peer reviewed articles on literature review

Scholarly Writing pp 41–70 Cite as

Writing the Literature Review: Common Mistakes and Best Practices

• Kelly Heider 3  
• First Online: 21 November 2023

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Part of the book series: Springer Texts in Education ((SPTE))

The literature review is an essential component of academic research writing, providing a comprehensive overview of existing research and informing the development of new studies. However, writing an effective literature review can be a challenging task for many authors, particularly those new to academic writing. This chapter aims to guide authors through the process of writing a literature review by highlighting common mistakes and best practices. The chapter begins with three short narratives that describe difficulties both novice and prolific authors encounter when writing the literature review. A chapter activity follows with steps that guide authors through the process of developing a research question to frame the literature review. Authors are then prompted to complete a self-assessment activity which includes a series of questions designed to build their skills as academic research writers. The body of the chapter recommends strategies and techniques to help authors locate and evaluate sources that will serve as the building blocks for a literature review that is thorough, current, and well-written. The chapter concludes with a discussion of the threats and benefits of artificial intelligence-based text production in relationship to academic research writing. Overall, this chapter provides practical guidance for authors looking to improve their literature review writing skills and enhance the quality of their research output.

• Locating sources
• Developing research questions
• Constructing search strings
• Evaluating sources
• Writing the literature review
• Analyzing the literature review
• AI-based text production

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Issue: AI-Based Text Production in Academic Research Writing

 Artificial Intelligence (AI) is a relatively new technological development that can be used to support academic research writing, particularly reviews of research. Although it holds promise as a research tool, there are also concerns that AI-based scholarly writing could threaten not only the integrity but also the creativity of academic research writing. ChatGPT, an advanced chatbot developed by OpenAI (a nonprofit research company founded by Elon Musk and Sam Altman in 2015) has been at the center of much controversy as of late because of its ability to produce academic papers using artificial intelligence-based text production that have fooled academics and academic journal publishers (Hern, 2022 ; Lucey & Dowling, 2023 ; TechTarget, 2023 ). To demonstrate ChatGPT’s capabilities, consider its response to the question, “What is artificial intelligence-based text production?”.

Artificial Intelligence-Based Text Production is a process where machine learning algorithms are used to generate written content such as articles, product descriptions, social media posts, and more. It involves training machine learning models with vast amounts of data to learn how to generate human-like text automatically. The process can involve different techniques such as Natural Language Processing (NLP), deep learning, and neural networks to analyze and understand language patterns, grammar, context, and semantics. The resulting AI-generated text can be used for a wide range of applications, including content marketing, chatbots, language translation, and more. One of the main benefits of AI-based text production is that it can help businesses and organizations automate their content creation process, saving time and resources while producing high-quality content. However, it is important to note that AI-generated text may not always be perfect and may require human editing and review to ensure accuracy and coherence.

This response was produced by ChatGPT in about ten seconds. According to Anson ( 2022 ), “cutting and pasting all or part of this auto-generated text into a new text box can continue to prompt further content. The material is not plagiarized from existing sources but freshly composed. For this reason, it usually evades plagiarism-detection programs like Turnitin” (p. 40).

How Might AI-Based Text Production Threaten Academic Research Writing?

Obviously, computer-generated text that evades plagiarism-detection programs threatens the integrity of academic research writing. Some academic publishers have already banned or limited the use of AI-generated text in papers submitted to their journals (Lucey & Dowling, 2023 ). However, that is easier said than done. OpenAI recently developed a tool that attempts to distinguish between human-written and AI-generated text to prevent chatbots like ChatGPT from being abused, but it is only 26% effective (Wiggers, 2023 ).

Lucey and Dowling ( 2023 ) tested the credibility of ChatGPT by having expert reviewers examine papers produced by the chatbot. First, they asked ChatGPT to generate four parts of a research study: (1) research idea, (2) literature review, (3) dataset, and (4) suggestions for testing and examination. They chose a broad subject and instructed the chatbot to create a paper that could be published in “a good finance journal” (para. 6). Second, they pasted 200 relevant abstracts into the ChatGPT search box and asked the chatbot to consider the abstracts when generating the four-part research study. Finally, they asked academic researchers to read both versions of the AI-generated text and make suggestions for improvement. A panel of thirty-two reviewers read all versions of the four-part research study and rated them. In all cases, the papers were considered acceptable by the reviewers, although the chatbot-created papers that also included input from academic researchers were rated higher. However, “a chatbot was deemed capable of generating quality academic research ideas. This raises fundamental questions around the meaning of creativity and ownership of creative ideas—questions to which nobody yet has solid answers” (Lucey & Dowling, 2023 , para. 10).

How Might AI-Based Text Production Benefit Academic Research Writing?

Despite several publishers deciding to ban the inclusion of AI-based text production in submissions, some researchers have already listed ChatGPT as a co-author on their papers (Lucey & Dowling, 2023 ). There are many who believe there is no difference between the way ChatGPT produces text and the way authors synthesize studies in their literature reviews. In fact, the chatbot’s review is much more exhaustive because it can analyze “billions of existing, human-produced texts and, through a process akin to the creation of neural networks, generate new text based on highly complex predictive machine analysis” (Anson, 2022 , p. 39).

There are other advantages to using AI-based text production. It has the potential to aid groups of researchers who lack funding to hire human research assistants such as emerging economy researchers, graduate students, and early career researchers. According to Lucey and Dowling ( 2023 ), AI-based text production “could help democratize the research process” (para. 18). Anson ( 2022 ) also sees the potential in AI-based text production to “spark some new human-generated ideas” (p. 42), extract keywords, and create abstracts. The development of AI-based text production might also force instructors to change the way they teach academic writing. Instead of trying to detect or prevent the use of chatbots like ChatGPT, “a more sensible approach could involve embracing the technology, showing students what it can and can’t do, and asking them to experiment with it” (Anson, 2022 , p. 44). In other words, students could be asked to write about writing which leads to a deeper understanding of the writing process and the ability to transfer that understanding to any writing project (Wardle & Downs, 2019 ).

The Responsible Use of AI-Based Text Production in Academic Research Writing

The responsible use of AI-based text production in academic research writing involves understanding the technology's capabilities and limitations, as well as considering its potential impact on the research process. Researchers must carefully evaluate the intended purpose and context of using AI-generated text and make certain they are not compromising the authenticity and integrity of their research work. To ensure responsible use, it is essential to balance the benefits of increased efficiency and new insights with the need for originality and critical thinking in academic research writing. Researchers must also be transparent in disclosing the use of AI-generated text when submitting their work for publication. By adopting a responsible and thoughtful approach to the use of AI-based text production, researchers can maximize the benefits of the technology while maintaining the quality and authenticity of their research.

Applications of Technology

How to Write a Paper in a Weekend : https://youtu.be/UY7sVKJPTMA

Note : University of Minnesota Chemistry Professor, Peter Carr is not advocating for procrastination. This video outlines a strategy for generating a first draft after you have all your reading and notes assembled.

Research Gap 101: What Is a Research Gap & How to Find One : https://youtu.be/Kabj0u8YQ4Y

Using Google Scholar for Academic Research : https://youtu.be/t8_CW6FV8Ac .

