nursing degree literature review

Searching the ‘grey literature’ is also an important factor in reducing publication bias. It is often the case that only studies with positive results and statistical significance are published. This creates a certain bias inherent in the published literature. This bias can, to some degree, be mitigated by the inclusion of results from the so-called grey literature, including unpublished work, abstracts, conference proceedings and PhD theses ( Higgins and Green, 2011 ; Bettany-Saltikov, 2012 ; Cognetti et al, 2015 ). Biases in a systematic review can lead to overestimating or underestimating the results ( Jahan et al, 2016 ).

An example search strategy from a published review looking at web use for the appraisal of physical health conditions can be seen in Box 2 . High-quality reviews usually detail which databases were searched and the number of items retrieved from each.

((web OR Internet OR “search engine” OR google OR online OR on line’’) AND (“help seeking” OR “help-seeking” OR “information seeking” OR “information-seeking”) AND (symptom OR symptoms OR diagnoses OR diagnosis))

A balance between high recall and high precision is often required in order to produce the best results. An oversensitive search, or one prone to including too much noise, can mean missing important studies or producing too many search results ( Cognetti et al, 2015 ). Following a search, the exported citations can be added to citation management software (such as Mendeley or Endnote) and duplicates removed.

Title and abstract screening

Initial screening begins with the title and abstracts of articles being read and included or excluded from the review based on their relevance. This is usually carried out by at least two researchers to reduce bias ( Bashir and Conlon, 2018 ). After screening any discrepancies in agreement should be resolved by discussion, or by an additional researcher casting the deciding vote ( Bashir and Conlon, 2018 ). Statistics for inter-rater reliability exist and can be reported, such as percentage of agreement or Cohen's kappa ( Box 3 ) for two reviewers and Fleiss' kappa for more than two reviewers. Agreement can depend on the background and knowledge of the researchers and the clarity of the inclusion and exclusion criteria. This highlights the importance of providing clear, well-defined criteria for inclusion that are easy for other researchers to follow.

Full-text review

Following title and abstract screening, the remaining articles/sources are screened in the same way, but this time the full texts are read in their entirety and included or excluded based on their relevance. Reasons for exclusion are usually recorded and reported. Extraction of the specific details of the studies can begin once the final set of papers is determined.

Data extraction

At this stage, the full-text papers are read and compared against the inclusion criteria of the review. Data extraction sheets are forms that are created to extract specific data about a study (12 Jahan et al, 2016 ) and ensure that data are extracted in a uniform and structured manner. Extraction sheets can differ between quantitative and qualitative reviews. For quantitative reviews they normally include details of the study's population, design, sample size, intervention, comparisons and outcomes ( Bettany-Saltikov, 2012 ; Mueller et al, 2017 ).

Quality appraisal

The quality of the studies used in the review should also be appraised. Caldwell et al (2005) discussed the need for a health research evaluation framework that could be used to evaluate both qualitative and quantitative work. The framework produced uses features common to both research methodologies, as well as those that differ ( Caldwell et al, 2005 ; Dixon-Woods et al, 2006 ). Figure 3 details the research critique framework. Other quality appraisal methods do exist, such as those presented in Box 4 . Quality appraisal can also be used to weight the evidence from studies. For example, more emphasis can be placed on the results of large randomised controlled trials (RCT) than one with a small sample size. The quality of a review can also be used as a factor for exclusion and can be specified in inclusion/exclusion criteria. Quality appraisal is an important step that needs to be undertaken before conclusions about the body of evidence can be made ( Sambunjak and Franic, 2012 ). It is also important to note that there is a difference between the quality of the research carried out in the studies and the quality of how those studies were reported ( Sambunjak and Franic, 2012 ).

The quality appraisal is different for qualitative and quantitative studies. With quantitative studies this usually focuses on their internal and external validity, such as how well the study has been designed and analysed, and the generalisability of its findings. Qualitative work, on the other hand, is often evaluated in terms of trustworthiness and authenticity, as well as how transferable the findings may be ( Bettany-Saltikov, 2012 ; Bashir and Conlon, 2018 ; Siddaway et al, 2019 ).

Reporting a review (the PRISMA statement)

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) provides a reporting structure for systematic reviews/meta-analysis, and consists of a checklist and diagram ( Figure 4 ). The stages of identifying potential papers/sources, screening by title and abstract, determining eligibility and final inclusion are detailed with the number of articles included/excluded at each stage. PRISMA diagrams are often included in systematic reviews to detail the number of papers included at each of the four main stages (identification, screening, eligibility and inclusion) of the review.

Data synthesis

The combined results of the screened studies can be analysed qualitatively by grouping them together under themes and subthemes, often referred to as meta-synthesis or meta-ethnography ( Siddaway et al, 2019 ). Sometimes this is not done and a summary of the literature found is presented instead. When the findings are synthesised, they are usually grouped into themes that were derived by noting commonality among the studies included. Inductive (bottom-up) thematic analysis is frequently used for such purposes and works by identifying themes (essentially repeating patterns) in the data, and can include a set of higher-level and related subthemes (Braun and Clarke, 2012). Thomas and Harden (2008) provide examples of the use of thematic synthesis in systematic reviews, and there is an excellent introduction to thematic analysis by Braun and Clarke (2012).

The results of the review should contain details on the search strategy used (including search terms), the databases searched (and the number of items retrieved), summaries of the studies included and an overall synthesis of the results ( Bettany-Saltikov, 2012 ). Finally, conclusions should be made about the results and the limitations of the studies included ( Jahan et al, 2016 ). Another method for synthesising data in a systematic review is a meta-analysis.

Limitations of systematic reviews

Apart from the many advantages and benefits to carrying out systematic reviews highlighted throughout this article, there remain a number of disadvantages. These include the fact that not all stages of the review process are followed rigorously or even at all in some cases. This can lead to poor quality reviews that are difficult or impossible to replicate. There also exist some barriers to the use of evidence produced by reviews, including ( Wallace et al, 2012 ):

• Lack of awareness and familiarity with reviews
• Lack of access
• Lack of direct usefulness/applicability.

Meta-analysis

When the methods used and the analysis are similar or the same, such as in some RCTs, the results can be synthesised using a statistical approach called meta-analysis and presented using summary visualisations such as forest plots (or blobbograms) ( Figure 5 ). This can be done only if the results can be combined in a meaningful way.

Meta-analysis can be carried out using common statistical and data science software, such as the cross-platform ‘R’ ( https://www.r-project.org), or by using standalone software, such as Review Manager (RevMan) produced by the Cochrane community ( https://tinyurl.com/revman-5), which is currently developing a cross-platform version RevMan Web.

Carrying out a systematic review is a time-consuming process, that on average takes between 6 and 18 months and requires skill from those involved. Ideally, several reviewers will work on a review to reduce bias. Experts such as librarians should be consulted and included where possible in review teams to leverage their expertise.

Systematic reviews should present the state of the art (most recent/up-to-date developments) concerning a specific topic and aim to be systematic and reproducible. Reproducibility is aided by transparent reporting of the various stages of a review using reporting frameworks such as PRISMA for standardisation. A high-quality review should present a summary of a specific topic to a high standard upon which other professionals can base subsequent care decisions that increase the quality of evidence-based clinical practice.

• Systematic reviews remain one of the most trusted sources of high-quality information from which to make clinical decisions
• Understanding the components of a review will help practitioners to better assess their quality
• Many formal frameworks exist to help structure and report reviews, the use of which is recommended for reproducibility
• Experts such as librarians can be included in the review team to help with the review process and improve its quality

CPD reflective questions

• Where should high-quality qualitative research sit regarding the hierarchies of evidence?
• What background and expertise should those conducting a systematic review have, and who should ideally be included in the team?
• Consider to what extent inter-rater agreement is important in the screening process

Doctor of Nursing Practice (DNP): Conducting a Literature Review

• Find Articles
• Reference Resources
• Writing & Citing
• Conducting a Literature Review
• Video/Tutorial Resources
• Web Resources
• Finding Full Text Articles
• Searching for Quantitative and Qualitative Articles
• Presentation Tips

Selected Literature Review Books

Tips for Literature Reviews

• Search the nursing/healthcare literature to find studies relevant to your topic or PICOT question.
• Appraise your findings
• Summarize research studies
• Compare and contrast studies
• Synthesize the key concepts of your readings

Selected Online Resources

• DOI Help: Digital Object Identifiers (DOIs) How to find an article's Digital Object Identifier, or DOI.
• Evaluating Research Literature A guide from Kennesaw State University on how to assess and evaluate research studies.
• Literature Review: A Self-Guided Tutorial A step-by-step guide to conducting a literature review.
• Literature Reviews This guide provides detailed information about conducting a literature review
• Literature Reviews This guide from NYU gives details about various types of literature reviews and a roadmap for evidence synthesis.
• Literature Reviews & Research Methods This JSU subject guide offers advice on doing literature reviews and types of research methods
• RefWorks: Analysis & Synthesis How to use RefWorks to help with the synthesis of articles for a literature review. Part of a comprehensive subject guide from Kennesaw State University.
• What is a Literature Review? This page offers information on literature reviews

Welcome to the Houston Cole Library Guide pages! The Conducting a Literature Review Guide gives you links to key resources to help you get started finding and organizing your resources. Information is also available at Houston Cole Library's How to Conduct a Literature Review page.

