions. As a result, the 1980 DSM-III formally separated academic skill disorders from ADHD. The 1994 DSM-IV differentiated reading, mathematics, and written expression SLD. The DSM-5 reversed that, merging these categories into one overarching category of SLD (nosologically distinct from although comorbid with ADHD), keeping the notion of specificity by stating that SLD can manifest in three major academic domains (reading, mathematics, and writing).

The third strand originated from the development of effective interventions based on cognitive and linguistic models of observed academic difficulties. This strand, endorsed in the 1960s by Samuel Kirk and associates, viewed SLD as an overarching category of spoken and written language difficulties that manifested as disabilities in reading (dyslexia), mathematics (dyscalculia), and writing (dysgraphia). Advances have been made in understanding the psychological and cognitive texture of SLD, developing interventions aimed at overcoming or managing them, and differentiating these disorders from each other, from other developmental disorders, and from other forms of disadvantage. This work became the foundation of the 1968 advisory committee definition of SLD, which linked this definition with that of minimal brain dysfunction via the same “unexpected” exclusionary criteria (i.e., not attributable primarily to intellectual difficulties, sensory disorders, emotional disturbance, or economic/cultural diversity).

Although its exclusionary criteria were well specified, the definition of SLD did not provide clear inclusionary criteria. Thus, the US Department of Education’s 1977 regulatory definition of SLD included a cognitive discrepancy between higher IQ and lower achievement as an inclusionary criterion. This discrepancy was viewed as a marker for unexpected underachievement and penetrated the policy and practice of SLD in the US and abroad. In many settings, the measurement of such a discrepancy is still considered key to identification. Yet, IDEA 2004 and the DSM-5 moved away from this requirement due to a lack of evidence that SLD varies with IQ and numerous philosophical and technical challenges to the notion of discrepancy (Fletcher, Lyon, Fuchs, & Barnes, 2019). IDEA 2004 also permitted an alternative inclusion criterion based on Response-to-Intervention (RTI), in which SLD reflects inadequate response to effective instruction, while the DSM-5 focuses on evidence of persistence of learning difficulties despite treatment efforts.

These three stands of inquiry into SLD use a variety of concepts (e.g., word blindness, strephosymbolia, dyslexia and alexia, dyscalculia and acalculia, dysgraphia and agraphia), which are sometimes differentiated and sometimes used synonymously, generating confusion in the literature. Given the heterogeneity of their manifestation and these diverse historical influences, it has been difficult to agree on the best way to identify SLD, although there is consensus that their core is unexpected underachievement. A source of active research and controversy is whether “unexpectedness” is best identified by applying solely exclusionary criteria (i.e., simple low achievement), inclusionary criteria based on uneven cognitive development (e.g., academic skills lower than IQ or another aptitude measure, such as listening comprehension), or evidence of persisting difficulties (DSM-5) despite effective instruction (IDEA 2004).

Manifestation, Definition, and Etiology

That the academic deficits in SLD relate to other cognitive skills has always been recognized, but the diagnostic and treatment relevance of this connection has remained unclear. A rich literature on cognitive models of SLD ( Elliott & Grigorenko, 2014 ; Fletcher et al., 2019) provides the basis for five central ideas. First, SLD are componential ( Melby-Lervåg, Lyster, & Hulme, 2012 ; Peng & Fuchs, 2016 ): Their academic manifestations arise on a landscape of peaks, valleys, and canyons in various cognitive processes, such that individuals with SLD have weaknesses in specific processes, rather than global intellectual disability ( Morris et al., 1998 ). Second, the cognitive components associated with SLD, just like academic skills and instructional response, are dimensional and normally distributed in the general population ( Ellis, 1984 ), such that understanding typical acquisition should provide insight into SLD and vice versa ( Rayner, Foorman, Perfetti, Pesetsky, & Seidenberg, 2001 ). Third, each academic and cognitive component may have a distinct signature in the brain ( Figure 3 ) and genome ( Figure 4 ). These signatures and etiologies likely overlap because they are correlated, but are not interchangeable, as their unique features substantiate the distinctness of various SLD ( Vandermosten, Hoeft, & Norton, 2016 ). Fourth, the overlap at least partially explains their rates of comorbidity ( Berninger & Abbott, 2010 ; Szucs, 2016 ; Willcutt et al., 2013 ). Fifth, deficiencies in these cognitive and academic processes appear to last throughout the lifespan, especially in the absence of intervention ( Klassen, Tze, & Hannok, 2013 ).

Results of meta-analyses of functional neuroimaging studies that exemplify the distribution of activation patterns in different reading- ( A ) and mathematics- ( B ) related networks, corresponding to componential models of the skills. A (Left panel, light blue): A lexical network in the basal occipito-temporal regions and in the left inferior parietal cortex. A (Middle panel, dark blue): A sublexical network, primarily involving regions of the left temporo-parietal lobe extending from the left anterior fusiform region. A (Right panel): Activation likelihood estimation map of foci from the word>pseudowords (light blue) and pseudowords>words (dark blue) contrasts. The semantic processing cluster is shown in green. B (Left panel): A number-processing network, primarily involving a region of the parietal lobe. B (Middle panel): An arithmetic-processing network, primarily involving regions of the frontal and parietal lobes. B (Right panel): Children (red) and adult (pink) meta-analyses of brain areas associated with numbers and calculations. Figure by Janet Croog.

A schematic representation of the genetic regions and gene-candidates linked to or associated with SRD and reading-related processes (shown in blue), and SMD and mathematics-related processes (shown in red). Dark blue signifies more studied loci and genes. Blue highlighted in red indicate the genes implicated in both SRD and SMD. Figure by Janet Croog.

The DSM-5 and IDEA 2004 reflect agreement that SLD can occur in word reading and spelling (Specific Word Reading Disability; SWRD) and in specific reading comprehension disability (SRCD). SWRD represents difficulties with beginning reading skills due at least in part to phonological processing deficits, while other language indicators (e.g., vocabulary) may be preserved ( Pennington, 2009 ). In contrast, SRCD ( Cutting et al., 2013 ), which is more apparent later in development, is associated with non-phonological language weaknesses ( Scarborough, 2005 ). The magnitude of SRCD is greater than that of vocabulary or language comprehension difficulties, suggesting that other problems, such as weaknesses in executive function or background knowledge, also contribute to SRCD ( Spencer, Wagner, & Petscher, 2018 ).

Math SLDs are differentiated as calculations (SMD) versus problem solving (word problems) SLD, which are associated with distinct cognitive deficits ( L. S. Fuchs et al., 2010 ) and require different forms of intervention ( L. S. Fuchs et al., 2014 ). Calculation is more linked to attention and phonological processing, while problem solving is more linked to language comprehension and reasoning; working memory has been associated with both. Specific written expression disability, SWED ( Berninger, 2004 ; Graham, Collins, & Rigby-Wills, 2017 ) occurs in the mechanical act of writing (i.e., handwriting, keyboarding, spelling), associated with fine motor-perceptual skills, or in composing text (i.e., planning and revising, understanding genre), associated with oral language skills, executive functions, and the automaticity of transcription skills. Although each domain varies in its cognitive correlates, treatment, and neurobiology, there is overlap. By carefully specifying the domain of academic impairment, considerable progress has been made in the treatment and understanding of the factors that lead to SLD.

Identification methods have searched for other markers of unexpected underachievement beyond low achievement, but always include exclusionary factors. Diagnosis solely by exclusion has been criticized due to the heterogeneity of the resultant groups ( Rutter, 1982 ); thus, the introduction of a discrepancy paradigm. One approach relies on the aptitude-achievement discrepancy, commonly operationalized as a discrepancy between measures of IQ and achievement in a specific academic domain. IQ-discrepancy was the central feature of federal regulations for identification from 1977 until 2004, although the approaches used to qualify and quantify the discrepancy varied in the 50 states. Lack of validity evidence ( Stuebing et al., 2015 ; Stuebing et al., 2002 ) resulted in its de-emphasis in IDEA 2004 and elimination from DSM-5.

A second approach focuses on identifying uneven patterns of strengths and weaknesses (PSW) profiles of cognitive functioning to explain observed unevenness in achievement across academic domains ( Flanagan, Alfonso, & Mascolo, 2011 ; Hale et al., 2008 ; Naglieri & Das, 1997 ). According to these methods, a student with SLD demonstrates a weakness in achievement (e.g., word reading), which correlates with an uneven profile of cognitive weaknesses and strengths (e.g., phonological processing deficits with advanced visual-spatial skills). Proponents suggest that understanding these patterns is informative for individualizing interventions that capitalize on student strengths (i.e., maintain and enhance academic motivation) and compensate for weaknesses (i.e., enhance the phonological processing needed for the acquisition and automatization of reading), but little supporting empirical evidence is available ( Miciak, Fletcher, Stuebing, Vaughn, & Tolar, 2014 ; Taylor, Miciak, Fletcher, & Francis, 2017 ). Meta-analytic research suggests an absence of cognitive aptitude by treatment interactions ( Burns et al., 2016 ), and limited improvement in academic skills based on training cognitive deficits such as working memory ( Melby-Lervåg, Redick, & Hulme, 2016 ).

Newer methods of SLD identification are linked to the development of the third historical strand, based on RTI. With RTI, schools screen for early indicators of academic and behavior problems and then progress monitor potentially at-risk children using brief, frequent probes of academic performance. When data indicate inadequate progress in response to adequate classroom instruction (Tier 1), the school delivers supplemental intervention (Tier 2), usually in the form of small-group instruction.

A child who continues to struggle requires more intensive, individualized intervention (Tier 3), which may include special education. An advantage of RTI is that intervention is provided prior to the determination of eligibility for special education placement. RTI juxtaposes the core concept of underachievement with the concept of inadequate response to instruction, that is, intractability to intervention. It prioritizes the presence of functional difficulty and only then considers SLD as a possible source of this difficulty ( Grigorenko, 2009 ). Still, concerns about the RTI approach to identification remain. One concern is that RTI approaches may not identify “high-potential” children who struggle to develop appropriate academic skills ( Reynolds & Shaywitz, 2009 ). Other concerns involve low agreement across different methods for defining inadequate RTI ( D. Fuchs, Compton, Fuchs, Bryant, & Davis, 2008 ; L. S. Fuchs, 2003 ) and challenges schools face in adequately implementing RTI frameworks ( Balu et al., 2015 ; D. Fuchs & Fuchs, 2017 ; Schatschneider, Wagner, Hart, & Tighe, 2016 ).

Prevalence and Incidence

Because the attributes of SLD are dimensional and depend on the thresholds used to subdivide normal distributions ( Hulme & Snowling, 2013 ), estimates of prevalence and incidence vary. SWRD’s prevalence estimates range from 5 to 17% ( Katusic, Colligan, Barbaresi, Schaid, & Jacobsen, 2001 ; Moll, Kunze, Neuhoff, Bruder, & Schulte-Körne, 2014 ). SRCD is less frequent ( Etmanskie, Partanen, & Siegel, 2016 ), but still represents about 42% of all children ever identified with SLD in reading at any grade ( Catts, Compton, Tomblin, & Bridges, 2012 ). Estimates of incidence and prevalence of SMD vary as well: from 4 to 8% ( Moll et al., 2014 ). Cumulative incidence rates by the age of 19 years range from 5.9% to 13.8%. Similar to SWRD, SMD can be differentiated in terms of lower- and higher-order skills and by time of onset. Computation-based SMD manifests earlier; problem-solving SMD later, sometimes in the absence of computation-based SMD ( L. S. Fuchs, D. Fuchs, C. L. Hamlett, et al., 2008 ). SWED is the least studied SLD. Its prevalence estimates range from 6% to 22% ( P. L. Morgan, Farkas, Hillemeier, & Maczuga, 2016 ) and cumulative incidence ranges from 6.9% to 14.7% ( Katusic, Colligan, Weaver, & Barbaresi, 2009 ).