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Heider, K. (2023). Writing the Literature Review: Common Mistakes and Best Practices. In: Renck Jalongo, M., Saracho, O.N. (eds) Scholarly Writing. Springer Texts in Education. Springer, Cham. https://doi.org/10.1007/978-3-031-39516-1_3

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• What Is Peer Review? | Types & Examples

What Is Peer Review? | Types & Examples

Published on December 17, 2021 by Tegan George . Revised on June 22, 2023.

Peer review, sometimes referred to as refereeing , is the process of evaluating submissions to an academic journal. Using strict criteria, a panel of reviewers in the same subject area decides whether to accept each submission for publication.

Peer-reviewed articles are considered a highly credible source due to the stringent process they go through before publication.

There are various types of peer review. The main difference between them is to what extent the authors, reviewers, and editors know each other’s identities. The most common types are:

• Single-blind review
• Double-blind review
• Triple-blind review

Collaborative review

Open review.

Relatedly, peer assessment is a process where your peers provide you with feedback on something you’ve written, based on a set of criteria or benchmarks from an instructor. They then give constructive feedback, compliments, or guidance to help you improve your draft.

Table of contents

What is the purpose of peer review, types of peer review, the peer review process, providing feedback to your peers, peer review example, advantages of peer review, criticisms of peer review, other interesting articles, frequently asked questions about peer reviews.

Many academic fields use peer review, largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the manuscript. For this reason, academic journals are among the most credible sources you can refer to.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure.

Peer assessment is often used in the classroom as a pedagogical tool. Both receiving feedback and providing it are thought to enhance the learning process, helping students think critically and collaboratively.

Prevent plagiarism. Run a free check.

Depending on the journal, there are several types of peer review.

Single-blind peer review

The most common type of peer review is single-blind (or single anonymized) review . Here, the names of the reviewers are not known by the author.

While this gives the reviewers the ability to give feedback without the possibility of interference from the author, there has been substantial criticism of this method in the last few years. Many argue that single-blind reviewing can lead to poaching or intellectual theft or that anonymized comments cause reviewers to be too harsh.

Double-blind peer review

In double-blind (or double anonymized) review , both the author and the reviewers are anonymous.

Arguments for double-blind review highlight that this mitigates any risk of prejudice on the side of the reviewer, while protecting the nature of the process. In theory, it also leads to manuscripts being published on merit rather than on the reputation of the author.

Triple-blind peer review

While triple-blind (or triple anonymized) review —where the identities of the author, reviewers, and editors are all anonymized—does exist, it is difficult to carry out in practice.

Proponents of adopting triple-blind review for journal submissions argue that it minimizes potential conflicts of interest and biases. However, ensuring anonymity is logistically challenging, and current editing software is not always able to fully anonymize everyone involved in the process.

In collaborative review , authors and reviewers interact with each other directly throughout the process. However, the identity of the reviewer is not known to the author. This gives all parties the opportunity to resolve any inconsistencies or contradictions in real time, and provides them a rich forum for discussion. It can mitigate the need for multiple rounds of editing and minimize back-and-forth.

Collaborative review can be time- and resource-intensive for the journal, however. For these collaborations to occur, there has to be a set system in place, often a technological platform, with staff monitoring and fixing any bugs or glitches.

Lastly, in open review , all parties know each other’s identities throughout the process. Often, open review can also include feedback from a larger audience, such as an online forum, or reviewer feedback included as part of the final published product.

While many argue that greater transparency prevents plagiarism or unnecessary harshness, there is also concern about the quality of future scholarship if reviewers feel they have to censor their comments.

In general, the peer review process includes the following steps:

• First, the author submits the manuscript to the editor.
• Reject the manuscript and send it back to the author, or
• Send it onward to the selected peer reviewer(s)
• Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
• Lastly, the edited manuscript is sent back to the author. They input the edits and resubmit it to the editor for publication.

In an effort to be transparent, many journals are now disclosing who reviewed each article in the published product. There are also increasing opportunities for collaboration and feedback, with some journals allowing open communication between reviewers and authors.

It can seem daunting at first to conduct a peer review or peer assessment. If you’re not sure where to start, there are several best practices you can use.

Summarize the argument in your own words

Summarizing the main argument helps the author see how their argument is interpreted by readers, and gives you a jumping-off point for providing feedback. If you’re having trouble doing this, it’s a sign that the argument needs to be clearer, more concise, or worded differently.

If the author sees that you’ve interpreted their argument differently than they intended, they have an opportunity to address any misunderstandings when they get the manuscript back.

Separate your feedback into major and minor issues

It can be challenging to keep feedback organized. One strategy is to start out with any major issues and then flow into the more minor points. It’s often helpful to keep your feedback in a numbered list, so the author has concrete points to refer back to.

Major issues typically consist of any problems with the style, flow, or key points of the manuscript. Minor issues include spelling errors, citation errors, or other smaller, easy-to-apply feedback.

Tip: Try not to focus too much on the minor issues. If the manuscript has a lot of typos, consider making a note that the author should address spelling and grammar issues, rather than going through and fixing each one.

The best feedback you can provide is anything that helps them strengthen their argument or resolve major stylistic issues.

Give the type of feedback that you would like to receive

No one likes being criticized, and it can be difficult to give honest feedback without sounding overly harsh or critical. One strategy you can use here is the “compliment sandwich,” where you “sandwich” your constructive criticism between two compliments.

Be sure you are giving concrete, actionable feedback that will help the author submit a successful final draft. While you shouldn’t tell them exactly what they should do, your feedback should help them resolve any issues they may have overlooked.

As a rule of thumb, your feedback should be:

• Easy to understand
• Constructive

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Below is a brief annotated research example. You can view examples of peer feedback by hovering over the highlighted sections.

Influence of phone use on sleep

Studies show that teens from the US are getting less sleep than they were a decade ago (Johnson, 2019) . On average, teens only slept for 6 hours a night in 2021, compared to 8 hours a night in 2011. Johnson mentions several potential causes, such as increased anxiety, changed diets, and increased phone use.

The current study focuses on the effect phone use before bedtime has on the number of hours of sleep teens are getting.

For this study, a sample of 300 teens was recruited using social media, such as Facebook, Instagram, and Snapchat. The first week, all teens were allowed to use their phone the way they normally would, in order to obtain a baseline.

The sample was then divided into 3 groups:

• Group 1 was not allowed to use their phone before bedtime.
• Group 2 used their phone for 1 hour before bedtime.
• Group 3 used their phone for 3 hours before bedtime.

All participants were asked to go to sleep around 10 p.m. to control for variation in bedtime . In the morning, their Fitbit showed the number of hours they’d slept. They kept track of these numbers themselves for 1 week.

Two independent t tests were used in order to compare Group 1 and Group 2, and Group 1 and Group 3. The first t test showed no significant difference ( p > .05) between the number of hours for Group 1 ( M = 7.8, SD = 0.6) and Group 2 ( M = 7.0, SD = 0.8). The second t test showed a significant difference ( p < .01) between the average difference for Group 1 ( M = 7.8, SD = 0.6) and Group 3 ( M = 6.1, SD = 1.5).

