APA Nursing Literature Review Example: Early Mobility in the ICU

Clinical boundary: This page is an educational writing example, not a mobility protocol or patient-care recommendation. Eligibility, timing, dosage, sedation, hemodynamic stability, staffing, and stopping criteria require local policy and qualified clinical judgment.

Start with a PICO question

Population: Mechanically ventilated adults in an ICU
Intervention: Protocolized early mobility or early physical and occupational therapy
Comparison: Usual care or a lower-intensity mobility approach
Outcomes: ICU-acquired weakness, ventilator-free days, functional independence, length of stay, adverse events, and longer-term recovery

A usable review question is: Among mechanically ventilated adults in intensive care, how does protocolized early mobility, compared with usual care, affect ICU-acquired weakness, ventilator-free days, and functional independence?

Evidence snapshot

Annotated nursing literature review example

Paragraph 1: State the clinical claim and quantify it carefully

[PICO-linked thesis] Protocolized early mobility may improve selected short-term outcomes for mechanically ventilated adults, but benefits depend on patient selection, intervention timing, co-interventions, and delivery fidelity. [Narrative synthesis] Zhang et al. (2019) reviewed 23 randomized trials involving 2,308 critically ill adults. Early mobility was associated with a lower incidence of ICU-acquired weakness at hospital discharge, RR = 0.60, 95% CI [0.40, 0.90], and a small increase in ventilator-free days, SMD = 0.17, 95% CI [0.02, 0.31]. [Clinical interpretation] These outcomes are relevant, but they should not be presented as one universal treatment effect: the weakness estimate came from three studies with 190 participants, whereas the ventilator-free-days estimate came from six studies with 745 participants. [Completion standard] A strong nursing review keeps each estimate attached to its contributing evidence rather than repeating the meta-analysis's total sample as though every participant informed every outcome.

Paragraph 2: Connect pooled evidence with a landmark trial

[Primary-study detail] Schweickert et al. (2009) tested early physical and occupational therapy during daily interruption of sedation. More patients in the intervention group returned to independent functional status at hospital discharge; the reported odds ratio was 2.7, 95% CI [1.2, 6.1]. [Synthesis, not duplication] This trial helps explain what “early mobility” involved, while Zhang et al. (2019) estimates the broader pooled pattern. The two sources should not be treated as independent confirmation when the primary trial also contributes to a later synthesis. [Feasibility qualifier] Hodgson et al. (2016) subsequently demonstrated that early goal-directed mobilization could be separated from usual care in a binational pilot trial, but a feasibility study cannot establish definitive clinical effectiveness. [Responsible conclusion] The evidence supports considering structured mobility within an appropriate ICU safety system; it does not support copying one protocol into every unit or patient population.

Paragraph 3: Separate intervention phases and identify the gap

[Boundary between related interventions] Mobilization during critical illness is not equivalent to exercise rehabilitation after ICU discharge. Connolly et al. (2016) found the post-discharge rehabilitation evidence limited and heterogeneous, so those findings should not be used to strengthen claims about bedside mobility during mechanical ventilation. [Implementation context] Kayambu et al. (2013) reported small pooled effects across physical function and related outcomes, but variation in interventions and measures complicates transfer to a single protocol. [Precise gap] A useful next review would examine adults aged 65 years or older who require prolonged mechanical ventilation, distinguish actual mobility dose from protocol assignment, and assess functional and cognitive outcomes at six and 12 months. [Why the gap matters] This formulation connects bedside implementation with outcomes important to patients after discharge without implying that short-term improvements guarantee long-term recovery.

Evidence hierarchy without false precision

Nursing programs use different appraisal systems. Johns Hopkins Evidence-Based Practice, GRADE, and institution-specific tools do not assign identical labels in identical ways. State the framework and version you use; do not combine a study-design level from one framework with a certainty grade from another without explaining the distinction.

A defensible appraisal separates:

1. Study design:

   systematic review, randomized trial, cohort, qualitative study, or expert guidance.

2. Study quality:

   risk of bias, precision, consistency, directness, and reporting quality.

3. Body-of-evidence certainty:

   confidence in the conclusion across relevant studies.

4. Clinical applicability:

   similarity to the local population, staffing, equipment, sedation practices, and safety criteria.

A systematic review is not automatically high certainty. Its conclusion can remain uncertain when contributing trials are small, heterogeneous, at risk of bias, or indirect.

APA 7 citation and reference checks

• For three or more authors, use the first author's surname plus “et al.” from the first in-text citation: Zhang et al. (2019) or (Zhang et al., 2019).

• For two authors, use “and” narratively and “&” parenthetically.

• In an APA 7 reference entry, list up to 20 authors. Do not use the APA 6 convention of replacing authors 7–19 with an ellipsis.