Comorbidity and Co-Occurrence

One reason SLD can be difficult to define and identify is that different SLDs often co-occur in the same child. Comorbidity involving SWRD ranges from 30% ( National Center for Learning Disabilities, 2014 ) to 60% ( Willcutt et al., 2007 ). The most frequently observed co-occurrences are between (1) SWRD and SMD ( Moll et al., 2014 ; Willcutt et al., 2013 ), with 30–50% of children who experience a deficit in one academic domain demonstrating a deficit in the other ( Moll et al., 2014 ); (2) SWRD and early language impairments ( Dickinson, Golinkoff, & Hirsh-Pasek, 2010 ; Hulme & Snowling, 2013 ; Pennington, 2009 ) with 55% of individuals with SWRD exhibiting significant speech and language impairment ( McArthur, Hogben, Edwards, Heath, & Mengler, 2000 ); and (3) SWRD and internalizing and externalizing behavior problems, with 25–50% of children with SWRD meeting criteria for ADHD ( Pennington, 2009 ) and for generalized anxiety disorder and specific test anxiety, depression, and conduct problems ( Cederlof, Maughan, Larsson, D’Onofrio, & Plomin, 2017 ), although comorbid conduct problems are largely restricted to the subset of individuals with both SWRD and ADHD ( Willcutt et al., 2007 ).

The co-occurrence of SMD is less studied, but there are some consistently replicated observations: (1) individuals with SMD exhibit higher rates of ADHD, and math difficulties are observed in individuals with ADHD more frequently than in the general population ( Willcutt et al., 2013 ); (2) math difficulties are associated with elevated anxiety and depression even after reading difficulties are controlled ( Willcutt et al., 2013 ); and (3) SMD are associated with other developmental conditions such as epilepsy ( Fastenau, Shen, Dunn, & Austin, 2008 ) and schizophrenia ( Crow, Done, & Sacker, 1995 ).

SLD is clearly associated with difficulties in adaptation, in school and in larger spheres of life associated with work and overall adjustment. Longitudinal research reports poorer vocational outcomes, lower graduation rates, higher rates of psychiatric difficulties, and more involvement with the justice system for individuals with SWRD ( Willcutt et al., 2007 ). Importantly, there is evidence of increased comorbidity across forms of SLD with age, with accumulated cognitive burden ( Costa, Edwards, & Hooper, 2016 ). Individuals with comorbid SLDs have poorer emotional adjustment and school functioning than those identified with a single impairment ( Martinez & Semrud-Clikeman, 2004 ).

Identification (Diagnosis)

Comorbidity indicates that approaches to assessment should be broad and comprehensive. For SLD, the choice of a classification model directly influences the selection of assessments for diagnostic purposes. Although all three models are used, the literature (Fletcher et al., 2019) demonstrates that a single indicator model, based either on cut-off scores, other formulae, or assessment of instructional response, does not lead to reliable identification regardless of the method employed. SLD can be identified reliably only in the context of multiple indicators. A step in this direction is a hybrid method that includes three sets of criteria, two inclusionary and one exclusionary, recommended by a consensus group of researchers (Bradley, Danielson, & Hallahan, 2002). The two inclusionary criteria are evidence of low achievement (captured by standardized tests of academic achievement) and evidence of inadequate RTI (captured by curriculum-based progress-monitoring measures or other education records). The exclusionary criterion should demonstrate that the documented low achievement is not primarily attributable to “other” (than SLD) putative causes such as (a) other disorders (e.g., intellectual disability, sensory or motor disorders) or (b) contextual factors (e.g., disadvantaged social, religious, economic, linguistic, or family environment). In the future, it is likely that multi-indicator methods will be extended, with improved identification accuracy, by the addition of other indicators, neurobiological, genetic, or behavioral. It is also possible that assessment of specific cognitive processes beyond academic achievement will improve identification, but presently there is little evidence that such testing adds value to identification ( Elliott & Grigorenko, 2014 ; Fletcher et al., 2019). All identification methods for SLD assume that children referred for assessment are in good health or are being treated and that their physical health, including hearing and vision, is monitored. Currently, there are no laboratory tests (i.e., DNA or brain structure/activity) for SLD. There are also no tests that can be administered by an optometrist, audiologist, or physical therapist to diagnose or treat SLD.

Etiological Factors

Neural structure and function.

Since the earliest reports of reading difficulties, it has been assumed that the loss of function (i.e., acquired reading disability) or challenges in the acquisition of function (i.e., congenital reading disability) are associated with the brain. Functional patterns of activation in response to cognitive stimuli show reliable differences in degrees of activation between typically developing children and those identified with SWRD, and reveal different spatial distributions in relation to children identified with SMD and ADHD ( Dehaene, 2009 ; Seidenberg, 2017 ). In SWRD, there are reduced gray matter volumes, reduced integrity of white matter pathways, and atypical sulcal patterns/curvatures in the left-hemispheric frontal, occipito-temporal, and temporo-parietal regions that overlap with areas of reduced brain activation during reading.

These findings together indicate the presence of atypicalities in the structures (i.e., grey matter) that form the neural system for reading and their connecting pathways (i.e., white matter). These structural atypicalities challenge the emergence of the cognitive—phonological, orthographic, and semantic—representations required for the assembly and automatization of the reading system. Although some have interpreted the atypicalities as a product of reading instruction ( Krafnick, Flowers, Luetje, Napoliello, & Eden, 2014 ), there is also evidence that atypicalities can be observed in pre-reading children at risk for SWRD due to family history or speech and language difficulties ( Raschle et al., 2015 ), sometimes as early as a few days after birth with electrophysiological measures ( Molfese, 2000 ). What emerges in a beginning reader, if not properly instructed at developmentally important periods, is a suboptimal brain system that is inefficient in acquiring and practicing reading. This system is complex, representing multiple networks aligned with different reading-related processes ( Figure 3 ). The system engages cooperative and competitive brain mechanisms at the sublexical (phonological) and lexical levels, in which the phonological, orthographic, and semantic representations are utilized to rapidly form representations of a written stimulus. Proficient readers process words on sight with immediate access to meaning ( Dehaene, 2009 ). In addition to malleability in development, there is strong evidence of malleability through instruction in SWRD, such that the neural processes largely normalize if the intervention is successful ( Barquero, Davis, & Cutting, 2014 ).

The functional neural networks for SMD also vary depending on the mathematical operation being performed, just as the neural correlates of SWRD and SRCD do ( Cutting et al., 2013 ). Neuroimaging studies on the a(typical) acquisition of numeracy posit SMD ( Arsalidou, Pawliw-Levac, Sadeghi, & Pascual-Leone, 2017 ) as a brain disorder engaging multiple functional systems that together substantiate numeracy and its componential processes ( Figure 3 ). First, the intraparietal sulcus, the posterior parietal cortex, and regions in the prefrontal cortex are important for representing and processing quantitative information. Second, mnemonic regions anchored in the medial temporal lobe and hippocampus are involved in the retrieval of math facts. Third, additional relevant regions include visual areas implicated in visual form judgement and symbolic processing. Fourth, prefrontal areas are involved in higher-level processes such as error monitoring, and maintaining and manipulating information. As mathematical processes become more automatic, reliance on the parietal network decreases and reliance on the frontal network increases. All these networks, assembled in a complex functional brain system, appear necessary for the acquisition and maintenance of numeracy, and various aberrations in the functional interactions between networks have been described. Thus, SMD can arise as a result of disturbances in one or multiple relevant networks, or interactions among them ( Arsalidou et al., 2017 ; Ashkenazi, Black, Abrams, Hoeft, & Menon, 2013 ). There is also evidence of malleability and the normalization of neural networks with successful intervention in SMD ( Iuculano et al., 2015 ).

Genetic and environmental factors

Early case studies of reading difficulties identified their familial nature, which has been confirmed in numerous studies utilizing genetically-sensitive designs with various combinations of relatives—identical and fraternal twins, non-twin siblings, parent-offspring pairs and trios, and nuclear and extended families. The relative risk of having SWRD if at least one family member has SWRD is higher for relatives of individuals with the condition, compared to the risk to unrelated individuals; higher for children in families where at least one relative has SWRD; even higher for families where a first-degree relative (i.e., a parent or a sibling) has SWRD; and higher still for children in families where both parents have SWRD ( Snowling & Melby-Lervåg, 2016 ). Quantitative-genetic studies estimate that 30–80% of the variance in reading, math or spelling outcomes is explained by heritable factors ( Willcutt et al., 2010 ).

Since the 1980s, there have been systematic efforts to identify the sources of structural variation in the genome, i.e., genetic susceptibility loci that can account for the strong heritability and familiality of SWRD ( Figure 4 ). These efforts have yielded the identification of nine regions of the genome thought to harbor genes, or other genetic material, whose variation is associated with the presence of SWRD and individual differences in reading-related processes. Within these regions, a number of candidate genes have been tapped, but no single candidate has been unequivocally replicated as a causal gene for SWRD, and observed effects are small. In addition, multiple other genes located outside of the nine linked regions have been observed to be relevant to the manifestation of SWRD and related difficulties. Currently there are ongoing efforts to interrogate candidate genes for SWRD and connect their structural variation to individual differences in the brain system underlying the acquisition and practice of reading.

There are only a few molecular-genetic studies of SMD and its related processes ( Figure 4 ). Unlike SWRD, no “regions of interest” have been identified. Only one study investigated the associations between known single-nuclear polymorphisms (SNP) and a composite measure of mathematics performance derived from various assessments of SMD-related componential processes and teacher ratings. The study generated a set of SNPs that, when combined, accounted for 2.9% of the phenotypic variance ( Figure 4 shows the genes in which the three most statistically significant SNPs from this set are located). Importantly, when this SNP set was used to study whether the association between the 10-SNP set and mathematical ability differs as a function of characteristics of the home and school, the association was stronger for indicators of mathematical performance in chaotic homes and in the context of negative parenting.

Finally, studies have investigated the pleiotropic (i.e., impacting multiple phenotypes) effects of SWRD candidate genes on SMD, ADHD, and related processes. These effects are seemingly in line with the “generalist genes” hypothesis, asserting the pleiotropic influences of some genes to multiple SLD ( Plomin & Kovas, 2005 ).

Environmental factors are strong predictors of SLD. These factors penetrate all levels of a child’s ecosystem: culture, demonstrated in different literacy and numeracy rates around the world; social strata, captured by social-economic indicators across different cultures; characteristics of schooling, reflected by pedagogies and instructional practices; family literacy environments through the availability of printed materials and the importance ascribed to reading at home; and neighborhood and peer influences. Interactive effects suggest that reading difficulties are magnified when certain genetic and environmental factors co-occur, but there is evidence of neural malleability even in SWDE ( Overvelde & Hulstijn, 2011 ). Neural and genetic factors are best understood as risk factors that variably manifest depending on the home and school environment and child attributes like motivation.