Finding Information and Keeping Track of References

Selected databases to search for literature are listed below. RefWorks is a reference manager designed to keep track of the references cited in your papers, and to create bibliographies.

Don't Fear the Literature Review

• Literature Review Tutorial This short tutorial breaks down the aspects of a literature review and how to perform one with emphasis on tips to take the anxiety out of the process.

Literature Reviews: An Overview for Graduate Students

Health and Sciences Librarian

Other Useful Subject Guides

• Basic Academic Research by John Upchurch Last Updated Aug 9, 2024 11 views this year
• Evidence Based Practice in Nursing by Paula Barnett-Ellis Last Updated Aug 9, 2024 443 views this year
• How to Conduct a Literature Review by Karlie Johnson Last Updated Aug 9, 2024 234 views this year
• Medicine, Health, and Nursing by Paula Barnett-Ellis Last Updated Aug 9, 2024 559 views this year
• RefWorks by Karlie Johnson Last Updated Aug 9, 2024 14 views this year
• Scholarly Writing and Publishing by Paula Barnett-Ellis Last Updated Aug 9, 2024 53 views this year
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• You are here: Students

Top Tips for doing your literature review!

07 September, 2010 By NT Contributor

Many undergraduates and qualified nurses who have returned to study do a literature review as the final part of their degree. Helen Aveyard’s advice will ease the process and make it more enjoyable

Many undergraduate students and qualified nurses who have returned to study embark on a literature review as the final dissertation component of their degree. If this applies to you then there are various things that you can do and people you can see to make this process easier, more rewarding and even enjoyable!

The following tips will guide you through the literature review process:

Choose a topic that interests you. This might sound obvious but it does make all the difference in keeping your interest and motivation.From this topic, identify a specific question that you can answer from the literature. The key is to find a question that is not too broad.

Discuss this topic with everyone who will listen to you! This way you will mull over and refine your question until you feel you have a useful question that you can answer.

Work out what literature you need to answer your question . Not everything relating to your question will be relevant and some information will be more relevant than others… be selective.

Most questions need to be answered using primary research . In general terms, if your question involves measuring or evaluating care or an intervention then you will probably need to use quantitative research. If your question is more explorative, then qualitative research is likely to be most relevant. However this is not absolute. Remember that identifying which literature you need is one of the most important aspects of doing your literature review and it is useful to discuss in detail your approach with your supervisor. Think carefully about the type of literature that is likely to be most useful to you. Once you know what you are looking for, you can start to think about how to search for it!

Go and see your subject librarian . Most academic libraries offer drop in sessions for dissertation students. These will enable you to work out how to search for literature on your topic.

Identify key words and search terms . Think laterally about this and don’t forget to use words that are less common or have become outdated. This is because relevant articles might have been indexed using these words and you will miss them if you do not include them in your list of key words.

Now consider which databases you will search through . Go to your academic library website and read through the descriptions of each database and what each holds and select those databases that seem most relevant to your topic.

You are now ready to start searching . Remember to familiarise yourself with the basic functions of the database you are using, remembering that each database is slightly different from another. Take advantage of the Boolean operators (AND/OR/NOT) which allow you to narrow or broaden a search. It is always a good idea to supplement electronic searching with additional searching strategies, for example hand searching relevant journals or reference lists. This is because some key articles might be missed through electronic searching due to the way the paper is indexed.

Look at the abstracts of the articles you come across . It is usually possible to identify from the abstract whether the paper is useful for your review.

Start getting hold of the articles that seem relevant . Sometimes you will need an inter-library loan to do this. At this stage you need to be ruthless. If the article is not relevant to your review, then do not include it. However anything that might be relevant must be looked at.

Collect together all the articles that address your research question . At undergraduate level, if you have around 10 articles, then this is ideal. Significantly more will mean that you are not able to refer to the articles in sufficient detail and too few will not give you enough data to write your review.

Be pragmatic! If needs be, refine your review question to fit the articles that you have. If you have too many articles, try limiting the focus of your question somehow. Can you restrict the focus to the UK only? or a particular nursing speciality?

The next step is to consider the quality of the articles you have . You might have a paper that is directly relevant to your research question but if the quality of the paper is poor it may not help you as much as you think. It is generally a good idea to use a critical appraisal tool that is specific to the research design of your given paper. This might mean that you need to use a few different critical appraisal tools if your literature review question requires you to access a wide range of literature. Discuss this with your supervisor. Using the critical appraisal tool, consider the strengths and limitations of the literature you have identified and consider how much impact each paper has in addressing your research question.

Bring all the papers together and provide an answer for your research question . It is often useful to make a chart of key themes that arise in the papers, the authors of the papers, when they were written and their strengths and weaknesses. You can then see at a glance which other papers identify similar (or different) themes.

As you do this, you will begin to see patterns emerging in the literature and will be able to form an answer to your question. Remember that your answer may well be incomplete. It is quite permissible to say ‘there is some evidence that…’ rather than to provide a definitive answer. What is not permissible is to make out that you have a clear answer when in fact the literature does not support this. In this case, honesty really is the best policy.

Above all remember to answer the question!

Finally remember to put your literature review on your CV and be prepared to discuss at interview. It is a strong selling point when you apply for your first job or a new job.

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Global Nursing—a literature review in the field of education and practice

1 The Swedish Red Cross University College, Department of Care and Nursing, Stockholm, Sweden

Anne Kästel

Henrik eriksson, ann‐marie rydholm hedman.

To describe key findings of Global Nursing in empirical nursing studies.

A literature review using descriptive data synthesis of peer‐reviewed articles in the field of nursing education and practice.

This review of Cinahl Complete, PubMed, Psyc INFO and Scopus was undertaken using the search strategy “global nursing”. Independent title/abstract and full‐text screening was undertaken, identifying original articles written in English.

A total of 472 titles and 170 abstracts were read through. Seventy‐three articles were included for full‐text review. Twenty published studies of Global Nursing with multiple research methodologies fulfilled the inclusion criteria. Findings were described with five categories. Global Nursing Arena, Global Nursing Working Environments, Global Nursing Workforce Management, Global Nursing Competencies and Global Nursing Networking were shown to be crucial when Global Nursing was addressed in the literature.

1. Background

Globalization is one of the most important driving forces in the new millennium. Together with urbanization and digitalization, it reshapes patterns of human existence and societies on a global scale. Although nursing to some extent has been a global profession, the expansion to global awareness clearly develops the patterns in nursing knowledge. However, there have been few attempts to grasp and overview the consequences of globalization as it is addressed in scholarly knowledge. Researchers stress that nursing in the 21st century has many challenges due to the globalized world (Austin, 2001 ; Bradbury‐Jones, 2009 ; Davidson, Meleis, Daly, & Douglas, 2003 ; Nardi & Gyurko, 2013 ; Silva, 2004 ). Furthermore, this global approach in nursing has been reported to correspond to the challenges of human vulnerability and equality. In addition, the strengthening of nursing discipline stands out, both in a local and Global Nursing scene (Bradbury‐Jones, 2009 ; Davidson et al., 2003 ).

It has been stressed that the trend towards global justice or fairness as a deeper human rights issue is everyone's responsibility. Benatar, Daar, and Singer ( 2003 ) reported that a global agenda could include greater attention to duties, social justice and interdependence. Globalization originally refers to the social and political collaboration of international organizations and people, to improve the quality of civil societies across the world (Crigger, 2008 ). High mobility, economic interdependence and electronic interconnectedness are positively addressed to globalization. To this date, the rapidly expanding global economy has failed to reduce poverty and improve health for all (cf. Benatar et al., 2003 ; Bradbury‐Jones, 2009 ). From one published literature review the findings can be used by policy makers, researchers, clinicians and educators, to guide nursing professionals as Global Nursing provides a framework for better health worldwide (Wilson et al., 2016 ).

The nursing profession is changing and has gone through several modifications during the last decades (Nichols, Shaffer, & Porter, 2011 ; Silva, 2004 ). For that reason, nurses, individually and collectively, have the power and the social consciousness to influence basic social services and health care. Thus, nurses should conceive a broader global picture (Bradbury‐Jones, 2009 ; Davidson et al., 2003 ; Silva, 2004 ). As global competencies must be mastered, a deconstruction of long held values, faculty knowledge, nursing policies, nursing education and research are highlighted as important factors (Bradbury‐Jones, 2009 ; Crigger, 2008 ; Nardi & Gyurko, 2013 ; Parcells & Baernholth, 2014 ; Riner, 2011 ).