This shows that teens sleep fewer hours a night if they use their phone for over an hour before bedtime, compared to teens who use their phone for 0 to 1 hours.

Peer review is an established and hallowed process in academia, dating back hundreds of years. It provides various fields of study with metrics, expectations, and guidance to ensure published work is consistent with predetermined standards.

• Protects the quality of published research

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. Any content that raises red flags for reviewers can be closely examined in the review stage, preventing plagiarized or duplicated research from being published.

• Gives you access to feedback from experts in your field

Peer review represents an excellent opportunity to get feedback from renowned experts in your field and to improve your writing through their feedback and guidance. Experts with knowledge about your subject matter can give you feedback on both style and content, and they may also suggest avenues for further research that you hadn’t yet considered.

• Helps you identify any weaknesses in your argument

Peer review acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process. This way, you’ll end up with a more robust, more cohesive article.

While peer review is a widely accepted metric for credibility, it’s not without its drawbacks.

• Reviewer bias

The more transparent double-blind system is not yet very common, which can lead to bias in reviewing. A common criticism is that an excellent paper by a new researcher may be declined, while an objectively lower-quality submission by an established researcher would be accepted.

• Delays in publication

The thoroughness of the peer review process can lead to significant delays in publishing time. Research that was current at the time of submission may not be as current by the time it’s published. There is also high risk of publication bias , where journals are more likely to publish studies with positive findings than studies with negative findings.

• Risk of human error

By its very nature, peer review carries a risk of human error. In particular, falsification often cannot be detected, given that reviewers would have to replicate entire experiments to ensure the validity of results.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Measures of central tendency
• Chi square tests
• Confidence interval
• Quartiles & Quantiles
• Cluster sampling
• Stratified sampling
• Thematic analysis
• Discourse analysis
• Cohort study
• Ethnography

Research bias

• Implicit bias
• Cognitive bias
• Conformity bias
• Hawthorne effect
• Availability heuristic
• Attrition bias
• Social desirability bias

Peer review is a process of evaluating submissions to an academic journal. Utilizing rigorous criteria, a panel of reviewers in the same subject area decide whether to accept each submission for publication. For this reason, academic journals are often considered among the most credible sources you can use in a research project– provided that the journal itself is trustworthy and well-regarded.

In general, the peer review process follows the following steps: 

• Reject the manuscript and send it back to author, or 
• Send it onward to the selected peer reviewer(s) 
• Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made. 
• Lastly, the edited manuscript is sent back to the author. They input the edits, and resubmit it to the editor for publication.

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. It also represents an excellent opportunity to get feedback from renowned experts in your field. It acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process.

Peer-reviewed articles are considered a highly credible source due to this stringent process they go through before publication.

Many academic fields use peer review , largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the published manuscript.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure. 

A credible source should pass the CRAAP test  and follow these guidelines:

• The information should be up to date and current.
• The author and publication should be a trusted authority on the subject you are researching.
• The sources the author cited should be easy to find, clear, and unbiased.
• For a web source, the URL and layout should signify that it is trustworthy.

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• Published: 12 October 2020

Eight problems with literature reviews and how to fix them

• Neal R. Haddaway   ORCID: orcid.org/0000-0003-3902-2234 1 , 2 , 3 ,
• Alison Bethel 4 ,
• Lynn V. Dicks 5 , 6 ,
• Julia Koricheva   ORCID: orcid.org/0000-0002-9033-0171 7 ,
• Biljana Macura   ORCID: orcid.org/0000-0002-4253-1390 2 ,
• Gillian Petrokofsky 8 ,
• Andrew S. Pullin 9 ,
• Sini Savilaakso   ORCID: orcid.org/0000-0002-8514-8105 10 , 11 &
• Gavin B. Stewart   ORCID: orcid.org/0000-0001-5684-1544 12  

Nature Ecology & Evolution volume  4 ,  pages 1582–1589 ( 2020 ) Cite this article

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An Author Correction to this article was published on 19 October 2020

This article has been updated

Traditional approaches to reviewing literature may be susceptible to bias and result in incorrect decisions. This is of particular concern when reviews address policy- and practice-relevant questions. Systematic reviews have been introduced as a more rigorous approach to synthesizing evidence across studies; they rely on a suite of evidence-based methods aimed at maximizing rigour and minimizing susceptibility to bias. Despite the increasing popularity of systematic reviews in the environmental field, evidence synthesis methods continue to be poorly applied in practice, resulting in the publication of syntheses that are highly susceptible to bias. Recognizing the constraints that researchers can sometimes feel when attempting to plan, conduct and publish rigorous and comprehensive evidence syntheses, we aim here to identify major pitfalls in the conduct and reporting of systematic reviews, making use of recent examples from across the field. Adopting a ‘critical friend’ role in supporting would-be systematic reviews and avoiding individual responses to police use of the ‘systematic review’ label, we go on to identify methodological solutions to mitigate these pitfalls. We then highlight existing support available to avoid these issues and call on the entire community, including systematic review specialists, to work towards better evidence syntheses for better evidence and better decisions.

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Acknowledgements

We thank C. Shortall from Rothamstead Research for useful discussions on the topic.

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Neal R. Haddaway

Stockholm Environment Institute, Stockholm, Sweden

Neal R. Haddaway & Biljana Macura

Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa

College of Medicine and Health, Exeter University, Exeter, UK

Alison Bethel

Department of Zoology, University of Cambridge, Cambridge, UK

Lynn V. Dicks

School of Biological Sciences, University of East Anglia, Norwich, UK

Department of Biological Sciences, Royal Holloway University of London, Egham, UK

Julia Koricheva

Department of Zoology, University of Oxford, Oxford, UK

Gillian Petrokofsky

Collaboration for Environmental Evidence, UK Centre, School of Natural Sciences, Bangor University, Bangor, UK

• Andrew S. Pullin

Liljus ltd, London, UK

Sini Savilaakso

Department of Forest Sciences, University of Helsinki, Helsinki, Finland

Evidence Synthesis Lab, School of Natural and Environmental Sciences, University of Newcastle, Newcastle-upon-Tyne, UK

Gavin B. Stewart

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Haddaway, N.R., Bethel, A., Dicks, L.V. et al. Eight problems with literature reviews and how to fix them. Nat Ecol Evol 4 , 1582–1589 (2020). https://doi.org/10.1038/s41559-020-01295-x

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Purdue Online Writing Lab Purdue OWL® College of Liberal Arts

Writing a Literature Review

Welcome to the Purdue OWL

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

Peer Reviewed Literature

What is peer review, terminology, peer review what does that mean, what types of articles are peer-reviewed, what information is not peer-reviewed, what about google scholar.

• How do I find peer-reviewed articles?
• Scholarly vs. Popular Sources

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For more help on this topic, please contact our Research Help Desk: [email protected] or 781-768-7303. Stay up-to-date on our current hours . Note: all hours are EST.

This Guide was created by Carolyn Swidrak (retired).

Research findings are communicated in many ways.  One of the most important ways is through publication in scholarly, peer-reviewed journals.

Research published in scholarly journals is held to a high standard.  It must make a credible and significant contribution to the discipline.  To ensure a very high level of quality, articles that are submitted to scholarly journals undergo a process called peer-review.