Intervention

Although the content of instruction varies depending on whether reading, math, and/or writing are impaired, general principles of effective intervention apply across SLD i . First, intervention for SLD is explicit ( Seidenberg, 2017 ): Teachers formally present new knowledge and concepts with clear explanations, model skills and strategies, and teach to mastery with cumulative practice with ongoing guidance and feedback. Second, intervention is individualized: Instruction is formatively adjusted in response to systematic progress-monitoring data ( Stecker, Fuchs, & Fuchs, 2005 ). Third, intervention is comprehensive and differentiated, addressing the multiple components underlying proficient skill as well as comorbidity. Comprehensive approaches address the multifaceted nature of SLD and provide more complex interventions that are generally more effective than isolated skills training in reading ( Mathes et al., 2005 ) and math ( L. S. Fuchs et al., 2014 ). For example, children with SLD and ADHD may need educational and pharmacological interventions ( Tamm et al., 2017 ). Anxiety can develop early in children who struggle in school, and internalizing problems must be treated ( Grills, Fletcher, Vaughn, Denton, & Taylor, 2013 ). Differentiation through individualization in the context of a comprehensive intervention also permits adjustments of the focus of an intervention on specific weaknesses.

Fourth, intervention adjusts intensity as needed to ensure success, by increasing instructional time, decreasing group size, and increasing individualization ( L. S. Fuchs, Fuchs, & Malone, 2017 ). Such specialized intervention is typically necessary for students with SLD ( L. S. Fuchs et al., 2015 ). Yet, effective instruction for SLD begins with differentiated general education classroom instruction ( Connor & Morrison, 2016 ), in which intervention is coordinated with rather than supplanting core instruction ( L. S. Fuchs, D. Fuchs, C. Craddock, et al., 2008 ).

In addition, intervention is more effective when provided early in development. For example, intervention for SWRD was twice as effective if delivered in grades 1 or 2 than if started in grade 3 ( Lovett et al., 2017 ). This is underscored by neuroimaging research ( Barquero et al., 2014 ) showing that experience with words and numbers is needed to develop the neural systems that mediate reading and math proficiency. A child with or at risk for SWRD who cannot access print because of a phonological processing problem will not get the reading experience needed to develop the lexical system for whole word processing and immediate access to word meanings. This may be why remedial programs are less effective after second grade; with early intervention, the child at risk for SLD develops automaticity because they have gained the experience with print or numbers essential for fluency. Even with high quality intensive intervention, some children with SLD do not respond adequately, and students with persistent SLD may profit from assistive technology (e.g., computer programs that convert text-to-speech; Wood, Moxley, Tighe, & Wagner, 2018 ).

Finally, interventions for SLD must occur in the context of the academic skill itself. Cognitive interventions that do not involve print or numbers, such as isolated phonological awareness training or working memory training without application to mathematical operations do not improve reading or math skill ( Melby-Lervåg et al., 2016 ). Physical exercises (e.g., cerebellar training), optometric training, special lenses or overlays, and other proposed interventions that do not involve teaching reading or math are ineffective ( Pennington, 2009 ). Pharmacological interventions are effective largely due to their impact on comorbid symptoms, with little evidence of a direct effect on the academic skill ( Tamm et al., 2017 ).

No evaluations of recovery rate from SLD have been performed. Intervention success has been evaluated as closing the age-grade discrepancy, placing children with SLD at an age-appropriate grade level, and maintaining their progress at a rate commensurate with typical development. Meta-analytic studies estimate effect sizes of academic interventions at 0.49 for reading ( Scammacca, Roberts, Vaughn, & Stuebing, 2015 ), 0.53 for math ( Dennis et al., 2016 ), and 0.74 for writing ( Gillespie & Graham, 2014 ).

Implications for Practice and Research

Practitioners should recognize that the psychological and educational scientific evidence base supports specific approaches to the identification and treatment of SLD. In designing SLD evaluations, assessments must be timely to avoid delays in intervention; they must consider comorbidities as well as contextual factors, and data collected in the context of previous efforts to instruct the child. Practitioners should use the resulting assessment data to ensure that intervention programs are evidence-based and reflect explicitness, comprehensiveness, individualization, and intensity. There is little evidence that children with SLD benefit from discovery, exposure, or constructivist instructional approaches.

With respect to research, the most pressing issue is understanding individual differences in development and intervention from neurological, genetic, cognitive, and environmental perspectives. This research will ultimately lead to earlier and more precise identification of children with SLD, and to better interventions and long-term accommodations for the 2–6% of the general population who receive but do not respond to early prevention efforts. More generally, other human conditions may benefit from the examples of progress exemplified by the integrated, interdisciplinary approaches that underlie the progress of the past 50 years in the scientific understanding of SLD.

The Peer-reviewed Scientific and Practical Journal «Creative Cardiology»

Title: «Creative Cardiology»

Transliteration: Kreativnaya kardiologiya

The journal is published quarterly since 2007. The journal is intended to highlight the latest achievements in different sections of modern cardiology (coronary heart disease and its features in patients of different age groups, acute coronary syndrome, heart valves disorders, cardiomyopathy, etc.) and the development of interdisciplinary relations not only in the context of clinical medicine but with other fields of science as well – genetics, physiology, physics and others.

The readers are invited to consider the reviews and original articles covering the issues of diagnostics, treatment of various cardiovascular system diseases and rehabilitation of patients after surgical interventions, the descriptions of clinical cases of great practical interest.

The journal is included in the list of Russian peer-reviewed scientific periodicals recommended by the Higher Attestation Comission for the publication of basic results of Ph.D. and doctoral theses in the specialties: 3.1.15. "Cardiovascular Surgery", 3.1.18. "Internal diseases", 3.1.20. "Cardiology", 3.1.25. "Radiation diagnostics".

Each new issue of the journal for its novelty and singularity will surely be of interest to clinicians, researchers, medical teachers, post-graduate students and resident physicians.

The possibility of placing their research is provided not only to experienced scientists and practitioners, but also to young professionals who are starting their way in the specialty.

The Journal's Thematic Rubrics

• Stable ischemic heart disease
• Valvular heart disease
• Basic research in cardiology
• Imagine in cardiology
• Vessel disease
• Clinical case

Periodicity: the issues are published once in three months

ISSN 1997-3187 (Print), ISSN 2410-9169 (Online), Subscription index in Rospechat’ Agency – 36797

The journal is represented in the following databases:

• International abstract and citation database  Scopus
• Scientific Electronic Library
• The National Digital Resource "Rukont"
• Electronic library system «Lan'»
• IPR Media company group

The journal is indexed in databases:

• Russian Science Citation Index Core
• Russian Science Citation Index on the base of Web of Science
• Ulrich’s International Periodical’s Directory

The journal is distributed to all leading libraries of Russia through the Russian Book Chamber / ITAR-TASS branch.

Chief Editor

Leo A. Bockeria , MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery

Office of the Vice President for Research

Ovpr announces recipients of 2024 discovery and innovation awards.

The Office of the Vice President for Research (OVPR) is honoring 11 faculty and staff for their exceptional contributions to research, scholarship, and creative activity as part of the 2024 Discovery and Innovation Awards .

“ The winners represent the best and the brightest of our University of Iowa faculty and staff, who are making an impact across a range of disciplines,”  said Marty Scholtz, vice president for research. “Their research and scholarship enhance undergraduate and graduate education on campus, and their efforts to expand the frontiers of discovery betters our community, state, and world.”

The OVPR solicited nominations from across campus for the awards, which include: Scholar of the Year, Early Career Scholar of the Year, Leadership in Research, and awards that recognize achievement in communicating scholarship with public audiences, community engagement, arts and humanities, mentorship, research administration and safety. A campuswide event on April 30 will celebrate the winners.

Faculty Awards

Jun Wang , James E. Ashton Professor and interim departmental executive officer in the College of Engineering’s

 Department of Chemical and Biochemical Engineering, is the 2024 Scholar of the Year . The award celebrates nationally recognized recent achievement in outstanding research, scholarship, and/or creative activities. 

Wang’s research centers on the development of novel remote sensing techniques to characterize aerosols and fires from space. He serves as the University of Iowa’s lead investigator on NASA’s TEMPO, Tropospheric Emissions: Monitoring Pollution, which Time magazine named one of its best inventions of 2023. 

“Professor Wang's scholarly endeavors over the past two years stand out as a paradigm of excellence, serving as an exemplary model for both emerging and seasoned faculty members to aspire toward,” said Karim Abdel-Malek, professor of biomedical engineering and director of the Iowa Technology Institute.

James Byrne , assistant professor of radiation oncology in the Carver College of Medicine ( CCOM ), is the 2024 Early Career Scholar of the Year . The award honors assistant professors who are currently involved in research, scholarship, and/or creative activity and show promise of making a significant contribution to their field. 

As a physician scientist, Byrne continues to care for patients while developing novel biomedical therapies for cancer, finding inspiration in everything from latte foam to tardigrades. In his first two years as faculty at the UI, he has earned more that $2.5M in external research funding, including a K08 award from the NIH.

“Dr. Byrne’s scientific creativity stems from both an active and curious mind as well as his ability to bridge diverse fields from engineering to biology to medicine,” said Michael Henry, professor and interim director of the Holden Comprehensive Cancer Center. “These interdisciplinary boundaries are where some of the most interesting and important work is happening today.”

Donna Santillan , research professor and director of the Division of Reproductive Science Research in the CCOM Department of Obstetrics and Gynecology, received the Leadership in Research Award , which recognizes research and scholarly accomplishments throughout a career. 

While Santillan’s research has spanned across the field of reproductive science, she has a particular interest in the deadly diseases of pregnancy, including preeclampsia and its intergenerational effects. She designed and directs the Women’s Health Tissue Repository. Santillan’s work has been cited more than 2,700 times, and she has mentored 114 early career scientists and students, a testament to her expansive impact.

“Dr. Santillan has consistently demonstrated an unwavering commitment to fostering the professional and personal development of trainees in research, including myself,” said Banu Gumusoglu, assistant professor of obstetrics and gynecology. “Her mentorship extends beyond the confines of traditional academic settings, touching the lives of many aspiring trainees from high school through residency, clinical fellowship, and faculty levels.”

Stephen Warren , professor of history and American studies in the College of Liberal Arts and Sciences (CLAS), received the Distinguished Achievement in Publicly Engaged Research Award . The award recognizes an individual faculty member who has put addressing public needs and direct engagement with the public, in the service of improving quality of life through research, at the forefront of his or her academic activities.

A prolific scholar of Native American culture, Warren’s research has centered on the Shawnee people of Oklahoma for the past two decades. He has published four books and co-authored the most recent one , Replanting Cultures: Community-Engaged Scholarship in Indian Country, with Chief Benjamin Barnes of the Shawnee Tribe. 

“Over the last two decades, Professor Warren has established himself as a leading community-engaged scholar, and his achievements in research and publishing demonstrate that community engagement and strong scholarship are not mutually exclusive,” said Nick Benson, director of the Office of Community Engagement. “Professor Warren’s work serves as an inspiration for researchers at Iowa and nationally who seek not only to make a difference in academia, but also in our communities.”

Kaveh Akbar , associate professor of English in CLAS, received the Distinguished Achievement in Arts and Humanities Research Award . This award honors distinguished achievement in humanities scholarship and work in the creative, visual and performing arts. 

Akbar joined Iowa in 2022 to serve as the director of the English and creative writing major. In January, his new novel, Martyr!, was published to critical acclaim. Akbar previously published two prize-winning poetry collections and has served as poetry editor for The Nation  since 2021. 

“Akbar’s leadership in the profession and on campus continues: his transformative work in our department not only enriches the academic experiences of 700+ English and creative writing majors, but also enhances the profile of UI as ‘The Writing University,’” said Blaine Greteman, professor and departmental executive officer of the Department of English.

Cara Hamann , associate professor of epidemiology, received the Faculty Communicating ideas Award . This award recognizes excellence in communication about research and scholarship in the sciences and humanities and the study of creative, visual, and performing arts to a general audience directly or via print and electronic media.