In an attempt to reconstruct nursing education, a critical reflection on Global Nursing practice is important and how it can be informed by enhanced political awareness. Furthermore, there have been few attempts to conceptualize Global Nursing to address the conclusive parts in the knowledge generated. Therefore, it is of vital importance to describe important aspects of Global Nursing. In addition, the focus in Global Nursing has often been from the perspective of cultural, ethnic and social differences or cultural diversity (cf. Leininger, 1997 ; Washburn, 1987 ; Wilson et al., 2016 ). To overcome this, nurses in clinical practice and nursing students in higher education are challenged to adopt a critical stance to such problematization and conceptualization in nursing. T

he aim of this study was to describe key findings of Global Nursing in empirical nursing studies.

A literature review using descriptive data synthesis of previous reported findings was used to conduct this investigation (cf. Evans, 2002 ; Kmet, Lee, & Cook, 2004 ).

2.1. Sample

An extensive four‐part search strategy was employed to identify relevant studies in the field of nursing education and practice. Research studies focusing on topics concerning Global Nursing were selected. Moreover, review criteria were established by three of the four authors to include articles of primary research or secondary data analysis.

Each phase of the data collection was carried out using six inclusion criteria described in Table  1 . Initially, a literature search based on the first inclusion criteria started the process. In accordance with criteria 2–6, the literature search was performed in databases: Cinahl Complete, PubMed, PsycINFO and Scopus. No date restrictions were applied. The use of the database PsycINFO was decided to include an interdisciplinary database with focus on psychology, behaviour and social science related to nursing.

Inclusion criteria in search strategy and the review

In the four databases, studies were excluded if they were critic comments, conference reports, historical discussions, meeting abstracts, opinion pieces or studies focused on globalization issues other than nursing. Moreover, review articles and non‐scientific publications were eliminated and only articles published in peer‐reviewed scientific journals were accepted. Some of the articles were not available with reasonable resources; they were therefore omitted. In addition, disagreements were resolved by consensus between the three authors (cf. Whittemore, 2005 ; Whittemore & Knafl, 2005 ).

A first search in databases was conducted in PubMed using the term “global nurse” or “global nursing” in title/abstract. The progression of the review process is shown in Figure  1 . The PubMed search generated 191 articles for potential inclusion. Then, publications were tentatively selected by title. After title and abstract review, 137 were retained. After exclusion, in total, 54 articles were included for full‐text reading ( n  =   54) after this first search. Next, a second search in databases was applied in PsycINFO using the term “global nurs*”. The PsycINFO search produced 59 articles for potential inclusion. Title review, abstract review and elimination of duplications yielded 13 additional articles from PsycINFO. Eight were included for full‐text reading. Then, a third search in databases was conducted in Scopus using the term “global nurs*” and generated 167 articles for potential inclusion. Title review, abstract review and elimination of duplications yielded 11 additional articles from Scopus for full‐text reading. Consequently, a fourth keyword search in databases was carried out in Cinahl Complete using the term “global nurs*” as a keyword ( n  =   55). All 55 articles were rejected after title review, abstract review and elimination of duplications.

Flow chart of the review process for search and inclusion

Finally, after searches in four databases, a total of 472 titles were read through. After reviewing 170 abstracts, 73 articles were included for full‐text review (Figure  1 ). In the following phase, data collection and article approval were carried out on the basis of the valid content of the full‐text articles.

The appreciation and evaluation of the selected articles ( n  =   73) were carried out using a checklist described in Table  2 . This checklist was created and modified by three of the authors on the basis of available literature. The used checklist (Table  2 ) was outlined according to Kmet et al. ( 2004 ). It was expanded with some components (sections 1–5) and a few components were modified (sections 10) or excluded. Ten specific evaluation sections were included in the checklist and each of these sections consisted of evaluation criteria (Table  2 ). Studies that accumulated “Yes” in 9 or 10 specific evaluation sections were accepted for the next phase. After the evaluation, 53 articles were rejected based on invalid content. Disagreements were resolved by consensus between three of the authors. Totally, after careful appreciation and evaluation of the full‐text research articles, 20 empirical studies between January 2003 ‐ October 2015 were accepted and included for the findings part of this review (Table  3 ).

Checklist with evaluation sections

Overview of the included studies

2.2. Data analysis

The studies were analysed using descriptive data synthesis according to Evans ( 2002 ). The studies were read repeatedly by two authors, separately, to gain a sense of the Global Nursing issues presented in the data as a whole. Furthermore, the content of the data was divided by choosing a unit of analysis. In the reading, attention was paid to both the details of accounts and to what each study described. Then, the key components were collected from each study and listed. After this listing of key components, they were also discussed together by the two authors. Furthermore, the process of identifying common areas continued. Differences and similarities were compared during this process. Similar key components were categorized into subcategories. The subcategories in turn constituted five overall explanatory categories (Table  4 ).

Subcategories and explanatory categories

3. Findings

Global Nursing was first and foremost published in Western journals, mostly represented by the United Kingdom (UK) and the United States (USA). Both educational and practice settings were presented and the participants were nursing students, nurses with varying educational levels and faculty members.

Global Nursing is described by key findings resulted in five categories; Global Nursing Arena, Global Nursing Working Environments, Global Nursing Workforce Management, Global Nursing Competencies and Global Nursing Networking. Overview of the explanatory categories in the included studies is presented in Table  5 .

Overview of the authors and the explanatory categories

3.1. Global Nursing Arena

Different areas have been addressed in the Global Nursing Arena. At the beginning of the millennium, perspectives on nursing education and nursing values in global contexts were topics of concern (Gerrish & Griffith, 2003 ; Kim, Woith, Otten, & McElmurry, 2006 ; Swenson, Salmon, Wold, & Sibley, 2005 ; Wieck, 2003 ; Wros, Doutrich, & Izumi, 2004 ). Moving towards the mid‐2010s, global leadership, global competencies and networks have arisen as important questions in the Global Nursing debate (Garner, Metcalfe & Hallyburton, 2009; Harrowing, Mill, Spiers, Kulig, & Kipp, 2010 ). At the beginning of 2020, the use of nurses’ professional competence in relation to vulnerability in health on a global scale and forming nursing competence in international work has dominated the Global Nursing arena (Brunetto, Farr‐Wharton, & Shacklock, 2012 ; Gutierrez, Candela, & Carver, 2012 ; Lesia & Roets, 2013 ; Squires & Juárez, 2012 ; Toren, Zelker, & Porat, 2012 ; Walton‐Roberts, 2012 ; Zhou, Windsor, Theobald, & Coyer, 2011 ; Zinsli & Smythe, 2009 ). Finally, in the mid‐2020s, the question of global leadership, nursing faculty competence, and discussions on nurse professionals and nurse faculty retirement has been key issues (Havens, Warshawsky, & Vasey, 2013 ; Meum, Ellingsen, Monteiro, Wangensteen, & Igesund, 2013 ; Tourangeau et al., 2014 ). During recent years, the vulnerability of nurse professionals’ educational and work status has been addressed (Ortiga, 2014 ; Weng, Huang, Chen, & Chang, 2015 ).

3.2. Global Nursing Working Environments

In the articles, Global Nursing practice in dynamic working environments was influenced by predictors such as encouragement in the work place; an organizational culture that values diversity and an inclusive social atmosphere (Garner et al., 2008; Gerrish & Griffith, 2003 ; Harrowing et al., 2010 ; Havens et al., 2013 ; Kim et al., 2006 ; Toren et al., 2012 ; Tourangeau et al., 2014 ; Weng et al., 2015 ). Nurse professionals’ equal opportunities for professional practice, use of competence and collaboration in academic and practice contexts were described as essential in supportive environments (Garner et al., 2008; Gerrish & Griffith, 2003 ; Harrowing et al., 2010 ; Wros et al., 2004 ). Creating a supportive environment for Global Nursing practice and research was described to require an appropriate ethical framework based on the actual context (Harrowing et al., 2010 ; Weng et al., 2015 ; Wros et al., 2004 ). Hence, it was noted that the tendency towards paternalism that may accompany research based on Western ethical traditions could be moderated in a milieu of collaboration (Harrowing et al., 2010 ). However, the power of joint nursing values and ethics was recognized in supportive environments and highlighted by Wros et al. ( 2004 ) as in the following citation: “in reviewing the data, it is apparent that nursing values and ethical concerns transcend culture” (p. 134).