Once an article has been submitted for publication, it is reviewed by other independent, academic experts (at least two) in the same field as the authors.  These are the peers.  The peers evaluate the research and decide if it is good enough and important enough to publish.  Usually there is a back-and-forth exchange between the reviewers and the authors, including requests for revisions, before an article is published. 

Peer review is a rigorous process but the intensity varies by journal.  Some journals are very prestigious and receive many submissions for publication.  They publish only the very best, most highly regarded research. 

The terms scholarly, academic, peer-reviewed and refereed are sometimes used interchangeably, although there are slight differences.

Scholarly and academic may refer to peer-reviewed articles, but not all scholarly and academic journals are peer-reviewed (although most are.)  For example, the Harvard Business Review is an academic journal but it is editorially reviewed, not peer-reviewed.

Peer-reviewed and refereed are identical terms.

From  Peer Review in 3 Minutes  [Video], by the North Carolina State University Library, 2014, YouTube (https://youtu.be/rOCQZ7QnoN0).

Peer reviewed articles can include:

• Original research (empirical studies)
• Review articles
• Systematic reviews
• Meta-analyses

There is much excellent, credible information in existence that is NOT peer-reviewed.  Peer-review is simply ONE MEASURE of quality. 

Much of this information is referred to as "gray literature."

Government Agencies

Government websites such as the Centers for Disease Control (CDC) publish high level, trustworthy information.  However, most of it is not peer-reviewed.  (Some of their publications are peer-reviewed, however. The journal Emerging Infectious Diseases, published by the CDC is one example.)

Conference Proceedings

Papers from conference proceedings are not usually peer-reviewed.  They may go on to become published articles in a peer-reviewed journal. 

Dissertations

Dissertations are written by doctoral candidates, and while they are academic they are not peer-reviewed.

Many students like Google Scholar because it is easy to use.  While the results from Google Scholar are generally academic they are not necessarily peer-reviewed.  Typically, you will find:

• Peer reviewed journal articles (although they are not identified as peer-reviewed)
• Unpublished scholarly articles (not peer-reviewed)
• Masters theses, doctoral dissertations and other degree publications (not peer-reviewed)
• Book citations and links to some books (not necessarily peer-reviewed)
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Factors contributing to healthcare professionals’ adaptive capacity with hospital standardization: a scoping review

• Foteini Tsandila-Kalakou   ORCID: orcid.org/0000-0001-7638-4643 1 ,
• Siri Wiig   ORCID: orcid.org/0000-0003-0186-038X 1 &
• Karina Aase   ORCID: orcid.org/0000-0002-5363-5152 1  

BMC Health Services Research volume  23 , Article number:  799 ( 2023 ) Cite this article

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Certain factors contribute to healthcare professionals’ adaptive capacities towards risks, challenges, and changes such as attitudes, stress, motivation, cognitive capacity, group norms, and teamwork. However, there is limited evidence as to factors that contribute to healthcare professionals’ adaptive capacity towards hospital standardization. This scoping review aimed to identify and map the factors contributing to healthcare professionals’ adaptive capacity with hospital standardization.

Scoping review methodology was used. We searched six academic databases to September 2021 for peer-reviewed articles in English. We also reviewed grey literature sources and the reference lists of included studies. Quantitative and qualitative studies were included if they focused on factors influencing how healthcare professionals adapted towards hospital standardization such as guidelines, procedures, and strategies linked to clinical practice. Two researchers conducted a three-stage screening process and extracted data on study characteristics, hospital standardization practices and factors contributing to healthcare professionals’ adaptive capacity. Study quality was not assessed.

A total of 57 studies were included. Factors contributing to healthcare professionals’ adaptive capacity were identified in numerous standardization practices ranging from hand hygiene and personal protective equipment to clinical guidelines or protocols on for example asthma, pneumonia, antimicrobial prophylaxis, or cancer. The factors were grouped in eight categories: (1) psychological and emotional, (2) cognitive, (3) motivational, (4) knowledge and experience, (5) professional role, (6) risk management, (7) patient and family, and (8) work relationships. This combination of individual and group/social factors decided whether healthcare professionals complied with or adapted hospital standardization efforts. Contextual factors were identified related to guideline system, cultural norms, leadership support, physical environment, time, and workload.

The literature on healthcare professionals’ adaptive capacity towards hospital standardization is varied and reflect different reasons for compliance or non-compliance to rules, guidelines, and protocols. The knowledge of individual and group/social factors and the role of contextual factors should be used by hospitals to improve standardization practices through educational efforts, individualised training and motivational support. The influence of patient and family factors on healthcare professionals’ adaptive capacity should be investigated.

Trial registration

Open Science Framework ( https://osf.io/ev7az ) https://doi.org/10.17605/OSF.IO/EV7AZ .

Peer Review reports

Studies have shown discrepancies between hospital policies and procedures set to improve quality of care and their implementation by healthcare professionals [ 1 , 2 ]. Why do healthcare professionals not comply with institutional policies, protocols, guidelines, and checklists set to improve quality? Healthcare professionals may be well intentioned and strive to offer quality of care, but they also face challenges such as limited resources, increasing work pressure, and burnout [ 3 , 4 , 5 ]. Non-compliance is multifactorial due to the complexity of the healthcare system and the quantity of information and hospital policies. Some factors are linked to the individual healthcare professionals, e.g. training, beliefs, habits, psychological factors and other factors are contextual such as social norms, staff workload and competing goals between the individual and the institution.

Adaptation or adaptive capacity is seen as a main pillar in resilience across several disciplines [ 6 , 7 , 8 ]. Several studies have aimed at exploring and understanding how resilience contributes to healthcare professionals’ adaptive capacities towards challenging work conditions [ 9 , 10 , 11 ], but still it is poorly understood. According to Smaggus [ 2 ] hospital healthcare professionals proactively adapt to compensate for systemic problems such as protocols and technology poorly aligned with their tasks. They do so through their dedication, expertise, and creativity. However, these adaptations might come at a cost to professionals’ well-being as they often include working longer and more intense hours. In the context of this study healthcare professionals’ adaptive capacity is seen as essential for hospital standardization to be successfully practiced thus contributing to quality of care. Adaptations might come in the forms of compliance or non-compliance to standardized guidelines and protocols, or in the forms of adjustment of the contents of the standardization efforts.

There are certain factors that contribute to healthcare professionals’ adaptive capacity such as habits, stress, anxiety, burnout, coping mechanisms, motivation (internal and external), intention, level of knowledge and education, cognitive capacity, perceptions, attitudes, and beliefs (individual and social) [ 9 , 10 , 11 ] . No evidence was found of literature reviews exploring factors that contribute to healthcare professionals’ adaptive capacity with hospital standardization, except one focusing on hand hygiene guideline adherence [ 12 ] and one on nurses’ non-compliance in infection prevention [ 5 ].

Therefore, the aim of this scoping review is to identify and map the factors contributing to healthcare professionals’ adaptive capacity with hospital standardization. Specific research questions addressed by this review were:

1. In which hospital standardization practices have healthcare professionals’ adaptive capacity been studied?

2. What factors influence healthcare professionals’ adaptive capacity with hospital standardization and how can they be categorized?