Hamann has frequently shared her work on transportation issues, including teen driving, bike and scooter safety, and pedestrian safety, through peer-reviewed journals and extensive media outreach. Her recent op-ed, “The most deadly traffic policy you’ve never heard of leaves you vulnerable, too,” drew widespread attention to a legal loophole in crosswalk laws and appeared in more than 50 news outlets nationwide, including USA Today .

“Dr. Hamann’s work is not only academically rigorous but also accessible and impactful to a

wide audience,” said Diane Rohlman, associate dean for research in the College of Public Health. “Her ability to communicate with clarity, creativity, and passion coupled with her extensive media outreach, exemplifies how she utilizes multiple approaches to address transportation challenges impacting society.”

Bob McMurray , F. Wendell Miller Professor in the Department of Psychological and Brain Sciences, and Caroline Clay , assistant professor of acting in the Department of Theatre Arts, were recipients of the Office of Undergraduate Research (OUR) Distinguished Mentor Awards . The awards honors mentors’ dedication to making their students research experiences successful.

“I can’t imagine my research journey without Bob’s welcoming kindness, thriving lab community, and confident mentorship, and I am so deeply grateful for his impact on me,” said Hannah Franke, a psychology and linguistics major mentored by McMurray.

“I know I am far from the only student whose life has been impacted by Caroline Clay,” said Isabella Hohenadel, a second-year theatre arts major. “She deserves to be recognized of all of the wonderful work she does and how much she cares about us as students. I cannot think of anyone more deserving of recognition than her.”

Staff Awards

Angie Robertson , department administrator for CCOM’s Department of Microbiology and Immunology, received the Distinguished Research Administrator Award . The award recognizes staff members who performed exceptional service in support of research at the UI by exploring funding opportunities, assisting in grant proposal preparation, submission, post-award administration, and operational support. 

In addition to overseeing every aspect of daily operations for the department, Robertson manages nearly 100 research grants for the department and three longstanding NIH T32 training grants. 

“Angie plays a leading role in our department office, inspiring us to achieve all aspects of our missions ,” said Li Wu, professor and department chair. “She is innovative, collaborative, accountable, and respectful  in her daily work. She exceeds any expectations and sets a great example for staff members in the department.”

Min Zhu , research specialist in the Iowa Institute for Oral Health Research (IIOHR) within the College of Dentistry, received the Distinguished Research Professional Award . The award recognizes staff members who performed exceptional service in support of research at the UI by conducting experiments, collecting, and analyzing results and performing operational duties associated with a laboratory or research program. 

Zhu has worked as a lab bench scientist in the College of Dentistry since 2006, executing experimental work for grants and other research, working closely with IIOHR faculty members, overseeing lab maintenance and environmental health and safety efforts. 

“Beyond her research skills, Dr. Zhu has been an exceptional mentor and educator for my students and other junior researchers,” said Liu Hong, professor of prosthodontics. “Her kindness and willingness to share her knowledge have made her a beloved figure among them.”

Curtis Iberg , manager of sterilization services in the College of Dentistry, received the Innovation in Safety Award, which celebrates exceptional and ground-breaking innovations that advance safety at the UI. Iberg led a major renovation of the College of Dentistry’s instrument processing and sterilization area, with the aim of encouraging better workflow and support for future growth. 

“His innovations in workspace are a valuable asset to the greater University and demonstrates that the most important people to be involved in a space renovation are those that use the area because they can see how the facility can better function and how it can be designed for future needs,” said Kecia Leary, associate dean of clinics.

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• Published: 01 April 2024

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• Bent Petersen   ORCID: orcid.org/0000-0002-2472-8317 8 , 26 ,
• Joseph A. Tobias   ORCID: orcid.org/0000-0003-2429-6179 27 ,
• Tamás Székely   ORCID: orcid.org/0000-0003-2093-0056 28 , 29 ,
• Jonathan David Kennedy 30 ,
• Andrew Hart Reeve   ORCID: orcid.org/0000-0001-5233-6030 24 ,
• Andras Liker 31 , 32 ,
• Martin Stervander   ORCID: orcid.org/0000-0002-6139-7828 33 ,
• Agostinho Antunes   ORCID: orcid.org/0000-0002-1328-1732 34 , 35 ,
• Dieter Thomas Tietze   ORCID: orcid.org/0000-0001-6868-227X 36 ,
• Mads Bertelsen 37 ,
• Fumin Lei   ORCID: orcid.org/0000-0001-9920-8167 38 , 39 ,
• Carsten Rahbek   ORCID: orcid.org/0000-0003-4585-0300 25 , 30 , 40 , 41 ,
• Gary R. Graves   ORCID: orcid.org/0000-0003-1406-5246 30 , 42 ,
• Mikkel H. Schierup   ORCID: orcid.org/0000-0002-5028-1790 7 ,
• Tandy Warnow 43 ,
• Edward L. Braun   ORCID: orcid.org/0000-0003-1643-5212 44 ,
• M. Thomas P. Gilbert   ORCID: orcid.org/0000-0002-5805-7195 8 , 45 ,
• Erich D. Jarvis 46 , 47 ,
• Siavash Mirarab   ORCID: orcid.org/0000-0001-5410-1518 48 &
• Guojie Zhang   ORCID: orcid.org/0000-0001-6860-1521 2 , 3 , 5 , 49  

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

• Evolutionary biology
• Genome evolution
• Molecular evolution
• Phylogenetics

Despite tremendous efforts in the past decades, relationships among main avian lineages remain heavily debated without a clear resolution. Discrepancies have been attributed to diversity of species sampled, phylogenetic method, and the choice of genomic regions 1–3 . Here, we address these issues by analyzing genomes of 363 bird species 4 (218 taxonomic families, 92% of total). Using intergenic regions and coalescent methods, we present a well-supported tree but also a remarkable degree of discordance. The tree confirms that Neoaves experienced rapid radiation at or near the Cretaceous–Paleogene (K–Pg) boundary. Sufficient loci rather than extensive taxon sampling were more effective in resolving difficult nodes. Remaining recalcitrant nodes involve species that challenge modeling due to extreme GC content, variable substitution rates, incomplete lineage sorting, or complex evolutionary events such as ancient hybridization. Assessment of the impacts of different genomic partitions showed high heterogeneity across the genome. We discovered sharp increases in effective population size, substitution rates, and relative brain size following the K–Pg extinction event, supporting the hypothesis that emerging ecological opportunities catalyzed the diversification of modern birds. The resulting phylogenetic estimate offers novel insights into the rapid radiation of modern birds and provides a taxon-rich backbone tree for future comparative studies.

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• Published: 28 March 2024

Core components of end-of-life care in nursing education programs: a scoping review

• Zahra Taheri-Ezbarami 1 ,
• Fateme Jafaraghaee 1 ,
• Ali Karimian Sighlani 2 &
• Seyed Kazem Mousavi 3 , 4  

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So far, there have been many studies on end-of-life nursing care education around the world, and in many cases, according to the cultural, social, and spiritual contexts of each country, the results have been different. The present study intends to gain general insight into the main components of end-of-life care in nursing education programs by reviewing scientific texts and the results of investigations.

This study was a scoping review conducted with the Arksey and O’Malley methodology updated by Peters et al. First, a search was made in Wos, ProQuest, Scopus, PubMed, Science Direct, Research Gate, and Google Scholar databases to find studies about end-of-life care education programs. Then, the screening of the found studies was done in four stages, and the final articles were selected based on the inclusion and exclusion criteria of the studies. Due to the nature of the research, editorials, letters, and commentaries were excluded. The screening steps are shown in the PRISMA-ScR diagram.

23 articles related to end-of-life care education programs were reviewed. The studies included eleven descriptive and cross-sectional studies, two qualitative studies, eight interventional studies, one concept analysis article, and one longitudinal study. By summarizing the data from the studies, six themes were obtained as the main components of end-of-life care education: principles of end-of-life care, communication skills, physical considerations, psychosocial and spiritual considerations, ethical considerations, and after-death care.

End-of-life care is one of the most challenging nursing care in the world. Since many nurses are not prepared to provide such care, the information obtained from this review can help nursing education and treatment managers develop more comprehensive training programs to improve the quality of end-of-life care.

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Death, as an inseparable aspect of human existence, has been the subject of everyone’s concern for many years [ 1 ]. This process is a bio-psychosocial and spiritual experience that, despite significant advances in medical science and technology, there is still no way to avoid it [ 2 ]. Today, due to the increase in life expectancy and relative well-being, more people are treated in different clinical environments in the final stages of life, and most deaths occur in conditions where patients are often isolated and under mechanical ventilation. Therefore, their families are concerned about how to care for them in such environments [ 3 ]. In this period, the needs and requests of patients and companions and the stressfulness of the conditions cause avoidance of participation in care decisions, dissatisfaction of care workers, disregard for care details, and, as a result, decreased quality of care [ 4 ].

End-of-life care is a part of palliative care and includes the care of people whose disease has progressed and are approaching the end of their lives [ 5 ]. Depending on the nature of the disease, this type of care can be provided in the last year, month, week, day, and hours of a person’s life [ 4 ]. Therefore, its main difference from palliative care is that palliative care can be used at any point in the treatment process. However, end-of-life care is at the end of the treatment process and is given to people with advanced, progressive, and incurable diseases [ 5 ]. It helps them live in the best possible way when death arrives [ 6 ]. Like palliative care, end-of-life care advocates the idea of a holistic, comprehensive and patient-centred, thus often includes a wide range of interventions and dimensions such as physical, emotional, mental, psychological, spiritual and social [ 7 ]. . By performing this type of care, patients’ and their families’ support and palliative needs are identified and answered in their last life stage [ 8 ]. Usually, these cares are provided in an environment filled with emotional and moral challenges. Therefore, issues related to end-of-life care are known as one of the world’s ten most significant ethical challenges, and receiving sustainable end-of-life care with the best quality has become one of policymakers’ and health managers’ most important concerns [ 4 , 7 ].

According to the available statistics, every year in the world, about 55 million people need palliative care, and 25 million people need end-of-life care [ 9 ]. Meanwhile, as the largest group of health workers, nurses play the most essential role in end-of-life care [ 5 ]. Caring for a dying patient and comforting and comforting his family is one of the most challenging nursing experiences [ 10 ]. Nurses can have the last and most significant effects on the person’s way of life until the time of death, the customs related to the event, and the family’s final memories of death [ 11 ]. However, the findings show that most nurses, especially those working in developing countries, need more capabilities in providing palliative and end-of-life care [ 8 , 12 ]. Since most body systems are affected in the final stages of life and show abnormal performance, nursing care interventions in these patients are complex and require high theoretical knowledge and practical skills. This is even though many nurses do not receive such training in full while studying and working [ 5 , 13 ]. Failure to provide palliative and end-of-life education for nurses is not new, and many reputable nursing organizations call it a historical flaw in the nursing education program [ 14 ].

Even though more than half a century has passed since the introduction of end-of-life care into the nursing curriculum, studies show that in most countries, there are severe deficiencies in quantity and quality regarding the education of this care, especially clinically [ 15 ]. For example, the findings of a study showed that out of three million working nurses in the United States, only 600,000 of them had completed the end-of-life care course, and less than 40% had such content in the program during their education [ 16 ]. So far, various studies have been conducted regarding end-of-life care education for nurses and nursing students in clinical and academic settings. However, the void of a comprehensive study categorizing these scattered findings and providing a solid theoretical foundation for future research is felt. Therefore, the authors decided to review and organize the main components of end-of-life care in all undergraduate and graduate nursing studies, regardless of the educational environment and type of education (theoretical or clinical).

The present study was planned and implemented with this aim.