Challenges in global practice environments were mentioned and often linked to inequalities in nursing practice such as marginalization and differences in professional equality (Kim et al., 2006 ; Lesia & Roets, 2013 ; Squires & Juárez, 2012 ; Toren et al., 2012 ; Walton‐Roberts, 2012 ; Zhou et al., 2011 ; Zinsli & Smythe, 2009 ). Many nurse professionals live in countries plagued by social instability and civic unrest, which can hinder growth in nursing identity and development of professional competence (Ortiga, 2014 ; Walton‐Roberts, 2012 ; Zinsli & Smythe, 2009 ). This was explained to lead to the deprofessionalization of nurses and deskilling with limited employment prospects (Walton‐Roberts, 2012 ; Zhou et al., 2011 ). Moreover, it was also described that nurse professionals without resources are often stuck in their localities (Squires & Juárez, 2012 ). For example, medical supply inventory management issues were mentioned as good illustrations of how context matters, as nurses in high‐income countries would not expect to be without medications for more than a few hours or materials for patient care for more than a shift (Squires & Juárez, 2012 ). Zhou et al. ( 2011 ) and Walton‐Roberts ( 2012 ) explained how overseas nurses with low status or lack of practice in the field of specialty expressed feelings of social exclusion. Zhou et al. ( 2011 ) stated that differences are socially constructed and reveal the mechanisms underlying discrimination and racism.

3.3. Global Nursing Workforce Management

Managing changes in gender, class and generational issues were described as essential when facilitating the Global Nursing practice (Brunetto et al., 2012 ; Havens et al., 2013 ; Lesia & Roets, 2013 ; Squires & Juárez, 2012 ; Toren et al., 2012 ; Wieck, 2003 ; Zhou et al., 2011 ; Zinsli & Smythe, 2009 ). For the nursing workforce, preferences on work engagement and subordinate communication followed generations (Brunetto et al., 2012 ; Gerrish & Griffith, 2003 ; Havens et al., 2013 ). According to Toren et al., the influence of gender and academic or non‐academic backgrounds were obvious when nursing students were choosing a workplace. Additionally, Wieck ( 2003 ) and Weng et al. ( 2015 ) explicated that the expectations from nurse professionals included a guarantee of growth in the nursing profession, less hierarchical environments, a determined innovation climate and support to work in various healthcare systems. Weng et al. ( 2015 ) also stated that, “Innovation climate fully mediated the relationship between transformational leadership and nurse innovation behaviour. Nurses could perceive the hospital's encouragement and a high degree of support for innovation in their hospitals” (p. 436).

Challenges in management were related to class, gender and power hierarchies, which negatively affected nurses’ perspectives on work (Brunetto et al., 2012 ; Gerrish & Griffith, 2003 ; Kim et al., 2006 ; Tourangeau et al., 2014 ; Zhou et al., 2011 ). For example, female nurse migration could perpetuate elements of patriarchy (Wros et al., 2004 ). Accordingly, nurses’ professional power with respect to diagnostic and prognostic disclosure has been negatively affected by hierarchies.

3.4. Global Nursing Competencies

The development of global competencies was explained as one of the great opportunities the nursing profession is facing in the future (Garner et al., 2009 ; Kim et al., 2006 ; Wieck, 2003 ). In the studies, these competencies were closely linked to global leadership. It was also stated that global leaders have knowledge about political operations, politically charged environments and their role in international nursing organizations (Garner et al., 2009 ; Kim et al., 2006 ). The view that global competencies could be extended by new educational models, allocated creative projects, and skilled nursing faculty was presented in the studies (Garner et al., 2009 ; Gutierrez et al., 2012 ; Kim et al., 2006 ; Meum et al., 2013 ; Tourangeau et al., 2014 ). In addition, education could teach students to apply leadership theories, co‐constructing global standards, collaborative activities in nursing research and an active use of nursing values or nursing ethics (Gutierrez et al., 2012 ; Meum et al., 2013 ; Wieck, 2003 ). Broadened perspectives of global competencies and effective leadership skills were noted by Garner et al. ( 2009 ) who stated that “The students gained awareness of Global Nursing issues (advocacy), presented research on topics of interest (activism) and contributed to a continuing education workshop based on their experiences (professional accountability)” (p. 105).

In the studies, there were descriptions of challenges with regard to global competencies (Ortiga, 2014 ; Walton‐Roberts, 2012 ; Zinsli & Smythe, 2009 ). This could, for example, be lack of equal recognition of knowledge in the field of nursing, inability to demonstrate nurse autonomy and negative connotations ascribed to nurses’ professional competence (Ortiga, 2014 ; Zinsli & Smythe, 2009 ). Challenges in terms of inequalities were further described by Ortiga ( 2014 ), when nurse educators outside the Western world are forced to negotiate an overloaded curriculum, due to the influx of aspiring migrants into nursing programmes. Differences were also indicated for international disaster and emergency nurses, when their growth in global competence was diminished due to personal danger and overwhelming needs (Zinsli & Smythe, 2009 ).

3.5. Global Nursing Networking

Global strategies were explained to build stronger international bodies (Kim et al., 2006 ; Swenson et al., 2005 ). Garner et al. ( 2009 ) also stated that global networking is promoted by global strategies and could be further developed in joint creative projects. In these projects, it was important to discuss activities for global networking (Garner et al., 2009 ; Kim et al., 2006 ; Swenson et al., 2005 ). It was also stated that the understanding of the impact of politics on healthcare provision and how it affects global networking could broaden the global perspectives (Garner et al., 2009 ; Harrowing et al., 2010 ; Ortiga, 2014 ; Walton‐Roberts, 2012 ; Zinsli & Smythe, 2009 ). Furthermore, growth in leadership competencies and an increased sense of both professional and personal nursing community was described as essential (Garner et al., 2009 ; Kim et al., 2006 ; Weng et al., 2015 ).

In the studies, it was stated that political differences in global networking are challenging. In some Global Nursing contexts, political disparities still exist, for example, international nurse migration has not been addressed (Ortiga, 2014 ; Walton‐Roberts, 2012 ; Wros et al., 2004 ; Zinsli & Smythe, 2009 ). According to Ortiga ( 2014 ), many countries bear the burden of nursing employability and nations lower down the chain supply labour to wealthier countries, “Nurse educators expressed wanting their students to be resourceful and quick on their feet, given the lack of proper facilities in many local hospitals. Yet, as schools became focused on producing nurses for export, the educators faced the dilemma of teaching students how to practice ‘first world’ nursing in a ‘third world’ context” (p. 67).

4. Discussion

The aim of this study was to describe key findings of Global Nursing in empirical nursing studies. The findings are described in five categories. The Global Nursing Arena category showed that the focus has shifted from an interest in education and values to a focus on how a nursing faculty can adopt sustainable strategies to engage in Global Nursing leadership (cf. Garner, et al., 2008). Therefore, we suggest that education for nurses has to contain broadened fundamental knowledge and awareness of dominant areas such as economics, demographics, politics and social constitutions. Our interpretation is that technological developments and policy changes during recent decades have increased the meaning and implication of Global Nursing in both nursing education and practice. The debate has matured considerably and become more extensive over time.

In the Global Nursing Working Environments category, discrepancies in work environments due to globalization might transform evidence‐based nursing practice or research to support inequalities in the global village (cf. Harrowing et al., 2010 ). Our concern is that global care chains demonstrate the south to north migration of nurses and this global movement reinforces inequities. Migration is structured by the power hierarchies embodied in class, ethnicity, gender, nationality and race especially in the era of Global Nursing shortage (cf. England, 2015 ; Xu, 2015 ). Widding Isaksen ( 2012 ) described how the Norwegian welfare state is becoming a global employer and global nurse recruitment generates transnational spaces of care. Furthermore, international nurse recruitment is not a win–win situation and the idealized image of social justice and gender equality needs to be critically examined. We suggest that power hierarchies and global justice or fairness as a deeper human right need to be discussed in practical contexts in nursing education. By training nurses to discover stereotypical behaviour, hidden prejudices and normative structures, nursing education has the opportunity to explain how to counteract inequities. Consequently, it is important that the use of suitable solutions follows local contexts in nursing practice and research.

The consequences of power hierarchies in healthcare systems cause differences in nursing, a loss of identity for nurses and a risk for deskilling in the profession (cf. Toren et al., 2012 ; Widding Isaksen, 2012 ). Gender and class are often constituted as “otherness”. Moreover, identity such as the Self is relative and changing compared with the Other (Eriksson‐Baaz, 2005 ). Said ( 1978 ) argued that Western societies have used their hegemonic position of interpretation to antagonize those who are non‐Western. Throughout colonial history, there have been descriptions of qualities such as the Other; to be childish, irrational and depraved in contrast to the Self which has been ascribed with qualities as rational, mature, virtues and normal (Eriksson‐Baaz, 2005 ; Said, 1978 ). White Western culture, historically and still today, has monopolized science, knowledge, clinical practice and health‐promoting models. Anderson et al. ( 2009 ) claimed that it is our lack of concern about the social disadvantage of “others” at local, national and global levels that leads to serious health disparities. Furthermore, social justice is highlighted as being of importance for nurses. Our interpretation is that these cases have to be further investigated. Education can prevent inequalities by training nurses to make conscious choices in nursing activities when power hierarchies occur in healthcare systems.