• Preserve the source's statistic and label: RR, OR, SMD, mean difference, or another measure are not interchangeable.

• Report confidence intervals when they materially affect interpretation.

• Match every in-text citation to one reference entry, and verify every DOI against the named source.

Poor draft versus stronger synthesis

Nursing revision checklist

• [ ] The review question contains explicit PICO elements.

• [ ] Eligibility and safety decisions remain with qualified clinicians and local protocols.

• [ ] Each statistic is traced to the correct source, outcome, and contributing sample.

• [ ] Patient-centered outcomes are included alongside process outcomes.

• [ ] Pilot, randomized, observational, and review evidence are not treated as equivalent.

• [ ] In-ICU mobilization and post-discharge rehabilitation are separated.

• [ ] Statistical significance is not equated with clinical importance.

• [ ] Implementation fidelity and actual intervention dose are discussed.

• [ ] The appraisal framework is named and applied consistently.

• [ ] All citations, references, and DOIs have been checked manually.

How Acade can support the nursing review workflow

Acade can help a student or researcher frame a PICO question, build literature-search terms, organize evidence notes, compare study designs, prepare a synthesis outline, and revise citation-supported academic writing. A practical workflow is:

1. Enter the patient population, intervention, comparator, outcomes, setting, and assignment requirements.

2. Search for relevant reviews and primary studies.

3. Record design, sample, intervention dose, comparator, outcome, estimate, risk-of-bias issue, and applicability in an evidence matrix.

4. Group sources by claim rather than listing authors sequentially.

5. Draft bounded conclusions and check each claim against the full source.

6. Apply the evidence framework and APA rules required by your program.

Acade does not replace clinical judgment, institutional policy, evidence-appraisal training, or human verification of sources and statistics.

Tell Acade your ICU population, review question, evidence framework, and assignment constraints, then ask it to help organize the next verifiable research step.

References

Connolly, B., Salisbury, L., O'Neill, B., Geneen, L., Douiri, A., Grocott, M. P. W., Hart, N., Walsh, T. S., & Blackwood, B. (2016). Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: Executive summary of a Cochrane Collaboration systematic review. Journal of Cachexia, Sarcopenia and Muscle, 7(5), 520–526. https://doi.org/10.1002/jcsm.12146

Hodgson, C. L., Bailey, M., Bellomo, R., Berney, S., Buhr, H., Denehy, L., Gabbe, B., Harrold, M., Higgins, A., Iwashyna, T. J., Papworth, R., Parke, R., Patman, S., Presneill, J., Saxena, M., Skinner, E., Tipping, C., Young, P., & Webb, S. (2016). A binational multicenter pilot feasibility randomized controlled trial of early goal-directed mobilization in the ICU. Critical Care Medicine, 44(6), 1145–1152. https://doi.org/10.1097/CCM.0000000000001643

Kayambu, G., Boots, R., & Paratz, J. (2013). Physical therapy for the critically ill in the ICU: A systematic review and meta-analysis. Critical Care Medicine, 41(6), 1543–1554. https://doi.org/10.1097/CCM.0b013e31827ca637

Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., Spears, L., Miller, M., Franczyk, M., Deprizio, D., Schmidt, G. A., Bowman, A., Barr, R., McCallister, K. E., Hall, J. B., & Kress, J. P. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. The Lancet, 373(9678), 1874–1882. https://doi.org/10.1016/S0140-6736(09)60658-9

Zhang, L., Hu, W., Cai, Z., Liu, J., Wu, J., Deng, Y., Yu, K., Chen, X., Zhu, L., Ma, J., & Qin, Y. (2019). Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLOS ONE, 14(10), Article e0223185. https://doi.org/10.1371/journal.pone.0223185

Frequently asked questions

Is APA the correct format for a nursing literature review?

APA is widely used in U.S. nursing education, but it is not universal. Follow your course, school, DNP program, institution, or target journal. Some clinical publications use numbered styles such as Vancouver.

Should I cite the systematic review or the primary trial?

Cite the review for its pooled question and estimates. Cite a primary trial when discussing its specific intervention, population, comparator, or patient-level outcome. Disclose overlap rather than presenting the same evidence twice as independent confirmation.

Can I combine Johns Hopkins levels with GRADE?

You may describe study design with one framework and body-of-evidence certainty with another only if you name both systems and explain what each label means. Otherwise, use the framework required by your program consistently.

How should I report heterogeneity?

Report the statistic as the review reports it and explain its relevance to the specific pooled estimate. Do not interpret an I² value in isolation; consider the number and size of studies, clinical differences, precision, and the analysis model.

Can I reuse these citations in my paper?

Use them only if they are relevant to your own question and you have read and verified them. This example is a writing model, not a substitute for a reproducible literature search.

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Source and product information checked September 2, 2026. Verify current evidence, institutional requirements, and Acade plan details before use.