You will write your Literature Review Section of your EBP Projec.docx

You will write your Literature Review Section of your EBP
Project Proposal. Here is a
Review of Literature Example (Word)
to use as a model or guide. To conduct your literature review,
you begin with the search strategy, gather your resources, then
start writing your literature review and gap analysis.
Search Strategy
In the literature review section, you are to identify your
search strategy
, which can include the following:
the databases and internet sites or search engines used to
explore the literature (CINAHL, Medline, Google, Yahoo, etc.)
the search terms you used
the beginning and ending dates of the period covered in this
study
the time period when the search was conducted (e.g., Fall 2008)
any special journals hand-searched and any relevant sources
used in performing the literature search
Description of Literature or Gaps in the Literature
The literature review section is a review of studies that are
related to your phenomenon. It should take up about eight to ten
pages, or approximately 3,000 to 4,000 words. The purpose is to

tell the reader what is known about your phenomenon and lead
the reader to what is not known about your phenomenon (your
research problem). You should have sub-headings throughout
this section of the paper.
The literature section discusses the relevant research related to
your study. Do not discuss each study individually; instead,
synthesize the literature based on your literature matrix. You
can discuss individual findings of studies (include all eight
studies that you described in your literature matrix in Weeks 4
and 9) as appropriate including the statistical findings and study
samples. This section needs to tell the reader what is known
about your clinical area of interest. You will also summarize
your review of the literature and discuss the gaps you have
identified.
Assignment Instructions
Your assignment should be:
Eight to ten pages, or approximately 3,000 to 4,000 words, no
cover page required, and the page count doesn’t include the
references list
Your search strategy
Description of articles (who, population, sample, what was
done, statistical findings, limitations, and so on)
Gaps section: the gaps you have identified from your literature
search
Please refer to the
Grading Rubric

for details on how this activity will be graded.
Example of A Literature Review : Follow the below example
Week 9 Review of Literature Example
Written by Jennifer Oddy, Entitled:
Distress And Coping of Mothers of Children With Muscular
Dystrophy
Introduction
The purpose of this literature review is to discuss the current
knowledge regarding experiences of mothers who care for their
child with muscular dystrophy, their coping mechanisms, and to
understand their lived experiences in order to provide better
nursing care to these mothers. Not only will the current
knowledge be addressed, this literature review will also speak
to what is unknown about this phenomenon. The concepts of
maternal stress/well-being, adjustment, anxiety, and coping will
all be addressed as common themes emerging from the data.
The research question for this study is:
What are the lived experiences of mothers who care for their
child with muscular dystrophy?
The search for literature took place in the spring of 2015, which
was completed using EBSCOhost to search 17 online databases
through the Regis College Library. Google Scholar was also
used, which brought up articles from PubMed that have been
utilized. Eight peer- reviewed research journal articles were

obtained and scrutinized for the purpose of this review of
literature and the literature matrix (Appendix B). Search terms
included: children, chronic disease, mother, distress, coping,
muscular dystrophy, maternal experience, stress, and
adjustment. To ensure the most relevant literature was cited, the
majority of the articles were from 2007-2013. One article was
from 2003, two from 2005, and the remaining five articles were
between 2007 and 2013. The older articles were included for the
purpose of their significance to the subject matter. However,
this gap in literature provides evidence that there is need for
further research regarding the lived experiences of mothers who
care for their child with muscular dystrophy.
This review of literature will include empirical and theoretical
sections, as well as a brief description of how the researcher
arrived at this topic of interest. In the empirical literature
section, the literature from eight peer-reviewed journals will be
synthesized. Individual findings from certain articles will be
cited in order to provide details about the experiences of
mothers caring for their child with muscular dystrophy. These
experiences will then be related to the discipline of psychology,
demonstrating the importance of a multi-disciplinary approach.
The empirical literature will be concluded with the gap in
literature and why there is a need to further investigate this
topic. These topics are all used to form the following sub-
headings: overview, lifestyle as a contributor to maternal stress
and well-being, difficulty adjusting, anxiety directly relates to
quality of life, the struggles of coping, maternal stress related to
other disciplines, a summary, and the gaps in literature. The
purpose of these sub-headings is to organize the empirical
literature section.
Empirical Literature
Overview.
There have been a number of research articles that delve into