The Global Nursing Workforce Management category highlighted transformational leadership, growth in the nursing profession, nurse innovation behaviour and high mobility. However, nurse migration and the export of nurses create business and profits for many countries, organizations and agencies (cf. Zhou et al., 2011 ). This raises the question of how inequality in nurse migration has become a moral problem. England ( 2015 ) concluded that analyses of linkages between globalization, migration and care are essential. In countries with nurse export, there is a lack of healthcare professionals, which in turn results in a lack of health care, an economic imbalance and vulnerability among people (cf. Kaelin, 2011 ). Accordingly, in developing countries, nurse recruitment hinders people in their ability to make use of their political liberties (ibid.). Thus, The World Health Organization calls for principles of transparency, fairness and the promotion of sustainability of health systems in developing countries (2010). Our interpretation is that nursing education and practice are challenged in meeting the expectations of nurse professionals and in guaranteeing growth in the nursing profession.

Global Nursing Competencies have shifted in focus to engagement in a global leadership and professional activism (cf. Garner et al., 2009 ). Based on the findings, we stress that nursing education provides a great opportunity to promote global competencies and explain diminishing aspects important for the nursing profession in nursing practice. Furthermore, a mission is to prepare students to train global awareness by actions and reflection on their experiences. According to our findings, we recommend an ethical framework and nursing actions as useful tools in the efforts to reduce inequities and inequalities in Global Nursing practice (cf. Grootjans & Newman, 2013 ; Gutierrez et al., 2012 ; Meum et al., 2013 ; Wieck, 2003 ).

Global Nursing Networking explained strategies that could be helpful and used to further develop joint creative projects (cf. Garner et al., 2009 ; Kim et al., 2006 ; Swenson et al., 2005 ). Moreover, global leadership was described as being of vital importance. One solution for change in nursing challenges is proposed by Nardi and Gyurko ( 2013 ). They highlight that Global Networking can be used to design new education models that suit global healthcare needs, pooling teaching resources, designing and using databases across organizations to track and project faculty needs. Accordingly, there is a need for innovation in nursing practice to accommodate the huge challenges facing the future of nursing (ibid.). We claim that work in different healthcare systems and team building together with a long‐term innovation climate is important for Global Nursing Networking. In both nursing education and practice, there are great opportunities for nurse professionals and faculty to collaborate in the global community.

Finally, we discuss why we only found two studies that were published outside the Western world although Global Nursing exists in the entire world. Furthermore, the results showed that the UK and the USA are active participants writing about Global Nursing issues, which means that it is essentially a Western perspective that is being shown. This is a question of concern as the concept of a global representation might also be connected to values that have their origin in colonialism. We stress the importance of postcolonial awareness in nursing when dealing with matters of globalization. Postcolonialism has been described as the response to the marginalization of Western cultures’ values and norms (cf. Said, 1978 ; Shakib, 2011 ). This is a concern as the Western context needs to undergo a series of changes to tackle its colonial past even in nursing. We would like to add that this is a critical aspect in advocating for a global agenda in nursing.

4.1. Methodological considerations

The data collection and data analysis in this review will be critically discussed based on various parts linked to trustworthiness (cp. Sandelowski, 1993 ; Rolfe, 2006 ).

Credibility involves aspects such as how to source articles, how to select key components and how well the explanatory categories cover the data. Careful considerations have been taken when planning and working with the appraisal of each phase in the review process.

The appraisal was based on inclusion and exclusion criteria in the search strategy. Subjective reading and evaluation with the modified checklist with evaluation sections related to Kmet et al. ( 2004 ). For the studies with qualitative methods, the appraisal process for each study included has been taken into account through an investigation of the reflexivity of the researcher, the participants and the description of context. For the surveys included, the appraisal process has been taken into account through an investigation of validity and reliability of sample, data collection, analysis methods, setting and participants, to enhance the understanding of the findings in this evaluation.

Transferability refers to the extent to which findings can be transferred to other settings. The number of organizations taking part in the study, where they are based and the number of participants involved have carefully been described to get sufficient contextual information about the studies included. Accordingly, the data collection methods that were employed and the time period over which the data were collected, has been reported. However, it is up to the reader to decide whether it is possible to transfer outcomes to other contexts.

Dependability of the data analysis was ensured by showing the procedure of coding and formulating the explanatory categories according to Evans ( 2002 ). In this review, the two authors who conducted the analysis reflected on and discussed the content and categorization models. To address the dependability issue, the processes in the study have been reported in detail and include the researcher design and how it was carried out. For this review, only the term Global Nursing in the field of nursing was accepted in the search and research literature. Other related terms were excluded due to the large amount of material and the intention to obtain a clear description with respect to the Global Nursing phenomenon. In addition, some research articles had to be excluded due to non‐availability or translation problems from the original language into English. Consequently, these aforementioned issues might limit the search and cause selection bias. Confirmability is the investigator's comparable concern to objectivity. In this review, a detailed methodological description allows the reader to determine how far the data and constructs emerging from it may be accepted.

5. Conclusion

This literature review emphasized that nursing education provides a great opportunity to promote global relationships through global networking. Global Nursing offers wider awareness in nursing knowledge and contributes to a nursing profession equipped for today's challenges and global work with inequalities.

Conflict of Interest

The authors declare no conflict of interest or external support in the form of grants.

Author contributions

MK, AK, AMRH, HE: Study design, data collection, data analysis and manuscript preparation.

All the Authors have agreed on the final version and meet at least one of the following criteria [recommended by the ICMJE ( http://www.icmje.org/ethical_1author.html )]:

• substantial contribution to conception and design, acquisition of data or analysis and interpretation of data;
• drafting the article or revising it critically for important intellectual content.

Acknowledgements

We thank The Swedish Red Cross University College, Department of Care and Nursing, Huddinge, Sweden, for giving a grant to the corresponding researcher, which made this review possible.

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Best Nursing Research Topics for Students

What is a nursing research paper.

• What They Include
• Choosing a Topic
• Best Nursing Research Topics
• Research Paper Writing Tips

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

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A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

• Select nursing topics for research
• Conduct effective research
• Analyze published academic literature
• Format and cite sources
• Synthesize data
• Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

• Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
• Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
• Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

• Assess the impact of nurse-led diabetes education in Type II Diabetics.
• Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

• Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
• Identify methods that best prepare pre-licensure students for clinical practice.
• Investigate factors that influence nurses to pursue advanced degrees.
• Evaluate education methods that enhance cultural competence among nurses.
• Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

• Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
• Assess the effectiveness of mental health education among emergency room nurses .
• Explore de-escalation techniques that result in improved patient outcomes.
• Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

• Assess the impact of parental involvement in pediatric asthma treatment adherence.
• Explore challenges related to chronic illness management in pediatric patients.
• Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

• Analyze the effects of short staffing on nurse burnout .
• Evaluate factors that facilitate resiliency among nursing professionals.
• Examine predictors of nurse dissatisfaction and burnout.
• Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

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Where is the evidence that master's level nursing education makes a difference to patient care? A literature review

Affiliation.

• 1 Critical Care Department, Waikato Hospital, New Zealand. [email protected]
• PMID: 21371793
• DOI: 10.1016/j.nedt.2011.02.001

Aim: This paper reports on a literature review conducted to explore whether there is evidence that postgraduate nursing education at master's level affects patient care.

Background: Continued nursing education has been shown to benefit nurses' development, though little research has been conducted in relation to patient benefit. It is increasingly widespread that nurses pursue education to master's level.

Method: Following a systematic review of the literature fifteen studies of mixed methodology and design were examined and data extracted using thematic analysis. Five common themes emerged relating to master's level nursing education that may ultimately affect patient care: increased confidence and self esteem; enhanced communication; personal and professional growth; knowledge and application of theory to practise; and analytical thinking and decision making.

Conclusion: It is apparent that there are positive gains for nurses who undertake postgraduate nursing study at master's level related to professional and personal qualities which may provide direct benefit to patients. The supportive evidence extracted from the literature was scant, however. Future research needs to focus on developing measurable and observable criteria against which the educational and skill based outcomes for master's level performance can be evaluated including constraints that may adversely affect a nurse's ability to apply knowledge and skills acquired.

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• Published: 13 August 2024

Development and validation of a patient-centered communication scale for nurses

• Youngshin Joo   ORCID: orcid.org/0000-0001-9986-5319 1 ,
• Yeonsoo Jang   ORCID: orcid.org/0000-0002-1898-025X 2 ,
• Chang Gi Park   ORCID: orcid.org/0000-0003-3366-4279 3 &
• You Lee Yang   ORCID: orcid.org/0000-0002-5512-089X 4  

BMC Nursing volume  23 , Article number:  550 ( 2024 ) Cite this article

141 Accesses

Metrics details

Patient-centered care aims to prevent disease and promote well-being by actively involving patients in treatment and decision-making that is based on respecting the patients and their families. However, no scales have been developed to assess patient-centered care from the nurse’s perspective. This study aimed to develop a scale to measure nurses’ level of patient-centered communication and confirm its validity and reliability.