A scoping review is used to quickly review key concepts in a specific research topic and find the primary sources and types of available evidence. This method can be project-specific, especially for complex issues not comprehensively reviewed [ 17 ]. In 2005, for the first time, Arksey and O’Malley presented a framework for conducting a scoping review, which is considered and used as the main guideline of this research methodology [ 18 ]. In this study, the steps proposed by Peters et al., the updated framework version, have been used [ 19 ].

Step 1: title and review questions

A preliminary search of the peer-reviewed primary research studies helped refine the research questions. The research questions aimed to determine the main components of end-of-life care in nursing education programs. These questions were: (1) Are there any suitable studies regarding end-of-life care education programs in nursing? (2) What are the main components of these educational programs implemented for nurses and nursing students?

Step 2: inclusion criteria

The inclusion criteria included electronic studies on end-of-life care education for nurses and nursing students published in English between 2015 and 2023.

Step 3: search strategy

The search was conducted to find studies using standard keywords in Wos, ProQuest, Scopus, PubMed, Science Direct, Research Gate, and Google Scholar. The keywords were used individually or with the prepositions “AND” and “OR” based on Boolean Logic. The combination of keywords used is shown in Table  1 .

Step 4: evidence screening and selection

Based on the search strategy, 721 articles were initially obtained. Then, the studies were screened in four stages based on the inclusion criteria by two-channel teams, including researchers and an experienced research librarian (to avoid bias). In the first screening, articles unrelated to end-of-life care education programs were excluded; duplicate reports were removed in the second step. In the third screening, editorials, letters, and commentaries were excluded due to the nature of the research. In the fourth and last screening stage, articles related to the study’s title that did not provide clear findings about end-of-life care components were excluded from the study. Finally, 23 articles were included in the study. The study selection process, reported in a flow diagram, as proposed by the PRISMA-ScR diagram (Fig.  1 ).

PRISMA-ScR diagram of screening process and selection of articles

Step 5: data extraction

The data obtained from the studies were summarized in a table (Table  2 ) and written separately for each survey. These data include the author’s name (s), year of publication, country, purpose, sample size, research method, and key findings.

Step 6: data analysis

A total of 23 articles related to end-of-life care education programs were reviewed. The studies included Eleven descriptive and cross-sectional, two qualitative, eight interventional, one concept analysis, and one longitudinal. A list of essential components in end-of-life care education was prepared by gathering the data from the studies. Then, a deep examination of the data and their summarization led to the extraction of codes and, finally, the main themes related to the research question. Therefore, six main themes were obtained as the main components of end-of-life care education: principles of end-of-life care, physical considerations, communication skills, psychosocial and spiritual considerations, ethical considerations, and after-death care (Table  3 ). It should be noted that the validity of the results was ensured through peer review by two expert faculty members.

Step 7: presentation of results

Theme 1- principles of end-of-life care.

In almost all reviewed studies, one of the main components of end-of-life care education programs in nursing is familiarity with the principles of end-of-life care [ 6 , 14 , 21 , 23 , 24 , 33 , 34 ]. These studies state that things like definition and historical overview of end-of-life care should be considered at the beginning of educational programs [ 6 , 14 , 23 , 24 ]. Jeong et al. in the same context, state that according to many nurses, their position in providing end-of-life care needs to be clarified, and they have challenges in differentiating this type of care from palliative care [ 11 ]. Also, according to studies, one of the most important elements of end-of-life care education programs is to explain the concept of death with dignity [ 4 , 11 , 27 ]. Even though more than seventy years have passed since this term was mentioned in the medical literature, many nurses still need clarification in defining this concept [ 4 ].

Theme 2- communication skills

Communication skills were the main elements of many studies [ 11 , 12 , 13 , 14 , 20 , 22 , 23 , 25 , 26 , 28 , 31 , 33 , 34 ]. Good communication is essential and challenging to provide good care to a dying person [ 11 , 25 ]. A person’s needs and preferences can change quickly in their last months, weeks, and days [ 11 ]. Good communication is essential to understanding their needs so the healthcare team can meet them [ 25 , 28 , 31 ]. Moreover, it can be challenging to broach the subject of dying within families because no one wants to admit what is coming [ 20 , 22 ]. However, getting to know communication barriers and facilitators in order to open up the lines of communication and talking about death can go a long way toward relieving anxiety for both parties [ 14 ]. In the end, it should be said that effective team communication in the end-of-life stages is necessary to support the patient and the family because it guarantees the transmission of new information and programs at critical times [ 31 , 34 ].

Theme 3- physical considerations

Content related to physical considerations was included in educational programs in about two-thirds of the reviewed studies [ 6 , 8 , 12 , 14 , 21 , 23 , 24 , 25 , 26 , 28 , 29 , 31 , 32 , 33 ]. This section included pain management [ 8 , 14 , 21 , 24 , 26 , 29 , 31 , 32 , 33 ], control of disposal [ 6 , 23 , 24 , 25 , 29 ] and respiratory [ 6 , 8 , 21 , 24 , 25 , 28 , 33 ] status, skincare [ 6 , 12 , 21 , 25 , 28 , 33 ], and improvement of nutritional status [ 6 , 24 ]. Almost all patients at the end of life suffer from severe pain [ 8 ], and many of them have incontinence and skin problems [ 21 , 24 , 25 ]. In addition, dying patients are exposed to malnutrition [ 24 ]. On the one hand, due to severe diseases and serious injuries, their body’s metabolic needs have increased. On the other hand, their usual nutrition is disturbed because most are not conscious or cannot eat normally due to illness [ 6 ]. . Since the physical problems of these patients are numerous and complex, providing them with physical comfort is primarily tricky, and from the point of view of nurses, it is said to be one of the most challenging parts of end-of-life care [ 8 , 28 , 32 ].

Theme 4- psychosocial and spiritual considerations

Meeting the psychosocial and spiritual needs of the patient has been a constant part of end-of-life care education programs in many studies [ 3 , 6 , 8 , 12 , 13 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 ]. The management of emotional problems, anxiety, and depression in the patient and family is one of the essential components that was emphasized in several reviewed studies [ 3 , 6 , 12 , 25 ]. These studies stated that dealing with end-of-life psychological problems can be debilitating for the patient and overwhelming for the family [ 6 , 12 ]. In addition, most studies have emphasized that end-of-life care should be family-based while maintaining the patient’s independence as much as possible. Hence, these items were included in the educational content of the reviewed studies [ 20 , 22 , 30 ]. Also, spirituality was one of the other basic dimensions of some educational programs of the studied studies [ 3 , 8 , 13 , 19 , 25 , 31 , 32 ]. They argued that spirituality is the most personal and unknown dimension of human beings, which may change when the time of death arrives, and the nurse should be able to provide spiritual care at this critical stage [ 8 , 31 ].

Theme 5- ethical considerations

Undoubtedly, getting to know the ethical principles of end-of-life care and facing the ethical challenges of this period is one of the most complex and sensitive parts of this care. Therefore, this dimension was considered in almost all reviewed studies [ 3 , 8 , 13 , 23 , 24 , 29 , 30 , 31 , 34 ]. According to the specific nature of the job, nurses must have a complete understanding of the four principles of biomedical ethics to provide appropriate care at the end of life by observing these principles [ 3 , 8 , 23 , 30 , 31 , 33 ]. Also, sometimes, they are exposed to difficult ethical decisions at the end of life, the most important of which are advanced care planning and withholding and withdrawing treatment [ 3 , 8 , 13 , 24 , 29 , 30 , 34 ]. Therefore, they must be ready to face the complex ethical challenges of this period [ 13 ].

Theme 5- after-death care

One of the essential topics in the field of end-of-life care is after-death care, which is considered in most of the educational content of the reviewed studies [ 8 , 21 , 23 , 24 , 29 , 32 , 34 ]. The studies in this section emphasize the two issues of supporting the deceased person’s family and helping them get through the loss and grief with minimal damage [ 4 , 6 , 8 , 12 , 23 , 32 , 34 ]. The death of a family member has profound physical, psychological, emotional, social, and economic effects on other members and makes them go through the difficult stages of loss and mourning. Therefore, supporting family members is essential to end-of-life care [ 25 , 27 ]. In addition, corpse care and legal considerations after death are among the topics that have been paid attention to in the educational content of some studies [ 3 , 21 ].

This study aimed to identify the main elements of end-of-life care in nursing education programs. Based on the summary of the studies in this review, the components of end-of-life care education programs were categorized into six main axes. The first component was the need to familiarize learners with the principles of end-of-life care. Ozturk Birge et al. stated that nurses and nursing students have many questions regarding palliative care and end-of-life philosophy. They like to talk about the process of death and the subsequent mourning. Therefore, it is necessary to clarify these concepts in related educational programs [ 23 ]. Also, Cordeiro et al. stated in their study that clinical terms have administrative, clinical, and academic implications. Therefore, at the beginning of every educational program, the words and terms of that program must be clearly defined. For example, they stated that although palliative and end-of-life care are related, they are two different care areas and should be defined separately, with their differences highlighted [ 35 ]. Harden (2021) believes that accurate definitions of words and terms are necessary to prepare and organize the educational program [ 36 ]. Therefore, defining terms and stating the history and principles of end-of-life care at the beginning of related educational programs can resolve possible ambiguities and create a suitable mental base for learners and educators [ 11 , 23 ].

Another main component of end-of-life care in the reviewed studies was communication skills, which, according to Wang et al., is the fundamental pillar of this care, and the nurse’s mastery of these skills is the basis for optimal care. However, Coyle et al. stated that despite the centrality of nurses in the health care team’s communication process, only some receive formal communication training, mainly related to end-of-life care [ 37 ]. It should be noted that nurses’ communication skills are essential for patient care, as they provide the bulk of care and support to patients and their families during the illness [ 25 , 33 ]. Finally, Ekberg et al. stated that training and strengthening communication skills are vital in improving nurses’ participation in the end-of-life care of patients, and this critical issue should be included in educational programs [ 38 ].

The third component of the reviewed educational programs was the need to learn the physical care of the dying patient. In most studies, this section focused on pain management in patients. For example, in the End-of-Life Nursing Education Consortium (ELNEC) educational program, two areas of pain management and management of other symptoms were dedicated to examining the patient’s physical problems [ 8 , 29 ]. In some educational content, this part was integrated with other parts of the program [ 14 , 24 ]. Since most body systems are affected in the final stages of life, the physical needs of these patients are numerous and complex [ 5 ]. Haavisto et al. stated that although more than 90% of these patients experience severe pain at the end of life, they have other critical physical needs, such as skin, excretory, and respiratory problems that require special attention [ 38 ]. Also, in another study, Welsch et al. criticized the focus only on pain relief in dying patients and considered it against the comprehensive care approach in nursing [ 39 ].

Psychological, social, and spiritual considerations were another component of reviewing end-of-life educational programs in this study. In the psychosocial dimension, the focus of end-of-life educational programs was on managing anxiety, depression, and emotional suffering in the patient and family. In this context, Sultana et al. stated that psychosocial health is a significant concern of end-of-life care worldwide. They pointed out that patients and caregivers involved in end-of-life care may experience severe psychosocial conditions that adversely affect the quality of this care [ 40 ]. In this regard, Goode et al. also stated in their study that nurses should specialize in teaching coping skills to patients and companions so that they can manage the situation in cases of increased stress and emotional tensions [ 27 ]. On the other hand, Rosenberg et al. believed that the dying patient has emotional and psychological needs other than anxiety and depression, which should be taken care of by the nurse. They recommended that in end-of-life care, attention should be paid to the whole person instead of focusing on disease processes [ 41 ]. Providing patient-centered and family-centered care were two other dimensions of psychosocial considerations addressed in end-of-life educational programs. In this regard, O’Shea et al. emphasized that patient-centered and family-centered care is the main characteristic of a quality clinical care program and a standard care education program [ 30 ]. In most educational content reviewed, spiritual considerations were essential to end-of-life care plans. In this context, Dobrowolska et al. stated in their study that spiritual care is an inherent aspect of end-of-life care, which has been neglected in related educational programs in recent years. This issue has caused an increase in the unmet spiritual needs of these patients [ 25 ].