A scoping review methodology was chosen because it provides a transparent approach to mapping relevant literature in emerging fields or topics [ 13 , 14 ] and has a broader “scope” and more expansive inclusion criteria than a systematic review [ 15 , 16 ]. It also allows for studies using different designs and methods to be included and synthesized, which was considered necessary for this review. We followed the methodological stages outlined by Arksey and O’Malley [ 13 ] and Levac et al.’s [ 17 ] enhancement to conduct the review. These were: (1) Identifying the research question, (2) Identifying relevant studies, (3) Study selection, (4) Charting the data, (5) Collating, summarizing and reporting the results, and (6) Consulting with relevant stakeholders. A review protocol was developed according to Peters et al. [ 14 ] and registered on October 11 th 2021 on the Open Science Framework ( https://osf.io/ev7az ) https://doi.org/10.17605/OSF.IO/EV7AZ . The reporting of the review follows the PRISMA-ScR Checklist [ 18 ] (Additional file 1 ).

Eligibility criteria

Articles were assessed against the following inclusion criteria: English-language, peer-reviewed research articles of any type published in scholarly journals where the full text was available, as well as grey literature not published in peer-reviewed journals. We chose to focus on healthcare professionals above 25 years indicating that they would have a minimum level of clinical experience including experiences with hospital standardization efforts. Furthermore, we chose the hospital setting to be able to possibly compare different standardization efforts identified. For a full description of inclusion and exclusion criteria, see Additional file 2 .

Information sources

The focus of the review was on peer-reviewed literature and electronic databases from different disciplines such as biomedicine, psychology, health services research, and nursing were searched on 12.10.2021 to identify relevant studies. The electronic databases searched included Scopus, MEDLINE (Ebsco & Ovid), Web of Science, CINAHL, EMBASE and PsycINFO [ 19 ]. Search terms were discussed by the three authors. The preliminary search strategy, search terms and inclusion/exclusion criteria were checked by a research librarian at the University of Stavanger.

The electronic database searches were then conducted by one researcher (FTK) and included all citations published before October 2021. A combination of Title, Subject, Subject headings, MeSH terms, and Keywords/Text words was used. The search strategy was adapted to individual databases. An example of a search strategy is presented in Table 1 .

To reduce the likelihood that relevant articles were overlooked we also hand searched reference lists of included articles and did an additional snowball-search. To further ensure that all relevant information was captured we conducted a targeted search of the grey literature in Google Scholar and in the following grey literature databases: Grey Literature Report ( https://www.greylit.org/ ) and OpenGrey ( http://www.opengrey.eu/ ). Hand searches, snowball-search, and grey literature resulted in an additional 19 records. All the search results were imported into EndNote bibliographic software and merged.

Selection of sources of evidence

The review process consisted of three levels of screening: (1) title, (2) abstract, and (3) full text. For the first level of screening, one researcher (FTK) screened the titles of retrieved citations. Abstract and full text screening involved two researchers (FTK and KA) who shared and independently assessed the articles to determine if they met the inclusion/exclusion criteria. Articles considered relevant by the reviewers were included in the full-text review. Discrepancies about study eligibility at the full-text review stage was solved through discussion for 14 studies. Consensus was achieved between the two researchers making it unnecessary to involve the third researcher (SW) at this stage.

Quality assessment of the included studies did not form part of the current scoping review [ 13 ]. Therefore, all studies were included in the analysis as they would potentially contribute to mapping the knowledge base.

Data charting process and data items

An electronic data charting form was developed in excel to guide data charting from included articles. Data concerning study characteristics, e.g., authors, year of publication, and the methodology, e.g., design, data collection, participants, results were charted in addition to information related to the aim of the review, i.e., hospital standardization type, factors of adaptive capacity, individual level, group/social level, and reviewers’ notes (Table 2 ).

The initial data charting sheet was validated by two reviewers (FTK and KA) with three articles each to corroborate consistency, as recommended by Daudt, van Mossel and Scott [ 20 ]. All data was extracted by two researchers (FTK, KA) independently and then agreed and merged with input and discussion by the third researcher (SW).

Synthesis of results

Results were synthesised and presented using frequency counting as well as summarised in text as categories. The data were compared and synthesised to summarise study characteristics, hospital standardization effort, and factors affecting healthcare professionals’ adaptive capacity. All three authors were involved in the process of synthesizing and describing the results in a suitable format.

Consultation with stakeholders

According to Levac et al. [ 17 ], we conducted the optional stage of consulting with relevant stakeholders once the results were synthesized. The researchers of the Centre for Resilience in Healthcare SHARE, University of Stavanger were identified as relevant and knowledgeable stakeholders on the topic. Hence, an email with draft results was sent to all 79 centre researchers with a request for feedback and input on any additional sources of information relevant to the research questions of the scoping study. Stakeholders’ literature input was sent to author FTK (one book and three studies) who then assessed the information. No additional studies were included.

The search resulted in 1414 unique records of which 180 full-text articles were assessed for eligibility and 57 were included in the review [ 12 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ]. From the grey literature four articles met the inclusion criteria. The most common reasons for exclusion were no healthcare professional related factors described, mixed sample with unclear reporting of results for healthcare professionals, not in hospital setting or setting unclear, or not a healthcare professional sample.

A total of 27 qualitative studies, 20 quantitative studies, six literature reviews, and four mixed-method studies were included in the review. Figure  1 demonstrates the inclusion and exclusion of records at each stage of the screening process, using the PRISMA flow diagram [ 77 ].

PRISMA flow diagram

Characteristics of studies

The included studies were published between 2000 and 2021, with a tendency towards increased publication frequency over the last five-year period (2017–2021). The studies originated from 26 different countries with all continents represented. Several of the studies were conducted in Australia ( n  = 5), Jordan ( n  = 5), USA ( n  = 5), the Netherlands ( n  = 4), China ( n  = 3), and the UK ( n  = 3). Twenty-nine studies were conducted in developed countries while 19 in developing countries. A total of 9 studies had unspecified country origin, the reason usually being that they were literature reviews.

Hospital standardization practices

The review identified healthcare professionals’ adaptive capacity in numerous standardization practices across hospitals’ specialties. The most common standardization types were clinical or practice guidelines and protocols, precautions, procedures, checklists, policies, forms, and hospital-generic precautions, rules, and regulations. The most common areas of standardization were hand hygiene and infection prevention, personal protective equipment use, surgery, medication administration, cancer, mother and new-born care, falls, asthma, and pneumonia (Table 3 ). Three studies on personal protective equipment use were conducted during pandemics [ 51 , 52 , 54 ] while two studies explored infection prevention after pandemics [ 32 , 55 ].

Factors influencing healthcare professionals’ adaptive capacity

The factors influencing healthcare professionals’ adaptive capacity with hospital standardization practices were grouped in eight categories as described in Table 4 . The eight categories constitute a combination of individual and group/social factors deciding whether hospital healthcare professionals comply with or adapt hospital standardization practices. Below the eight categories are described in more detail.