the experiences of mothers who care for their child with
muscular dystrophy. The Literature Matrix (Appendix B) is an
overview of eight research articles that studied the experiences
and lifestyle of these women. Two research articles were
literature reviews and six were experimental studies. One study
used a conceptual model to guide the research, which will be
presented in the theoretical section of this literature review.
Children and families who are faced with the stress of having a
child with muscular dystrophy must adapt to physical,
emotional, social, and financial challenges. The increase in
every-day caregiving requirements, lifestyle, the disease
complexities, and family dynamics can influence long-term
health outcomes (Barlow & Ellard, 2005). In addition, the
financial status and interactions of the child and/or family with
their environment can be severely impacted (Brown et al.,
2007). Through this review of literature from the eight articles,
four emerging themes became evident: the lifestyle associated
with having a child with muscular dystrophy affects maternal
stress and well-being; mothers experience difficulty adjusting;
maternal anxiety is directly related to quality of life; and the
struggles with the experience of coping. This empirical research
section will use the themes to organize the literature, followed
by a brief section about maternal distress relating to other
disciplines, as well as the gap in the current literature.
Lifestyle as a contributor to maternal stress and well-being.
While both mothers and fathers may have worries about
maintaining family function when caring for a child with
muscular dystrophy, typically the mother herself is identified as
the primary caregiver (Brown et al., 2008). This is described as
“carrying the burden,” since the mothers are the individuals
following through with doctor appointments, monitoring the
child’s status, administering medications/treatments, all in
addition to feeding the rest of the family and cleaning the home
(Brown, et al. 2008). This places a large stressor on the mother,

who may be so concerned about everyone else’s well-being, that
she may not have time for her own. The literature has shown
that the lifestyle of having a child with muscular dystrophy can
severely impact maternal well-being (Barlow & Ellard, 2005).
Carroll, Gallagher, and Phillips (2010) conducted a descriptive
comparative study regarding the psychosocial predictors of
sleep quality in parents caring for a child with a chronic
disease. The researchers used convenience sampling to obtain
67 parents of children with developmental disabilities to
compare to 42 parents of typically-developing children. The
results of the study identified sleep quality as an important
aspect of well-being and strongly related it to overall quality of
life. There is reasonable consensus across the literature that
problematic and challenging behaviors are a main source of
stress for parents of children with a chronic disease (Carroll et
al., 2010). Having a child with muscular dystrophy may invoke
a state of stress in mothers. Unfortunately, stress has been
found to be the strongest predictor of poor sleep quality (β =.45,
t = 4.17, p <.001) and accounted for 30% of the variation in
sleep quality among mothers who care for a child with a chronic
disease. Knowing this, it is no surprise that parents of children
with chronic disease report poorer sleep quality than parents
who do not face this burden. In addition, the majority of these
parents met the “poor sleepers” criterion. While sleep is
something that most people take for granted, it is an important
part of well-being that can be altered in impeding circumstances
such as having a child with muscular dystrophy (Carroll et al.,
2010).
Another descriptive comparative research study conducted by
Nereo, Fee, and Hinton (2003), was aimed at examining parental
stress in mothers of boys with muscular dystrophy (MD). The
sample was done by consecutive and convenience sampling, and
consisted of 112 mothers of boys with MD, 800 mothers of
healthy children, 28 mothers of children with cerebral palsy,