Ethical considerations, as the fifth component of end-of-life educational programs, were the most sensitive and challenging part of these programs. In this dimension, two issues of getting to know the ethical principles in end-of-life care and how to face the ethical challenges of this period were included in the programs. There are four universally recognized ethical principles in providing care, especially at the end of life: Autonomy, beneficence, nonmaleficence, and justice [ 23 , 30 , 31 ]. In this context, Akdeniz et al. stated that since decisions made may concern family and community members of patients as well as patients, it is essential to protect the rights, dignity, and power of all parties involved in the clinical ethical decision-making process. Therefore, when providing end-of-life care, nurses should be aware of and learn the internationally recognized ethical principles of care [ 42 ]. Deciding to withhold or withdraw treatment or advanced care planning are two of the most common end-of-life care challenges that cause ethical dilemmas [ 24 , 29 ]. Jack et al. stated that most nurses need more confidence in their knowledge and skills in fulfilling their ethical obligations in this field and feel the need for more training [ 43 ]. Also, O’Shea et al. emphasized the consideration of laws and policies of societies and countries in the design of educational programs, especially in ethical and legal aspects [ 30 ].

Along with the above factors, after-death care was recognized as the last component of end-of-life care education programs. In the same context, Mota-Romero et al. mentioned that nurses should be prepared for the events after the patient’s death during end-of-life care and be able to manage the situation appropriately [ 6 ]. Also, Hao et al. stated that since the patient’s condition deteriorates, the patient and especially his family become involved in loss and mourning, which is the peak of this phenomenon after the patient’s death. Therefore, nurses should provide the necessary support to the family to pass this stage [ 4 ]. In the end, it should be said that legal issues, especially after the patient’s death, are essential aspects of end-of-life care, knowing that nurses can provide the necessary guidance to the deceased’s family [ 3 ].

Strengths and limitations

One strength of this review was the use of an acknowledged framework for conducting scoping reviews, as described by Arksey and O’Malley [ 18 ] updated by Peters et al. [ 19 ]. Also, the reporting was supported by the PRISMA-ScR checklist [ 44 ].

Developing the search strategy and comprehensive search for published studies was done in close collaboration with an experienced research librarian, and the search strategy was discussed several times. However, some specialized studies relevant to end-of-life care educational programs may have yet to be considered. Also, no comprehensive judgment has yet to be made about the quality of the included studies, and the studies have been selected only in terms of access to evidence and answers to the current research question and not based on the strengths and weaknesses of the findings. Hence, any educational and clinical implications should be interpreted with caution. Also, some relevant studies may have been excluded due to language limitations.

End-of-life care may be considered the most complex and sensitive type of care in nursing. This is why many nurses need to prepare to provide such care. In this review, the educational content of end-of-life care was reviewed in different studies and classified into six main components. The information obtained from this review can help nursing education and treatment managers develop more comprehensive training programs to improve the quality of end-of-life care. What the researchers felt during the study was the limitation of the studies conducted in this field despite the importance of the subject. It is hoped that more rich findings will be reported in this field in the coming years to obtain a comprehensive and accurate framework for end-of-life care.

Data availability

Data used in this manuscript consist of published articles which cannot be shared by the authors for copyright reasons but are available through subscription to the relevant journals/databases.

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Acknowledgements

We would like to acknowledge librarian Ramin Soulati for peer reviewing our search strategy.

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ZTE and SKM designed the study. FJ developed the database search strategy in collaboration with the other authors. ZTE and SKM collected and extracted data. Data analysis was conducted by SKM, with critical review by FJ and AKS. SKM drafted the manuscript, ZTE and FJ reviewed. ZTE, FJ, and AKS approved the final version. The author(s) read and approved the final manuscript.

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Taheri-Ezbarami, Z., Jafaraghaee, F., Sighlani, A.K. et al. Core components of end-of-life care in nursing education programs: a scoping review. BMC Palliat Care 23 , 82 (2024). https://doi.org/10.1186/s12904-024-01398-3

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Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review

• Jeongok Park   ORCID: orcid.org/0000-0003-4978-817X 1 ,
• Sang Bin You   ORCID: orcid.org/0000-0002-1424-4140 2 ,
• Gi Wook Ryu   ORCID: orcid.org/0000-0002-4533-7788 3 &
• Youngkyung Kim   ORCID: orcid.org/0000-0002-3696-5416 4  

Systematic Reviews volume  12 , Article number:  230 ( 2023 ) Cite this article

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Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature.

This scoping review was conducted using the framework proposed by Arksey and O’Malley and PRISMA-ScR. Overall, four databases—PubMed, Web of Science, EMBASE, and CINAHL—were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar.

A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs.

Conclusions

Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system.

Peer Review reports

Medication errors are closely associated with patient safety and the quality of care [ 1 , 2 ]. In particular, medication errors, which denote a clinical issue of global importance for patient safety, negatively affect patient morbidity and mortality and lead to delays in discharge [ 3 , 4 ]. The National Health Service in the UK estimates that 237 million medication errors occur each year, of which 66 million cause clinically significant harm [ 5 ]. The US Food and Drug Administration reported that they received more than 100,000 reports each year associated with suspected medication errors [ 6 ]. Additionally, it was estimated that 40,000–98,000 deaths per year in the USA could be attributed to errors by healthcare providers (HCPs) [ 7 ]. Previous studies have revealed that medication errors account for 6–12% of hospital admissions [ 8 ].

Intravenous (IV) medication is a common treatment in hospitalized patient care [ 9 ]. It is used in wards, intensive care units (ICUs), emergency rooms, and outpatient clinics in hospitals [ 9 , 10 ]. As direct HCPs, nurses are integral in patient safety during the IV medication process which could result in unintended errors or violations of recommendations [ 3 ]. As many drugs injected via the IV route include high-risk drugs, such as chemotherapy agents, insulin, and opioids [ 10 ], inappropriate dose administration could lead to adverse events (AEs), such as death and life-threatening events [ 11 , 12 ].

IV medication process is a complex and multistage process. There are 12 stages in the IV medication process, which can be classified as follows: (1) obtain the drug for administration, (2) obtain the diluent, (3) reconstitute the drug in the diluent, (4) take the drug at the patient’s bedside, (5) check for the patient’s allergies, (6) check the route of drug administration, (7) check the drug dose, (8) check the patency of the cannula, (9) expel the air from the syringe, (10) administer the drug, (11) flush the cannula, and (12) sign the prescription chart [ 13 ]. IV medication errors can occur at any of these stages. It is imperative to administer the drug at the correct time and rate during the IV medication process [ 13 ]. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defined an error in IV medication rates as “too fast or too slow rate than that intended” [ 14 ]. Maintaining the correct rate of IV medication is essential for enhancing the effectiveness of IV therapy and reducing AEs [ 9 ].

Infusion pumps are devices designed to improve the accuracy of IV infusions, with drug flow, volume, and timing programmed by HCPs [ 15 ]. A smart pump is an infusion pump with a software package containing a drug library. During programming, the smart pump software warns users about entering drug parameters that deviate from the recommended parameters, such as the type, dose, and dosage unit of the drug [ 15 ]. In the absence of a device for administering IV medication, such as an infusion pump or smart pump, the IV rate is usually controlled by counting the number of fluid drops falling into the drip chamber [ 9 ].

According to the previous study, applying an incorrect rate was the most prevalent IV medication error, accounting for 536 of 925 (57.9%) total IV medication errors [ 16 ]. Although rate control of IV medications is critical to patient safety and quality care, few studies review and map the relevant literature on rate control of IV medications. Therefore, this study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing the existing literature.

The specific research questions of this study are as follows:

What are the general characteristics of the studies related to rate control of IV medications?

What are the attributes of errors associated with rate control of IV medications?

What are the facilitators and barriers to rate control of IV medications?

This scoping review followed the framework suggested by Arksey and O’Malley [ 17 ] and developed by Levac et al. [ 18 ] and Peters et al. [ 19 ]. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) developed in 2020 by the Joanna Briggs Institute (JBI) were used to ensure reliability in the reporting of methodology (Additional file 1 ) [ 19 ].

Search strategy

According to the JBI Manuals for Evidence Synthesis, a three-step search strategy was adopted [ 19 ]. First, a preliminary search in PubMed was conducted based on the title, abstract, keywords, and index terms of articles to develop our search strategy. In the preliminary search, we used keywords such as “patients,” “nurse,” “IV therapy,” “monitoring,” “rate,” and “medication error.” The search results indicated that studies on medical devices and system-related factors were excluded. Therefore, we decided to exclude the keywords “patients” and “nurse” and focus on “IV therapy,” “monitoring,” “rate,” and “medication error” to comprehensively include studies on factors associated with rate control of infusion medications. Secondly, we used all identified keywords and index terms across all included databases following consultations with a research librarian at Yonsei University Medical Library to elaborate our search strategy. Four databases—PubMed, CINAHL, EMBASE, and Web of Science—were searched using the keywords, index terms, and a comprehensive list of keyword variations to identify relevant studies published before January 2023. The details of the search strategy are described in Additional file 2 . All database search results were exported into Endnote version 20. Finally, we manually searched the reference lists of the included articles identified from the database search. Furthermore, we manually searched two journals related to medication errors and patient safety, and Google Scholar to comprehensively identify the relevant literature. When performing a search on Google Scholar, keywords such as “medication,” “rate,” “IV therapy,” “intravenous administration,” and “medication error” were appropriately combined using search modifiers.

Eligibility criteria

Inclusion criteria were established according to the participants, concept, and context (PCC) framework recommended by the JBI manuals for scoping reviews [ 19 ]. The participants include patients receiving IV therapy, HCPs involved in administering IV medications, and experts from non-healthcare fields related to rate control of IV medications. The concepts were facilitators and barriers to rate control of IV medications, and the contexts were the environments or situations in which errors in rate control of IV medications occurred. While screening the literature identified by the three-step search based on the inclusion criteria, we refined the exclusion criteria through discussion among researchers. The exclusion criteria were as follows: (1) not available in English, (2) not an original article, (3) studies of medication errors in general, (4) not accessible, or (5) prescription error.

Study selection

Once duplicates were automatically removed through Endnote, two independent researchers assessed the eligibility of all articles by screening the titles and abstracts based on the inclusion and exclusion criteria. Studies identified via database searches were screened by GWR and YK and studies identified via other methods were screened by SBY and YK. Full-text articles were obtained either when the studies met the inclusion criteria or when more information was needed to assess eligibility and the researchers independently reviewed the full-text articles. In case of any disagreement in the study selection process, a consensus was reached through discussion among three researchers (GWR, SBY, and YK) and a senior researcher (JP).

Data extraction

Through consensus among the researchers, a form for data extraction was developed to extract appropriate information following the JBI manuals for scoping reviews [ 19 ]. The following data were collected from each study: author information, publication year, country, study design, study period, aims, participants or events (defined as the occurrences related to patient care focused on in the study), contexts, methods, errors related to the control of IV medications (observed results or intervention outcomes), error severity, facilitators, and barriers according to the NCC MERP criteria. Three researchers (GWR SBY, and YK) independently conducted data charting and completed the data extraction form through discussion.