A methodological cross-sectional study was adopted to develop and validate the Patient-Centered Communication Scale (PCCS). The items were developed through a literature review and online interviews with nurses. Content validity was assessed by experts and the content validity index was calculated. A pretest of the questionnaire was conducted with 10 clinical nurses. To evaluate the factor structure and internal consistency reliability, the PCCS was administered online to 325 nurses in South Korea. Data were analyzed using descriptive statistics, explanatory factor analysis (EFA), and confirmatory factor analysis (CFA).

The final instrument consisted of 12 items and three factors: (1) information sharing, (2) patient-as-person, and (3) therapeutic alliance. EFA revealed a distinct three-factor structure, explaining 59.0% of the total variance. CFA confirmed the adequacy of the model fit and validated the inclusion of the final items. The Cronbach’s alpha values ranged from 0.60 to 0.77, indicating acceptable internal consistency. Convergent validity was evidenced by the correlation between the PCCS and a measure of interpersonal communication competence.

Conclusions

The 12-item PCCS showed good reliability, construct validity, and convergent validity. The scale has utility for measuring the level of patient-centered communication skills in nurses.

Peer Review reports

Communication is a vital component for nurses to establish therapeutic relationships with patients and their families, as well as to maintain cooperative relationships with other healthcare providers [ 1 ]. According to the Beryl Institute, key elements in the nursing experience of consumers include effective communication, which encompass active listening and clear conversations between healthcare providers and patients, and using understandable language when interacting with patients and their families [ 2 ]. However, in clinical practice, nurses often encounter challenges in communicating with patients, their families, and other healthcare providers. These difficulties not only diminish the quality of care but also elevate the risk of medication errors, potentially resulting in adverse outcomes or even fatalities [ 3 ]. Recent studies have shown that improved communication skills among nurses correlate with reduced medical errors, enhanced quality of care, better nursing performance, increased job satisfaction, stronger organizational commitment, and higher self-efficacy [ 2 , 4 , 5 ].

Current trends in the healthcare system emphasize the importance of nurses providing patient- and family-centered care (PFCC). This approach represents a philosophical shift in medical care, emphasizing collaboration between healthcare providers and patients along with their families [ 6 ]. PFCC represents the ideal direction for healthcare systems and policies, as it promotes active involvements of patients and their families in decision-making based on their values, preferences, and needs [ 7 ]. Previous studies have emphasized nurses’ communication competency as the primary factor in performing PFCC. Additionally, communication has been identified as a significant associating factor [ 8 , 9 ]. To align with this trend, a number of communication programs have been developed by healthcare providers to enhance PFCC, such as the situation, background, assessment, recommendation (SBAR) tool and assertiveness training programs for nurses [ 10 ]. These programs not only improve communication skills, the level of clinical performance, critical thinking skills, job satisfaction, and self-efficacy but also reduce turnover intention in nurses [ 11 , 12 ].

In clinical practice, nurses’ communication should be goal-oriented and focus on enhancing patients’ physical and mental health, which is consistent with patient-centered communication (PCC) [ 13 ]. PCC aims to prevent disease and promote well-being by actively involving patients in their treatment and decision-making that is based on respecting patients and their families [ 14 ]. However, there is no study evaluated nurses’ level of PCC, who communicate the most with patients and their families in clinical settings. Furthermore, the commonly used scales to measure PCC were not developed for clinical nurses.

Thus far, the scales developed for measuring general communication skills or for communication competencies of nursing students in simulation courses have been used [ 11 , 15 ]. For example, Hur [ 15 ]’s global interpersonal communication competence scale is often utilized to assess clinical nurses’ communication skills, although it was not designed specifically for nurses in clinical settings. Some PCC scales that assess the patient’s perspective have been developed [ 16 , 17 ]. Moser et al. [ 16 ]'s PCC scale evaluated patients' experiences of PCC, while Reeve et al. [ 17 ] validated communication measures specifically from colorectal cancer patients. However, these instruments solely reflect the patient’s viewpoint and not that of the providers. There exists a instrument primarily developed by researchers for their own studies that evaluates nurses’ perspectives, yet it has not been validated [ 18 ]. Furthermore, another instrument evaluates nurses' attitudes towards patients communication [ 19 ], while a tool specifically assesses PCC in older patients with acute myeloid leukemia [ 20 ], limiting its applicability. Moreover, these existing instruments have limitations in evaluating PCC from the perspective of nurses, as they do not fully capture the attributes of the therapeutic relationship between nurses and patients. Therefore, it is necessary to develop and analyze the psychometric properties of an instrument that comprehensively measures PCC in nurses.

This study aimed to develop the Patient-Centered Communication Scale (PCCS) for clinical nurses and evaluate the reliability and validity of the scale.

Study design

This was a methodological cross-sectional study to develop and validate the PCCS for nurses.

Scale development

Conceptual framework of the patient-centered communication scale (pccs).

In this study, the concept of PCC was defined as a set of actions aimed at empowering patients or their families, including providing adequate information, addressing emotions, expressing empathy, actively reflecting their values and preferences in decision-making, and involving them in therapeutic decisions. We adopted five domains from the PCC model [ 14 ]: biopsychosocial, patient-as-person, sharing power and responsibility, therapeutic alliance, and provider-as-person.

The biopsychosocial domain encompasses the biomedical, psychological, and sociological aspects of illness, emphasizing information exchange for patients and families. The patient-as-a person domain involves understanding patients’ unique personalities beyond their illness. The sharing power and responsibility domain includes actively engaging the patient or family members in treatment decision-making and reaching an agreement on the care plan. The therapeutic alliance domain focused on the quality of the relationship between healthcare providers and patients. Mutual understanding of treatment goals, a personal bond, or a patient's trust or perceptions of healthcare providers can influence the quality of the relationship. The provider as-a-person domain involves effectively engaging with other healthcare providers in patients’ care or treatment and recognizing one’s own emotions experienced while caring patients [ 14 , 21 ].

Preliminary items of the PCCS

To develop the preliminary items of the PCCS, the literature reviews and e-mail interview were conducted. Firstly, we searched PubMed, the Cumulative Index to Nursing & Allied Health Literature, the Research Information Sharing Service, and the Korean-Studies Information Service System databases using the keywords such as “patient-centered communication,” “therapeutic communication,” “communication skill,” and “nurs*. Through this literature review, we developed initial 50 items.

We conducted an e-mail interview consisting of four open-ended questions regarding the concept of PCC, distinctions between PCC and non-PCC approaches, specific methods or strategies for implementing PCC, and the essential competencies for nurses to effectively engage in PCC. For interviews, we selected 10 nurses using purposive sampling, as suggested by Sandelowski [ 22 ], which is considered adequate for qualitative study when contextual factors among participants are similar. Inclusion criteria were bedside nurses in hospitals with over 300 beds, with a minimum of one year of clinical experience caring for patients. Exclusion criteria were nurses with less than one year of hospital experience, nurse managers or those not directly involved in bedside patient care.

We distributed the questions to 10 nurses using their individual e-mail addresses and received responses. The collected data were analyzed using content analysis [ 23 ]. To analyze the content, we collected descriptions from 10 nurses for each item and thoroughly reviewed them, selecting meaningful statements and grouping similar responses together. After reviewing the grouped content and holding team meetings, we established categories based on five domains of PCC and added 20 items.

According to the results of the literature review and e-mail interviews, a total of 70 items were created. These items were then classified by the first author according to the five domains of the PCC concept and later discussed within the research team. Using a team to develop items benefits from the fact that people express similar ideas in diverse ways [ 24 ].

Subsequently, during research team meetings, we refined the classification and removed 19 items. This included: 1) items with duplicate or similar meanings, especially those related to providing information to patients and their families, engaging them in care processes, and demonstrating respect for their needs, values, and preferences; and 2) items that were not directly relevant to PCC by nurses. Consequently, 51 items were selected as the preliminary items for the PCCS.

Content validity

Experts were used to evaluate the content validity of the PCCS. Four clinical nurses with more than 10 years of work experience and three nursing professors participated as the expert panel. Following the recommendation of Burns and Grove (2005), seven experts were recruited to assess the content validity of the PCCS [ 25 ]. The expert panel consisted of four nurses and nurse managers with over 10 years of clinical experience and have master’s degrees or higher. Additionally, three nursing professors who have experience in communication-related education and research, as well as scale development research, were included.

A 4-point Likert scale was used for the evaluation of the content and to determine the item content validity index (CVI) (I-CVI; higher than 0.80) and scale CVI (S-CVI; higher than 0.90) [ 26 ]. The response options were categorized based on the degree of agreement with the content validity of each item, ranging from 'Not valid at all' (1-point) to 'Very valid' (4-points). Additionally, experts were asked to provide reasons for any item rated 2 points or lower, as well as overall opinions on items that needed to be revised, deleted, or added. Furthermore, based on the experts’ feedback, we had research team meetings to discuss, modify, integrate, and extract items. Items that were ambiguous or confusing were removed from the preliminary scale.