and 46 siblings of boys with MD. The results demonstrated that
stress related to child behavior was higher in the MD group
(23.98) than the normative group (18.7). The mean MD parent-
child dysfunctional interaction score was also much great in the
MD group (M=23.98) than the normative sample (M=18.7).
Lastly, the mean MD difficult child score (M=30.64) was
greater than the normative sample (M=26). These results
demonstrate the presence of problem child behaviors
consistently predicting maternal stress, which relates to child
behavior and the difficulty of caring for a child with muscular
dystrophy. In addition, Nereo and colleagues (2003)
characterize muscular dystrophy as a complex chronic condition
since it involves specialized and time-consuming care. The
disease poses stressors in terms of daily care requirements.
Negotiating wheelchair transportation, meeting recommended
physical therapy requirements, and increasing physical demands
are just a few of the accommodations that mothers must make
time for in their daily schedules. These physical burdens can
place a strain on the caregiving mother and increase preexisting
stress (Nereo et al., 2003).
In addition to the physical aid that mothers provide, muscular
dystrophy can also affect mental health. The disease is both
chronic and terminal, therefore carrying the necessity for many
psychological adjustments to occur within the family at any
given time (Nereo et al., 2003). Furthermore, parental stress can
have a direct impact on the health of the child. Lynn et al.
describe the concept of uncertainty in relation to family and
dynamics. As parental uncertainty increased, child uncertainty
also increased (Lynn et al., 2010). As uncertainty in the child
increases, so do anxiety, depression, and psychological distress.
This is not healthy for the child, nor the mother and/or the rest
of the family that is involved.
Difficulty adjusting.
Chronic diseases in children have an impact not only on the

child, but also on other members of the family. Barlow and
Ellard (2005) provided an overview of the current literature
regarding the psychosocial well-being of children with chronic
disease, their parents, and siblings. A total of 391 articles were
identified that were selected according to strict inclusion
criteria. Two researchers reviewed the articles for reliability.
The findings were consistent that emotional distress (anxiety
and depression) was greater among parents of children
diagnosed with chronic diseases. Mothers may not have the
financial ability to hire a caregiver, leaving the stress solely on
her. It then becomes an issue that the mother does not have time
to run errands, get the household chores done, or even be able
to work. Not only does this hinder the mother, it also impedes
on the already delicate health of the child (Barlow & Ellard,
2005). Consistent with this research, the article “Correlates of
maternal and paternal adjustment to chronic childhood disease”
states that mothers reported significantly more difficulties than
fathers while attempting to adjust to things like new lifestyle,
caregiving requirements, and changing prognosis (Crawford &
Dewey, 2007). Specifically, mothers were prone to higher levels
of psychological distress if they had poor family cohesion and
less social support. This is consistent with the rest of the
literature, Barlow & Ellard (2005) stating that mothers are less
likely to be affected by the stress of their child’s chronic
disease if they have a social output, and Brown et al. (2008)
referring to demographic variables such as resources and social
groups and how they play a role in the support of these parents.
Crawford and Dewey (2007) conducted a descriptive study in
order to determine if different factors were associated with
maternal and paternal adjustment to having children with life-
limiting chronic diseases. Convenience sampling was used in
order to obtain a sample of 11 mothers and 9 fathers of children
with muscular dystrophy. A control group of 19 mothers and 11
fathers of healthy children was also obtained for comparison.
The results demonstrated that mothers reported significantly

more adjustment difficulties than fathers (F[1,124]= 6.57, p<
.05), had a harder time adapting (F[1,124]= 4.80, p< .05), and
families with children with chronic diseases had lower scores in
family cohesion (F[2,124]= 4.84, p< .01). Through data
collection, Crawford and Dewey attribute adaptation struggles
to things like previous psychological functioning of family
members, socioeconomic status, concurrent psychosocial
stressors, and quality of relationships. These are all things that
have the potential to significantly alter a mother’s ability to
adjust. Another large factor that plays a role in maternal
adjustment is the prognosis of muscular dystrophy. It is a
progressive and fatal disease where the child can take a turn for
the worse at any given moment (Nereo et al., 2003). Because of
this, it is difficult for mothers to adjust to an ever-changing
state of health of their child (Lucio et al., 2013). Lucio et al.
also states the significance of this in the health care setting.
“The adaptation process of mothers is not instantaneous and it
can change from one period of control to a situation of lack of
control. Taking care of a sick child requires skills, knowledge
about the disease and the devices to be used. The mothers need
clear information from the health professionals and their doubts
need to be clarified, so that the care to these children is
performed safely and autonomously,” (Lucio et al., 2013, p. 87)
Anxiety directly relates to quality of life.
In a qualitative, descriptive research study, Lucio and
colleagues (2013) aim to understand the mother’s perspective on
caring for their child with muscular dystrophy. Convenience
sampling was used to select children with muscular dystrophy
from a public hospital, and the nurses then made contact with
their mothers. The open- ended interviews revealed important
information about the quality of life while caring for a child
with muscular dystrophy. Mothers considered caring for their
child to be a difficult task, since they deal with unknown
devices that their child has become dependent on. This leads to
a chronic fear of losing their child and fear of what happens