Data synthesis

The general characteristics of included studies such as publication year, country, study design, and study period were analyzed using descriptive statistics to identify trends or patterns. The aims, participants, events, contexts, and methods of the included studies were classified into several categories through a research meeting including a senior researcher (JP) to summarize and analyze the characteristics of the included studies comprehensively. Attributes of errors associated with rate control of IV medications were analyzed and organized through consensus among researchers based on extracted data. Facilitators and barriers to rate control of IV medications were independently classified according to NCC MERP criteria by three researchers (GWR, SBY, and YK) and iteratively modified. Discrepancies were resolved by discussion and re-reading the articles, with the final decision made in consultation with the senior researcher (JP).

A total of 1211 studies were selected through a database search. After reviewing the titles and abstracts of the studies, 42 studies were considered for a detailed assessment by the three researchers. In particular, 2 were not available in English, 3 were not original articles, 24 were studies of medication error in general without details on rate control of IV medications, 2 were regarding prescription errors, and 1 was not accessible. Finally, 10 studies were identified through a database search. Additionally, 23 studies were identified from a manual search. Among the 23, 5 were not original articles, and 6 were studies on medication error in general. Finally, 12 studies were identified via other methods. Hence, 22 studies were included in the data analysis (Fig.  1 , Additional file 3 ).

PRISMA flow chart for literature selection

Characteristics of the studies

General characteristics.

Table 1 presents the general characteristics of the included studies. Two of the included studies had a publication year before 2000 [ 20 , 21 ], and more than half of the studies ( n  = 15) were published in 2010 and later. A majority of the included studies were conducted in Western countries ( n  = 15) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], four were conducted in Asia [ 20 , 37 , 38 , 39 ], two were conducted in Australia [ 21 , 40 ], and one was conducted in Egypt [ 2 ]. In terms of the study design, most studies were project studies ( n  = 7) [ 22 , 24 , 27 , 28 , 30 , 34 , 39 ] or prospective observational studies ( n  = 5) [ 2 , 20 , 29 , 32 , 40 ], followed by retrospective studies ( n  = 3) [ 21 , 25 , 35 ], qualitative or mixed-methods studies ( n  = 3) [ 23 , 26 , 33 ], and descriptive cross-sectional studies ( n  = 2) [ 36 , 38 ]. Additionally, there was one controlled pre-posttest study [ 37 ] and one simulation laboratory experiment study [ 31 ]. The study period also varied greatly from 2 days [ 32 ] to 6 years [ 25 ].

The aims of the included studies were divided into two main categories. First, 13 studies identified the current status, causes, and factors influencing errors that could occur in healthcare settings [ 2 , 20 , 21 , 23 , 25 , 26 , 29 , 32 , 33 , 35 , 36 , 38 , 40 ]. Among these, three studies were on errors that may occur in specific healthcare procedures, such as anesthesia [ 20 ], vascular access [ 21 ], and pediatric chemotherapy [ 25 ]. Additionally, three studies explored possible errors associated with specific settings and medications, such as an obstetric emergency ward [ 2 ], cardiac critical care units [ 38 ], and high-alert medications [ 36 ], and three studies investigated the errors associated with the overall IV medication preparation or administration [ 23 , 33 , 40 ]. Moreover, three studies aimed at identifying potential problems associated with the use of IV medication infusion devices [ 26 , 32 , 35 ], and one study was about errors in medication preparation and administration that could occur in a setting using a specific system connected to electronic medical records [ 29 ]. Second, nine studies described the procedure of developing interventions or identified the effect of interventions [ 22 , 24 , 27 , 28 , 30 , 31 , 34 , 37 , 39 ].

Participants and events

Participants in the 22 studies included HCPs such as nurses, doctors, pharmacists, and patients. Notably, four of these studies were only for nurses [ 31 , 37 , 38 , 40 ] and there was also one study involving only pharmacists [ 36 ]. Furthermore, there were five studies wherein people from various departments or roles participated [ 23 , 26 , 27 , 28 , 39 ]. There were three studies wherein the patients were participants, and two studies included both patients and medical staff [ 29 , 33 ].

Among the included studies, nine studies focused on errors in IV medication preparation and administration as events [ 23 , 26 , 30 , 32 , 33 , 34 , 37 , 38 , 40 ] and five studies focused on the administration process only [ 30 , 32 , 34 , 37 , 40 ]. Four studies focused on problems in the administration of all types of drugs including errors associated with rate control of IV medications [ 2 , 22 , 28 , 29 ]. Additionally, four studies focused on events that occurred with IV medication infusion devices [ 24 , 27 , 35 , 39 ], two studies explored the events that occurred during chemotherapy [ 22 , 25 ], and some analyzed events with problems in vascular access [ 21 ], iatrogenic events among neonates [ 28 ], and critical events in anesthesia cases [ 20 ].

Contexts and methods

The contexts can be largely divided into healthcare settings, including hospitals and laboratory settings. Three hospital-based studies were conducted in the entire hospital [ 20 , 22 , 24 ], eight studies were conducted at several hospitals, and the number of hospitals involved varied from 2 to 132 [ 23 , 26 , 32 , 33 , 34 , 35 , 38 , 40 ]. Furthermore, four studies were conducted in different departments within one hospital [ 29 , 30 , 37 , 39 ], three studies were conducted in only one department [ 2 , 27 , 28 ], two studies considered other healthcare settings and were not limited to hospitals [ 21 , 25 ], and one study was conducted in a simulation laboratory setting that enabled a realistic simulation of an ambulatory chemotherapy unit [ 31 ].

Specifically, seven out of the nine studies developed or implemented interventions based on interdisciplinary or multidisciplinary collaboration [ 22 , 24 , 28 , 30 , 34 , 37 , 39 ]. Two studies developed and identified the effectiveness of interventions that created an environment for nurses to improve performance and correct errors associated with medication administration [ 31 , 39 ], and two intervention studies were on error reporting methods or observation tools and the processes of addressing reported errors [ 28 , 30 ]. There were also a study on a pharmacist-led educational program for nurses [ 37 ], a comprehensive intervention from drug prescription to administration to reduce chemotherapy-related medication errors [ 22 ], infusion safety intervention bundles [ 34 ], the implementation of a smart IV pump equipped with failure mode and effects analysis (FMEA) [ 24 ], and a smart system to prevent pump programming errors [ 27 ].

Data collection methods were classified as a review of reported incidents [ 20 , 21 , 22 , 25 , 35 ], a review of medical charts [ 26 ], observations [ 23 , 29 , 30 , 31 , 32 , 33 , 34 , 37 , 40 ], follow-up on every pump alert [ 27 ], and self-reporting questionnaires or surveys [ 36 , 38 ]. Some studies utilized retrospective reviews of reported incidents and self-report questionnaires [ 39 ]. Also, in the study by Kandil et al., observation, nursing records review, and medical charts review were all used [ 2 ].

Attributes of errors associated with rate control of IV medications

Table 2 presents the attributes of errors related to rate control of IV medications in observed results or intervention outcomes, and error severity. Notably, 6 of 13 studies presenting observed results reported errors related to IV medication infusion devices among the rate control errors [ 20 , 25 , 32 , 33 , 35 , 36 ]. Additionally, four studies reported errors in bolus dose administration or IV push and flushing lines among IV rate errors [ 2 , 23 , 36 , 40 ]. Among the 13, nine studies reported error severity, and among these, three studies used NCC MERP ratings [ 25 , 32 , 33 ]. In four studies, error severity was reported by describing several cases in detail [ 2 , 21 , 23 , 25 ], and two studies reported no injuries or damages due to errors [ 26 , 29 ]. Among the nine studies that developed interventions and identified their effectiveness, four presented the frequency of incorrect rate errors as an outcome variable [ 28 , 30 , 34 , 37 ]. Moreover, two studies suggested compliance rates for intervention as outcome variables [ 24 , 31 ].

Among the nine project or experiment studies, three showed a decrease in error rate as a result of the intervention [ 28 , 31 , 34 ]. Three studies developed interventions to reduce rate errors but did not report the frequency or incidence of rate errors [ 22 , 24 , 27 ]. A study reported the frequency of rate errors only after the intervention; the effect of the intervention could not be identified [ 30 ]. Also, three studies showed the severity of errors related to rate control of IV medications [ 24 , 30 , 34 ], two used NCC MERP severity ratings [ 30 , 34 ], and one reported that all errors caused by smart IV pumps equipped with FMEA resulted in either temporary harm or no harm [ 24 ].

Facilitators and barriers to rate control of IV medications

Table 3 presents the facilitators and barriers related to rate control of IV medications according to the NCC MERP taxonomy based on the 22 included studies. Sub-categories of human factors were classified as knowledge deficit, performance deficit, miscalculation of dosage or infusion rate, and stress. The sub-category of design factor was device. System-related contributing factors were classified as frequent interruptions and distractions, inadequate training, poor assignment or placement of HCPs or inexperienced personnel, policies and procedures, and communication systems between HCPs [ 14 ].

Human factors

Among the barriers extracted from the 22 studies, 11 factors belonged to the “knowledge deficit,” “performance deficit,” “miscalculation of dosage or infusion rate,” and “stress (high-volume workload)” in this category. Half of these factors are related to the “performance deficit.” Barriers identified in two or more studies were tubing misplacement [ 24 , 35 ] and non-compliance with protocols and guidelines [ 2 , 25 ], all of which belonged to the “performance deficit.” Additionally, the high workload and environmental characteristics of the ICU, which corresponded to the “stress,” were also identified as barriers to rate control of IV medications [ 23 , 37 ].

Most factors in this category were related to IV medication infusion devices such as infusion pumps and smart pumps. In the study by Lyons et al., the use of devices, such as patient-controlled analgesia pumps and syringe drivers, was a facilitator of rate control of IV medications [ 33 ]. In addition to the use of these devices, the expansion of capabilities [ 26 ], monitoring programming [ 27 ], and standardization [ 22 ] were also facilitators. Unexpected equipment faults, a barrier, were identified in five studies [ 2 , 20 , 25 , 35 , 38 ]. Moreover, the complex design of the equipment [ 23 , 24 ] and incomplete drug libraries in smart pumps [ 33 , 35 ] were identified in two studies each. Factors such as the misassembly of an unfamiliar infusion pump [ 21 ] and smart pumps not connected to electronic systems [ 30 ] were also barriers.

Contributing factors (system related)

The factors belonging to the “frequent interruptions and distractions” in this category were all barriers. Specifically, running multiple infusions at once [ 24 , 27 ], air-in-line alarms, or cleaning air [ 24 ] were identified as barriers. Among the facilitators of the “training,” there were education and training on the use of smart IV pumps [ 24 ] and chemotherapy errors [ 22 ]. There are two factors in the “assignment or placement of a HCP or inexperienced personnel,” where ward-based pharmacists were facilitators [ 36 ], but nurses with less than 6 years of experience were barriers [ 40 ]. The sub-category with the most factors was “policies and procedures,” where the facilitators extracted in the four studies were double-checks through the process [ 22 , 24 , 28 , 36 ]. Among the barriers, two were related to keep-the-vein-open, which was identified in three studies [ 30 , 32 , 33 ]. The lack of automated infusion pumps [ 2 ], the absence of culture for use [ 32 , 33 ], and problems in the drug prescription process [ 33 ] were also identified as barriers. Communication with physicians in instances of doubt identified was the only identified facilitator in the “communication systems between HCPs” [ 28 ].