Psychological and emotional factors

In many instances professionals choose to adhere to infection prevention guidelines due to the psychological pressure or fear of contracting or spreading infections [ 23 , 32 , 41 ]. Adverse incidents with infection prevention equipment are perceived as stressful and worrying [ 51 ], while following standard precautions would decrease their anxiety [ 41 ].

Healthcare professionals’ sense of invulnerability and confidence would lead them to adapt hospital standardization [ 22 , 31 , 55 , 63 , 75 ]. Reasons would differ from physicians considering themselves to be entitled to work independently without protocols to guide them [ 31 ], to professionals feeling minor concerns for infection transmission over time when not acquiring any infection [ 55 ] to nurses expressing psychological gratification about their own ability to creatively solve problems and work around standardization practices  [ 75 ].

Cognitive factors

Various attitudes and beliefs were reported in several studies as influencing healthcare professionals’ adaptive capacity or compliance to hospital standardization [ 28 , 29 , 33 , 37 , 41 , 45 , 47 , 48 , 52 , 55 , 61 , 62 , 69 , 73 , 75 ]. Some of these attitudes and beliefs were patient related [ 41 , 45 , 52 , 62 , 69 ,  74 , 75 ]. For example, in a study on the use of personal protective equipment in the emergency room during the COVID-19 pandemic, there was only a slight difference between healthcare professional beliefs on whether the equipment was protective or not for patients (52% vs. 46%) [ 52 ]. In another study, physicians believed that diarrhoea was a low-risk disease with overrepresentation among poor people but adapted the diarrhoea treatment to patients with higher social status [ 45 ]. Moreover, nurses justified adaptations when they believed that use of gloves or masks was an exaggeration when treating children considered low risk and not contagious [ 41 ].

Attitudes and beliefs were also related to the professional group that healthcare professionals belonged to [ 29 , 61 ]. Physicians and nurses had opposing views on surgical count protocol violations and what constitutes safe clinical practice [ 61 ]. Nurses believed that physicians had lower hand hygiene compliance, while physicians believed that they were role models and leaders of hand hygiene and would warn other staff members [ 29 ].

Healthcare professionals’ agreement or disagreement with specific guidelines also led to adaptations of hospital standardization. Adaptations were made when for example radiologists considered diagnostic imaging guidelines not useful, too rigid, or that they failed to include specific information about changes [ 47 ] or were perceived as inefficient or unnecessary [ 75 ], not relevant for the clinical practice [ 37 , 64 ], or not relevant for certain care systems [ 48 ], or when healthcare professionals doubted the effectiveness of isolation precautions to prevent disease contagion [ 55 ]. Similarly, a systematic review reported adaptations when guidelines and other standardized practices were considered too generic, promoted 'cookbook medicine', oversimplified, difficult or controversial treatment decisions, or when the evidence they were based on was conflicting [ 62 ]. By contrast healthcare professionals complied to standards, protocols and guidelines when believed to be useful tools [ 49 ] in clinical decision making and providing uniform care [ 48 , 62 ], were easy to understand, highly relevant to clinical practice and patient population, and based on credible information sources [ 62 ].

Motivational factors

Motivational factors for healthcare professionals’ adaptive capacity are mainly reported in studies on infection prevention and control. Personal motivational drivers such as moral responsibility, obligation and duty are reported by different professional groups related to infection control practices in the emergency room and on hospital wards in general [ 26 , 33 ], within tuberculosis infection control measures [ 22 ], within hand hygiene obligations [ 29 ], within venous thromboembolism prophylaxis management [ 46 ], within respiratory infectious diseases [ 24 ], and with clinical practice guidelines to prevent falls and injuries [ 71 ]. The moral responsibility would be directed towards themselves as professionals to reduce transmission of pathogens or expressed as a duty of care to their patients. Motivational factors were most often internally driven in the sense of professionals’ own intent and feelings of psychological safety [ 30 , 75 ], while some studies reported on external drivers such as a motivational person in their organization [ 71 ], the intensity of activity in the clinical setting [ 30 ] or organizational neglect of occupational health and safety [ 60 ].

Healthcare professionals’ comfort or discomfort with personal protective equipment would influence their motivation to adapt infection prevention and control standardization practices [ 24 , 33 , 41 , 51 , 53 , 56 ].

Knowledge and experience factors

Knowledge and training of standardization practices was described as important and increased compliance among nurses [ 34 , 42 , 43 ] and younger physicians [ 55 ], but was not seen as sufficient for physicians and nurses in other studies [ 25 , 44 , 47 , 50 , 55 , 58 , 59 ].

Length and type of clinical experience would often lead healthcare professionals to either adapt hospital standardization [ 35 , 41 , 55 , 59 , 61 , 67 , 73 ] or to comply with it [ 43 , 68 , 71 ]. For example, experienced senior nurses had more confidence to adapt protocols in intensive care units [ 59 ] or during fever management [ 73 ], than less experienced nurses with barcode medication administration technology [ 68 ]. Among surgical team members, physicians relied on their experience and tactical knowledge [ 61 ], nurses on their repeated experience of working daily with the same instrument trays [ 59 ] and disregarded surgical count guidelines or made workarounds on surgical safety checklist use [ 58 ]. However, in another study increased length of experience was reported as a contributing factor to compliance with hand hygiene for both physicians and nurses [ 43 ].

Insufficient knowledge and training led healthcare professionals to make adaptations. For example, knowledge deficits about tuberculosis led healthcare professionals to use ineffective measures in preventing transmission [ 33 ]. Similarly, midwives’ limited knowledge of aspects of infection prevention control guidelines [ 23 ] or being unaware that national postnatal care protocols had been updated led them to make adaptations based on inappropriate experiential knowledge [ 60 ].

For some healthcare professionals, negative experiences during clinical practice increased their compliance with clinical guidelines [ 71 ], while experience of lack of consequences led them to continue their adaptations of universal precautions [ 55 ].

Professional role factors

In many cases, the clinical role or profession of healthcare workers influenced their ability and desire to adapt hospital standardization [ 12 , 55 , 57 , 60 , 75 ]. Nurses defined problem solving as part of their job thus contributing to workarounds from standardization practices [ 75 ]. Physicians often defined their role in authoritative ways contributing to lower compliance with hospital standardization than other professions, for example within hand hygiene [ 12 ], the surgical safety checklist [ 57 , 60 ], and MRSA precautions [ 55 ]. In one study, professional status and reputation were identified to influence physicians’ clinical decision-making [ 45 ]. Healthcare professionals’ perception of their own roles also challenged their possibility to intervene in each other’s work tasks and their ability to collectively adapt standardization practices [ 45 , 57 ].

Furthermore, autonomy and clinical and/or professional judgment were seen as vital elements of healthcare professionals’ adaptive capacity [ 39 , 59 , 62 , 75 ]. For example, commitment to infection prevention and control was high in a neonatal unit, however, severely constrained resources made improvisation a vital element of professionals’ clinical judgment and adaptive capacity [ 23 ].