The I-CVI ranged from 0.57 to 1.0, and 13 items had a value less than 0.80. The S-CVI average was 0.86. Based on the experts’ feedback and study team meetings, 11 of the 13 items with a CVI of less than 0.80 were deleted [ 26 ]. The deleted items were difficult to link directly to communication and were highly abstract. However, the two items that had a value less than 0.80 were retained being modified. Furthermore, based on the feedback from the experts, items that were 0.80 or higher and had duplicate content were integrated into one item. Through this process, we developed a 31-item questionnaire.

Pretest and cognitive testing

Based on a previous study that developed an instrument for nurses [ 27 ], a pretest of the 31-item questionnaire was conducted with 10 bedside clinical nurses to evaluate the understandability of the items, the time it took to complete the questionnaire, the appropriateness of the arrangement, and the length of each item. Then, among the 10 nurses who participated in the pretest, five were selected for telephone interviews to identify the items. Then, among the 10 nurses who participated in the pre-test, five were selected for telephone interviews to identify the items. Based on feedback suggesting that providing more specific examples or clarifying ambiguous terms would enhance clarity, we revised the items accordingly. It took 9.40 ± 3.86 min to complete the questionnaire. The understandability of the items, appropriateness of the items’ arrangement, and time to complete the questionnaire received more than 3 out of 4 points. The expressions of three items were modified in keeping with the participants’ feedback.

Validation of the PCCS

Study participants.

The study participants were bedside nurses working at hospitals in South Korea. The inclusion criteria were nurses (1) working at a hospital with more than 300 beds, (2) who had at least one year of work experience, and (3) working as a bedside nurse. Exclusion criteria were nurses (1) who were working at a specialized hospital, such as dentistry, oriental medicine, or nursing home, or (2) who were a charge nurse or unit manager.

To evaluate construct validity using exploratory factor analysis (EFA), a sample of five times the minimum number of items is required [ 28 ] and a confirmatory factor analysis (CFA) requires a minimum sample size of 150 participants [ 29 ]. The preliminary PCCS consisted of 31 items; therefore, 155 participants were needed for the EFA and 150 for the CFA. Considering a 90% valid response rate, a total of 339 nurses were recruited. After excluding questionnaires that had duplicate or inappropriate answers, questionnaires from 325 participants were included in the analysis.

Instruments

The PCCS consisted of 31 items that participants responded to using a 5-point Likert scale, where 1 = “strongly disagree” and 5 = “strongly agree.” The scale was constructed with eight items for the biopsychosocial domain, nine items for patient-as-person, three items for sharing power and responsibility, four items for therapeutic alliance, and seven items for the provider-as-person. Higher scores indicate a higher level of PCC.

Interpersonal communication skills

To evaluate convergent validity, we used the Global Interpersonal Communication Competence (GICC) Scale [ 15 ], which is based on Rubin’s [ 30 ] eight communication skills (self-disclosure, empathy, social relaxation, assertiveness, interaction management, expressiveness, immediacy, supportiveness), and seven more concepts (concentration, goal detection, noise control, efficiency, assertiveness, conversational coherence, responsiveness) on interpersonal communication. Participants responded to the 15 items using a 5-point Likert scale. Higher scores indicate a higher degree of interpersonal communication skills. Hur [ 15 ] reported a Cronbach’s alpha of 0.74 for the scale.

General and professional characteristics

Data were collected through self-report on the following participant characteristics: gender, age (year), education, marital status, religion, work experience (year), and work unit.

Data collection

Data were collected through online survey via the Survey Monkey website from June 27, 2022 to July 15, 2022. A recruitment notice that included a URL address to participate in the study was posted in two online communities freely opened to the nurses across the country. After accessing the URL link, potential participants were asked to read the informed consent form, and those who decided to participate in the study clicked on “agree” to go to the next page. Then, participants were asked about each inclusion/exclusion criterion, ensuring that only those who answered "yes" to all criteria were eligible to participate in the survey. We permitted only one IP address to submit a single response to minimize duplicate participation. All the questions required a response to prevent missing values. We distributed an online coffee coupon to the participants who completed the questionnaire.

Data analysis

The data were analyzed using IBM SPSS/Win 28.0 (IBM Corp., Armonk, NY, USA) and R version 4.2.1 (R Foundation for Statistical Computing, Vienna, Austria). The process included the following steps.

The characteristics of the participants were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation. Differences between the CFA and EFA groups were analyzed using the chi-square test and independent t-test.

An EFA was performed using principal axis factoring to extract meaningful structures common to all the items. We performed direct oblimin rotation to minimize the inter-factor correlations and make the factor more interpretable [ 31 ]. The Kaiser-Meyer-Olkin (KMO) test and Bartlett’s test for sphericity were conducted to determine whether the collected data were suitable for factor analysis.

A CFA was performed to test the accuracy of the structure revealed by the EFA; weighted least squares means and adjusted variance (WLSMV) were used. WLSMV is known as an appropriate estimation method to conduct CFA for Likert scales, with fewer than five points in medium-to-small sample sizes [ 32 , 33 ]. Absolute fix and incremental fit indices were evaluated. The fit indices included χ 2 statistic ( p -value), normed χ 2 (chi-square/degrees of freedom [CMIN/df]), goodness of fit index (GFI), standardized root mean square residual (SRMR), root mean square error of approximation (RMSEA), Tucker-Lewis index (TLI), and comparative fit index (CFI). The reference values for each fitness index were p > 0.05, χ 2 (CMIN/df) ≤ 3.0, GFI ≥ 0.90, SRMR ≤ 0.08, RMSEA ≤ 0.08, TLI ≥ 0.90, and CFI ≥ 0.90.

The Pearson correlation coefficient for the PCCS and GICC scale [ 16 ] was calculated to verify convergent validity.

Cronbach’s alpha coefficient was analyzed to evaluate the internal consistency reliability of the scale.

Ethical consideration

We received the approval of the Institutional Review Board of Eulji University prior to the study (IRB No. EUIRB2022-013).

All study participants were informed about the aims and the method of the study, and they were asked to provide written informed consent.

Characteristics of the participants

A total of 325 bedside nurses participated in the study (175 for the EFA and 150 for the CFA). Most of the participants were women (95.4%), and the mean age was 32.15 ± 3.93 years. Most participants had a bachelor’s degree (86.2%), followed by a diploma (9.2%), or master’s degree or higher (4.6%). Mean years of work experience was 6.25 ± 3.55 years, and the working units were medical (37.8%), surgical (29.5%), obstetrics gynecology, pediatrics (14.5%), intensive care (11.1%), and emergency room (6.2%). There were no significant differences in gender, age, education, marital status, religion, or the working units between the EFA and CFA groups (Table  1 ).

Item analysis

The item analysis revealed the mean score for the 31 items was 3.73 ± 0.48, and the range was 3.42–4.03 (standard deviation 0.71–1.01). Skewness and kurtosis were less than ± 2.00 on all the items, so normality was satisfied. The item-total correlations were more than 0.30 and less than 0.80, implying that no items deviated from the standard (see Supplementary file 1) [ 34 ].

Exploratory factor analysis

The KMO value of the data was 0.87, and Bartlett’s test of sphericity was χ 2  = 632.95 ( p  < 0.001); therefore, the conditions for the EFA were satisfied. After checking repeatedly for communality and factor loadings, three factors with an eigenvalue of 1.0 or greater were derived, and 16 items were deleted. The reasons are those items exhibited less than 0.40 in communality or cross loaded on two or more factors and the difference in the factor loading value was less than 0.20. The standard criteria were set at 0.40 [ 35 ], and prior study on scale development for nurses [ 36 ]. Additionally, three items did not load on any factor. Consequently, 12 items were confirmed and accounted for 59.0% of the variance. Factor 1 (information sharing) comprised five items and explained 38.2% of the variance. Factor 2 (patient-as-person) comprised four items and explained 10.6% of the variance. Factor 3 (therapeutic alliance) comprised three items and explained 9.8% of the variance (Table  2 ).

Confirmatory factor analysis (CFA)

A CFA was performed on the three factors and 12 items of the PCCS. All items had a standardized factor loading of 0.40 or higher. The fitness indices were as follows: χ 2  = 57.601 ( p  < 0.001), CMIN/df = 1.12, GFI = 0.98, SRMR = 0.05, RMSEA = 0.03, TLI = 0.98, CFI = 0.98. All the fit indices satisfied the criteria (Table  3 ).

Convergent validity

The correlation coefficient between the PCCS and GICC scale was 0.68 ( p  < 0.001), providing support for convergent validity.

Reliability

The Cronbach’s alpha of the total scale was 0.84. The Cronbach’s alpha for the three factors were 0.77, 0.72, and 0.60 (Table  4 ).

This study aimed to develop and validate a Patient-Centered Communication Scale (PCCS) for clinical nurses, comprising three factors and 12 items. The PCCS demonstrated good reliability and validity as a measure of PCC in clinical nurses. The scale could be considered as a useful tool for evaluating and designing improvements of clinical nurses’ skill of PCC. This study developed the scale based on the domains of PCC, which including biopsychosocial, patient-as-person, sharing power and responsibility, therapeutic alliance, and provider-as-person [ 14 ].