Resolutions for the barriers to rate control of IV medications

Table 4 presents the resolutions for the barriers to rate control of IV medications in the included studies. The suggested resolutions primarily belonged to the “contributing factors (system-related)” category. Resolutions in the “human factors” category were mainly related to the knowledge and performance of individual healthcare providers, and there were no studies proposing resolutions specifically addressing stress (high-volume workload), which is one of the barriers. Resolutions in the “design” category focused on the development [ 26 , 30 ], appropriate use [ 24 , 33 ], evaluation [ 26 ], improvement [ 24 , 26 , 30 ], and supply [ 23 ] of infusion pumps or smart pumps. Resolutions addressing aspects within the “contributing factors (system-related)” category can be classified into six main areas: interdisciplinary or inter-institution collaboration [ 23 , 25 , 28 , 30 , 34 , 35 , 36 , 37 ], training [ 24 , 37 , 40 ], implementation of policies or procedures [ 29 , 31 , 34 , 35 , 37 , 39 ], system improvement [ 25 , 30 , 32 ], creating a patient safety culture [ 25 , 37 , 38 ], and staffing [ 2 , 38 ].

This scoping review provides the most recent evidence on the attributes of errors, facilitators, and barriers related to rate control of IV medications. The major findings of this study were as follows: (1) there were a few intervention studies that were effective in decreasing the errors related to rate control of IV medications; (2) there was limited research focusing on the errors associated with IV medication infusion devices; (3) a few studies have systematically evaluated and analyzed the severity of errors associated with rate control of IV medications; and (4) the facilitators and barriers related to rate control of IV medications were identified by NCC MERP taxonomy as three categories (human factors, design, and system-related contributing factors).

Among the nine project or experiment studies, only two interventions showed statistically significant effectiveness for IV rate control [ 28 , 31 ]. Six studies did not report the specific statistical significance of the intervention [ 22 , 24 , 27 , 30 , 37 , 39 ], and one study found that the developed intervention had no statistically significant effect [ 34 ]. In another study, administration errors, including rate errors, increased in the experimental group and decreased in the control group [ 37 ]. IV rate control is a major process in medication administration that is comprehensively related to environmental and personal factors [ 3 , 41 ]. According to previous studies, interdisciplinary or multidisciplinary cooperation is associated with the improvement in patient safety and decreased medical errors [ 42 , 43 , 44 ]. Seven of the included studies were also project or experiment studies that developed interventions based on an interdisciplinary or multidisciplinary approach [ 22 , 24 , 28 , 30 , 34 , 37 , 39 ]. Additionally, an effective intervention was developed by a multidisciplinary care quality improvement team [ 28 ]. Therefore, it is crucial to develop effective interventions based on an interdisciplinary or multidisciplinary approach to establish practice guidelines with a high level of evidence related to IV rate control.

Of the 22 included studies, three identified potential problems associated with the use of IV medication infusion devices [ 26 , 32 , 35 ], and four described the application of interventions or explored the effects of the intervention developed to reduce errors that occur when using IV medication infusion devices [ 24 , 27 , 34 , 39 ]. IV medication infusion devices, such as infusion pumps and smart pumps, are widely used in healthcare environments and allow more rigorous control in the process of administering medications that are continuously infused [ 45 ]. Smart pumps are recognized as useful devices for providing safe and effective nursing care [ 15 ]. However, the use of IV medication infusion devices requires an approach different from traditional rate monitoring by counting the number of fluid drops falling into the drip chamber [ 9 ]. However, there exist many problems, such as bypassing the drug library, device maintenance, malfunction, tubing/connection, and programming in the use of IV medication infusion devices [ 32 , 35 ]. None of the four studies that described the application of interventions or explored the effects of the intervention demonstrated statistically significant effects. All four studies had no control group [ 24 , 27 , 34 , 39 ] and two studies had only post-test designs [ 24 , 27 ]. Therefore, further research needs to be conducted to analyze errors in rate control related to IV medication infusion devices and develop effective interventions.

A few studies have systematically evaluated and analyzed the severity of errors associated with rate control of IV medications. Among the 12 studies that reported the severity of errors associated with rate control of IV medications, five studies used NCC MERP, an internationally validated and reliable tool for assessing error severity, and one study used the Severity Assessment Code (SAC) developed by the New South Wales Health Department. Six studies did not use tools to assess error severity. The term “error severity” means the degree of potential or actual harm to patients [ 46 ]. Evaluating the severity of medication errors is a vital point in improving patient safety throughout the medication administration process. This evaluation allows for distinguishing errors based on their severity to establish the development of risk mitigation strategies focused on addressing errors with the great potential to harm patients [ 47 , 48 ]. Specifically, errors associated with rate control of IV medications were categorized as A to E on the NCC MERP and to groups 3 and 4 on the SAC. Additionally, errors associated with rate control of IV medications caused direct physical damage [ 2 , 21 ] and necessitated additional medication to prevent side effects or toxicity [ 23 ]. Therefore, as errors in rate control of IV medications are likely to cause actual or potential harm to the patient, research systematically evaluating and analyzing error severity should be conducted to provide the basis for developing effective risk reduction strategies in the rate control of IV medications.

Facilitators and barriers were identified as human, design, and system-related contributing factors. Among the human factors, “performance deficit” included failure to check equipment properly, tubing misplacement, inadequate monitoring, non-compliance with protocols and guidelines, and human handling errors with smart pumps. Nurses play a major role in drug administration; thus, their monitoring and practices related to IV medication infusion devices can influence patient health outcomes [ 3 , 49 ]. A major reason for the lack of monitoring was overwork, which was related to the complex working environment, work pressure, and high workload [ 3 , 11 , 49 ]. Moreover, two of the included studies identified high workload as a barrier to rate control of IV medications [ 23 , 37 ]. Therefore, to foster adequate monitoring of rate control of IV medications, a systematic approach to alleviating the complex working environment and work pressure should be considered.

Most facilitators and barriers in the devices category were related to IV medication infusion devices. In particular, expanding pump capabilities [ 26 ], monitoring pump programming [ 27 ], standardization [ 22 ], and using a pump [ 33 ] can facilitate rate control of IV medications. However, unexpected equipment faults are significant barriers, as identified in five studies among the included studies [ 2 , 20 , 25 , 35 , 38 ]. Moreover, the design [ 23 , 24 ], user-friendliness [ 21 ], connectivity to electronic systems [ 30 ], and completeness of drug libraries [ 33 , 35 ] are factors that can affect rate control of IV medications. Therefore, it is important to improve, monitor, and manage IV medication infusion devices so that they do not become barriers. Moreover, because rate errors caused by other factors can be prevented by devices, active utilization and systematic management of devices at the system level are required.

Although there are many benefits of infusion and smart pumps for reducing errors in rate control of IV medications, they cannot be used in all hospitals because of the limitation of medical resources. The standard infusion set, which is a device for controlling the rate of IV medication by a controller [ 9 ], is widely used in outpatient as well as inpatient settings [ 32 ]. Devices for monitoring the IV infusion rate, such as FIVA™ (FIVAMed Inc, Halifax, Canada) and DripAssist (Shift Labs Inc, Seattle, USA), which can continuously monitor flow rate and volume with any gravity drip set, have been commercialized [ 33 ]. However, they have not been widely used in hospitals. Therefore, developing novel IV infusion rate monitoring devices that are simple to use, can be used remotely, and are affordable for developing and underdeveloped countries can help nurses to reduce their workloads in monitoring IV infusion rates and thus maintain patient safety.

Most facilitators and barriers were system-related contributing factors, most of which belonged to the “policies and procedures.” In four studies, the absence of hospital policies or culture related to rate control of IV medications was identified as a barrier [ 2 , 30 , 32 , 33 ]. Medication errors related to incorrect rate control are problems that should be approached from macroscopic levels, such as via institutional policies and safety cultures. Therefore, large-scale research including more diverse departments and institutions needs to be conducted.

The second most common categories in system-related contributing factors were “frequent interruptions and distractions” and “training.” Although nurses experienced frequent interruptions and distributions during work, only one of the included studies was on interventions that were developed to create an environment with reduced interruptions [ 31 ]. Additionally, four studies found that education for nurses who are directly associated with medication administration is mandatory [ 22 , 23 , 24 , 36 ]. Therefore, education and a work environment for safety culture should be created to improve IV rate control.

Based on resolutions for barriers to rate control of IV medications, key groups relevant to rate control of IV medications include HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices. HCPs directly involved in the preparation and administration of IV medications need to enhance their knowledge of drugs, raise awareness for the importance of rate control of IV medications, and improve performance related to IV infusion device monitoring. Engineers specializing in IV medication infusion devices should develop these devices by integrating various information technologies used in clinical settings. Additionally, they should identify issues related to these devices and continuously enhance both software and hardware. Healthcare administrators play a crucial role in establishing and leading interdisciplinary or inter-institution collaborations. They should foster leadership, build a patient safety culture within the organization, and implement training, interventions, and policies for correct rate control of IV medications. Decreasing medication errors, including errors in IV rate control, is closely linked to the various key groups [ 50 , 51 , 52 , 53 ], and multidisciplinary collaboration is emphasized for quality care [ 54 , 55 , 56 , 57 ]. Therefore, each key group should perform its role and cooperate for appropriate IV rate control within a structured system.

This review has some limitations that should be considered. As there was no randomized controlled trial in this review, the causal relationship between wrong rate errors and their facilitators or barriers could not be determined. Moreover, only limited literature may have been included in this review because we included literature published in English and excluded gray literature. Since we did not evaluate the quality of the study, there may be a risk of bias in data collection and analysis. Despite these limitations, this study provides a meaningful assessment of published studies related to rate control of IV medications. This contribution will provide an important basis for new patient safety considerations in IV medication administration when determining future policies and device development.

The findings of this review suggest that further research is needed to be conducted to develop effective interventions to improve the practice of IV rate control. Moreover, given the rapid growth of technology in medical settings, research on IV medication infusion devices should be conducted. Additionally, to establish effective risk reduction strategies, it is necessary to systematically evaluate and analyze the severity of errors related to the rate control of IV medications. Several facilitators and barriers to rate control of IV medications were identified in this review to ensure patient safety and quality care, interventions and policy changes related to education and the work environment are required. Additionally, the development of a device capable of monitoring the flow of IV medication is necessary. This review will be useful for HCPs, hospital administrators, and engineers specializing in IV medication infusion devices to minimize errors in rate control of IV medications and improve patient safety.

Availability of data and materials

The corresponding author can provide the datasets that were utilized and/or examined during the present study upon reasonable request.

Abbreviations

Adverse event

Healthcare provider

Intensive care unit

Intravenous

Joanna Briggs Institute

The National Coordinating Council for Medication Error Reporting and Prevention

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L Naseralallah D Stewart M Price V Paudyal 2023 Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review Int J Clin Pharm https://doi.org/10.1007/s11096-023-01626-5

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This research was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: RS-2020-KD000077) and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (No. 2020R1A6A1A03041989). This work also supported by the Brain Korea 21 FOUR Project funded by National Research Foundation (NRF) of Korea, Yonsei University College of Nursing.

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Jeongok Park

University of Pennsylvania School of Nursing, Philadelphia, PA, USA

Sang Bin You

Department of Nursing, Hansei University, 30, Hanse-Ro, Gunpo-Si, 15852, Gyeonggi-Do, Korea

Gi Wook Ryu

College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea

Youngkyung Kim

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Conceptualization: JP; study design: JP; data collection: GWR, YK, SBY; data analysis: JP, GWR, YK, SBY; administration: JP; funding acquisition: JP; writing—original draft: JP, GWR, YK; writing—review and editing: JP, YK.

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Additional file 1:.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

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Search queries and strategies by electronic databases.

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Studies included in the data analysis.

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Park, J., You, S.B., Ryu, G.W. et al. Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review. Syst Rev 12 , 230 (2023). https://doi.org/10.1186/s13643-023-02386-z

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Received : 15 May 2023

Accepted : 08 November 2023

Published : 13 December 2023

DOI : https://doi.org/10.1186/s13643-023-02386-z

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