Risk management factors

Healthcare professionals adapted their practices to meet hospital standardization due to individual perceptions of risk and belonging personal costs. They adhered to infection prevention guidelines to protect themselves from being infected or from infecting family and others [ 24 , 27 , 29 , 33 , 41 , 53 , 56 ], or they wanted to avoid reprimands and litigations [ 46 , 62 , 72 ] or negative media attention [ 71 ]. The perceived risk for reprimands or litigations might for example lead to nurses performing fall prevention according to the guideline “just in case” even with non-risk patients [ 71 ] p90. The same goes for physicians sending patients for x-rays “just to be safe” [ 71 ] p90. However, in another study perceived enforcement of rules in the form of monitoring and threats of punishment or sanctions had no direct or indirect effect on physicians’ compliance [ 40 ].

Clinical practice guidelines were adapted or disregarded if healthcare professionals perceived them to constitute a potential risk to patients [ 59 , 67 , 69 , 75 ]. This could involve physicians using more highly concentrated medications than recommended to prevent fatal arrhythmia [ 69 ] or nurses to disregard the protocol for surgical count of instruments in life-threatening emergencies [ 59 ].

Patient and family factors

The main reason for healthcare professionals wanting to adapt hospital standardization was to meet patient needs. In general, this involved deviations from hospital guidelines or policies when they saw them as barriers to patient care and/or patient safety. Patient needs were exemplified as timely care, patient-centred care, quality of patient communication, privacy, improved outcomes [ 36 , 55 , 56 , 67 , 74 , 75 ] and customized care [ 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. Several studies related to infection prevention including three during pandemic situations pointed at adaptations made to personal protective equipment protocols to improve patient communication, reduce patients’ feeling of isolation, and better establish therapeutic relationships [ 22 , 52 , 54 , 55 , 56 ]. This was especially relevant for older patients [ 55 ] and children [ 41 , 56 ]. In emergencies, workarounds of protocols were justified not to jeopardise the patients’ safety [ 75 ], while in surgical settings compliance with the checklist protocol was seen as preserving patient safety [ 60 ].

Family factors were related to presence and expectations, and cultural conflicts. Examples of adaptations span from clinicians not complying with the family witnessed resuscitation protocol as they value it as traumatic for relatives with risk of PTSD [ 72 ] to pressure for antibiotics and intravenous fluids in diarrheal management [ 45 ] to disapproval of pre-operative skin preparation policy due to cultural preferences [ 76 ].

Work relationship factors

Most studies reporting on work relationship factors were related to conditions negatively affecting the adaptive capacity of healthcare professionals such as power issues, group norms, hierarchical relationships, and breakdown in communication [ 21 , 23 , 31 , 41 , 57 , 59 , 61 , 65 ]. This could entail surgeons’ power influencing the practice of the surgical count procedure negatively where nurses felt unable to demand to undertake the count even though it constitutes a crucial safeguard for the outcome of the surgery [ 59 , 61 ]. Hierarchical relationships were shown to negatively affect the use of the safe surgery checklist as surgeons and anaesthetists would disincline to volunteer information and openly communicate with each other and other team members [ 57 ]. Breakdown in communication was identified to negatively influence healthcare professionals’ adaptive capacity within antimicrobial prophylaxis [ 21 ], postnatal care protocols [ 60 ], and infection outbreaks [ 55 ].

A few studies reported on positive effects of work relationship factors such as peer pressure in the forms of healthcare professionals’ reminding each other to wear protective equipment [ 24 ], physicians acting as positive role models to other staff members on hand hygiene [ 29 ], nurse leaders modelling practicing safety rounds to staff [ 38 ] or collegial support from senior medical and nursing staff to junior professionals to improve adherence to standardization practices in the emergency department [ 70 ].

Contextual factors influencing healthcare professionals’ adaptive capacity

Based on our synthesis of studies we identified several contextual factors that influenced healthcare professionals’ adaptive capacity with hospital standardization. These were factors “outside” the individual and group/social level. Even though the review did not focus specifically on the organizational or institutional level, the contextual factors formed parts of healthcare professionals’ explanations for degree of adaptation or compliance with hospital standardization.

Guideline “system”

Some studies described characteristics of the guidelines per se to influence how healthcare professionals adapted to them or not [ 24 , 47 , 48 , 68 , 71 ]. For example, guidelines that were too long and ambiguous or outdated and unclear [ 24 , 47 ] or complex [ 64 ] were considered as barriers as healthcare professionals were confused and unsure how to adhere to them. Moreover, constantly changing guidelines given the time restrictions of daily clinical practice overwhelmed healthcare professionals who could not keep up with the updates or changes [ 24 ]. In addition, insufficient guidelines which lacked specific information were seen as a barrier and practical implementation depended on the healthcare professionals’ expertise [ 48 ].

However, high usability and guidelines that reflected national or international guidelines facilitated healthcare professionals’ compliance [ 24 , 68 ].

Cultural norms

Workplace culture was described to influence adaptation or compliance with hospital standardization [ 24 , 33 , 41 ]. For example, adaptations were made when standard precautions were not the routine practice in the clinical department [ 41 ], when there was complacency to infection prevention control guidelines [ 24 ] or when workplace culture was part of a national culture [ 33 ]. When hospital standardization practices were followed by senior colleagues [ 41 ] or by all staff the compliance was high [ 24 ].

Leadership support

Several studies reported that the level of adaptation or compliance with hospital standardization was influenced by the level of support healthcare professionals received by their clinical leadership [ 24 , 29 , 33 , 60 , 62 , 65 , 71 ]. Leadership support was understood as visibility, encouragement, and modeling compliance with standardization practices [ 24 , 29 , 38 , 65 ].

Physical environment

Healthcare professionals described various factors in the physical environment that led to adaptations of hospital standardization practices [ 24 , 45 , 62 , 67 , 71 ]. For example, limited access to treatment services and facilities [ 62 ], wards being too crowded, noisy, and dirty [ 45 ], lack of adequate ventilation, isolation rooms, and shower facilities to prevent infection transmission [ 24 ], narrow hospital bathrooms [ 71 ], or lack of vital space in examination cubicles [ 60 ].

Time constraints were in several studies described as a reason for adaptations [ 29 , 36 , 48 , 49 , 57 , 58 ]. For example, during emergencies there was no time to either perform proper hand hygiene or proper use of gloves [ 29 ], or to perform time-out procedures or safety checklists during surgical operations [ 57 ]. However, a systematic review suggested that implementation of the surgical safety checklist reduced time delays as miscommunication and confusion were avoided [ 60 ].

Workload issues

Increased workload was mainly reported in studies on infection prevention practices to explain healthcare professionals’ adaptations of hospital standardization [ 12 , 21 , 24 , 29 , 55 ]. Similarly, in a study on perinatal care obstetricians reported that they were more likely to comply with changes in practice if their workloads did not increase [ 34 ]. Staff shortages leading to demanding workloads was also a contributing factor for midwives to collectively decide not to update their knowledge of the new post-natal care protocols, despite training being offered [ 60 ].