Regarding the validity of the instrument, study findings showed an adequate content validity for the questionnaire. Thus, the items that make up the instrument accurately and clearly reflect what it is meant to measure and the domain in which it is meant to measure. In terms of construct validity, factor analysis was conducted. In the EFA, 12 items and three dimensions were extracted. The factor loadings of the items were all greater than 0.4. In the CFA, a well-fitting model was obtained, with all indices in the acceptable range. The three-factor structure of the scale had an appropriate fit.

The first subscale extracted in the EFA was the information sharing, which is consistent with the biopsychosocial perspective domain in the PCC conceptual framework [ 14 ]. The factor consists of five items and has the most explanatory power among the three factors at 38.17%. The items are related to explaining interventions and procedures about medical treatment and nursing care. The Institute of Patient- and Family-Centred Care (IPFCC) emphasized the importance of delivering information which is timely, complete, and accurate [ 37 ]. According to these items, the biopsychosocial domain was a large portion of nurses’ communication with patients and their families, primarily addressing acute biomedical issues such as vital signs, technical matters, medical history, and nursing interventions [ 14 ]. Therefore, it is an essential component and considered as one of the core concepts in PCC. Additionally, this factor consists of items wherein nurses assess patients’ and families’ understanding and allowing them sufficient time to ask questions. This emphasizes the bidirectional communication of patient-centered care. Furthermore, patients are not solely providing information about their medical symptoms and illness, they are actively participating in a reciprocal exchange of disease-related information [ 16 ].

The second subscale of the PCCS was patient-as-person, which has four items. This factor is consistent with the patient-as-person domain in the PCC conceptual framework, which emphasizes the aspects of caring that include sharing emotions and understanding individual worries and concerns related to the disease rather than focusing only on curing the disease [ 14 ]. Open ended questions are used to encourage patients and families to express their emotions. PCC includes eliciting the patient’s agenda through open-ended questions and engaging in focused active listening. The key features of PCC involve understanding the patient’s perspective on the illness and demonstrating empathy [ 38 ]. This understanding encompasses exploring the patient’s feelings, ideas, concerns, and experiences related to the impact of the illness, as well as recognizing the patient’s expectations from health care providers [ 39 ].

Non-verbal communication is critically important to express empathy and achieve patient-centered communication [ 40 ]. However, some preliminary items in this study about using non-verbal communication methods (e.g., touch and non-verbal expressions of empathy) and casual conversation with patients were deleted during factor analysis due to their low communality. This finding may be derived due to barriers on patient-centered care and communication. In previous studies, nurses spent less time on interactions with patients due to poor staffing ratios, higher workload, and lack of institutional and healthcare system support [ 1 , 8 ]. This may be reflected in the relatively lower performance of PCC, such as having a daily conversation with a patient or understanding their feelings, because nurses frequently experience a great amount of pressure to accomplish a large amount of work within their duty hours [ 41 , 42 ].

The third subscale of the PCCS was therapeutic alliance, which is consistent with the therapeutic alliance and provider-as-person domains in the PCC conceptual framework [ 14 ]. The factor consists of three items regarding introductions of other departments or organizations to the patient or family, collaborating across disciplines, and communicating and sharing emotions with colleague. However, in the PCCS, 3 items were correlated to alliance between healthcare providers, without including collaboration with patients and their families. According to the IPFCC, alliance refers not only to the care of patients and families, but also to health care providers involved in the development, implementation, and evaluation of policies beyond patients’ basic care [ 37 ]. Despite this expanded definition, there remains a lack of consensus between patients and healthcare providers [ 43 ], and Interprofessional collaboration among healthcare providers is more commonly addressed than collaboration between patients and healthcare providers in clinical settings [ 44 ]. This alliance ultimately occurs as a result of patient centered communication and enhances the quality of patient-and family-centered care [ 43 ]. Further studies are recommended for clearly establishing the concept and strategies to enhance the alliance between patients and health care providers.

Two domains, provider-as-person and sharing power and responsibility, were conceptually validated but did not ultimately emerge as final domains; corresponding items were removed through the EFA process. Following clinical nursing circumstances likely influenced the exclusion of these domains from the final PCCS.

The provider-as-person domain, which assesses healthcare providers' self-evaluation of communication skills and participation in training programs, was removed. Nurses faced challenges in dealing with aggressive patients, communicating with seriously ill patients, and encountered barriers to training participation [ 45 ]. To address this, tailored communication education programs addressing actual clinical difficulties and incentive strategies for participation should be adopted for nurses.

Another excluded domain, sharing power and responsibility, promotes mutual equality between healthcare providers and patients, emphasizing active patient involvement in decision-making and consideration of their personal experiences [ 14 , 21 ]. However, nurses often felt distant from such interactions, deferring decisions to doctors perceived as having superior knowledge [ 46 ]. Additionally, nurses believed this domain was more prominent between patients, families, and physicians rather than nurses [ 15 ].

In this study, 70 initial items were developed; however, only 12 items were finally confirmed as part of PCCS. Initial items were developed to encompass a broad range of attributes related to PCC, with the aim of distinguishing them from existing PCC instruments and to maximize coverage of therapeutic relationships between patients and nurses in clinical settings. Despite recognizing PCC as crucial component in healthcare, paternalistic values persist, and nurses may lack perception of collaboration among healthcare providers, patients, and families. Various clinical situations and factors, including nurses' personal values and workplace culture, could influence the study results [ 44 ]. We recommend developing additional items for removed domains and conducting validity testing again.

Convergent validity was assessed by analyzing the correlation with GICC and PCCS, which yielded a value of 0.68. Based on the criterion that a correlation coefficient between 0.40 and 0.80 ensures convergent validity [ 47 ], this value was considered to be sufficient. The reliability was assessed using Cronbach's alpha for all the items, resulting in 0.84, and each subscale ranged from 0.60 to 0.77. Cronbach's alpha tends to decrease with fewer items, and the therapeutic alliance scale, comprised of three items, exhibited the lowest alpha value of 0.60. However, for both the overall scale and each subscale, values were above the criterion of 0.60 [ 47 ], indicating satisfactory internal consistency and reliability of the instrument.

This study has several limitations. Firstly, this study used convenience sampling, which may have contributed to sampling bias. Secondly, during the process of obtaining content validity from experts, we did not send revised items back for a second round of feedback. Re-evaluation could enhance the robustness of initial item development. Therefore, it may be necessary to consider incorporating this step in future tool development. Thirdly, the reliability coefficient of the therapeutic alliance factor is low, possibly due to the small number of items. Therefore, the reliability requires further evaluation using larger sample size. Fourthly, as this study was conducted in South Korea, cultural background may have influenced the study results. Therefore, further study is recommended to test the psychometric properties of the PCCS in various countries.

The PCCS developed in this study showed good validity and reliability. The scale consists of three factors and 12 items: information sharing (five items), patient-as-person (four items), and therapeutic alliance (three items). The scale can be used to assess the level of PCC in nurses, increase nurses’ understanding of PCC in a hospital setting, and promote patient-centered care. Further studies are recommended to test the validity of the PCCS in various hospital settings with a larger sample size and to explore factors associated with PCC in nurses.

Availability of data and materials

All data generated or analyzed during this study are included in this article. The data can be made available upon reasonable request from the corresponding author.

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Youngshin Joo received a scholarship from Brain Korea 21 FOUR Project funded by National Research Foundation (NRF) of Korea, Yonsei University College of Nursing.

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Nursing literature review examples serve as beacons of inspiration for researchers at all levels. Here’s why they are so valuable:

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University libraries and academic databases are excellent starting points. Most universities provide access to digital dissertations, theses, and research papers through their library websites. Academic databases such as PubMed and CINAHL also host a vast collection of nursing literature reviews. You can search for literature reviews related to your specific nursing topic and access them online.

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Carballo Cuello, C.; Flores Milan, G.; Baerga, N.; Greenberg, M.; Alikhani, P.; Hayman, E. C5 Palsy after Cervical Disc Arthroplasty: Two Case Reports and Literature Review. Surgeries 2024 , 5 , 719-725. https://doi.org/10.3390/surgeries5030056

Carballo Cuello C, Flores Milan G, Baerga N, Greenberg M, Alikhani P, Hayman E. C5 Palsy after Cervical Disc Arthroplasty: Two Case Reports and Literature Review. Surgeries . 2024; 5(3):719-725. https://doi.org/10.3390/surgeries5030056

Carballo Cuello, César, Gabriel Flores Milan, Nicolas Baerga, Mark Greenberg, Puya Alikhani, and Erik Hayman. 2024. "C5 Palsy after Cervical Disc Arthroplasty: Two Case Reports and Literature Review" Surgeries 5, no. 3: 719-725. https://doi.org/10.3390/surgeries5030056

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