when the electricity goes out. All this fear causes anxiety,
which the researchers found to directly affect the quality of life
of the mother as well as child. Quality of life can be greatly
negated while caring for a child with muscular dystrophy.
Mothers often leave their chores, change their daily routine, and
postpone their commitments in order to stay with their child
who is dependent on their care. Not only are these children
care-dependent, a lot of them also rely on mechanical equipment
to live. Much of the anxiety experienced in these mothers roots
from “being afraid with the possibility of them not surviving,
due to the malfunction of the equipment,” (Lucio et al., 2013, p.
86). Besides the fear of death, anxiety is highlighted as a factor
that directly afflicts with quality of life of both the children and
mothers (Lucio et al., 2013).
The struggles with coping.
Webb (2005) completed a qualitative grounded theory study that
was completed with the purpose of addressing the lack of
available information for parents about coping with muscular
dystrophy (Webb, 2005). Twenty-three parents (15 families) of
children with MD were selected from postings on the internet
and from an annual Parent Project Muscular Dystrophy
Conference. Six major coping themes emerged from the in-depth
interviews: (1) MD is caused from a mutation in the X
chromosome, therefore mothers tend to blame themselves; (2)
Diagnosis is the first tough issue that parents face; (3) Mothers
feel fear, denial, anger, guilt, and confusion about the
diagnosis; (4) Mothers sought “treatment” to help slow the
progression; (5) The anxiety related to their child chronically
relying on equipment; (6) Worries about the child finishing
school. These are all issues that cause stress and anxiety in
mothers caring for their child with muscular dystrophy. In one
instance, the researcher found that families “coped” by
overprotection, lack of child discipline, and magical thinking
(Webb, 2005). On the contrary, there were some positive
findings. Four types of coping strategies emerged: (1) Families

focused on the present, living one day at a time; (2) Families
attempt to live as normal a life as possible; (3) Families had a
proactive attitude regarding care for the child in order to reduce
the risk of crises; (4) Families developed coping resources
based on personal strength (Webb, 2005). Although there are
not a lot of studies regarding coping skills in parents of children
with disabilities, what is available demonstrates the need for
progression. This demonstrates the necessity to empower other
families to learn coping strategies like these. Parents want to
proactively participate in their sons’ lives, and they, as well as
practitioners, need to encourage other parents to do the same
(Webb, 2005).
Maternal distress related to other disciplines.
The effects of having a child with a chronic disease definitely
influence the mind and behavior of the mothers doing the
caregiving (Barlow & Ellard, 2005). A number of studies have
confirmed an increased risk for psychological dysfunction in
mothers who have chronically ill children, one of which will be
discussed in detail, “Single parents of children with chronic
illness: an understudied phenomenon,” (Brown et al., 2008).
Brown and colleagues performed a narrative systematic review
whose purpose was to examine the literature revolving around
chronic illness and to evaluate the impact on single parenting
and children with chronic diseases. Twenty articles were used to
study single parenting. The researchers found that the anxiety
experienced by a mother during the treatment of her child was a
predictor for later posttraumatic stress symptoms (PTSS).
Parents of children with chronic diseases also demonstrated
increased rates of treatment for anxiety and had increased
maternal negative affect scores. These parents have few social
resources, thus increasing parental stress and other
psychological disorders. These results just barely skim the
surface of the complicated psychosocial issues experienced
when caring for a child with a chronic disease (Brown et al.,
2008).