In this paper we have reviewed the literature to identify the factors contributing to healthcare professionals’ adaptive capacity with hospital standardization. We have documented that adaptive capacity is multidimensional according to eight factors: psychological and emotional, cognitive, motivational, knowledge and experience, professional role, risk management, patient and family, and work relationships. This multidimensional aspect is supported by Huey and Palaganas’ [ 11 ] emphasizing the influence of individual and workplace cultural factors. Individual traits such as having a higher purpose is in our review specified as motivational, emotional, cognitive, and knowledge-based factors. Our review also adds group/social factors including work relationship, professional role, and physical environment, in line with Toode, Routasalo and Suominen [ 78 ]. New in this study is the establishment of the patient and family factor as a main driver for healthcare professionals’ adaptation of hospital standardization.

The eight factors of adaptive capacity are situated within a contextual setting, described by healthcare professionals as the background for their adaptation. Time and workload issues were most frequently described in studies on infection prevention and control and in surgery, with different reasoning. The time issue in infection prevention and control is related to the time-consuming and resource intensive procedures, while in surgery the time issue is related to urgency and acute situations. Both contexts might lead to a need for healthcare professionals having to adapt protocols and guidelines. Individual factors are indisputable engrained in the contextual surroundings meaning that healthcare professionals’ adaptive capacity needs to be understood in light of the guideline system, cultural norms, leadership support, time and workload issues, and the physical environment. This is in line with previous research on the role of context in healthcare [ 79 , 80 ].

This scoping review covers 26 different countries representing all continents of which 29 studies are from developed countries and 19 from developing countries. We did notice some variation in the extent and type of details reported by healthcare professionals across regions and countries. However, a geographic comparison was not included in our scope and future research comparing continents, regions, or countries based on their economic status and healthcare professionals’ adaptive capacity should be conducted.

In our review infection prevention and control and practices related to hand hygiene and use of personal protective equipment stand out as the most common standardization practices studied. This is an area with clear individual and organizational targets thus requiring a combination of individual and organizational adaptive capacity [ 81 ]. Based on our review and previous research we claim that the field of adaptive capacity and resilience would benefit from incorporating knowledge on individual factors to succeed [ 82 , 83 , 84 ]. Adaptive capacity for healthcare professionals and healthcare organizations seems to depend on each other more than the research has acknowledged so far and should be the topic of future research.

Implications for hospital management and practice

The new knowledge from this review on individual, group/social factors and contextual factors influencing healthcare professionals’ adaptive capacity should be used by hospitals to improve and tailor make current standardization practices. Efforts should be made to construct educational efforts, individualise training and motivational support, and to address the role of patients and families as the main driver for healthcare professionals’ adaptation of hospital standardization.

Based on the findings of this scoping review, complex standardisation practices should be revised to be easily understandable, as short as possible, and relevant to the professional practice. Healthcare professionals should be involved in standardization development and/or revisions to achieve this. Educational efforts to inform healthcare professionals on new or revised standardisation practices should integrate knowledge building not only on the standardisation measure in itself, but also on how individual, group/social, and contextual factors promote or hamper their compliance to or adaptation of it. This is especially important within the areas of infection control and personal protective equipment as the evidence for healthcare professionals’ adaptation is strong.

Strengths and limitations

The review was conducted in accordance with an acknowledged framework for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The scoping methodology allowed information from a broad range of studies, using different designs and methods, to be included and synthesized. The findings highlight individual and group/social factors for healthcare professionals to comply with or adapt hospital standardization practices.

The review was limited to English-speaking literature and the included studies were not assessed for quality. The review does not provide a definitive account of the successful outcomes of healthcare professionals’ adaptive capacity towards standardization practices. Moreover, this scoping review focused on individual factors and group/social factors and did not include a full review of organizational factors as this is done in other studies. Finally, it was not possible to draw any conclusions on how pandemics influence healthcare professionals’ adaptive capacity, as only five studies met the inclusion criteria. This should be followed-up with further research.

Conclusions

Our study identified the following hospital standardization practices where healthcare professionals’ adaptive capacity has been studied: clinical guidelines and protocols, precautions, procedures, checklists, policies, forms, and hospital-generic precautions, rules, and regulations. These are typically studied within infection prevention and control, followed by more disease-specific areas such as for example cancer.

There has been lack of knowledge on factors impacting on healthcare professionals’ adaptation or compliance with hospital standardization. This scoping review stands out by identifying a multidimensional set of eight factors at the individual and group/social level. The main factor influencing healthcare professionals’ adaptation of hospital standardization was patient and family needs. The review also identified surrounding contextual factors influencing healthcare professionals’ adaptive capacity including the guideline system, cultural norms, leadership support, physical environment, time, and workload issues.

Future research needs to investigate the relationship between individual factors for adaptive capacity and their contextual setting, as well as the relationship between individual, group/social, and organizational factors.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews

Medical Subject Headings

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Acknowledgements

We would like to thank Eline Ree and Adriana Rosenberg of the Centre for Resilience in Healthcare (SHARE) at the University of Stavanger for their contributions and feedback in this scoping review.

This research was funded by the Centre for Resilience in Healthcare (SHARE) at the University of Stavanger. The funder has played no role in the design and completion of the study.

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FTK: study inception and study design, database searches and title screening. KA & FTK: abstract and full text screening, data extraction, data charting, thematic analysis, synthesis, and description of results. FTK, KA, SW agreed on study design, search strategy, data extraction, thematic analysis, synthesis, and description of the results. All three authors contributed, edited, and approved the final manuscript.

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Additional file 1..

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

Additional file 2.

Inclusion Exclusion criteria.

Additional file 3.

Table of all studies included in the review.

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Tsandila-Kalakou, F., Wiig, S. & Aase, K. Factors contributing to healthcare professionals’ adaptive capacity with hospital standardization: a scoping review. BMC Health Serv Res 23 , 799 (2023). https://doi.org/10.1186/s12913-023-09698-9

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DOI : https://doi.org/10.1186/s12913-023-09698-9

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Writing narrative literature reviews for peer-reviewed journals: secrets of the trade

Bart n. green.

a Associate Editor, National University of Health Sciences

Claire D. Johnson

b Editor, National University of Health Sciences

c Vice President of Academic Affairs and Program Development, Texas Chiropractic College

This document may be redistributed and reused, subject to certain conditions .

To describe and discuss the process used to write a narrative review of the literature for publication in a peer-reviewed journal. Publication of narrative overviews of the literature should be standardized to increase their objectivity.

In the past decade numerous changes in research methodology pertaining to reviews of the literature have occurred. These changes necessitate authors of review articles to be familiar with current standards in the publication process.

Narrative overview of the literature synthesizing the findings of literature retrieved from searches of computerized databases, hand searches, and authoritative texts.

An overview of the use of three types of reviews of the literature is presented. Step by step instructions for how to conduct and write a narrative overview utilizing a ‘best-evidence synthesis’ approach are discussed, starting with appropriate preparatory work and ending with how to create proper illustrations. Several resources for creating reviews of the literature are presented and a narrative overview critical appraisal worksheet is included. A bibliography of other useful reading is presented in an appendix.

Narrative overviews can be a valuable contribution to the literature if prepared properly. New and experienced authors wishing to write a narrative overview should find this article useful in constructing such a paper and carrying out the research process. It is hoped that this article will stimulate scholarly dialog amongst colleagues about this research design and other complex literature review methods.

Sources of support: This article is reprinted with permission. Its original citation is: Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Sports Chiropr Rehabil 2001;15:5–19.