Summary.
The literature provided supports this study and addresses the
research question. The literature provides insight on what the
experiences of mothers are who care for their children with
muscular dystrophy. In conclusion of the empirical literature
section, it is safe to say that mothers caring for their child with
muscular dystrophy experience a great amount of stress and
anxiety (Barlow & Ellard, 2005; Brown et al., 2008; Carroll et
al., 2010; Lynn et al., 2010; Nereo et al., 2003). This can affect
maternal well-being, and also take a toll on the child’s health
(Carroll et al., 2010). Stress and anxiety play a large role in the
quality of life of mothers, which reflects in the care they
provide to their child (Lucio et al., 2013). These things can all
lead to difficulty adjusting and poor coping skills in the mother.
Stress, anxiety, maternal well- being, adjustment, and coping all
relate to the discipline of psychology, which demonstrates the
need to approach this problem in a multi-disciplinary fashion. If
practitioners, psychologists, social workers, parents, etc. can
spread their knowledge about healthy coping and adaptation,
other parents could be empowered to live the same way,
bettering their lives as well as that of their child (Webb, 2005).
The range of psychological functioning in mothers is a very
wide spectrum. That being said, the emphasis should be placed
on identifying triggers that influence mothers’ psychological
responses to the stressors of a child’s chronic disease. Mothers
in this situation should make time for themselves, even if that
means having a family member take over the caregiving role for
a few hours. In an article based upon stress reduction in mothers
of children with autism, researchers from Vanderbilt University
speak on the subject. Studies have shown clear benefits of
mother-led stress-reduction classes for women in the same,
unique situation. Researchers created two programs: one
focusing on mindfulness and training, the other emphasizing
dealing with guilt by developing character strengths and

positive, healthy mental exercises. “Evaluations conducted
during and after the study showed that the mothers benefited
from either program. They had lower levels of stress, anxiety
and depression, along with improved sleep and life satisfaction.
They also had fewer ‘dysfunctional,’ or unhelpful and negative,
interactions with their children,” (Autism Speaks, 2014). It is
essential that mothers partake in such activities in order to
maintain a healthy lifestyle and relationship with their family
and children.
Gaps in Literature.
Muscular Dystrophy is a very time-consuming disease for the
child and the mother. The experiences, adjustment skills, and
coping capabilities should be shared for other mothers to feel
empowered. “Studies based on coping skills of parents whose
children have disabilities, although scant, add valuable
information to the research literature,” (Webb, 2005, p. 386). If
there were more research on this topic, mothers who are
currently struggling could perhaps be inspired to better their
situation.
One recommendation for further research should include
adaptations by the child and family to the diagnosis of a chronic
disease across the lifespan. Most of the articles focused on the
effects and adaptations of the family in the immediate stage of
diagnosis and soon after. If we knew more about the adaptations
made over a long period of time, it would enable caregivers to
plan for developmentally appropriate support as the patient
changes over time (Mussatto, 2006). In addition, there should
be tools to identify families that are at risk for poor
adaptation/resilience. If families do not have access to
necessary resources, they could struggle and be at risk for being
in an even worse situation (Brown et al., 2008).
Brown et al. (2008) included an entire table (Table II) dedicated
to the gaps in research and questions to be addressed. The

biggest gap in research seems to be during the adaptation phase.
At what point in the child’s life does being a single parent
matter post? How does adaptation for the single parent change
over time? Are there protective factors enhancing single
parenting? Negative factors? And culture. The articles seemed
to have sampled a homogenous population. Would the results be
different if other cultures were sampled? (Brown et al., 2008)
As one can tell, there are still many questions to be asked and
research to be completed. Mothers who have children with
muscular dystrophy are a very fragile population. Understanding
the lived experiences of these women can help practitioners and
other women in the same situation reach out to offer help and to
empower mothers to do the same.
Grading Rubric
Writing the Literature Review Section Rubric
Writing the Literature Review Section Rubric – 100
PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsIntroductionIntroduction includes all of
the following components and they are clearly stated: The
purpose of the ROL (may want to repeat research questions).

How the ROL is organized (empirical literature,
conceptual/theoretical literature, and the theory that will guide
your study
if appropriate
).
Databases, internet sites, and search engines, and other sources
that were used to explore the literature.
Search words used. Time period when the search was conducted.
10 points
Introduction includes most of the introduction components and
they are clearly stated.
9 points
Introduction is somewhat clear, but only partially addresses the
components of the ROL introduction.
8 points
Introduction is vague and unclear and does not include the
purpose or any of the components of the ROL introduction.
7 points10
Empirical ResearchThe first paragraph of the empirical
literature clearly tells the reader what is included and how it is
organized.

Critical thinking is present and there is evidence of synthesis of
the literature that is based on the literature matrix.
Individual studies are presented as needed. All of the following
elements are included and clearly stated: The review includes
all of the major studies on the topic.
The review includes recent research. Studies from other related
disciplines are included, if appropriate.
The eight articles from the literature matrix are in the review of
literature (ROL).
The last paragraph summarizes what is known about the
research area and identifies the gaps in the literature. The
paragraph includes a statement about how the literature supports
your study.
50 points
The first paragraph of the empirical literature clearly tells the
reader what is included and how it is organized.
Critical thinking and synthesis of the literature is clearly
evident.
Most of the ROL elements are included but some are missing.
The last paragraph summarizes what is known about the

research area and identifies the gaps in the literature.
The paragraph includes a statement about how the literature
supports your study.
45 points
The first paragraph of the empirical literature minimally tells
the reader what is included and how it is organized.
Critical thinking and synthesis of the literature is not always
evident.
Many of the ROL elements are missing.
The last paragraph does not clearly summarize what is known
about the research area and identifies the gaps in the literature.
The paragraph does not include a statement about how the
literature supports your study.
40 points
The first paragraph of the empirical literature does not tell the
reader what is included and how it is organized.
Critical thinking and synthesis of the literature is seldom
evident.

Most of the ROL elements are missing.
The last paragraph does not summarize what is known about the
research area and omits the gaps in the literature.
The paragraph does not include a statement about how the
literature supports your study.
35 points50
Gaps from ROL
and SummaryGaps from the literature are identified and
described.
Critical thinking is evident in summarizing the ROL.
The summary includes all the key elements of the ROL.
20 points
Gaps from the literature are identified.
Critical thinking is evident.
Some key elements of the ROL are missing.
18 points
Some gaps from the ROL are identified.

Critical thinking is not evident consistently.
Many of the key elements of the ROL are missing.
16 points
Gaps from the literature are not identified and/or described.
Critical thinking is not evident.
Most of the key elements are missing.
14 points20
Writing Mechanics
and APA FormatAPA is used throughout the paper with few to
no errors.
Correct title page, headers, page numbers, grammar, and correct
referencing format are used.
Few to no writing mechanic errors.
The writing was clear and easy to read.
Follows page recommendations:

Empirical Section: eight to ten pages
Theoretical/Conceptual: one to two pages.
Page length may vary depending on the literature found.
20 points
APA format was generally used correctly most of the time.
Few APA errors were included: title page, headers, page
numbers, grammar, and referencing format.
Some writing mechanic errors.
The writing was not clear at times. It was difficult to read and
understand at times.
Page recommendations are followed almost perfectly.
18 points
APA format was seldom used.
Many APA errors were included: title page, headers, page
Moderate to many writing mechanic errors.

The writing was unclear some of the time. It was very difficult
to read and understand at times.
16 points
APA format was not used.
Many APA errors were included: title page, headers, page
Many writing mechanic errors.
The writing was unclear most of the time. It was not possible to
read and understand at times.
14 points20
Total Points
100

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